The Allergist Episode 80 – The Smoke Detector Problem

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“Allergy tests are evidence toward a verdict, but they are not the verdict themself.”

–  Dr. Nicole Chase

There’s no shortage of tests allergists use. Skin prick tests, component testing, serum-specific IgE. These are all go-to tools for allergists. But are we asking too much from them and are we changing the test meaning with some of our interventions?

Dr. Nicole Chase thinks so. Dr. Chase is associate professor of medicine at the University of Minnesota and a partner at St. Paul Allergy and Asthma, with clinical expertise in anaphylaxis, atopic dermatitis, chronic urticaria and novel therapeutics. She walks through what these tests can and cannot tell us, and how there’s no substitute for old-fashioned clinical skill.

On this episode, they discuss:

  • Skin prick tests and serum-specific IgE measure sensitization. They don’t predict threshold or severity.
  • Biologics change the numbers. On dupilumab or omalizumab, a negative test may not mean what it used to
  • Population data, n of 1 patients
  • We don’t routinely repeat-test after venom or aeroallergen immunotherapy. So why do we with food?
  • Stop omalizumab and protection in food allergy can start slipping within about three months. Remember the asterisk when counselling patients after challenges.
  • Dupilumab drags total and food-specific IgE down over time. That can hide more than food allergy; don’t forget ABPA!

Tests are a smoke detector. What we want to know is how big the fire is. Dr. Chase’s rule before ordering anything: what are you going to do with the result? A better test doesn’t get you out of that question.

Posted on October 27, 2026.