Hay Fever and Asthma
These are considered allergic diseases of the respiratory tract, and are the most common referrals we see. These are often due to allergens in the air (inhalants), and skin testing to inhalants is almost always done with these patients. Older patients may remember allergy work-ups as being painful and extensive multi-day procedures; this is not the case anymore. We usually test for about 20-30 allergens, done on the arms, and it takes about 15 minutes. There are no needles or shots involved. New patient visits for these symptoms typically last about an hour-and-a-half, and includes paperwork, skin testing, and getting test results.
**Antihistamines can interfere with our testing, so it is important that patients come into the office without having taken antihistamines for 4-5 days prior to the visit. These include Zyrtec (ceterizine), Benadryl (diphenhydramine), Claritin (loratidine), Allegra (fexofenidine), stomach medications such as Pepcid (famotidine), Zantac ( ranitidine), Tagamet (cimetidine), and even some anti-depressants such as Sinequan (doxepin).
Eczema and Hives
Eczema is a chronic skin inflammation that is itchy, red, and scaly. If you close your eyes and run your hand over the rash, it will feel rough. These spots will usually last for days to weeks in the same place. Eczema is common in allergic infants and we call this atopic dermatitis. Food allergy is very common as a cause of atopic dermatitis in children, therefore skin testing may be necessary to figure this out. In kids, we use a plastic multitest device that causes little to no pain and allows us to test 10 different allergens. If you are seeing us for this problem, avoiding antihistamines is important prior to the test as we mentioned above.
Hives (urticaria) is a transient rash that comes and goes very quickly, usually within a day or so in one place. If you run your hand over it, you may not feel anything. Sometimes it is associated with severe swelling of the lips, eyes, hands, or feet (angioedema). Acute hives last less than a month or two and are often due to a preceding viral illness...especially in children. Chronic hives come and go over a few months, or even years. Although we know that allergic reactions can produce hives, the reverse is not true. Most patients with chronic hives do not have allergy; therefore, we rarely skin test patients with chronic hives - rather blood tests may be ordered to rule out illnesses that can cause hives.
Chronic or frequent sinus infections is a common and stubborn problem. The allergist's job in these cases is to assess patients for risk factors. Allergy is a major risk factor for chronic sinusitis, so skin testing will usually be done, especially for indoor allergens such as house dust mites and animal dander. In addition, some patients with chronic sinusitis may have a low level of infection fighting antibodies, and blood tests may be required to diagnose this condition.
The immunology portion of our specialty involves the assessment of immune system function. Deficiency of immune function can cause a host of diseases, like the mentioned chronic sinusitis above. In severe forms, immunodeficiency leads to "bubble babies", but mild forms are much more common. Any patient who has had numerous infections, such as sinusitis or pneumonia, or has had unusual infections, needs an immunodeficiency evaluation done by blood test. Conversely, there are many diseases in which the immune system is too active, or active in a mis-directed way. These include autoimmune and autoinflammatory disorders. All of these would be tested by blood test.
Allergy shots have been the mainstay of allergy practice for over 100 years. We administer gradually increasing doses of allergy extracts by injection in two phases. The first phase of build up requires visits usually weekly until we reach a maintenance dose. This can take up to 20 doses. It can also be accelerated by twice weekly visits. Once maintenance is reached, patients will come in once every 3-4 weeks for shots. Symptom improvement starts within a few months. The shots are given with 27 gauge needles and are not very painful. We have children as young as 4 who tolerate the shots with no protests. Maintenance continues for 3-5 years; after that, many patients are cured of their allergies. About 30% may need long term immunotherapy.
Sublingual (under the tongue) immunotherapy, or SLIT, is a form of allergy desensitization that can be done at home without shots. It is widely practiced in Europe and Japan and is slowly being introduced in the USA. We have been providing SLIT drops for patients for patient use at home, but they are not FDA approved.