What to Expect

Allergy testing

Skin testing

Skin testing is one of the most common and reliable ways to test for environmental and food allergies. These tests are not very invasive, and results are available in about 20 minutes.

A prick test is when a diluted allergen is applied using a small, disposable plastic device to prick the surface of the skin. Side effects include redness, swelling, and itching at the prick site.

Do not take antihistamines before skin testing. Please do not stop any antibiotics, asthma inhalers, or steroid nose sprays before skin testing.

These antihistamines must not be given for 48 hours before skin testing:

  • Chlorpheniramine (Diabetic Tussin and ChlorTrimeton)
  • Clemastine (Tavegyl)
  • Cyproheptadine (Periactin)
  • Dexchlorpheniramine (Polaramine)
  • Diphenhydramine (Benadryl)
  • Hydroxyzine (Atarax)
  • Promethazine (Phenergan and Phenadoz)
  • Tripelennamine (Pyribenzamine)

These antihistamines must not be given for five days before skin testing:

  • Azelastine nasal spray (Astepro and Astelin)
  • Cetirizine (Zyrtec)
  • Fexofenadine (Allegra)
  • Loratidine (Claritin, Alavert)
  • Levocetirizine (Xyzal)
  • Desloratadine (Clarinex)

If you have any questions regarding your appointment, please contact us.

Blood testing

Another method of testing for allergies is blood tests. Blood is drawn from a vein and sent to a lab, and results are available in approximately a week. Lab tests can look at antibodies to specific allergens, like grass pollens, or antibodies to specific allergenic proteins, especially in foods.

Allergy shots

Allergy shots are unique to each patient and contain a small amount of the allergens that a child is allergic to. Allergy shots are administered every week. We start by administering a very small amount of diluted allergen and gradually build up the dose weekly.

Please plan on bringing your child to a weekly allergy appointment for approximately six months. Once your child receives all injections in the buildup phase, we will maintain your child’s tolerance with monthly shots at the child’s highest dose tolerated.

Please note:

  • Allergy shots should be given once a week in the same clinic location.
  • Patients and their parent/guardian must wait at least 48 hours between each injection.
  • Over the first year, patients receive approximately 25 allergy shots weekly, then a monthly allergy shot for three to five years.
  • If more than 14 days pass between each injection, we repeat or decrease the dose.
  • Your child must wait 30 minutes after each injection and be evaluated by an RN before leaving the clinic. If you cannot wait 30 minutes, please reschedule the shot for a different day.
  • You are required to bring an epinephrine auto injector to each allergy shot appointment and carry it for the remainder of the day.
  • Skip your weekly allergy shot if your child has been sick with a cold, flu, or fever, or if your child is having an asthma exacerbation.

Food challenges

An oral food challenge appointment involves eating measured doses of the allergic food every 15 minutes in a slow, graded fashion. These visits last three to four hours.

The doctor will prescribe three to seven graded doses of the allergic food. He or she will start with a very small dose that is unlikely to trigger any symptoms. With each dose, the doctor and/or registered nurse will assess for any signs of a reaction. If no symptoms or adverse reactions are noted, the nurse will give the next prescribed dose (slightly larger than the previous dose). After the last dose is given, you child will be observed for at least one hour prior to discharge.

The oral food challenge will stop if your child develops a mild or severe reaction during the challenge.

Additional information:

  • You are responsible for bringing in the food your doctor has recommended to challenge (for example, nut butter, baked egg muffin, scrambled egg). Please see egg and dairy recipe options below.
  • Please do not give your child any antihistamines for a minimum of five days prior to the food challenge. Continue all asthma medications on the day of the challenge.
  • Please do not give your child the food to be tested for prior to the appointment.
  • You will be scheduled to see the nurse conducting the food challenge in addition to the doctor who ordered the food challenge.
  • Please bring your child’s current epinephrine auto-injector with you to the appointment. This is required in the event that your child develops an allergic reaction after being discharged from the appointment.
  • We recommend only very small amounts of food two hours prior to the oral food challenge to ensure that your child eats the prescribed doses during the appointment. Small snacks/breastfeeding prior to the appointment are OK. You may bring additional food that your child eats regularly without concern (such as applesauce, crackers, or juice).
  • Please ensure that your child is healthy—call to reschedule if your child is sick, is experiencing an asthma flare-up, or is currently on prednisone or any antibiotic.
  • Feel free to bring age-appropriate activities to pass the time during the challenge.

