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ALLERGY TESTING

with Dr Faheem Latheef

Dr Latheef is a specialist in skin allergy and uses specialist tests such as skin prick and patch tests to diagnose allergies.

 

The term Allergy has different meanings to various people and is often misunderstood by both patients and healthcare professionals. It is best considered to mean an adverse and often inappropriate immune response (involving our body’s defence system) to a protein (allergen) in our environment. Allergies can develop in anyone, to virtually anything, at any age and can easily occur “overnight” without any necessary change in exposures. As they are memorised responses they will always recur when the person is exposed to the same allergen.

 

The type of symptoms experienced by someone who is allergic is dependent upon which part of our immune system is initially activated following allergen exposure.

 

If it is the immediate part of the defence system it involves antibodies (IgE) and histamine is the main chemical mediator.

 

 

Common allergens causing immediate allergic reactions include airborne ones (eg pollens, dust mite faeces, animal danders, mould spores etc.). These exposures could result in the development of hayfever like symptoms involving the eyes, nose and lower airways and exacerbations of asthma.

 

However, they can also be triggered by foods (eg cow’s milk , egg, peanut, tree nuts, fish, shellfish etc.) These reactions can result in itching/swelling of the mouth and throat, itchy skin rashes, gastrointestinal effects (vomiting, diarrhoea, abdominal pain) and occasionally anaphylaxis.

 

Immediate allergic reactions may also be triggered by medications (eg penicillin) or bee or wasp venom.

 

These types of allergies are investigated with skin pricking which Dr Latheef is able to perform to a limited set of allergens and its helpful to inform us beforehand regarding suspected allergies so we can ensure these are available when you attend for the allergy testing.

If the delayed arm of the defence system is activated then as the name suggests these reactions take longer to be elicited and involve different cells and chemicals of the immune system.

This is the sort of allergy that people develop to chemical exposure and generally when these chemicals come into contact with the skin they result in allergic contact eczema/dermatitis (eg. allergic reactions to cosmetic ingredients such as preservatives, fragrances, hair dye chemicals etc.) Some people may develop allergic contact dermatitis following exposure to chemicals at work.

If the delayed arm of the defence system is activated then as the name suggests these reactions take longer to be elicited and involve different cells and chemicals of the immune system.

This is the sort of allergy that people develop to chemical exposure and generally when these chemicals come into contact with the skin they result in allergic contact eczema/dermatitis (eg. allergic reactions to cosmetic ingredients such as preservatives, fragrances, hair dye chemicals etc.) Some people may develop allergic contact dermatitis following exposure to chemicals at work.

 

Some reactions to foods may also involve the delayed arm of the defence system which might affect someone’s skin – contributing to the development of eczema- or causing adverse effects on the gut with pain and diarrhoea eg non IgE mediated allergy to cow’s milk protein.

This description to the left is rather over-simplified and in many cases both the immediate and the delayed part of the immune system can be activated at the same time.

 

These types of allergies are investigated with skin patch testing which Dr Latheef is able to perform to a very exhaustive set of allergens at the centre of excellence in contact dermatitis in Leeds. Many centres in the country offer patch testing but to a very limited panel increasing the risk of missing allergies and Leeds is one of a handful of centres in the country to offer this high level of service.

 

Dr Latheef offers a patch and prick testing service from Chapel Allerton Hospital, Leeds. Patch testing is a test that can help your doctor determine whether your skin condition is caused by an allergy to substances in contact with your skin e.g. substances at home or at work.

If you already have patch test appointments arranged, please read through the information below.

To what will I be tested?


You will be tested with approximately 70 standard substances commonly in contact with the skin e.g. rubber chemicals, metals, perfumes and plants. You may also be tested on additional substances, dependant on your skin problem. This may also include some of your own work or home products.




What should I bring to the Patch Test clinic?


For your first appointment, please bring the following with you: A list of medication & prescribed drugs that you are taking. All ointments and creams that you use, including over the counter creams. Your own products from home that you think you might be allergic to e.g. toiletries, cosmetics, nail polish, perfumes and hair care products. Please bring the product packaging with you that will list all the contents. If you think you are allergic to any work chemicals that may be aggravating or causing your rash, you will need to deliver the substance samples two weeks before your appointment. The samples need to be in well sealed labelled containers and need to be delivered to the following address. Dr Faheem Latheef, Dermatology Outpatients, First Floor, Chapel Allerton Hospital, LS7 4SA. When delivering your samples you also need to provide the Health and Safety data sheets which will be available at your place of work.




What does Patch Testing involve?


Three visits to the hospital are required in one week. At the first appointment (Monday morning) you will be interviewed by the Dr Latheef who will decide what tests are needed. The substances which need to be tested will be applied in special small containers to your back, and the sites will be marked with ink. If your back is hairy, we may need to shave your skin first. You will need to allow 2 hours for this visit. The samples will be taped to your back and will remain in place until your second visit on Wednesday morning. The substances will be removed from your back and any reactions will be noted by Dr Latheef. Additional patches may be applied at this stage. Please allow 30 minutes for this appointment. At the third visit (Friday morning) you will be examined by Dr Latheef who will discuss any reactions with you. The sites on your back may itch but this is completely normal. At this visit it may be necessary to expose part of your back to ultraviolet light if we suspect a light induced contact allergy. This is known as Photopatch Testing. A standard Friday appointment should only take 30 minutes, but this will take longer if you need Photopatch Testing. It is possible that your Patch Tests will be negative. This is helpful because we will have eliminated contact allergy as the cause of your skin problem. Positive reactions become red and itchy at the test site and this usually happens in time for the Friday appointment. However, it may be possible for your skin to develop a late reaction. If this happens please contact us by email or telephone as soon as possible. Sometimes the substances may stain the skin or clothing, but this is normal. We may not Patch Test you if you are pregnant, breast feeding, have extensive eczema on your back, have had sun exposure or used a sun bed over the previous 2 weeks, or are on a moderate to high dose of steroids. If any of these apply to you, please phone us to rearrange your appointment.




