Patient Info

ALLERGEN IMMUNOTHERAPY

Allergen immunotherapy, also known as allergy shots, is a form of treatment that decreases symptoms for many people with allergic rhinitis, allergic asthma, allergic conjunctivitis, eczema or stinging insect allergy. The goal of the shots is to decrease sensitivity to allergens and they may lead to long-lasting relief even after treatment is stopped.

pollen

Who can benefit from allergy shots?

Allergy shots can be beneficial to any patient with positive testing to environmental allergens or stinging insect venom. The shots can begin as early as age five. Adults with other medical conditions, such as cardiac disease, may not be able to receive shots. This can be discussed with your allergist.

How do allergy shots work?

Allergy shots are similar to receiving a vaccine. Skin testing will be used to create a serum specific to each patient. Your immune system responds to the vaccine by developing tolerance to allergens that previously caused symptoms. It may take up to 12 months of receiving the shots to notice an improvement in symptoms as the dose has to be gradually increased. Peak improvement is noticed between years 2 and 3. Maintenance treatment is typically continued for 5 years.

How effective are allergy shots?

In children, allergy shots may prevent the progression from allergic rhinitis to asthma. The effectiveness of the shots is related to the length of treatment and the dose of the allergen. Many patients experience lasting relief after stopping the shots, however, some patients do relapse after stopping. The decision to stop allergy shots will be discussed with your allergist.

What are the risks?

Redness, swelling and/or itching at the injection site can occur. Rarely, systemic reactions do occur. These may include shortness of breath, nausea, throat tightness/swelling, and/or dizziness. The highest risk for serious reactions is in the first 30 minutes after receiving the injections. For this reason, the shots must be given in a supervised setting where emergency equipment is available and patients must remain in the office for 30 minutes after the shots. If it is not convenient to receive the shots in our office, our staff can work with you to send the serum to an alternate location.

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Allergic Rhinitis

An allergy is the result of the immune system overreacting to a substance that is typically harmless, such as plant pollen or animal dander. This overreaction causes the release of chemicals, including histamine into the bloodstream and may result in runny nose, sneezing, itching, nasal congestion and cough.

Why do people develop Allergies?

Having a family history of allergies seems to be the main reason that people develop allergies. If both parents have allergies, their child has a 75% chance of being allergic. If only one parent has allergies, their child has a 30-40% chance of developing some form of allergy. If neither parent has allergies, a child still has a 15% chance of developing allergies. Although children are more likely to develop allergies, anyone may develop an allergy at any age. Approximately 50 million people in the United States suffer from allergies; of these, at least 9 million have asthma.

How can an allergist help?

With the use of skin testing, specific allergens can be identified. For the testing, a small amount of diluted extract containing pollen, animal dander, mold, etc is placed on the skin, followed by a light puncture or scratch. Within 15 minutes, a positive reaction (similar to a mosquito bite) may appear. This information can be used to develop a specific treatment plan including avoidance measures, medication and possibly allergy shots.

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allergy shot info

Allergy immunotherapy (allergy shots) consists of exposing the patient to small doses of the patient’s allergens to teach his/her body not to overreact to those allergens. The sera contains pollens (grasses, weeds, trees), mold, or other environmental inhalants (mites, dog, cat) to which a patient has been shown to be allergic by skin testing. Venom immunotherapy, as the name implies, are actual doses of natural stinging insect venom or its purified components.

Appointment Times for Allergy Injections

Injections received in this office are by appointments. Our present times for giving allergy injections are as follows: Please note that the last time given is when the last shot is given – you must be here before that time.
Mondays
9:00 a.m. to 12:00 p.m. and 2:00 p.m. to 5:30 p.m.
Tuesdays
2:30 p.m. to 5:30 p.m.
Wednesdays
3:00 p.m. to 5:30 p.m.
Thursdays
3:00 p.m. to 5:30 p.m.

