Allergy shots are usually administered two to three times weekly at the beginning of the treatment procedure. With this rapid build up, improvements can occur within three to four months and will usually be at its full benefit within the first 12 to 18 months. In a typical treatment schedule, shots are tapered to weekly intervals once maintenance is reached (usually at three to six months) then every two weeks at 12 months, then every three to four weeks after 18 to 24 months. Over time, and as the dosage is increased, the patient will gradually develop a stronger tolerance for his or her allergic triggers. During this time symptoms can be decreased, minimized or even eliminated. Most people can discontinue the treatment after about five years.

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.

If you are able to avoid the trigger of your allergies or if usual doses of medications control your symptoms, then immunotherapy might not be needed. You may benefit from allergy shots if:

• 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 can be the underlying cause of frequent sinus, ear and upper and lower respiratory tract infections. Untreated allergies can even exacerbate or cause asthma; The Academy of Allergy, Asthma and Immunology states “approximately 80 percent of all asthma in children and half of all asthma in adults is caused by allergies.”

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 drops (Sublingual immunotherapy or SLIT), is a desensitization treatment in which patients’ self-administer allergen drops under their tongue on a daily basis. Although not as effective as allergy shots, medical research done both in Europe and the United States has found that SLIT therapy is quite safe and effective at building a patient’s tolerance to allergic triggers and ultimately improving symptoms. SLIT may be an option for certain types of allergy patients, but SLIT is not yet approved by the FDA. Therefore at this time, insurance companies are not reimbursing for this form of immunotherapy.

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.

A number of different allergens are responsible for allergic reactions, but the most common include:

• 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.

Reactions to medications range from vomiting and hair loss with cancer chemotherapy to upset stomach from aspirin or diarrhea from antibiotics. If you take ACE (angiotensin converting enzyme) inhibitors for high blood pressure, you may develop a cough or facial and tongue swelling.

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 side effects that concern you or you suspect a drug allergy has occurred, be sure to contact your physician. If your symptoms are severe, seek medical help immediately. A serious anaphylactic reaction requires immediate medical attention because the results 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.

Allergic reactions to latex range from mild to very severe. Every year, there are hundreds of cases of anaphylaxis, a life-threatening allergic reaction due to latex allergy. The severity of allergic reactions to latex can worsen with repeated exposure to the substance.

Given the potential for a very serious allergic reaction, proper diagnosis of latex allergy is important. An allergist has specialized training and expertise to accurately diagnose your condition and provide relief for your symptoms.

Our doctors care for a large number of patients with eosinophilic esophagitis (EoE). Eosinophilic esophagitis (EoE) causes large numbers of eosinophils, a type of white blood cell, to gather in the esophagus (the tube that connects the mouth to the stomach). As a result, the lining of the esophagus becomes inflamed, making it difficult for food to go down. EoE can be triggered by certain foods. Symptoms vary, depending on age. With infants and toddlers, families often note feeding difficulties, irritability, and occasionally poor weight gain. Older children typically have regurgitation, vomiting, heartburn and “belly pain.” Teenagers and adults may have chest pain, difficulty swallowing and a feeling that food “gets stuck” when they swallow. Some individuals complain that it takes a long time to eat meals and that large quantities of water are needed to help swallow food. They may also complain of feeling full rapidly and may stop eating before finishing a meal. Once a diagnosis of EoE is confirmed, food allergy testing is typically performed to determine if a food is triggering the condition. To learn more about EoE, please visit the website of the American Partnership for Eosinophilic Disorders.

One of the more common allergy-related diseases we treat is milk protein allergy, which typically affects infants after the first few weeks of life. Food protein-induced enterocolitis syndrome(FPIES) is a serious, non-IgE-mediated type of food allergy. FPIES is usually triggered by cow’s milk or soy, though some cereal grains, especially rice and oat, and other foods may cause it. The symptoms typically include severe vomiting and diarrhea. Reactions are often delayed by 2-3 hours after the trigger food is eaten. Standard food allergy tests are not used for diagnosing FPIES. The primary test medical professionals use to diagnose this disease is an oral food challenge with the suspected trigger food. In most cases, FPIES is resolved by the age of three. More information about FPIES is available from the FPIES Foundation and the International Association for Food Protein Enterocolitis.

Oral allergy syndrome (OAS), also known as pollen-food syndrome, is a term used to describe itchy or scratchy mouth symptoms caused by raw fruits or vegetables in people who also have hay fever. Symptoms are typically limited to the mouth. This reaction is caused by an allergic response to the pollen that crosses over to similar proteins in the foods. Because these proteins are sensitive to heating, most people affected by OAS can eat cooked fruits or vegetables. Symptoms usually resolve within minutes after the food is swallowed or removed from the mouth, and treatment generally is not necessary. OAS typically presents in older children, teens or young adults. Often, patients have been eating the offending foods without problems for many years.

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.

With the exception of celiac disease (see below), food intolerances do not involve the immune system. Although food intolerances may cause some of the same symptoms as a true food allergy, they cannot trigger anaphylaxis, a potentially life-threatening reaction. Common intolerances include:

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.

Gastroesophageal Reflux Disease (GERD) is a digestive disorder that occurs when acidic stomach juices, or food and fluids back up from the stomach into the esophagus. GERD affects people of all ages—from infants to older adults. People with asthma are at higher risk of developing GERD. Asthma flare-ups can cause the lower esophageal sphincter to relax, allowing stomach contents to flow back, or reflux, into the esophagus. Some asthma medications (especially theophylline) may worsen reflux symptoms. On the other hand, acid reflux can make asthma symptoms worse by irritating the airways and lungs. This, in turn, can lead to progressively more serious asthma. Also, this irritation can trigger allergic reactions and make the airways more sensitive to environmental conditions such as smoke or cold air.

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.

People with asthma experience symptoms such as:

• 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.

Many treatments are available to control asthma and reduce flares including:

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.

Both asthma and COPD may cause shortness of breath and a cough. A daily morning cough that produces a yellowish phlegm is characteristic of COPD. Episodes of wheezing and cough at night are more common with asthma. Other symptoms of COPD include fatigue and frequent respiratory infections.

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.

There’s no cure for COPD. But proper medications and lifestyle changes can control symptoms and reduce the progression of damage to the lungs.

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.

Serious PIDDs typically become apparent in infancy. In milder forms, it often takes a pattern of recurrent infections before PIDD is suspected. In some cases, a PIDD is not diagnosed until people reach their 20s and 30s.

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.

Research in primary immunodeficiency is making great strides, improving treatment options and enhancing the quality of life for most people with these complex conditions.

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.