How Do I Find Out What I’m Actually Allergic To?

When a patient tells me they sneeze every single day and they have no idea why, the first thing I want to know is what they were exposed to before the sneeze. Where were they? What were they doing? Were they inside or outside? Was there a pet in the room? Had they just walked through a dusty area, opened a window, or stepped into a freshly cut lawn? That exposure history is the first clinical clue — and by the time I am asking those questions, I am already thinking allergy and planning to recommend testing.

Daily sneezing, wheezing, and persistent respiratory symptoms are not random. They have triggers. And the purpose of allergy testing is to identify those triggers precisely — so that we can move from guessing to knowing, and from managing symptoms to addressing the cause.

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Skin Testing Versus Blood Testing — What Each One Actually Does

There are two primary methods for allergy testing, and understanding the difference between them matters for choosing the right one for the right patient.

Skin prick testing is my preferred method for most patients. It directly challenges the immune system by introducing tiny amounts of specific allergens just beneath the skin surface and observing the reaction in real time. A wheal — a raised, red, itchy bump — at the test site confirms a reaction to that specific allergen. The results are immediate, highly sensitive, and give both me and the patient a clear visual confirmation of exactly what the immune system is responding to. We test for a broad panel of allergens in a single session, ranked from most reactive to least reactive, and that ranking directly guides the treatment plan.

Blood testing — commonly referred to as RAST testing or specific IgE testing — measures the level of allergy antibodies in the bloodstream rather than challenging the skin directly. I use this method for patients who are needle-averse and cannot tolerate the multiple skin pricks involved in a full panel. I also use it when a patient has unstable asthma that is in an active flare — skin testing in that situation carries risk of a systemic reaction, and blood draw is the safer alternative. Patients on beta blockers also receive blood testing, because beta blockers can interfere with the body’s ability to respond to the epinephrine used to treat a severe reaction if one were to occur during skin testing.

Both methods are accurate. The choice between them is clinical — based on the patient in front of me, not a preference for one technology over the other.

What We Test For in Scottsdale — and What Surprises Patients

Arizona presents a unique allergy environment that consistently surprises patients who moved here from other parts of the country. The desert is not the allergen-free refuge many assume it will be. Scottsdale and the broader Phoenix metro area have some of the highest pollen burdens in the United States — not despite the desert, but because of it.

Our panel includes the full range of regional outdoor allergens: olive tree, which is one of the most problematic in Scottsdale and was widely planted as an ornamental tree before its allergenicity was fully understood; Bermuda grass, which produces pollen year-round in our warm climate; desert weeds including ragweed, sage, and careless weed; and the full spectrum of Arizona tree pollens that produce an extended spring season unlike anything patients experienced in the Midwest or Northeast.

We also test for perennial allergens — the ones that are present year-round regardless of season. Dust mites, cockroach, cat, dog, and various molds make up this category. These are frequently the hidden drivers of symptoms that patients cannot connect to a season, because their exposure never stops. A patient who wakes up congested every morning without fail is far more likely reacting to something perennial in their bedroom than to a seasonal outdoor trigger.

How I Review Results With the Patient — and What Comes Next

When the results come in, the patient receives their own copy and I review mine with them in detail. I go through the panel from most allergic to least allergic — so the patient understands immediately which triggers are driving the most immune activity and which are minor contributors.

I start with avoidance. If we can reduce or eliminate exposure to the highest-reacting allergens, we reduce the total allergic load on the immune system and symptoms improve — sometimes dramatically — without any medication at all. For dust mite allergy, that means mattress and pillow encasements, washing bedding in hot water weekly, and reducing carpet where possible. For pet allergy, I have the conversation honestly: I know you will get rid of me before you get rid of the cat. So instead of asking the impossible, we talk about keeping the pet out of the bedroom, running HEPA air filtration, and washing hands after contact. For outdoor pollen, we discuss timing — pollen counts peak in the morning, so exercise and outdoor activity later in the day reduces exposure meaningfully.

After avoidance, the next step is medication — antihistamines, nasal corticosteroid sprays, and other agents to manage the immune response to unavoidable exposures. And for patients whose allergy burden is significant enough that avoidance and medications alone are insufficient — the veterinarian who is allergic to dogs and cats and cannot change careers, the plumber who is allergic to dust and mold and works in crawl spaces — the answer is immunotherapy.

Immunotherapy — Treating the Allergy, Not Just the Symptoms

There is an important distinction between treating allergy symptoms and treating the allergy itself. Medications manage symptoms — they reduce the inflammatory response that the allergen triggers, but they do not change the underlying immune sensitivity. The moment you stop the medication, the symptoms return with the next exposure.

Immunotherapy is different. It is the slow, regular introduction of the very same allergen you are allergic to into your immune system — in gradually increasing amounts over time — where it gets processed and you begin to develop blocking antibodies. Over the course of treatment, the immune system learns to tolerate the allergen rather than overreacting to it. Symptoms reduce. Medication dependence decreases. For many patients, the benefit persists long after the treatment course is complete.

At SAWC, we use sublingual immunotherapy — drops administered under the tongue rather than injections. This allows patients to continue treatment at home after an initial in-office period, which significantly improves compliance and convenience without sacrificing effectiveness.

Why Your Immune System Can Change — Even After Years With No Allergies

One of the most common questions I get from long-term Scottsdale residents is some version of: I have lived here for fifteen years and never had allergies — why am I suddenly sneezing every spring? The answer is that the immune system is not static. It is dynamic and always changing.

Repeated seasonal exposures to high allergen loads — particularly the olive and Bermuda pollen that saturate the Scottsdale air — can sensitize an immune system that previously tolerated those exposures without reaction. Age-related immune changes, hormonal shifts, illness, stress, and cumulative environmental exposure all alter the threshold at which the immune system begins to react. There is no immunity to developing allergy. And the longer a patient waits to have it evaluated and treated, the more sensitized the system becomes and the harder it is to manage.

The good news is that testing gives us a precise map of what the immune system has decided to react to — and once we have that map, we can build a treatment plan that is specific, logical, and far more effective than guessing.

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This post is part of the Understanding Your Symptoms section of the Airway & Sinus Wellness Review.

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About the Author

Franklyn R. Gergits, DO, MBA, FAOCO is an otolaryngologist and rhinologist with over 30 years of clinical experience. He is the founder of the Sinus & Allergy Wellness Center of North Scottsdale, where he performs in-office balloon sinuplasty, turbinate reduction, NEUROMARK® posterior nasal nerve ablation (Neurent Medical, FDA-cleared radiofrequency ablation system), and Eustachian tube dilation under local anesthesia. He performed the first balloon sinuplasty in Pennsylvania and holds dual Entellus Centers of Excellence certifications. Dr. Gergits is the originator of the Posterior Sinonasal Syndrome (PSS) hypothesis, with a preprint available at Preprints.org (DOI: 10.20944/preprints202603.0858.v1). ORCID: 0009-0000-4893-6332.

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This content is for educational purposes only and does not constitute medical advice. If you are experiencing allergy or sinus symptoms, please consult a qualified physician for evaluation and individualized treatment recommendations.