Administration of Allergy Injections Determinations

It is the policy of this office that injections not be given for the following reasons:
  • If the patient is acutely ill;
  • If the patient has a fever;
  • If the patient is coughing/wheezing, or has acute allergy symptoms which could be confused with anaphylactic reaction;
  • If the patient has a rash or is in the acute phase of skin reactions;
  • On days when the patient will be active in sports, practices or outside in high pollen seasons;
  • If the patient is currently taking beta-blockers or
  • If there is a fall in peak flow (for patients who do peak flow readings).

Allergy injections should also be 48 hours pre or post other immunizations.

Allergy injections can be given while a patient is on an antibiotic as long as the patient is not in the acute phase of an illness and the patient has been on the antibiotic for at least 48 hours.

If the patient becomes pregnant they must have approval to remain on shots from their OB/GYN physician. If approval granted there will be a reduction in the vaccine dose and they will go to a weekly vaccine schedule to decrease the risk of anaphylaxis.

The patient understands that despite appropriate precaution, reactions may occur without warning signs or previous symptoms.

Weather Policy

In the case of inclement weather our office will record a message on the phone telling our patients if we will be closed or if the hours have been altered. We do not follow the school systems closings so do not assume we are closed because schools are closed. Call our office to determine whether we are open or not. If we are open and you cannot make it to the office a courtesy call is appreciated.

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Breastfeeding Problems & Food Allergies

Food Allergies in Breastfed Infants

6 to 8% of infants in the first 3 years of life suffer from food allergies.Approximately 1/3 of infants with eczema have a food allergy. Studies have shown foods ingested by the mother can be detected in her breast milk.

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Eczema

What is Atopic Dermatitis?

Atopic dermatitis, or eczema, is a chronic skin disease estimated to occur in 10% of children. Those affected have dry skin with an itchy, red rash. The rash typically affects the insides of the elbows, back of the knees, and the face; however, it can also cover the entire body. Weeping sores may develop due to vigorous scratching or infection. The scratching is felt to play a major role in the development of the eczematous rash. Bacterial skin infection is common and causes more itching and redness. While the exact cause is not known, eczema is frequently associated with allergies (e.g. foods, dust, pollens, animals) and irritating substance (e.g. soaps, chemicals). Other common triggers include skin infections, heat, sweating, and emotional stress. Eczema is not contagious; it is inherited from one’s parents.

itchy-skin

How is eczema cured?

At present, eczema cannot be cured, but it can usually be managed so that the child can play and live comfortably. For most individuals, eczema improves significantly by age 3. Statistics suggest that approximately 50% will completely lose their rash, and 40% will have only mild skin lesions. However, the remaining 10% continue to have problems with eczema into adulthood (although perhaps less severe). Approximately 75% of children with eczema will develop allergic rhinitis (hay fever) and/or asthma.

How does an allergist diagnose and treat eczema?

About 1/3 of infants and young children with eczema have food allergy. Appropriate diagnosis of food allergy (accomplished with skin tests and blood tests) and elimination of the offending allergen leads to significant clearing or improvement of the skin rash in many young children with both eczema and food allergy. The allergist will also discuss ways to manage eczema through proper skin care and prescribe medications (antihistamine, antibiotics, topical steroidal and non-steroidal creams) to treat the red rash or flared areas. Studies have shown that inhalant and environmental allergy immunotherapy has been shown to be efficacious in allergic patients with eczema.

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Eosinophilic Gastrointestinal Disorders

Eosinophilic Gastrointestinal Disorders (EGID) result from an increased number of an inflammatory cell, called an eosinophil, in the lining of the digestive tract. The most commonly affected area is the esophagus (food pipe) and this is called Eosinophilic Esophagitis (EoE). This is a newly recognized group of disorders that has been increasingly diagnosed over the past decade. It may affect children and adults.

What are symptoms of EGID/EoE?

