Conditions & Treatments

Per the American Academy of Pediatrics, age is not a barrier to skin testing – even infants can benefit. Children can also receive allergy shots. The age in which shots may be recommended to young children is done on a case-by-case basis. While there has been some disagreement in the medical community about the role of allergy shots in children younger than 5, there have been multiple studies showing effectiveness for this age group. Research has also shown that allergy shots can prevent children who have allergic rhinitis from getting asthma.

You should always consult with an allergy and asthma specialist before beginning a series of allergy shots. Your shot schedule will be individualized by our board certified allergists. They are the only providers who receive specialized training in this procedure.

• medications to control your symptoms (i.e., antihistamines, decongestants) do not work
• medication used to control your symptoms produces too many side effects
• complications (i.e., sinus infections, ear infections) develop
• you have asthma triggered by allergies
• you are at risk of developing anaphylaxis (a severe reaction that, in some cases, may be fatal) when exposed to an allergen (As noted above: Allergy shots are not used for food allergy)
• medications control your symptoms, but your symptoms flare back up every time you try to reduce your medications
• you can’t effectively avoid things that trigger your allergies
• you would rather take a series of allergy shots than daily medications
• you would rather treat the actual problem rather than just use medications to control symptoms
• cost of the medications is a burden, allergy shots are very cost effective compared to the use of daily prescription medications over several years

Allergies are responsible for symptoms that may make it difficult for you to stay productive in your work, school and home life. Don’t let your allergies control you, take control of your allergies.

Allergy Tablets are another form of oral immunotherapy and have recently been approved by the FDA for use in the United States. These fast-dissolving tablets are placed under the tongue and work to help the body build tolerance to allergens through consistent exposure. In general they are less effective than allergy shots. Allergy shots have an effectiveness of over 80%. Allergy tablets are in the range of 40-60% effective. The tablets only contain one type of allergen and are indicated for people with allergies to grass or ragweed. Allergy tablets require a prescription, and it is required that a patient be allergy tested prior to being prescribed the tablet(s). The cost of the tablets will vary based on your insurance. At this time, we expect the cost to be comparable to allergy shots for most patients.

Speak to one of our board certified allergists to determine what the best possible individualized care is for you.

• Pollen
• Dust
• Food
• Insect stings
• Animal dander
• Mold
• Medications
• Latex

Acute Sinusitis

Acute sinusitis refers to sinusitis symptoms lasting less than four weeks. Most cases begin as a common cold. Symptoms often go away within a week to 10 days; but in some people, a bacterial infection develops.

Chronic Sinusitis

Chronic sinusitis, also referred to as chronic rhinosinusitis, is often diagnosed when symptoms have gone on for more than 12 weeks, despite medical treatment.

• Postnasal drip
• Discolored nasal discharge (greenish in color)
• Nasal stuffiness or congestion
• Tenderness of the face (particularly under the eyes or at the bridge of the nose)
• Frontal headaches
• Pain in the teeth
• Coughing
• Fever
• Fatigue
• Bad breath

Sinus disease is often confused with rhinitis, a medical term used to describe the symptoms that accompany nasal inflammation and irritation. Rhinitis only involves the nasal passages. It could be caused by a cold or allergies.

Allergies can play an important role in chronic (long-lasting) or seasonal rhinitis episodes. Nasal and sinus passages become swollen, congested, and inflamed in an attempt to flush out offending inhaled particles that trigger allergies. Pollen are seasonal allergens. Molds, dust mites and pet dander can cause symptoms year-round.

Asthma also has been linked to chronic sinus disease. Some people with a chronic nasal inflammation and irritation and/or asthma can develop a type of chronic sinus disease that is not caused by infection. Appropriate treatment of sinus disease often improves asthma symptoms.

Sinusitis may also be caused by an infection, a fungus, deviated nasal septum, and nasal polyps or in rare cases an immune system deficiency.

If you think you have sinus disease, see our allergists for proper diagnosis. In most cases, sinus disease treatment is easy. By stopping a sinus infection early, you avoid later symptoms and complications.

