Allergy 101 for Dermatologists: What to Test, What to Treat, and What to Ignore
At the 2026 Masterclasses in Dermatology Annual Meeting, David E. Sloane, MD, EdM, delivered a practical and often humorous roadmap for dermatologists navigating allergy referrals. His focus was not simply what to send, but what not to send.
Dr Sloane began with clear indications for referral. Dermatologists should consider allergy/immunology consultation when evaluating allergic asthma or rhinoconjunctivitis for aeroallergen skin testing, venom-induced anaphylaxis requiring Hymenoptera testing, food allergy evaluation, or drug allergy assessment, particularly to “de-label penicillin allergy.” Recurrent infections that raise suspicion for primary or secondary immunodeficiency also warrant referral.
He emphasized that allergy testing has limits. Many IV beta-lactam antibiotics, vancomycin, fluoroquinolones, selected monoclonal antibodies, local anesthetics, and some chemotherapeutics can be tested. However, nonsterioidal anti-inflammatory drugs (NSAIDs), opioids, radiocontrast material (RCM), and any medication suspected of causing a severe cutaneous adverse reaction (SCAR) cannot be reliably skin tested.
Similarly, desensitization applies selectively. Many antibiotics, aspirin/NSAIDs, certain monoclonal antibodies, taxanes, platins, and progesterone can be desensitized. Opioids, RCM, and SCAR-associated drugs should not be.
For food allergy, desensitization may be possible in select cases, and omalizumab has emerged as a treatment option in carefully selected patients.
One of the most valuable segments of the session addressed when not to refer: chronic fatigue syndrome, chronic Lyme disease, black mold toxicity concerns, hypermobile Ehlers-Danlos syndrome, fibromyalgia, postural orthostasis and tachycardia syndrome, small fiber peripheral neuropathy, and idiopathic environmental intolerance (formerly multiple chemical sensitivities). “We just don’t have the science built around these,” Dr Sloane indicated.
For more meeting coverage, visit the Masterclasses in Dermatology newsroom.
Reference
Sloane DE. Allergy 101 for the dermatologist: what to know, when to refer. Presented at: Masterclasses in Dermatology; February 19–22, 2026; Sarasota, FL.
