February 12, 2004
You are scheduled for allergy testing on:
______________day ___________________date ________________time
Attached is a list of medications to discontinue for skin testing. Please read the list and follow the
instructions for any medications you take on the list.
Fill out the allergy questionnaire completely
, it helps us gain an understanding of your symptoms and
when they affect you.
Wearing short sleeves is preferred (weather permitting) as all the testing is done on the arms. Layering
with a t-shirt under long sleeves is helpful too. *If you have any questions/concerns please call the office at 616.994.2770 and ask to speak with
the Allergy Department, we are happy to help.
Michigan ENT & Allergy Specialists
Please discontinue any of the listed medications you may be taking.
Stop one week before testing
Stop four days before testing
If you are currently taking a Beta Blocker, you must discontinue this medication for a minimum of
4 days prior to allergy skin testing. Do not discontinue your Beta Blocker on your own. The
physician who prescribed the medication will evaluate your ability to be off the medication for
allergy skin testing. If you would like, our office will communicate with your primary care
physician regarding the Beta Blocker.
The following is a list of Beta Blockers:
Some eye drops are Beta Blockers that must be discontinued 4 days prior to allergy skin testing.
These eye drops include:
Timoptic Atypical Antidepressants/Sedatives must be discontinued prior to allergy skin testing.
Stop 5-7 days before testing
Stop 3 days before testing
Adapin (Doxepin) If you are on a Tricyclic Antidepressant you must stop it 3 days before the allergy skin testing.
Do not change your diet before the allergy skin testing. Make sure to eat breakfast before
an early appointment or lunch before an afternoon appointment.
Testing usually takes 1-1.5 hours.
Call our office with any questions prior to the testing at 616-994-2770.
Check any of the following symptoms you have:
What do you believe is causing your symptoms?
What months or time of year do you suffer most?
Have you ever been diagnosed with asthma?
Do you miss school or work because of allergies? No Occasionally Frequently
Are your symptoms worse (circle) indoors, outdoors, at home, at work, mornings, or evenings?
Have you ever had hives or anaphylaxis (difficulty breathing, throat or tongue swelling) after eating a
Do certain foods cause you to have diarrhea, gas, heartburn, nausea, vomiting, and/or chronic abdominal
Please list all medications you have tried to treat allergy symptoms:
Have you ever been tested for allergies in the past?
If so, did they help? Yes No Did you ever have a reaction to an allergy shot? Yes No
Have you ever had an allergic reaction to a medication? Yes No If yes, please list
Have you ever been hospitalized for allergy problems? Yes
Have you ever had a severe reaction to immunizations? Yes
Do you smoke or have you ever smoked? Yes No
Are you pregnant, trying to conceive, or nursing a baby? Yes
Do any blood relatives have known allergies or asthma? Yes
Please list any other areas of residence:
Do you live in a (circle) house, apartment, mobile home, or other?
How long have you lived at current residence?
Home is located in (circle) residential area, fields, farms, factories, lakes, or marshes.
Circle source of heat in home: forced air of any type, wood stove, fireplace, other.
Do you have a humidifier on your furnace?
Please list any pets in the home and quantity of each:
Are the pets (circle) indoors, outdoors, or both?
Are the pets allowed in the bedroom? Yes
Are you exposed to anything at work or school that aggravates your symptoms? Yes No
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