Please call us at (650) 725-7233 if you have any questions about food challenges.

Recipes for food challenges

Yield: 6 muffins

Dry ingredients:

1 cup flour
¼ tsp. cinnamon (optional)
¼ tsp. salt
1 tsp. baking powder
½ cup sugar

Wet ingredients:

½ cup rice milk (may use cow or soy milk if your child is not allergic to cow milk or soy)
2 eggs, beaten
½ tsp. vanilla
½ cup applesauce
¼ cup corn oil


Preheat oven to 350 degrees F.

Mix all dry ingredients together (flour, cinnamon, salt, baking powder, sugar).

In a separate bowl, use a whisk to mix all liquid ingredients thoroughly (rice milk, eggs, vanilla, applesauce, corn oil).

Gradually add the liquid ingredients to the dry ingredients, mixing until well combined. Some small lumps may remain. Do not overstir.

Spoon batter into 6 prepared cups in a muffin tin.

Depending on the size of your muffin tin, you may need to fill the muffin liners all the way to the top. If you make more than 6 muffins, please note how many muffins you made, and bring at least two muffins with you on the day of the challenge.

Bake for 35 to 40 minutes or until golden brown and firm to the touch. Center should be thoroughly cooked through (not moist or soft). Do not add any additional ingredients (such as icing or frosting) to the muffins.

Please bring 6 regular-size muffins with you. Do not use jumbo or mini muffin/cupcake pans. Bake at the temperature and time recommended to be sure the milk is fully baked. Do not add any additional ingredients (such as icing or frosting) to the muffins.


1 cup milk
2 tbsp. vegetable or canola oil
1 egg (large) (or *for egg allergy: Use 1½ tsp. Ener-G brand Egg Replacer)
1 tsp. vanilla extract
1¼ cups all-purpose flour
½ cup sugar
2 teaspoons baking powder
½ teaspoon salt


Preheat oven to 350 degrees F.

Line muffin pan(s) with paper liners.

Whisk together the liquid ingredients: milk, oil, egg or egg replacer (although the egg replacer is a dry ingredient, add it at this time), vanilla extract.

In a separate bowl, mix the flour, sugar, baking powder, and salt.

Add the liquid ingredients to the dry ingredients and mix.

Pour mixture into pan, dividing equally, using all the batter.

Bake for 30–35 minutes (do not bake for less than 30–35 minutes). Center should be thoroughly cooked through (not moist or soft).

Home-baked goods (such as rolls, muffins, cupcakes, or cookies) that have ¼ cup plus 1 teaspoon of nonfat dry milk powder per 1 cup flour or 1 cup milk per batch of a recipe (yield six servings per batch). Products should be baked in individual serving size: cupcake, not cake; brownie muffins, not brownies; rolls, not bread.

Store-bought baked goods (such as rolls, muffins, cupcakes, cookies, crackers, or bread) with milk or milk protein ingredients listed as the third ingredient or farther down the list of ingredients.

Below is a list of items that have baked milk as the third ingredient or farther down. This is not an exclusive list. There are many items on the market that contain a milk ingredient as the third ingredient or farther down, which may be appropriate for your child. Many of the items listed below contain other allergenic ingredients, and it is important that you read each product label to ensure that the products do not contain any other food ingredient your child may be avoiding. Please check all product labels every time an item is purchased, as ingredients may change at any time. Also check the label for any other ingredients your child may be avoiding. Do not use any item that contains or may contain your child’s other food allergens.

Bread: Wonder Bread, Thomas’ 100% Whole Wheat English Muffins.

Crackers/pretzels: Original Goldfish crackers, Goldfish Pretzel crackers, Goldfish 100-calorie packs, Cheez-It pretzels.

Cookies: Goldfish Grahams, chocolate or cinnamon or honey grahams, Entenmann’s 100-calorie Little Bites Soft Baked Brownie Squares, Fig Newtons (fat-free), Keebler Frosted Animal cookies, Nilla Wafers.

Please call us at (650) 725-7233 if you have any questions about food challenges.