Symptoms of EGID/EoE may vary with age, but commonly include:
  • Gastroesophageal reflux (acid reflux)
  • Dysphagia (difficulty swallowing)
  • Food impactions (a bite of food becomes stuck in the esophagus)
  • Nausea and Vomiting
  • Failure to thrive (poor growth or weight loss)
  • Poor appetite
  • Abdominal or chest pain

How is EGID/EoE diagnosed?

The diagnosis is made by obtaining biopsies (samples of tissue) from the lining of the digestive tract in various locations. This is done by a gastroenterologist.

The majority of individuals with EGID have a family history of allergies and may have symptoms of other allergic disorders such as asthma, nasal allergies, or atopic dermatitis. Food allergy is a major, yet complex, cause of EGID. Therefore, an allergist can determine the role of allergies in the condition. We will work together with your gastroenterologist to make diet and treatment recommendations.

What role does an allergist have in diagnosing/managing EoE?

Once the diagnosis of EGID has been made, your allergist will perform skin prick testing to evaluate for sensitivity to foods known to be highly associated with EGID and any other suspect foods. Blood tests have not been as helpful in identifying causative foods in EGID.

Food patch testing is another type of testing that may be used in the evaluation of EGID. Patch testing evaluate for a delayed reaction to specific foods. However, this testing is not standardized which makes it somewhat difficult to interpret. Its reliability and value in the treatment of EGID is somewhat controversial.

If specific foods are positive on skin testing, your allergist will recommend an elimination diet. There are a few foods which have been highly associated with EGID even with negative skin tests in research studies. Your allergist may recommend eliminating these foods. For some people, food avoidance is the only treatment required to control EGID. Pollen and environmental allergies may contribute to EoE. Allergy Immunotherapy in certain patients may be beneficial.

There are currently no medications approved by the FDA specifically for the treatment of EGID. However, many research studies have shown that swallowed steroids from an inhaler typically used to treat asthma can be effective in controlling EoE.

Your gastroenterologist will determine when biopsies should be repeated to see if the condition has improved. This result will help to guide possibly stopping medications and/or reintroducing foods to the diet.

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Exercise Induced Asthma

Exercised-induced asthma (EIA) also called exercise-induced bronchoconstriction (EIB) is a narrowing of the airways in the lungs that is triggered by physical activity. EIA/EIB causes a person to experience breathing difficulties after strenuous exertion. In both adults and children, the symptoms of this condition include:
  • Wheezing
  • Coughing
  • Chest tightness
  • Fatigue
  • Shortness of breath

They usually appear within 8 to 12 minutes after exercise begins, reaching a peak five to ten minutes after exercising. In children, EIA/EIB symptoms often appear as coughing during or after exercising and/or as abdominal pain during exercise. Most people recover from EIA/EIB within one hour, however some experience a second attack 3 to 9 hours after exercise.

What is the frequency of EIA/EIB?

This condition occurs in people whose airways are acutely sensitive to sudden changes in temperature and humidity. During strenuous exercise, people usually breathe through their mouth rather than their nose; this allows cold dry air to reach the lower airway and lungs. In addition to mouth-breathing, such things as air pollution, high levels of pollen, and respiratory infections are also factors in EIA/EIB.

Studies have shown that 80% of all asthmatics will experience EIA/EIB symptoms during or after exercise, while 40% of all people with nasal allergies may experience asthma symptoms during exercise.

Diagnosis

An allergist/immunologist will begin by getting your health history, conducting a physical examination and performing a breathing test called spirometry.

If your breathing test shows that you might have asthma, your physician may give you a drug to inhale such as albuterol. If your breathing test numbers improve after inhaling the medicine, then the diagnosis of asthma is more likely.

You may be asked to take an additional test, called a bronchoprovocation challenge test. Your physician you have you exercise in the sport you play, run outside or have you cycle or run on a treadmill. Before and after the exercise, your physician will test the amount of air you force out of your lungs with a spirometry test. If you exhale air less forcefully after exercise, the problem may be EIA/EIB.