Antibiotics

Antibiotics are standard treatments for bacterial sinusitis. Antibiotics are usually taken from 3 to 28 days, depending on the type of antibiotic. Because the sinuses are deep-seated in the bones, and blood supply is limited, longer treatments may be prescribed for people with longer lasting or severe cases. Overuse and abuse of antibiotics have been causing a major increase in antibiotic resistance. Therefore, patients with sinus symptoms should consider taking an antibiotic only if symptoms (including discolored nasal discharge) persist beyond 7-10 days. Antibiotics help eliminate sinus disease by attacking the bacteria that cause it, but until the drugs take effect, they do not do much to alleviate symptoms. Some over-the-counter medications can help provide relief.

Nasal Decongestant Sprays

Topical nasal decongestants can be helpful if used for no more than three to four days. These medications shrink swollen nasal passages, facilitating the flow of drainage from the sinuses. Overuse of topical nasal decongestants can result in a dependent condition in which the nasal passages swell shut, called rebound phenomenon.

Antihistamines

Antihistamines block inflammation caused by an allergic reaction so they can help to fight symptoms of allergies that can lead to swollen nasal and sinus passages.

Nasal Decongestants and Antihistamines

Over-the-counter combination drugs should be used with caution. Some of these drugs contain drying agents that can thicken mucus. Only use them when prescribed by your doctor.

Topical Nasal Corticosteroids

These prescription nasal sprays prevent and reverse inflammation and swelling in the nasal passages and sinus openings, addressing the biggest problem associated with sinusitis. Topical nasal corticosteroid sprays are also effective in shrinking and preventing the return of nasal polyps. These sprays at the normal dose are not absorbed into the blood stream and could be used over long periods of time without developing “addiction.”

Nasal Saline Washes

Nasal rinses can help clear thickened secretions from the nasal passages.

Surgery

If drug therapies have failed, surgery may be recommended as a last resort. Anatomical defects are the most common target of surgery, and an allergist would usually refer you to an otolaryngologist.

In many cases, it can be difficult to determine if the reaction is due to the medication or something else. This is because your symptoms may be similar to other conditions.

The most frequent types of allergic symptoms to medications are:

• Skin rashes, particularly hives
• Itching
• Respiratory problems
• Swelling, such as in the face
• Anaphylaxis (Anaphylaxis is a serious allergic response that often involves more than one system of the body like swelling, hives, lowered blood pressure or in severe cases, shock. Anaphylactic shock is a severe condition and if it isn’t treated immediately, it can be fatal.)

If you have a history of reactions to different medications or if you have a serious reaction to a drug, an allergist/immunologist, often referred to as an allergist, has specialized training and testing experience to diagnose the problem and help you develop a plan to protect you in the future.

In most cases of adverse reactions, your physician can prescribe an alternative medication. For serious reactions, your doctor may provide antihistamines, corticosteroids or epinephrine.

When no alternative is available and the medication is essential, a desensitization procedure to the medication may be recommended. This involves gradually introducing the medication in small doses until the therapeutic dose is achieved.

Make sure your physician, dentist and pharmacist are kept current regarding your drug allergies. This will help determine which medications should be avoided.

Common pollen-food associations:

*These are potential associations. Not every individual allergic to pollen develops symptoms with cross-reacting fruits or vegetables. Individuals may react to a few but not all of the above.

Lactose Intolerance

Lactose intolerance occurs when a person’s small intestine does not produce enough of the lactase enzyme. As a result, affected individuals are not able to digest lactose, a type of sugar found in dairy products. The symptoms of lactose intolerance typically occur within 30 minutes to two hours after ingesting dairy products. Large doses of dairy may cause increased symptoms

Celiac Disease

An adverse reaction to gluten is known as celiac disease or “celiac sprue.” This chronic digestive disease requires a lifelong restriction of gluten, which is found in wheat, rye, barley, and perhaps oats. People with celiac disease must strictly avoid these grains and their by-products. When people with celiac disease eat gluten, they experience an immune reaction in the small intestine. IgE, the antibody responsible for life-threatening reactions (anaphylaxis) does not play a role in this disorder. However, the immune response in celiac disease may damage the lining of the small intestine, preventing proper absorption of the nutrients in food. Over time, patients may become malnourished. Celiac disease can cause many symptoms, including bloating and gas, diarrhea, constipation, headaches, itchy skin rash, and pale mouth sores, to name a few. The symptoms may vary among affected individuals. More information about celiac disease is available from the Celiac Disease Foundation and Beyond Celiac.

