Frequently Asked Questions

As patients, you may have many questions, such as, what services do Allergists/Immunologists provide?  Do I take allergy shots forever?  Why have I been able to take penicillin in the past but now I get hives?  Why can I not wear my favorite earrings?  Below you will find answers to many of these questions and more.

What is an Allergist-Immunologist?
What is a Nurse Practitioner?
Allergy Skin Testing
Allergy Shots
Allergist's approach to Asthma
Food Allergies
Sinusitis/Nasal Polyps
Chronic Cough
Contact Dermatitis
Insect Sting Allergy
Drug Allergies/Desensitization
Urticaria (Hives)
Atopic Dermatitis (Eczema)

What is an Allergist-Immunologist?
An Allergist-Immunologist is a physician who is board certified first in either Internal Medicine or Pediatrics.  We then pursue 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.  We have trained at an accredited Allergy and Immunology training program and have then passed the arduous allergy and immunology board examination.  Allergists also maintain their certification on an ongoing basis.

Allergists have a breadth of knowledge in the diagnosis and management of a variety of chronic or recurrent conditions such as asthma, allergic rhinitis, sinusitis, hives and angioedema, eczema, chronic cough and drug allergies just to name a few.  We are trained in performing and interpreting diagnostic procedures including allergy skin testing and blood testing, pulmonary function testing, food testing and food challenges, along with drug testing and desensitization. Allergists are experts in the administration of allergen immunotherapy or allergy shots.  The Allergist-Immunologist, after a thorough evaluation, will provide an explanation of the disease and will then, along with the patient, will develop a treatment plan.

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What is a Nurse Practitioner?
A nurse practitioner (NP) is a registered nurse who has a minimum of a masters 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 healthcare 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 heathcare education.  Nurse practitioners are recognized as excellent heathcare providers who provide professional, quality care.

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Allergy Skin Testing
Determining what a patient is 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.  However, blood testing is available and may be necessary if the patient has such significant skin disease that application of the test is not feasible or if certain medications cannot be withheld that interfere with the skin test reaction.  Blood tests are commonly used to follow a patient's food sensitivity over time.

There are many unproven testing techniques that are used by practitioners not formally trained in allergy and immunology.  An example is IgG testing for food sensitivities.  This form of testing has no clinical relevance in assessing allergies and is typically not recommended.

If you have any questions about our method of testing, please call the office.

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Allergy Shots
Allergen immunotherapy, or allergy shots, is a method of treatment to reduce a patients 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.

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Allergist's approach to Asthma
Asthma, no matter how severe, is a chronic inflammatory condition of the lungs.  This inflammation is inside the airways and causes the symptoms of asthma.  The symptoms are 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 asthmatics 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 are receiving their 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.

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Food Allergies
Unfortunately, food allergies are becoming more common and can manifest in a variety of ways.  Reactions can be mild, as in oral allergy syndrome, to life threatening.  There are plenty of misconceptions and misunderstandings about food allergies that put patients at risk.

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 worsen with repeated exposure, therefore it is important to identify the offending food so it can be avoided.  The allergist can also educate the food-allergic patient on potential cross-reactive foods and implement an emergency action plan that includes the use of epinephrine.

It is true that some patients will lose their food sensitivity over time with proper avoidance.  The allergist can also work to monitor and identify whether a food can be reintroduced back into the diet.  Many patients are needlessly avoiding foods and/or situations, therefore thorough evaluation can help patients relax their diet and expand their social interactions.

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Sinusitis/Nasal Polyps
Sinusitis is a common acute or chronic inflammatory condition of one or more of the four sinus cavities.  The sinus cavities 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.  Allergist are not surgeons so we approach the management to sinus disease from a different perspective than that of the otorhinolaryngologists or ENTs.  The 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.

Nasal polyps are small sacs that grow from the tissue lining the nasal turbinates and sinus cavities.   Nasal polyps result from chronic inflammation, such as allergies and infections.  They can signify a unique type of inflammation in asthma and are also associated with cystic fibrosis.

Nasal polyps are difficult to manage.  They can obstruct the nasal passages, lead to recurrent sinus infection, cause headaches and diminish a person's sense of smell.  Simply cutting out the polyp does not address the underlying inflammation that causes the polyp and therefore they can soon grow right back.  It is essential to address the inflammation with topical corticosteroid nasal sprays, allergen immunotherapy and even aspirin desensitization in the appropriate patient.  The allergist is uniquely equipped to guide the patient through this medical maze.  Sometimes it is necessary to remove the polyps, therefore the Allergist and ENT will work closely together to solve the problem.

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Chronic Cough
When a person coughs, the body is trying to clear mucus or secretions from the lungs and upper airways.  It is common to have a cough with a simple viral upper airway infection and these typically resolve in a few weeks.  When a cough persists, 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.  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.

Allergists have the specialized training to evaluate and treat the patient with chronic cough.  After a thorough history and physical exam, they can determine which diagnostic procedures are appropriate.

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Contact Dermatitis
Contact dermatitis refers to a broad range of skin reactions resulting from the direct contact of an allergen or an irritant with the skin.  Some of these reactions are the result of an allergic reaction and are called allergic contact dermatitis.  Others are the result of a non-allergic, or irritant reaction called irritant contact dermatitis.  The classic allergic contact dermatitis (ACD) is poison ivy.  The reactions of ACD typically appear one to three days after exposure.  Other common causes of ACD are metals (nickel), cosmetics, latex, dyes, perfumes or fragrances and topical medications.  Irritant contact dermatitis is typically caused by cleaning agents or detergents and characteristically occurs on the hands.

The skin becomes red, itchy and inflamed and will frequently develop small blisters.  If contact is prolonged, the skin can become crusted and hard.

Allergists are skilled at evaluating and identifying the cause of contact dermatitis.  Patch testing can be performed when appropriate.  This 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 causative agent is the cornerstone of treatment for contact dermatitis.

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Insect Sting Allergy
For most people, an insect sting means a little pain and discomfort.  A local reaction will consist of swelling, pain, 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.  The Allergist has expert training to evaluate and diagnosis insect sting allergy.  Skin testing, and at times blood testing, is used to determine the causative insect.  Those sensitive individuals need to carry antihistamines and injectable epinephrine.  Venom immunotherapy (allergy shots for insects) is also recommended in these individuals.  Venom immunotherapy can lower a patient's sensitivity that of the level of normal population.

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Drug Allergies/Desensitization
While medicines are given to help patients, they all have side effects.  Sometimes these reactions are true allergic reactions.  This is the case in 5-10% of drug reactions.  It is important to recognize these reactions because they can be life threatening.

Allergists have extensive training to evaluate and diagnosis drug allergies.  At the present time, only limited testing for some agents are available.  The Allergist 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 history of a drug allergy and that specific drug, or a close relative, is required.  Allergists have the ability to 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 or if you may be having a reaction, please call our office.

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Urticaria (Hives)
Urticaria, also frequently referred to as hives, is not uncommon.  Hives are red, itchy, swollen areas of the skin that range in size and appear anywhere on the body.  Hives tend to appear and disappear fairly quickly only to resurface on another area of the body.  This is characteristic of hives.  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.  Allergists are well-trained to diagnosis and treat allergic urticaria.  Usually the hives 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 are not typically caused by allergies.  Again, Allergists are uniquely qualified to diagnosis and manage chronic urticaria.  Unfortunately, successful treatment of chronic urticaria can be very complex.

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Atopic Dermatitis (Eczema)
Atopic dermatitis, or 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.  Allergists are well equipped to help identify the causative agent.  During childhood, upwards of 1/3 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.

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