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Does Exercise-Induced Asthma affect only serious athletes?

Although EIA/EIB is more prevalent among Olympic athletes than among the general population, this condition is not limited to athletes. School-age children who participate in physical education classes and play sports are also susceptible. Even those who engage in non-athletic, but strenuous activities (for example, yard work and shoveling snow) may experience breathing difficulties after a period of exertion. In both children and adults, the more subtle symptoms of EIA/EIB are often missed when people mistakenly blame reluctance to participate in sports or poor athletic performance as being out of shape.

Can someone with Exercise-Induced Asthma exercise and play sports?

A diagnosis of EIA/EIB does not mean a person must give up all strenuous physical activity. An allergist can prescribe inhaled and/or oral medications that, taken before exercising, will help control and prevent EIA/EIB. In addition, the doctor will explain to the patient (and, if necessary, to teachers and coaches) how a combination of proper training and medication can alleviate the symptoms of this condition. With appropriate diagnosis and treatment, a person with EIA/EIB can continue to reap the benefits of physical exercise and even excel in sports.

Managing your condition

If you have been diagnosed with EIA/EIB, talk with your allergist before you begin an exercise program. Together, you can develop a management plan that will allow you to participate in activities with minimal asthma symptoms.

To prevent asthma flare-ups, your doctor may prescribe that you take an inhaled short-acting medication prior to exercise. These medications are effective in preventing EIA/EIB symptoms in 80 to 90% of patients.

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Food Allergy

While approximately 40 to 50 million Americans have allergies, only 1.5% to 2% of all adults are allergic to foods. Adverse reactions to foods are common among young children, affecting 6% to 8% of infants in the first 3 years of life. The following information addresses commonly asked questions regarding food allergy.

What are the symptoms of food allergy?

Allergic reactions to foods usually appear within minutes to a few hours after eating the offending food. The severity of the symptoms varies from one person to another. Mild symptoms may include a runny nose with sneezing, while a highly allergic person may experience severe and life-threatening symptoms such as swelling of the tongue, lips, and throat, and difficulty breathing.

The most common symptoms of food allergy involve the skin and gut. Skin rashes include hives and eczema. Symptoms involving the gut include vomiting, nausea, stomach cramps, indigestion, GERD and diarrhea. Food allergies have been shown to play a significant role in the cause of eosinophilic esophagitis (EoE). Other symptoms of food allergies include cough, wheezing, and rhinitis (itchy, stuffy, runny nose, and sneezing). Anaphylaxis, a severe allergic reaction that involves many organ systems, may occur.

Food allergies in infants can present with one or more of the above symptoms as well as colic, irritability, poor sleeping patterns and refusal to breastfeed or fussy nursing behavior.

Which foods commonly cause food allergies?

Peanuts, cow’s milk, soy, wheat, eggs, fish and shellfish are the most common foods causing allergic reactions. However, almost any food has the potential to trigger an allergic reaction. Foods most likely to cause anaphylaxis are peanuts, tree nuts, and shellfish.

If an individual is allergic to a particular food, they might be allergic to related foods. For example, if an individual has an allergy to almonds, testing may show that this individual is not only allergic to almonds but also to one or two other members of the tree nut family such as cashews and walnuts. Our allergists can help identify the offending food allergen and the cross-reactive foods.

Although food allergy occurs most often in children, it can appear at any age and can be caused by foods that had been previously eaten without any problems.

Finally, cultural difference in food ingestion affects the likelihood that a certain food will cause allergy. For example, there is a high prevalence of fish allergy among Scandinavians, of rice allergy among the Japanese, and of sesame allergy among the Israelis.

Food-Allergies
 

Is eczema caused by food allergies?

