Allergy Treatment Services
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General allergy skin testing to reliably determine the cause of an allergic reaction.
Testing, identification, and treatment for patients with drug-related allergies.
Treatment for patients with abnormal immune responses to non-threatening foods.
Treatment for hives, allergic contact dermatitis, and other irritating skin allergies.
Treatment for local, large local, and systemic anaphylactic reactions to insect stings.
Treatment for patients with discomfort caused by hay fever (allergic rhinitis).
Treatment for patients with allergic reactions to non-threatening substances like latex.
Primary immunodeficiency disease (PIDD) & Secondary diagnosis and treatment.
Treatment of disease by inducing, enhancing, or suppressing an immune response.
Your allergist must first determine what is causing your allergy in order to manage your allergy symptoms most effectively. Once the specific allergens causing symptoms have been identified through allergy testing, a treatment plan aimed at controlling your allergy symptoms. Allergy testing is ideally performed through skin testing (prick), since the results are available immediately and are more reliable than blood testing. The testing is not painful but young children sometimes report minor discomfort. The most common complaint is itching from wheals that develop in response to testing that resolve within 30 minutes.
Antibiotic allergy skin testing and graded challenge procedures: If you require penicillin or any other beta lactam antibiotic, but have an allergy to this medication class listed in your medical record, you may still be able to receive the medication without complications.
While patient reported antibiotic allergies are relatively common (for example, about 10 percent of people report a penicillin allergy), the incidence of true sensitization is significantly lower. This is either because the reaction was not truly allergic in nature to begin with, or because their allergy has resolved over time.
Identification of tolerance to these antibiotics is important because otherwise, patients are unnecessarily exposed to alternative, often less effective, antibiotic classes. This also favors the development of antibiotic resistance.
For a documented penicillin allergy in particular, a validated skin test is available that rules out true sensitization with extremely high accuracy. If the skin test is negative, this is followed by an oral challenge with a full dose of amoxicillin to ensure tolerance.
In the setting of other antibiotic allergies, skin testing has not been substantiated by a large body of evidence. However, even in these cases, graded drug challenges have been successfully employed with a documented high safety rate, when selected according to patient histories with a low likelihood of true reactivity. These challenges can extend from hours to days to weeks, all depending on the evolution of the prior reaction.
Even if the history suggests a low likelihood of clinical reactivity, all of these procedures will be performed under close monitoring and supervision for any adverse reactions, to ensure that a full dose can be tolerated and that the allergy can be safely deleted from the medical record.
Penicillin Skin Test/Challenge
Patients who may have previously had an allergic reaction to penicillin may no longer be sensitive to the medication and may benefit from a penicillin allergy test if they require penicillin for medical treatment. During an initial consultation, our physicians will evaluate your medical and penicillin sensitivity history, and thereby determine candidacy for further testing.
At a subsequent visit, if deemed eligible, skin prick tests and intradermal tests with standardized reagents will be performed, and should these be negative, an open challenge with an oral form of penicillin will be performed under close physician supervision.
Food allergy is an abnormal response to a food triggered by the body’s immune system, in which the body produces what is called an allergic, or IgE, antibody to a food, and affects up to 6 to 8 percent of children under the age of 3 and close to 4 percent of adults. Allergic reactions to food can cause serious illness and, in some cases, death. Therefore, if you have a food allergy, it is extremely important for you to work with your healthcare provider to find out what food(s) causes your allergic reaction.
Sometimes, a reaction to food is not an allergy at all but another type of reaction called “food intolerance.” Food intolerance is more common than food allergy. The immune system does not cause the symptoms of food intolerance, though these symptoms may look and feel like those of a food allergy.
Baked Egg/Baked Milk Challenge
If your child has an egg or milk allergy, it may be possible to safely incorporate baked egg and baked milk products such as cakes and cookies into their diet. This is because patients are often allergic to proteins in egg and milk that are easily destroyed by heat, therefore conferring tolerance to extensively heated products.
