When I first started to blog, I read a cardinal rule--"post on your blog site regularly"...as those of you who follow my blog are well aware, I have violated this rule repeatedly...and as a result, I've probably lost most of my readers...but such is life.  I blog for myself, and to divulge the innermost secrets--my passions--in the allergy profession I've dedicated my life to.  I've been busy getting lectures ready for our annual allergy meeting, so I suppose that is a meager excuse for my tardiness on my blog site.  But in the process of giving a talk on diagnostic techniques used by the allergist, I once again come back to the critical importance of the history in allergy diagnosis...

It's funny that when I take a past medical history on my patients, so many of them say "I went to an allergist and had skin testing"...but none--and I mean none--have ever said 

"I went to an allergist to get a good allergy history and appropriate testing"

It's as if the procedure of skin testing tells the whole story.

It doesn't.

...I'll be getting a colonoscopy in the near future.  I really don't expect the colonoscopist to know my whole story...he's a technician designed to look at my colon--and to see if anything is abnormal. But he can't put the findings into any clinical context.  That's for my doctor to do...I don't expect him to give me any answers except for what he sees at the moment.  

I saw a patient last week...the man looked absolutely miserable. He had a history of sneezing, congestion, facial swelling initially beginning in the spring, but then building up and getting worse each summer and fall.  The problem had been going on for several years.  He had a nice skin response to a histamine control, but his skin tests were largely negative.  It has been an aphorism of mine that the allergist can stop thinking when the skin tests are strongly positive, but needs to start thinking when the tests are negative in someone with a clinical history of allergic problems. He'll undoubtedly be a delayed reactor to molds on is skin tests in 24-48 hours. I'll be interested in his delayed-reaction report.  

Another patient had seen me recently, with the onset of congestion in the summer of 2008, continuing throughout the winter and into the summer of 2009 when I had seen her.  She was also miserable. My initial impression of possible dust mite sensitivity didn't show up on skin testing--in fact, skin testing failed to reveal anything of importance.  More significantly, further history-taking had revealed she had traveled from Minnesota to Arizona over the winter, with absolutely no improvement in her symptoms.

So it was back to the history, once again...

What was going on last summer 2008 that was "out of the ordinary?" I asked.  "Nothing, she replied, except that I had had diverticulitis and was hospitalized briefly for it", she stated.  "Did anything change after that?" I asked.  "No, except that I began eating very large quantities of yogurt to help my intestine, she said".

It turns out that after additional testing I found out that she was milk protein sensitive, and the dramatic increase in milk protein beginning last summer was enough to cause her problems from that point onward--and would explain why she hadn't improved with a change in climate from Minnesota to Arizona.  

The most important diagnostic tool we have is not the needle we stick in the skin, but the grey matter between our ears.  

Skin testing and colonoscopies are fine, but only tell part of the story.  The rest is up to the doctor and the patient.

Later, Dude