Eczema (atopic dermatitis) is one of the most common skin problems today. Eczema is a skin condition characterized by chronic itching that leads to red, swollen, scaly patches. This condition usually appears during the first year of life and generally involves the face, torso and creases of the extremities. About one-third of infants and young children with eczema have food allergy. Appropriate diagnosis of food allergy and elimination of the offending allergen leads to significant clearing or improvement of the skin rash in many young children with both eczema and food allergy. Food allergens may be triggers for some acute eczema exacerbations.

What causes food allergies?

Having a family history of allergies seems to be the main reason why certain people develop allergies, while others don’t. If both parents have allergies there is approximately a 75% chance of being allergic. If only one parent has allergies, there is a 30% – 40% chance of developing some form of allergy. If neither parent has allergies, there is still a 15% chance of developing allergies.

How do allergists determine which foods cause the allergy?

Some people know precisely which foods caused their allergic symptoms; however, other individuals need the expertise of an allergist to determine the offending food, especially when the food is not obvious, or the symptoms (for example, eczema) appear many hours after ingesting the food. Our physicians will begin by taking a thorough medical history. Skin testing may be performed, in which a diluted amount of food extract is placed on the skin, followed by a light puncture or scratch. This procedure is safe and is usually not painful. Within 15 minutes, a positive reaction (similar to a mosquito bite) will appear.

How is food allergy treated?

Once the diagnosis of food allergy is made, the most effective treatment is to eliminate the food from the diet completely. Therefore, ingredient labels of food products must always be checked and scanned for other “hidden” names.

Our allergists will help the family of a food allergic infant or child with adjusting their diet ensuring nutritional needs are met as well as becoming proficient label readers.

Children with food allergies should have a clearly defined plan of action for handling situations in which they accidentally ingest a food allergen. An injectable epinephrine device should be carried by individuals with food allergies.

Can food allergies be outgrown?

Strict adherence to an elimination diet appears to promote the process of outgrowing a food allergy. The majority of children with allergies to eggs, cow’s milk, and soy will eventually outgrow their allergy although it may take a longer time than originally thought. Unfortunately, allergies to peanuts, tree nuts, fish, and shellfish are generally considered life-long allergies. In rare cases, these allergies are outgrown but careful testing and an oral food challenge conducted in the office is required.

Patients who are cautious and comply with their allergist’s recommendations can bring food allergy under control.

Can food allergies, such as peanut allergy, be prevented?

A recent study, Learning Early About Peanut Allergy (LEAP), published in the New England Journal of Medicine showed that early oral introduction of peanuts could prevent peanut allergy in high-risk infants who are not yet allergic to peanuts. This is a change from the former recommendation of avoiding peanuts as a strategy to prevent peanut allergy.

High-risk infants include:

  • Infants with eczema
  • Infants with egg allergy
  • Infants with a family history of food allergies
  • The LEAP study findings suggest that early and sustained consumption of peanut products was associated with a substantial and significant decrease in the development of peanut allergy in high-risk infants. Conversely, peanut avoidance was associated with a greater frequency of clinical peanut allergy than was peanut consumption.

    Based on this study, high-risk infants should be evaluated prior to having peanuts introduced into their diets. Our allergists will take a history, perform peanut testing by skin test and assess peanut IgE blood levels. Our physicians will then determine whether peanuts can be safely introduced into the infant’s diet via a controlled in-office oral peanut challenge.

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ORAL FOOD CHALLENGES

A positive skin prick test and/or a positive food blood test are indicative of allergic sensitization, but these findings alone may or may not be clinically relevant. Food allergy experts agree that verification of clinical reactivity oftentimes require a well-designed oral food challenge. In addition to verifying food allergy, challenge testing prevents unnecessary dietary avoidance and enhances compliance with the elimination diet.

