Advice

An allergist-immunologist is a board-certified physician in either Internal Medicine or Pediatrics. This physician then pursues a fellowship or subspecialty training of at least two years in the field of Allergy and Immunology. Our physicians are Diplomates of the American Board of Allergy and Immunology, which means we have trained at an accredited Allergy and Immunology program and then passed the allergy and immunology board examination. We maintain our certification on an ongoing basis.

Allergists have a breadth of knowledge in the diagnosis and management of chronic or recurrent conditions such as asthma, sinusitis, hives, eczema, chronic cough and drug allergies. We are trained in performing and interpreting diagnostic procedures and are experts in the administration of allergen immunotherapy or allergy shots. After a thorough evaluation, we will provide an explanation of the disease and develop a treatment plan best suited for your individual condition.

Determining what you’re allergic to is critical in helping to tailor an appropriate treatment plan. Allergy testing provides you and the clinician with the necessary information about your specific allergy triggers. Skin testing involves placing a small drop of an allergenic extract on the skin and pricking through the extract into the skin. This prick-puncture technique is not the same as the past scratch technique. If you are allergic to one of the allergens, a small, raised itchy bump will appear within 15-20 minutes. These bumps can look like small mosquito bites and will only last for a short time. Skin testing is typically performed because it is safe, accurate and the results are immediate.

Blood testing is available and may be necessary if you have such significant skin disease that application of the test is not feasible or if certain medications interfere with the skin test reaction. Blood tests are commonly used to follow your food sensitivity over time.

Yes. There are many unproven testing techniques that are used by practitioners not formally trained in allergy and immunology. IgG is such an example. This form of testing has no clinical relevance in assessing allergies and is not recommended.

Allergen immunotherapy, or allergy shots, is a method of treatment to reduce a patient’s allergic response. A physician develops an immunotherapy serum specifically tailored for each individual patient after reviewing the patient’s history, symptoms and allergy test results. An immunotherapy treatment program consists of injections of a diluted allergy extract administered at set intervals in increasing doses until a maintenance dose is achieved. Allergy injections are usually given at variable intervals for three to five years. Over time, your body develops a protective response, so when you are exposed to the environmental triggers in the future, your allergy and/or asthma symptoms will be less severe.

Allergy shots are recommended for patients who cannot avoid their offending triggers and medications are ineffective or excessive doses are required. Immunotherapy is also considered when patients experience unacceptable side effects to their medications. Allergy shots are advised for patients with allergic rhinitis and asthma. They can also be used to treat patients with severe allergic reactions to stinging insects such as bees, wasps, hornets, yellow jackets and fire ants.

Asthma is a chronic inflammatory condition of the lungs. This inflammation lives inside the airways and causes symptoms such as coughing, wheezing and shortness of breath. Asthma is also associated with brochospasm and constriction of the muscles around the airways. The cause of asthma is unknown but those with asthma typically have certain triggers that lead to asthma symptoms or attacks.

The allergist-immunologist is uniquely qualified and specifically trained to determine what allergic triggers may or may not affect a patient. We are also educated to evaluate the other triggers, including exercise, inhalation of cold air, air pollution, respiratory illnesses and gastroesophageal reflux. As clinicians, we are able to perform and interpret pulmonary function tests in the office. We also provide comprehensive management with patient education and regular follow-up, constantly customizing the treatment plan to fit the patient’s needs. Allergen immunotherapy can be an integral part of an asthmatic’s treatment plan. There is evidence that allergy shots may prevent the development of asthma in children. We have the ability to treat acute asthma exacerbations in the office with nebulizers and I.V. therapy if needed.

Studies have shown that asthmatic patients who receive care by a board-certified allergist have decreased asthma symptoms, improved asthma-related quality of life, reduced emergency room visits and decreased hospitalization rates. Patients also have reduced work and school absenteeism.

Although food reactions are more prevalent during childhood, they can occur at any time, even if the food was present in the diet for quite some time. Food reactions can be mild, as in an oral allergy syndrome, or can become life-threatening. For this reason, it’s important to see an allergist and identify the offending food so it can be avoided. The allergist can also educate the patient on potential cross-reactive foods and implement an emergency action plan that includes the use of epinephrine. Over time, some patients will lose their food sensitivity with proper avoidance. The allergist can also work to monitor and identify whether a food can be reintroduced back into the diet. Many patients needlessly avoid foods and/or situations. A thorough evaluation by an allergist can help patients relax their diet and expand their social interactions.

Sinusitis is a common acute or chronic inflammatory condition of one or more of the four sinus cavities. Sinuses are air-filled, bony cavities located in the forehead area, between the eyes and in the cheekbones. Inflammation in the sinuses can occur for a variety of reasons, including bacterial or viral infections, anatomical abnormalities and chronic nasal allergies. Allergists are specialists in the medical management of sinus disease. As opposed to an ENT, an allergist will determine if there is an underlying allergy leading to the chronic or recurrent infection or if there is a problem with the immune system causing the disease. Allergists and ENTs often work together to fully manage the most severe cases of chronic sinusitis.

