How to Administer/Patient Counseling

If you are a medical provider, adding patch testing to your armamentarium can be a valuable service to your patients. This page contains everything you need to self-train – including videos and written instructions. If you prefer, we can walk you through the process. Contact us for a phone tutorial.

IBS-80 and the Art of Patch Testing

The below video provides detailed instructions on the administration of patch testing.

 

IBS-80 Food Patch Testing for the
Evaluation and Management of Irritable Bowel Syndrome

The below video provides detailed instructions on IBS-80 food patch testing.

 

Written Instructions for IBS-80 Food Patch Testing

Before Applying the Patches

Instruct the patient to avoid direct sun exposure on his/her back for 4 weeks prior to application of the patch tests.  Sun may decrease his/her skin’s ability to mount an immune response to the test materials. Individuals with hair on their upper and/or mid back should shave it off two days before their appointment. Instruct them to not use chemical hair removers. Have the patient take a bath or shower the morning of the first appointment, but instruct him/her to not apply any lotions or other products to his/her back after the shower.

Day 1
Gown the patient from the waist up with the opening in the back. Have women remove their bra but tell them they can put it back on once the patches are in place. Gently wipe the back with an isopropyl (rubbing) alcohol pad, let dry, then apply the patches. After the patches are applied, instruct the patient to take a tub or sponge bath only, avoid excessive sweating and avoid leaning over or bending his/her back too much for the next 2 days so that the patches stay in place.
Day 3
After marking the back (see videos) and removing the patches, remove any allergen debris with a rubbing alcohol pad, perform the 48 hour patch test reading, and record the results on the provided Data Collection Form. Instruct the patient the he/she can bathe normally but should avoid directly washing his/her back until after the final patch test reading 1 or 2 days later so that the black marker lines remain visible until after the final reading.
Day 4 or 5
Perform the final reading and record the results, then generate Food Avoidance Information (see Food Avoidance section below) based on the patient’s results. Include even the allergens that generated just a questionable reaction as these are sometimes relevant. Review the avoidance information with the patient and instruct him/her to avoid all foods in question for one month and, if helpful, indefinitely. If there is improvement after a month and if some of the patch reactions were just questionable, rechallenging one at a time with those that were questionable may be worthwhile. If symptoms recur, these foods may again be eliminated from the diet. Instruct the patient that the marks on the back will slowly fade. Any pruritic reaction site may be treated with a mid or high potency topical corticosteroid cream for a few days (samples are convenient). The difficulty of the patch test-guided avoidance diet will depend on the number of allergens and the ubiquity of each specific allergen. Some are harder to avoid than others. Depending on the complexity of the avoidance, referral to a dietitian may be helpful.

Food Avoidance

The Food Avoidance Information (FAI) is an important part of the process. Please be sure to provide this information to your patients. To utilize this resource, after agreeing to the terms, check off each food allergen to which the patient had a patch test reaction, then scroll to the bottom of the page and click the “Print Allergens/Avoidance Info” button to generate a pdf that provides information about each of the allergens and how to avoid them.

Food Allergen Material Safety Data Sheets

Download Material Safety Data Sheets for all allergens used in IBS-80 Basic and IBS-80 Plus. (This is a large file that may take several seconds to download).

Follow-up Questionnaire

It is recommended that you give your patient the Food Avoidance Questionnaire either at the last visit, along with a pre-addressed, stamped envelope, or by mail one month after completion of testing. (The latter of these options usually yields higher response rates.) Instruct the patient to complete and return the questionnaire one month after avoiding the foods in question so that you receive follow-up on the outcome of the patch test-directed food avoidance. Utilize copies of the completed questionnaire to provide follow-up information to any of the patient’s other providers.

Model IBS-80 Consent Form

If needed, download a model IBS-80 Informed Consent Form.