Prior to initiating an oral food challenge, suspected foods are eliminated from the diet for 2 to 8 weeks depending upon the type of food allergic reaction being examined. After documenting significant improvement on dietary elimination, the challenge test is carried out while the patient is on no medications. The food challenge test is designed and performed under medical supervision to document the dose that provoked the reaction and to administer symptomatic treatment, which may require management of anaphylaxis. Food challenge begins with a low dose, which is then gradually increased, while monitoring for any symptoms, until a cumulative dose at least equal to the usually eaten quantity is reached. Due to the risk of a severe reaction, intentional challenge should be avoided in patients who have recently experienced a life-threatening reaction to a particular food. Food challenge can be performed to any suspected foods, but the most common foods tested are peanut, milk, soy, wheat and eggs.

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DIRECTIONS FOR A FOOD CHALLENGE

  1. Please arrive to office at 9:00am.
  2. Food challenge will begin at 9:15am.
  3. Light breakfast in the morning, nothing to eat after 7:45am.
  4. No antihistamines 48 hours prior.
  5. No Zyrtec (Cetirizine), Xyzal (Levocetirizine), Atarax (Hydroxyzine), Astelin (Azelastine), Patanase(Olopatadine) 5 days prior.
  6. If the patient is sick (fever, vomiting, diarrhea, abdominal pain or has an eczema flare) on the day of the food challenge, please call to cancel the appointment because the patients’ subjective complaints may influence the interpretation of the procedure.
  7. Food challenge is approximately 4 hours.
  8. Please bring the following food relative to your challenge:
    • Egg: At home, make scrambled eggs, using either 1 or 2 eggs, as directed. Make sure that the eggs are dry and well-cooked. In addition, bring 2 raw eggs to the office on the day of the challenge. In the case that the scrambled eggs (made at home) are not satisfactory for the challenge (too uncooked), the 2 raw eggs will be scrambled at the office.
    • Baked Egg: Cupcakes made as follows:
      • Commercial brand cake mix (yellow or chocolate, e.g., Duncan Hines)
      • Add oil, water, and 3 large eggs
      • Bake 350⁰ for 20 minutes
      • Make exactly 21 cupcakes
    • Milk: 1 small carton milk (skim, 1%, 2%, or whole)
    • Baked Milk: Cupcakes made as follows:
      • Commercial brand cake mix (yellow or chocolate, e.g., Duncan Hines)
      • Add oil, 1 cup milk, and 3 large eggs
      • Bake 350° for 20 minutes
      • Make exactly 20 cupcakes
    • Peanut: JIF creamy peanut butter
    • Tree Nut: Bring in 1 can of mixed nuts that contains: almonds, brazil nuts, cashews, hazelnuts, and pecans. In addition, bring in a small separate bag of walnuts and pistachios.
    • Soy: 1 small carton of soy milk
    • Shellfish: Bring in the following COOKED shellfish, as directed by your allergist: 1 lobster tail, 8 ounces of lump crab meat, and 8 medium shrimp (size #31-40). If you are steaming or boiling the shellfish, make sure the shellfish are well-cooked and firm.
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Hives

What is Urticaria (Hives)?

Hives are typically red, raised bumps or welts on the skin that can occur anywhere on the body. They are normally very itchy and may come and go for several hours or days once they appear. Hives often appear as reaction to an allergen.

Why do hives occur?

Hives occur when the chemical histamine is released into the blood stream. Histamine causes the small blood vessels in the skin to become “leaky” allowing areas of swelling or raised bumps. If the leaky vessels are deeper in the skin (lips, eyes, ears), this may result in more significant swelling.

How do allergists determine the cause?

Allergists often divide hives into two categories: acute (occurring for 6 weeks or less) and chronic (occurring for 6 weeks or more). Acute hives are commonly caused by exposure to an allergic trigger. By reviewing your history thoroughly, your allergist can help to narrow down the cause so that the exposure can be avoided and, thus, the hives avoided. This may require the use of skin testing in which a small amount of dilute extract containing pollen, animal dander, food protein, etc. is placed on the skin followed by a light puncture or scratch. Within 15 minutes, a positive reaction (similar to a mosquito bite) may appear.