The result of chronic inflammation, caused by allergies and infections, nasal polyps are small sacs that grow from the tissue lining the nasal turbinates and sinus cavities. Polyps can signify a unique type of inflammation in asthma and are also associated with cystic fibrosis. Additionally, they can obstruct the nasal passages, lead to recurrent sinus infection, cause headaches and diminish a person’s sense of smell. Unfortunately, simply cutting out the polyp does not address the underlying inflammation that causes the polyp, which means they can soon grow back. It is essential to address the inflammation with topical corticosteroid nasal sprays, allergen immunotherapy and even aspirin desensitization in the appropriate patient. Our allergists can guide you to the best treatment, often working directly with your ENT.

A cough is the body’s way to clear mucus or secretions from the lungs and upper airways. Coughs caused by simple viral upper airway infections typically resolve in a few weeks. When a cough persists, however, it should be evaluated. A chronic cough is generally due to either postnasal drainage, asthma or gastroesophageal reflux disease (GERD). Excessive postnasal drainage may be secondary to allergic or non-allergic nasal disease or sinus disease. In addition, asthma may be present with cough, wheezing or chest tightness/shortness of breath. Many times, cough is the only symptom of asthma in children. Likewise, cough may be the only presenting symptom of GERD. Significant acid reflux may be present even without the typical symptoms of heartburn or indigestion. Our allergists have the specialized training to evaluate and treat chronic cough. After a thorough history and physical exam, we can determine the most effective diagnostic procedures.

Contact dermatitis refers to a broad range of skin reactions resulting from the direct contact of an allergen or an irritant with the skin. The classic allergic contact dermatitis (ACD) is poison ivy, usually appearing one to three days after exposure. Other common causes include metals (nickel), cosmetics, latex, dyes, perfumes or fragrances and topical medications. Irritant contact dermatitis is typically caused by cleaning agents or detergents and generally occurs on the hands. In these cases, the skin becomes red, itchy and inflamed and will frequently develop small blisters. Allergists can evaluate and identify the cause of contact dermatitis. When appropriate, we’ll perform patch testing that involves placing small amounts of potential allergens in contact with the skin on the back for 48 hours. Results are noted at 48 and 72 hours. Identifying the cause of your allergies is the first step in treating your contact dermatitis.

For most people, an insect sting means slight pain and discomfort. A local reaction will consist of swelling, redness and warmth at the site of the sting. These normal reactions will last from a few hours to a couple of days and are easily treated with ice and anti-inflammatory medications. Those who are highly allergic will develop generalized hives, itching, swelling and breathing trouble. In the most severe cases, a person can lose consciousness due to a drop in blood pressure. These severe or anaphylactic reactions occur in less than 5% of all stings. If a person has had a systemic reaction to a sting in the past, they have a 70% chance of another severe reaction with their next sting. The five most common insects to cause these reactions are wasps, honeybees, yellow jackets, hornets and fire ants. Skin testing, and, at times, blood testing, is used to determine the causative insect. Highly sensitive individuals need to carry antihistamines and injectable epinephrine. Venom immunotherapy (allergy shots for insects) is also recommended in these cases in order to lower a patient’s sensitivity to normal levels.

While medicines are given to help patients, they all have side effects. Sometimes these reactions are true allergic reactions and can be life-threatening. This is the case in 5-10% of drug reactions. Our allergists can help determine if the reaction is truly allergic in nature and, if so, what is the most likely agent. There are times when a patient has a specific drug allergy and that drug is required for treatment. Allergists can evaluate these situations and desensitize the patient to the specific medication for that treatment period. This may be done in the office setting or it may require hospitalization. If you have any concerns about a particular medication, call our office.

Hives are red, itchy, swollen areas of the skin that range in size and can appear anywhere on the body. In general, hives appear and disappear fairly quickly only to resurface on another area of the body. Lesions that appear and do not resolve are normally not hives. Usually, the cause of urticaria that occurs quickly and resolves rapidly is readily identifiable, often a viral infection or an allergic reaction to a food, drug or environmental agent. Hives typically will resolve spontaneously with avoidance of the offending allergen, but at times antihistamines or even steroids may be needed. Some patients have chronic urticaria. These cases are not typically caused by allergies, but our allergists can help to diagnose and manage this complex condition.

Eczema is a general allergic reaction usually seen during childhood but can occur at any time. Itching is the hallmark symptom of eczema and can be very intense, often interfering with sleep. The rash may be dry and flaky or can have lesions that ooze. During childhood, upward of one-third of the more severe cases have a food allergy at the root of the problem. Identifying and avoiding the allergic trigger is critical for treatment. Therapy consists of regular use of moisturizers along with topical anti-inflammatories and oral antihistamines. Many times, antibiotics are necessary to treat secondary bacterial infections.

A nurse practitioner (NP) is a registered nurse who has a minimum of a master’s degree in science and nursing. NPs have academic preparation in symptom assessment, diagnosis, pharmacology and health management. This higher level of knowledge allows the nurse practitioner to operate in an autonomous professional role, providing comprehensive care to individuals, families or communities in a variety of ambulatory and inpatient settings. While demonstrating the highest degree of technical skill and knowledge, the NP continually focuses on comprehensive health care that considers all of the patient’s physical and emotional needs. Practice priorities include developing a partnership with the patient while stressing health promotion and health care education.