There were two little girls about the same age in the testing room a while back. One had been coming for several months. She lives nearby, so she was able to come in once a week until we had tested enough to give her a fair amount of treatment in different areas. She was pretty allergic, so her testing took quite a while to complete. At first, she was a little anxious, but she soon settled into the routine of “pinch”, wait 8 minutes while playing with her DS , then another pinch. Her mom usually let her test about 2 hours at a time. Some of our patients come a long distance and it is not practical to test only 2 hours at a time, but to push a child beyond his or her level of endurance is often counterproductive.

The other little girl, a new patient, was pretty typical of children who test. She was frightened—there were needles involved! Her dad brought her, and he was loving but firm. No matter how many tears she shed, she was going to be tested, “or else.” I think this dad was using a combination of firmness, threat and reward. The formula, whatever it was, seemed to be effective and eventually, the little girl let me stick her. She wasn’t happy about it, but we settled into a routine. With each stick she put up less resistance, and I even heard her laugh a time or two. I never tell a child that testing doesn’t hurt. I’ve been tested, and sometimes it feels like a bee sting. Some children really don’t seem to mind the sticks, but they are in the minority. The pain doesn’t last long, and when we neutralize patients to enough of the antigens which may be a problem for them, it seems to have a calming effect, which allows the child to test with less anxiety and discomfort.

Trying to reason with children doesn’t seem to work when fear is in control. Even threats of losing a privilege, or missing out on an anticipated treat don’t always work. Money? The child often agrees to a bargain before testing begins, but a delayed reward doesn’t seem so appealing when the reality sets in. If the parent brings a pocketful of quarters (or singles) the immediate reward system may work if the child can be persuaded to try the first stick.

Sometimes it seems as if the child is in charge—a bad situation for all concerned. I believe children should be allowed to choose in some situations, but when it comes to their health, probably not. If the parent is anxious about the process, the child often picks up on the parent’s attitude, and this situation makes things harder for the child and the tester. Loving firmness from a parent who is in control of the situation seems to work better than anything else.

Most of us live our lives in the fast lane pursuing the American dream. As the popular song by Cage the Elephant goes, “I got bills to pay, I got mouths to feed…” it can be difficult to get ahead in this world. We have jobs to complete, responsibilities to work and family, and many times we place ourselves last in the long list of growing obligations. I know from experience – as a working mother of two it can be very hard to take a “time out” for yourself in any capacity. It just seems like there aren’t enough hours in the day. However, these various stressors from the daily routine can easily cause a weakened immune system and allow viruses to force us into that “time out” – whether we want it or not. “Illness” has no patience for our responsibilities in life. It will take over quickly and have you cancelling plans and putting aside matters before you know it. Illness may come in the form of a sore throat, a cough, a sinus infection, maybe even the flu, but whatever you may be experiencing, one thing is for sure. Functioning at normal capacity is nearly impossible. So in this world of “let’s go go go” and “get r’ done” how do we avoid such forceful interruption?

We protect ourselves! Here are a couple suggestions. #1 Take your Vitamins! A good multivitamin is always best, and two of the most important are Vitamins D and C. Vitamin D aids in the prevention of heart disease, cancer, diabetes, and even depression, and can improve your overall health in many ways, while Vitamin C can help prevent illnesses such as the common cold and boost the immune system during active infections. #2 Monolaurin! At the on-set of illness monolaurin can be very helpful. It contains the monoester of the fatty acid lauric acid. It has antiviral properties and can be used for influenza, Herpes, HSV 1 or 2, bronchitis virus, Cytomegalovirus, and many other viruses that have a lipid envelope. Monolaurin dissolves this viral envelope so the virus can be destroyed. It’s strategic and effective!

Don’t let getting sick/being sick get in the way of your life, work, the daily plans you make, or your responsibilities to family.