Tolerance of baked products can be confirmed by a stepwise oral challenge performed in a monitored setting, after taking into consideration several factors.
The implications of passing an oral challenge to baked egg and baked milk are multifold:
There is considerable evidence that incorporating baked egg and baked milk into the diet of egg/milk allergic patients hastens resolution of their allergy
It allows for considerable liberalization of dietary restrictions
Tolerance of baked products is a predictor that the allergy itself will be outgrown sooner rather than later
All food challenges are done the same way. A small amount of the baked food is given. The patient is observed for 15-30 minutes and a larger portion is given and then observed again. This is repeated 3-5 times until the child has consumed a meal sized portion of the food. The amount varies by age. If there is any reaction at any point, the challenge is stopped, the reaction treated and it is a positive challenge. If the child gets to the end, it is a negative challenge and the child can eat the tested products.
Food challenges should never be done at home. Consult a board certified allergist who may recommend a carefully monitored food challenge.
Please contact the office with any questions regarding these procedures or to schedule a consultation.
Although allergic skin reactions are very common, it is often difficult to determine what causes them. Irritated skin can be caused by a variety of factors. These include immune system disorders, medications and infections. When an allergen is responsible for triggering an immune system response, then it is an allergic skin condition.
Angiodema is often seen with hives, and occurs when there is swelling and inflammation in the deep layers of the skin. Angioedema many times occurs in soft tissues such as the eyelids, mouth or genitals.
Eczema (Atopic Dermatitis)
Eczema, or atopic dermatitis is extremely common, especially in children. It is thought to be caused by a defect in the skin barrier, which causes skin to dry out and become irritated and inflamed. Some food sensitivities can make eczema symptoms worse. Eczema is often linked with asthma, allergic rhinitis, or food allergy. You are more likely to develop eczema if a parent has any of the above conditions. Unlike with urticaria (hives), the itch of eczema is not caused by histamine, so anti-histamines will not control the symptoms.
When your immune system releases histamine, small blood vessels leak, which leads to swelling and inflammation of the skin, or hives. Swelling in deep layers of the skin is called angioedema.
There are two kinds of urticaria, acute and chronic. Acute urticaria occurs after eating a particular food or coming in contact with a particular trigger such as heat or exercise, as well as medications, foods, or insect bites. To be considered chronic, the condition must last for at least six weeks, although in some cases it lasts for years.
Omalizumab, known by the brand name Xolair, is a treatment for chronic hives that do not respond to antihistamine treatment, approved by the FDA in 2014 after trials showed the drug to be highly effective in reducing symptoms and improving quality of life for patients of the condition
Xolair is an injected drug that’s had several years of success in treating allergic asthma. It neutralizes IgE antibodies (the antibodies involved in allergic reactions), resulting in symptom reduction.
In the U.S. the drug is approved for CIU patients who are 12 years of age and older.
Allergic Contact Dermatitis
When your skin breaks out in a rash after direct contact with an allergen, it’s called allergic contact dermatitis. For example, many people have allergies to nickel, which is often in belt buckles, jewelry, etc. They may develop a red, bumpy, itchy, or swollen rash at the place of contact.
Plants such as poison ivy, poison oak, and poison sumac also cause allergic contact dermatitis.
Most everyone will react in some way to stinging insects, but up to 13.5 million people in the U.S. may be at risk of anaphylaxis, a life threatening allergic reaction.
There are three types of allergic reactions to insect stings:
Swelling and redness confined to the general area of the sting. Generally these are not dangerous.
Large Local Reaction
Symptoms include swelling, redness and itching that may or may not be confined to the general area of the sting. Generally these reactions are not dangerous, but very large areas of swelling may warrant further evaluation. Contact your allergist if you have questions about a large local reaction.
An allergic reaction that results in symptoms other than localized swelling. Symptoms may include itching, hives or swelling away from the sting site. This type of reaction may progress to anaphylaxis. Anyone who has experienced an allergic reaction in the past has a significantly increased chance of a similar or worse reaction if stung again. If you have experienced an allergic reaction of any kind, consult an allergist as soon as possible to perform an evaluation to determine the most appropriate treatment plan.
