Clinic Handouts
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Allergen Immunotherapy
Diagnosis and Treatment of Sinusitis
Gastroesophageal Reflux Disease
House Dust Mite Allergy
Urticaria
Vasomotor or Non Allergic Rhinitis
Can hives be controlled? How do I find the best inhaler for my toddler? Why do some allergies act up during the winter months? Are dust mites our enemy?
Allergy and Asthma Medical Group answers all of your questions. Please call (925) 327-1460 to make an appointment today. Build your knowledge. Read on for patient-friendly information.
What is an Allergist-Immunologist?
Allergists and asthma
Sinusitis
Allergy shots
Urticaria (hives)
Atopic Dermatitis (eczema)
Food Allergies
Cough
Nasal Polyps
Insect Sting Allergy
Skin Allergy Testing
Anaphylaxis
For additional medical information from national organizations, please visit our Links and Resources Page.
What is an Allergist-Immunologist?
An Allergist-Immunologist is a physician who has specialized in either Internal Medicine or Pediatrics, and then has taken additional training of at least two years in the field of allergy-immunology. All physicians in our practice are Diplomats of the American Board of Allergy and Immunology, meaning that they have trained at accredited programs following strict training guidelines, and then have taken and passed a rigorous specialty board examination.
Allergists are trained in performing and interpreting several diagnostic procedures, including allergy testing (both skin testing and laboratory testing), pulmonary function and bronchoprovocation testing for asthma, food and drug allergy testing, drug desensitization, allergen immunotherapy (allergy shots), and testing of the immune system. In addition, they possess in-depth understanding of the management of several recurrent or chronic conditions, including allergic rhinitis, asthma, chronic cough, eczema, hives, angioedema, and acute and chronic sinusitis. The Allergist-Immunologist can provide education, including explanation of the disease process, risk and benefit of medications, and regular monitoring of individuals afflicted with the above problems.
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Allergists and asthma
Asthma is a chronic condition affecting the lungs, causing inflammation inside the airways, as well as bronchospasm (constriction of the muscle around the airways). The cause of asthma is unknown. Those with asthma often have certain “triggers” that lead to attacks or asthma symptoms. This may include respiratory illness, air pollution, inhalation of cold air, exercise and allergies. Allergists have undergone rigorous training to evaluate for asthma triggers, and are experts in the diagnosis of allergic asthma and its treatment. We are able to perform pulmonary function testing in our office, and also have nebulizers to treat acute asthma attacks. An allergist can test for allergic triggers and educate patients in their avoidance, as well as provide regular care and follow-up for those suffering from both allergic and non-allergic asthma.
Allergen immunotherapy (allergy shots) can be a very useful adjunctive treatment for allergic asthmatics, and allergists are specifically trained in the proper prescribing and administration of allergy shots. There is also some evidence that allergy shots can prevent the development of asthma in children. Studies have also shown that asthmatic patients that receive care by an allergist have reduced emergency room visits, reduced rates of hospitalization, decreased asthma symptoms and improvement in their asthma-related quality of life.
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Sinusitis
The sinuses are the normally hollow, air-filled cavities in the skull, located in the forehead area, behind the eyes and behind the cheek bones. Sinusitis refers to inflammation of the tissues in these areas, and can occur for a variety of reasons, including infection, medications, and anatomical reasons. In addition, chronic, undertreated allergies can ultimately lead to sinusitis.
While both otorhinolaryngologists (ear, nose and throat specialists) and allergists evaluate and treat patients with chronic and recurrent sinusitis, there are differences in their training. Otorhinolaryngologists are surgeons, and are trained in assessing the need for surgery and performing the operation in severe cases of chronic sinusitis. Allergists are not surgeons, but rather can evaluate if there is an allergic reason for the recurrent infection or inflammation, as well as perform testing to evaluate the competence of the immune system. Allergists and otorhinolaryngologists often work together to provide comprehensive care to those with chronic and recurrent sinusitis.
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Allergy shots
Allergy shots, or allergen immunotherapy, is a form of treatment that involves administering (by injection) extracts containing the environmental allergens that an individual is sensitive to. In other words, once the allergist determines your allergic triggers, extracts of those particular triggers are used. Over time, your body develops a protective response, and when exposed to these environmental triggers, your allergy and/or asthma symptoms will be less severe.