Testing can be a little frightening for children at first, and the experience can be as hard, or harder, on the parent as it is on the child. Children behave like children—most are resistant at first, but resigned and somewhat cooperative eventually. If the parent is firm but comforting when necessary, the child usually has an easier time accepting the idea of being stuck. Young children usually have a lower tolerance for testing than adults have, and I recommend that a young child not be expected to test for more than 3 or 4 hours at a time. They generally let you know when they’ve reached their limit. All cooperation ceases and each stick becomes a battle. Sublingual testing can be done if we are looking for specific symptoms, but this type of testing requires the parent to be very alert to changes in the child. Skin testing and waiting for delays is usually more accurate. We don’t want the child to remember his visit to COEM as a traumatic experience, so we’d rather leave a few things for a later time if the child seems to have used up all his tolerance. Most children on a return visit remember the location of the play room with all the toys and head straight there, dragging Mom with them. That’s the way we want them to feel, that this is a fun place to be. I understand that when patients travel long distances to get here, they want to accomplish as much as possible, but there is a fine line sometimes between necessary pain and cruelty where young children are concerned. To ask a child to endure testing past the point where he seems able to tolerate it is not usually advisable. After consulting with the doctor, decide what things are most important to test at this time in case some things have to wait until later.

Sometimes it seems to be an efficient use of time for a parent and child to test at the same time, but it doesn’t usually work out as a good thing for either one. It is difficult for a parent to monitor their own symptoms, and be attentive to what’s going on with the child (or children). Testing can affect concentration, mood and rational thinking, as well as the body. We often provoke symptoms not usually considered allergy related. Young children cannot always tell us how they feel. It takes a parent who knows her child to pick up on some of the signs of distress children exhibit while being tested. It takes an alert parent to monitor a nonverbal child, and a parent who is being tested is not always alert. Even if a child can tell you what he feels, sometimes he is not a reliable witness. Usually Mom knows how much confidence can be put in what her child tells her. Children are often eager to please, and if they think they are supposed to be symptomatic, they may complain of something they are not really feeling. Again, it takes a parent who knows her child, and a parent who is concentrating on the child and not herself to let the tester know what is going on with the child. And the parent who is primarily concerned with the child’s symptoms may not let the tester know what is going on with her symptoms. We rely on both whealing (skin reactions) and symptoms provoked during testing. Both the parent and the child may get inaccurate testing results if they test at the same time.

If several family members come to the office at the same time, it would be advisable to spend a little time before the visit planning how to make sure everyone gets maximum benefit from the time spent at COEM. In the long run it may be best to schedule separate times for some of the family members.

Our method of allergy testing is called Provocation-Neutralization because we sometimes provoke symptoms with the “wrong” dose and turn them off with the “right” or neutralizing dose. Dr. Carlton Lee is credited as the discoverer of Provocation-Neutralization. He, with the help of Dr. Herbert J. Rinkle, developed this method for testing food allergies. Their work was published in 1964 after the death of Dr. Rinkle. Dr. Joseph Miller, a conventional allergist, heard Dr. Lee deliver a paper on the method. Skeptical at first, he tried the technique and found it to be effective in treating food allergies. He refined the method, and also found it could be used in treating active viral infections and hormonal problems. Dr. Miller’s book Food Allergy, published in 1972, is our textbook for allergy testing.

We call our skin testing intradermal or intracutaneous because we inject a small amount (usually 0.05 cc) of an antigen just under the skin. A wheal (bubble) is formed, which we measure with a little card marked off in millimeters. When examining the wheal we also note certain characteristics such as color, hardness, shape and whether or not the wheal is raised above the surface of the skin.

Not only do we consider the appearance and size of the wheal, but we also take into account any changes in the way the patient feels. In our method of testing the kind of symptom changes and when they occur can be useful in determining whether a dose/dilution is right or wrong. Sometimes the patient experiences the same symptoms with testing that they noticed when they were exposed to the antigen. This experience can be exciting for the patient and the tester because a mystery has been solved and questions have been answered.

Our method of testing is more time-consuming initially than conventional allergy testing, but we believe it is more accurate, and it seems to bring relief of symptoms faster because there is no build up process. We find the dose the patient’s body tolerates for each antigen tested, and it is safe for the patients to administer their own extracts as shots or drops.