During your Patch Test treatment


  • DO NOT get your back wet during the tests. You can wash down with a flannel.
  • DO NOT wear your best clothes as the marker ink may stain.
  • DO NOT expose your back to the sun during this procedure.
  • DO avoid sport or heavy physical work during the week of the tests.
  • DO wear an old bra or t-shirt for the week of the tests. Also wear a t-shirt or vest to sleep on to protect the tests.
  • If a patch test peels off, reinforce using tape. If a whole patch comes loose, remove it and note the time & date.
  • Do contact us if you have any concerns.




What side effects may occur?


Side effects are rare but may include:

  • Skin reddening and itching from positive test results. This usually disappears after a few days.
  • Persistent reaction to some positive test reactions e.g. A reaction to gold may persist for up to one month.
  • Flare of eczema. A positive Patch Test may be accompanied by a flare of existing or previous eczema.
  • Pigmentary change. An increase or decrease in pigment may be seen at the site of the Patch Tests.
  • Infection or scarring, but both of these are rare.
  • Allergy. Very rarely (approx 1 in 500 times) you may become allergic to one of the substances applied during Patch Testing. In practice this does not seem to cause a problem in the long term.




Storage of test results


We will record the information about your Patch Test results in an anonymised form on a computerised database. We will use the results for audits, in accordance with good medical practice. The date may be used for research and may be shared with other centres.




Failure to attend


Failure to attend your Patch Test appointments without informing us, will result in you being discharged and referred back to your GP. You can also visit the British Society For Cutaneous Allergy website where you can download patient leaflets for each allergy. The patient leaflets offer lots of useful information, including things to avoid for each allergy.





My Contact Dermatitis Journey - 

On my birthday this year I woke up with redness and quite apparent swelling around my eyes. Every night before bed I put Vaseline around my eyes religiously to keep the eczema away and to prevent my makeup being flaky the next day. I had always suffered from eczema but never severely, which is why I just put this down to ‘not putting Vaseline around my eyes’. As you can imagine I was very upset that my face was looking like this on my 17th birthday and it had completely ruined all my plans, which is why I went to the doctors immediately. They prescribed me some steroid cream to use for a week to calm the swelling down. A week later, the swelling and redness had appeared again every night after I removed my makeup. This is when I began to think I was allergic to something in my makeup products. After numerous doctor appointments and a referral to a GP who specialised in dermatology, I was still in the dark about how to stop my skin flaring up like this and thought there would never be an end.

Fortunately, I am lucky enough to have private health care. So we decided to seek medical advice privately which is when we met Dr Latheef. During my first consultation my skin had flared up worse than ever, it was now covering my hands/wrists and spreading further down my neck. I was extremely embarrassed to the point where I didn’t even want to go to the appointment or see the people closest to me. Not only was I embarrassed, but I was in pain with how dry, tight, itchy and sore my skin was. Dr Latheef immediately diagnosed my condition as contact dermatitis and filled me with confidence that we could sort the issue. I was then faced with the decision of should I take medication to clear my skin up or should I have the patch tests immediately to find out the allergy causing it. This was because the steroids would hide any substance I was to react to in the patch tests. We came to the agreement that my skin was far too severe to leave it untreated so I was then prescribed steroids for 7 days to calm the reaction. During the following week I had patch tests done privately by Dr Latheef. 

My patch tests immediately proved I was actually allergic to Rubber-Latex which I was extremely shocked at but over the moon that it wasn’t something in my makeup products! Although, it was the beauty sponge I had been using, my rubber phone case and mascara wand that had caused the huge reactions. Dr Latheef then prescribed me a 6 week course of steroids to clear the dermatitis up completely along with some antibiotics to prevent any infection.

Looking back at how this whole thing dropped my confidence hugely, I cannot believe how Dr Latheef has managed to diagnose and clear my skin up in just under 8 weeks! As a 17 year old girl who loves wearing makeup and going out, for a whole 2 months I couldn’t go anywhere without being asked why my eyes were red or being continuously looked at. It just goes to show how much feeling comfortable in you own skin really does matter. My skin is better than ever now, and I can finally get back to feeling myself and wearing makeup everyday, just making sure I avoid Rubber-Latex! 😊

Here are some of the pictures of before and after my skin condition. And as you can see, within 3 days I noticed a huge improvement. I’d love to delete these pictures and never have to look at them again, but I hope that putting them out there can help anybody else with this horrible skin condition! I can’t thank Dr Latheef enough for his reassurance and commitment to treating my skin! 🤞🏼💫

- Courtney Brook, Facebook Review

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COPYRIGHT © DR FAHEEM LATHEEF 2019

ENQUIRIES:

CHRISTINE KIRKHAM (PRIVATE SECRETARY)

kirkham_medsec@yahoo.co.uk

07784 476 138