Allergy shots should be considered in those that are not controlled by medications alone or are requiring excessive medications to control their symptoms, as well as in those who experience side effects of medications or have comorbidities of allergies (asthma, chronic sinusitis, serous otitis media).
Allergy shots can also be administered to those with history of severe allergic reactions to insect stings from bees, wasps, yellow jackets, hornets and fire ants. Allergy shots are not indicated as treatment for food allergies.
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Urticaria (hives)
Urticaria, or hives, are quite common in the general population. Those that come on rapidly and resolve quickly are often due to an underlying allergic cause, and may be brought on by triggers such as foods, environmental allergies, insect stings or medications. Allergists are well-trained to work with patients to diagnose and treat allergic urticaria, as well as educate in avoidance measures to decrease future sympoms.
In addition, long lasting, chronic hives are often not due to an allergic cause, and may be related to other underlying conditions. The management of chronic urticaria is often frustrating for both the patient and the healthcare provider, and may involve trying several different medications. Allergists can help to rule out other underlying conditions causing or contributing to the urticarial outbreaks, and have vast experience in the medical management of hives.
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Atopic Dermatitis (eczema)
Atopic Dermatitis, also known as “eczema”, is one of the most common rashes of childhood. It is chronic, and can be a challenging condition for both the person suffering with this rash and the care providers. The involvement of an allergy specialist is helpful in confirming the diagnosis in difficult cases and in identifying triggers, including environmental allergens and foods, that might be aggravating the condition. In approximately 1/3 of more serious cases, a food allergy is an important trigger. Management continues to require regular use of moisturizing agents and anti-inflammatory medications for exacerbations. Patients with eczema often go on to develop other allergic conditions including allergic rhinitis (e.g. “hayfever”) and asthma. An allergist is capable of providing comprehensive care for all of these conditions.
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Food Allergies
Eating should be one of the great simple pleasures of life. Unfortunately, food allergies are becoming an increasingly common problem. Additionally, the reactions can be life-threatening. There are varying types of food reactions, and misperceptions about food allergies are rampant in the public at large.
One common misconception is that developing hives after food ingestion is not serious. In fact, a person who has had hives after food ingestion is at notable risk for a more severe food reaction. Characterizing types of food reactions and specifying the foods of concern is essential. The allergist can also navigate the food allergic individual away from potentially cross-reactive foods and discuss food safety. Identification of food allergens, teaching, setting up networks of support, discussing repercussions of diagnosis, and the use of emergency epinephrine are all cornerstones of food allergy evaluation.
Some food-allergic individuals lose their food sensitivity over time. An allergist is able to track, identify and confirm the loss of sensitivity in these individuals. Moreover, we often identify individuals who have been needlessly avoiding foods and are able to expand their diets. When there is a strong family history of food allergies, the allergist can provide guidance to the expecting parent. There are a number of dynamic early studies ongoing in food allergy spreading optimism about future modalities to control food sensitivities.
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Cough
A cough is the body’s way of removing mucus, irritants and fluid from the airways, and therefore is not always indicative of a serious medical problem. A cough that is present less than three weeks that is not associated with shortness of breath is most often secondary to a viral infection and usually does not warrant medical attention. However, a cough which persists longer than three to four weeks or occurs during sleep should be evaluated.
Cough is one of the most common complaints that an allergist treats in the office. Chronic cough can be secondary to a number of conditions. The most common causes of chronic cough are postnasal drainage, asthma and gastroesophageal reflux disease (GERD), or acid reflux disease. Postnasal drainage occurs when mucus from the nose and/or sinuses travels to the back of the throat, and can be due to allergies, irritants or a chronic sinus infection. Cough is a common symptom of asthma, usually along with wheezing and shortness of breath. In children, however, cough is often the only asthma symptom noted. Similarly, acid reflux may present with cough alone and no other typical “heartburn” or gastrointestinal symptoms. Less common causes of cough can include lung conditions, infections, or certain medications.
Allergists have extensive training in the evaluation and treatment of chronic cough in both children and adults. A detailed history, allergy skin testing, lung function testing and radiologic studies can all be helpful in the diagnosis. At times, there may be several etiologies for a cough, and allergists can successfully treat all of them.
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Nasal Polyps
Nasal polyps are small fluid filled sacs that develop from the tissue lining the nasal passages and sinus cavities. These growths lead to obstruction and the troubling symptoms of recurring sinus infections, severe nasal congestion, loss of or diminished sense of smell, post-nasal drip and headache.