Chronic hives, on the other hand, are usually not from an allergic reaction. An evaluation for chronic hives may also include skin testing and some blood tests. Your allergist will work with you to determine a medication regimen to control the hives when they are present.

What is an allergy?

An allergy is the result of the immune system overreacting to a substance that is typically harmless, such as plant pollen or animal dander. This overreaction causes the release of chemicals, including histamine, into the bloodstream and may result in runny nose, sneezing, itching, nasal congestion and cough.

Why do people develop allergies?

Having a family history of allergies seems to be the main reason that people develop allergies. If both parents have allergies, their child has a 75% chance of being allergic. If only one parent has allergies, their child has a 30 – 40% chance of developing some form of allergy. If neither parent has allergies, a child still has a 15% chance of developing allergies. Although children are more likely to develop allergies, anyone may develop an allergy at any age. Approximately 50 million people in the United States suffer from allergies; of these, at least 9 million have asthma.

How can an allergist help?

With the use of skin testing, specific allergens can be identified. For the testing, a small amount of diluted extract containing pollen, animal dander, mold, etc. is placed on the skin, followed by a light puncture or scratch. Within 15 minutes, a positive reaction (similar to a mosquito bite) may appear. This information can be used to develop a specified treatment plan including avoidance measures, medication and possibly allergy shots.

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Immuno CAP testing

Immuno Cap testing is preferred to RAST tests. Immuno CAP is a blood test that can detect specific allergens in the blood. The sensitivity (accuracy) of these tests is about 70%. Therefore, skin test are superior and are presently the preferred tests/gold standard for diagnosis of IgE-mediated allergy. The Immuno CAP test may be preferable in the following situations:
  • Testing in patients with severe dermatographism or widespread eczema.
  • Testing in patients who are currently taking long-acting antihistamines, tricyclic antidepressants, or medications that may put the patient at risk if they are discontinued.
  • For evaluation of cross-reactivity between insect venom
  • When clinical history suggest a high risk of anaphylaxis from skin testing.
  • To follow patient with food allergies to help determine when food challenges may be performed in an attempt to re-add allergic foods back to the diet.
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Insect Stings

Cause of the allergic problem

It is estimated that one to two million people in the US are severely allergic to the venom of stinging insects with approximately 50 – 150 deaths per year. The majority of most insect stings in the US come from wasps, yellow jackets, hornets and bees. In the southern US states, fire ants may be the number one cause of insect stings.

The most severe form of an allergic reaction, called “anaphylaxis,” can result in any combination of these symptoms:
  • Dizziness, drop in blood pressure
  • Weakness, unconsciousness or cardiac arrest
  • Throat tightness, difficulty breathing, hoarseness or swelling of tongue
  • Itching
  • Hives of the skin
  • Generalized swelling
  • Nausea, vomiting or abdominal cramps

The reaction usually starts minutes after the sting and can be life threatening and occasionally fatal. Patients who have had an allergic reaction to an insect sting have a 60% chance of a similar, possibly more severe reaction when they are stung again.

How are allergic reactions to insect stings treated?

Insect sting allergy is treated in a two-step approach.

bee-sting

The first step is the emergency treatment of the symptoms of a serious reaction. Life threatening allergic reactions can progress very rapidly and require immediate medical attention. Emergency treatment usually includes the administration of certain drugs, such as epinephrine, antihistamines, and in some cases, corticosteroids, intravenous fluids, oxygen and other treatments.

The second step is preventative treatment of underlying allergy with venom immunotherapy. Based on your past history the allergist will determine if you are a candidate for skin testing and immunotherapy. Injectable epinephrine to carry for self-administration is often prescribed as emergency rescue medication for treating an allergic reaction.