Venom Immunotherapy (allergy shots) to bees or fire ants, if warranted, is a potential treatment option. Venom Immunotherapy can dramatically reduce the likelihood of anaphylaxis from future stings and may result in a permanent cure.
Allergic rhinitis (also called “hay fever”) affects 40 million people in the United States. It develops when you breathe in something you are allergic to, with consequent inflammation or swelling of the lining of your nose.
What Are The Signs And Symptoms of Allergic Rhinitis (Hay Fever)?
- Signs of allergic rhinitis are similar to signs of a common cold but can last for more than 8-10 days and may include:
- A stuffy nose or a runny nose.
- Itchy nose, itchy eyes or watery eyes.
- Children might have dark circles under their eyes, or use the palm of their hand to push their nose up as they try to stop the itching (called the “allergic salute”).
- Coughing caused by clear mucus running down the back of your throat.
What Causes Hay Fever?
- Allergens that trigger allergic symptoms can be found both outdoors and indoors. When allergic rhinitis is caused by common outdoor allergens—such as mold or trees, grass and weed pollens, it is often referred to as seasonal allergies, or “hay fever.”
- Allergic rhinitis may also be triggered by household allergens, such as animal dander, indoor mold, or the droppings of cockroaches or house dust mites.
- If you have symptoms in spring, you are probably allergic to tree pollens.
- If you have symptoms in the summer, you are probably allergic to grass and weed pollens.
- If you have symptoms in late summer and fall, you probably are allergic to ragweed.
- Dust mites, molds and animal dander cause symptoms all year.
- Skin tests by an allergist/immunologist can help determine the etiology of your allergic symptoms.
What Are My Treatment Choices?
- Environmental control:
- Although it’s best not to have pets when you have allergic rhinitis, washing your furry pet once a week and keeping it out of the bedroom and off the furniture will help.
- Put pillows, box springs and mattresses in sealed plastic covers that keep out dust mites, and wash sheets in hot water every week.
- Keep windows closed. If possible, get an air conditioner and run a dehumidifier, so that there will not be so many pollens and molds in the house.
- Medical management:
- Antihistamines and nasal sprays as prescribed by an allergist can be very helpful for controlling symptoms. Some are safe for young children and all are safe for adults.
- Allergy Immunotherapy (Traditional, RUSH, and Cluster Immunotherapy)
Anaphylaxis is a very serious and possibly life-threatening allergic reaction. This severe allergic reaction occurs when the immune system releases a flood of chemicals, such as histamines when exposed to seemingly non-threatening substances.
What Causes Anaphylaxis?
Anaphylaxis is often caused by certain foods. Other common causes of this severe allergic reaction include:
- Insect stings, mainly wasps, bees and ants
- Certain medications
- Exercise following consumption of trigger foods
Symptoms of Anaphylaxis
- Severe eye or facial itching
- Breathing and swallowing difficulties
- Abdominal Pain
The symptoms of anaphylaxis can quickly evolve into anaphylactic shock, so it is important to treat these symptoms immediately.
If you are experiencing recurring infections, it could be the result of primary immunodeficiency disease (PIDD). When part of the immune system is either absent or not functioning properly, due to hereditary or genetic reasons, it’s called PIDD. If the immune system is damaged due to other factors (chemotherapy, HIV, malnutrition, etc.), the condition is called secondary immunodeficiency disease.
Signs and Symptoms That May Indicate A PIDD:
- Recurrent, unusual, or difficult to treat infections
- Poor growth or loss of weight
- Recurrent pneumonia, ear infections, or sinusitis
- Multiple courses of antibiotics or IV antibiotics necessary to clear infections
- Recurrent deep abscesses of the organs or skin
- A family history of PIDD
- Swollen lymph glands or an enlarged spleen
- Autoimmune disease