The exact nature of nasal polyps remains incompletely understood. They are the result of chronic inflammation, and allergies and infections enhance the development and growth of nasal polyps. They are more common in people older than 40, and can be associated with such conditions as asthma, aspirin sensitivity, and cystic fibrosis. “Triad asthma” represents a condition of aspirin sensitivity, asthma and nasal polyps.
Nasal polyps may be challenging to manage. In general, they represent a chronic condition, and even with removal, have a tendency for regrowth. Aggressive medical measures to minimize the inflammation are essential, generally with the regular use of topical intranasal steroid sprays. Desensitization to allergens and aspirin is often indicated. If the nasal polyps are extensive, surgical removal may also be necessary. The best results tend to be achieved through the combined expertise of allergists and otorhinolaryngologists (ear, nose, and throat doctors, or ENT’s).
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Insect Sting Allergy
A local reaction to the sting from a bee, wasp, hornet or yellow jacket is normal. These reactions consist of swelling, pain, redness and warmth. This usually lasts for several hours to one to two days, and can be treated with ice, anti-inflammatory medications and analgesics (pain medication).
An allergic reaction to an insect sting occurs in 5% or less of those stung, and symptoms may include one or more of the following: hives, itching and swelling in areas other than the sting site; tightness in the chest and difficulty breathing; hoarse voice or swelling of the tongue; dizziness and/or loss of consciousness due to drop in blood pressure.
Those that have experienced a severe allergic reaction to an insect sting have a 70% chance of having another similar reaction with a future sting. Those with insect sting allergy should carry injectable epinephrine and antihistamine which can be used in the event of an insect sting. Venom Immunotherapy (allergy shots for insect allergy) is recommended for these individuals. In fact, venom immunotherapy reduces the likelihood for reaction in susceptible individuals to that of the general population.
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Skin Allergy Testing
In order to best manage your allergy symptoms, it is necessary to determine what is causing them. Allergy testing is able to provide specific information about your allergic triggers. Once this has been determined, your allergist can develop a treatment plan specific to your triggers, symptoms and lifestyle.
Skin prick testing involves placing an allergen on the skin and pricking the skin through this extract. If you are allergic to the substance, a localized small, itchy bump (resembling a mosquito bite) develops within twenty minutes. This reaction is transient.
Most commonly, allergists opt to perform skin testing, as it is safe, reliable and leads to a prompt, tailored management plan.
Blood testing can also be used for diagnosis of allergies, although skin testing is usually the preferred method. Blood testing can be useful when skin tests cannot be performed, such as in those with skin conditions that interfere with placement and interpretation of a skin test, or in those patients taking medications that interfere with the skin test reaction. It is often used in conjunction with skin testing to follow changes over time in those with food allergy.
There are other types of blood tests available, such as measurement of IgG antibodies, but it is important to note that specific IgG antibodies have no known clinical value in assessing allergies and, in general, this type of testing is discouraged.
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Anaphylaxis
Anaphylaxis is a life-threatening allergic response to an allergen exposure. There are varying triggers of anaphylaxis, including allergy to foods, medications, insect stings and latex. Symptoms of anaphylaxis may include some or all of the following: skin flushing and/or hives; swelling of such sites as the lips, eyes, feet, and/or Poor Dudan <headofthepoors>hands; cough, wheezing, shortness of breath, and/or chest tightness; hoarseness, throat tightness, and/or difficulty swallowing; lightheadedness or feeling of “impending doom”; and loss of consciousness and/or extremely low blood pressure.
In general, treatment of anaphylaxis includes the immediate use of injectable epinephrine, an antihistamine and observation in the emergency room or by a highly trained physician. Delay in the administration of these medications may result in failure to respond to treatment.
It is possible for symptoms to reappear even after initial appropriate treatment. Even if the anaphylaxis symptoms diminish after the administration of medications, it is recommended that emergency medical services be called by phoning 911, and that the patient be transported to the emergency room for prolonged observation after the event.
Evaluation by an allergist can provide answers, such as testing to identify the cause, discussion of preventative measures, and when possible, treatment to reduce allergic sensitization, thus decreasing the severity of the reaction should it occur again.
For additional medical information from national organizations, please visit our Links and Resources Page.