Diagnosis

By skin testing with specific venoms, your physician is able to accurately diagnose allergies to specific insects in most instances. A past experience you may have had with insects are also important for your physician to know. They can give you vital clues that would be helpful if you could describe the insect that stung you, the symptoms you may have had and any treatment you were given.

What is venom immunotherapy?

The long term treatment of insect sting allergy is called venom immunotherapy, a highly effective program administered by an allergist, which can prevent future allergic reactions to insect stings. This treatment has been shown to be 97% effective. Venom immunotherapy involves administering gradually increasing doses of venom to decreases the patients sensitivity to the venom. This can reduce the risk of a future allergic reaction to that of the general population. In a matter of weeks to months, people who previously lived under the constant threat of severe reactions to insect stings can return to leading normal lives.

Additional Precautions

If you are allergic to any of the stinging insects, your doctor may also advise you to carry a form of injectable epinephrine for self-administration. This is especially important during the time before the patient reaches the maintenance dose level and before the immunotherapy provides protection. The epinephrine is available as an auto-injector. You would be instructed on how to inject this material into an appropriate site, such as your thigh, in emergencies.

Epinephrine is often effective in slowing or stopping the reaction, but is not always enough. In some cases, intravenous fluids, oxygen and other treatments are necessary, so you should still seek medical attention after being stung. The epinephrine might also be ineffective in combination with certain other medications and over time many patients tend to forget to carry it with them. For these reasons epinephrine should not be seen as a substitute for immunotherapy.

Avoidance

Your doctor can explain preventative steps to try to protect yourself from locations, situations and clothing that attracts these insects.

Conclusion

Allergic reactions to insect stings can be very serious and there is a high probability for patients to have a similar or more severe reaction when they are stung again. Venom immunotherapy has shown to be extremely effective in eliminating a reoccurrence of an allergic reaction. Patients should also practice avoidance measures and carry epinephrine for self-administration in emergencies. By taking these steps, much of the fear and anxiety of being suddenly victimized by the sting of an insect can be relieved, leading to a freer, happier life.

Please consult an allergy specialist if you have any questions about venom immunotherapy or the prevention to stinging insects.

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Metallic Implant Allergy

Allergy Testing in Patients Receiving Orthopedic Implants

Metal patch testing should be considered in patients who develop symptoms post implantation to rule out a metal allergy. Additionally, with the increase in frequency of joint replacements, it may be advantageous to perform preoperative patch testing for allergies. Preoperative metal patch testing should not only be performed in patients with a positive history of metal allergy, but also in patients with a negative history of metal allergy.

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patch-test

PATCH TESTING

What is patch testing?

Patch testing can help determine sensitivities to common environmental exposures (such as fragrance, nickel, metals contained in knee and hip implants, cosmetics, chemicals, etc.) which may lead to a rash (contact dermatitis). Contact dermatitis is typically a delayed reaction to contact with an allergen. Symptoms may take 24 – 72 hours to appear and may include redness, itching, soreness and vesicles or blisters. The patch testing can help to identify potential allergens that can be avoided.

How does patch testing work?

A panel of patches with many common allergens is placed in contact with the skin on the upper back and covered with adhesive. These patches are worn for 48 hours and removed in the office. Initial impressions are recorded in your chart. You will return for a final reading of the patches 48 – 96 hours later. This last visit will help distinguish between irritant dermatitis (which is not a true allergic response) and contact dermatitis. Information on any positive responses will be provided so that these substances can be avoided.

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Skin Prick test

In order to do skin testing, do not take antihistamines for 5 days before your appointment. This includes nasal sprays that are an antihistamine. Please call if you are not sure if your medication contains an antihistamine.

The prick test is performed on the inner arm and on rare occasions on the back. The skin prick test is performed with a plastic stick with a pointed end. There are no needles involved. The prick test may be uncomfortable and itch, but the itchiness will resolve in 12 – 24 hours. The skin prick test are read 15 minutes after application and the results are discussed on the same day of the consultation. The number of prick tests performed depends on your history.

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