Symptoms

Everyone has experienced gastroesophageal reflux. It happens when you burp, have an acid taste in your mouth or have heartburn. However, if these symptoms interfere with your daily life it is time to see your physician. Other symptoms that occur less frequently but can indicate that you could have GERD are:

• acid regurgitation (retasting your food after eating)
• difficulty or pain when swallowing
• sudden excess of saliva
• chronic sore throat
• laryngitis or hoarseness
• inflammation of the gums
• cavities
• bad breath
• chest pain (seek immediate medical help)

Diagnosis

Several tests may be used to diagnose GERD including: x-ray of the upper digestive system, x-ray of the upper digestive system, endoscopy (examines the inside of the esophagus), ambulatory acid (pH) test (monitors the amount of acid in the esophagus), esophageal impedance test (measures the movement of substances in the esophagus).

Treatment

If you have both GERD and asthma, managing your GERD will help control your asthma symptoms.Studies have shown that people with asthma and GERD saw a decrease in asthma symptoms (and asthma medication use) after treating their reflux disease.

Lifestyle changes to treat GERD include: elevate the head of the bed 6-8 inches, lose weight, stop smoking, decrease alcohol intake, limit meal size and avoid heavy evening meals, do not lie down within two to three hours of eating, decrease caffeine intake, avoid theophylline (if possible). Your physician may also recommend medications to treat reflux or relieve symptoms. Over-the-counter antacids and H2 blockers may help decrease the effects of stomach acid. Proton pump inhibitors block acid production and also may be effective.In severe and medication intolerant cases, surgery may be recommended.

• Chest tightness or pain
• Wheezing
• Coughing
• Shortness of breath
• Trouble sleeping due to coughing, wheezing, and/or shortness of breath

Asthma attacks are caused by a variety of triggers. These can vary from person to person and include: allergens, infections (such as colds and sinus infections), pollution, tobacco smoke, gastroesophageal reflux disease (GERD), stress and strong emotions, physical exercise, and exposure to cold air.

The severity of asthma can vary. Some people have very mild disease that rarely causes symptoms. Others have asthma that interferes with daily activities and can lead to severe – even life-threatening – attacks.

Long acting (controller) medications

• Inhaled steroids
• Inhaled long-acting beta agonists
• Combination inhalers (inhaled steroid + long-acting beta agonist)
• Leukotriene modifiers

Short acting (quick relief) medications

• Short-acting beta agonists
• Ipratropium
• Oral, intramuscular, and IV steroids

Treatments to control allergic inflammation

• Allergy immunotherapy (allergy shots)
• Allergy medications
• Omalizumab (Xolair)

An allergist/immunologist has specialized training and expertise to accurately diagnose your condition and provide relief for your symptoms.

To make an accurate diagnosis of COPD, your doctor should spend time with you discussing your medical history and perform a physical examination. Chest X-rays, spirometry, CT scans or blood work may also help in diagnosing your condition.

If you smoke, stop. It is the only way to prevent COPD from getting worse. Quitting isn’t easy, so talk to your doctor about medications that might help.

Medications are used to treat symptoms of COPD. These include:

• Bronchodilators that relax the muscles around the airways
• Inhaled corticosteroids can be helpful for people with moderate to severe COPD
• Antibiotics are prescribed during symptom flare-ups because infections can make COPD worse

People with COPD are susceptible to getting lung infections, so get flu and pneumonia shots every year.

Avoid things that can irritate your lungs, such as smoke, pollution, and air that is cold and dry.

Important signs that may indicate a PIDD include:

• 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

Some immunodeficiency disorders are not primary (hereditary or genetic). A secondary immune deficiency disease occurs when the immune system is compromised due to an environmental factor. Examples of these external causes include HIV, chemotherapy, severe burns or malnutrition.

If you or your child have symptoms of these sometimes critical conditions, you want the best care available.

An allergist/immunologist or a clinical immunologist has specialized training and expertise to accurately diagnose and coordinate a treatment plan for PIDD. A treatment plan may require collaboration with your primary physician and other specialists to provide the best possible individualized care for you.