DO I HAVE ALLERGIES?
Allergic rhinitis (hayfever):
Allergy symptoms can be varied. The allergic rhinitis patient often presents with fits of sneezing, profuse runny nose, post nasal drainage, cough, itching and redness of the eyes, and itching of the nose. However, these symptoms can vary from patient to patient and any one symptom may take precedence over the others. Often allergic rhinitis is seasonal, as with ragweed or grass allergy, but it can also be perennial with allergens such as house dust, mold, or animal danders. The ability to have allergies is inherited; if there is one allergy (like cat) there is a much greater likelihood that there are other allergies which maybe not as acute or obvious.
Asthma is a disease of hypersensitivity of the bronchial tubes which can be reversed by treatment. Treatment consist of medication, avoidance of offending triggers, and/or allergy injections. Like allergic rhinitis, asthma is inherited and the gene has been linked to chromosome 11 (11 q 13). Although asthma is inherited, people who have this tendency can be triggered by various factors such as exercise, irritants (e.g. smoke), allergies, infections, or even emotional tension.
WHAT CAN I EXPECT WHEN I GO FOR AN ALLERGY EVALUATION?
Like any other medical appointment the doctor will discuss the medical problem and take a medical history of the present illness. He will ask questions about past medical history of illnesses, surgeries, or hospitalizations, and discuss ongoing conditions unrelated to allergies as these conditions (such as Hypertension or Diabetes) may bear some significance in treating allergies. A family history will provide the allergist with the needed information about allergies in other family members as allergies are often inherited. An environmental history is also an essential part of the allergy evaluation. As pets, bedding, smokers, and heating and air conditioning systems may all play a role in allergies. A medication and food allergy history will be taken and factors that trigger the allergy symptoms will be discussed such as what time of the year symptoms are most prevalent. After the history, a physical examination usually centering on ears, eyes, nose, throat, sinuses, neck, and chest is preformed. Unlike most physical exams part of the allergy examination will involve a thorough examination of the nose with a lighted speculum.
Skin tests are usually performed to determine the spectrum of airborne allergens that trigger allergic symptoms. These tests, contrary to public opinion, are not exceedingly painful. Small drops of allergen (e.g. grass, ragweed, animal dander, or food) are placed on the upper-arm (adults) or back (children) and a disposable device is used to prick or puncture the top layer of skin. Although multiple allergens are often tested, the time to apply all the “puncture” tests rarely exceeds a minute or two. At 10 minutes positive skin reactions (mosquito bite like swellings and redness) are measured and recorded. To determine the degree of the reaction or sensitivity to an allergen, intradermal (small injections under the first layer of skin) skin tests are performed. These test are also measured and recorded at the end of 10 minutes. The whole skin test procedure rarely takes more than one hour including technician time to prepare the materials. Discomfort from the skin testing procedure can be minimized by application of EMLA cream, a lidocaine based (numbing) cream, which remains on the skin for one hour prior to testing. This is recommended for young children, but may be used by anyone to minimize discomfort from the testing procedures.
OTHER ALLERGY TESTS
A small sample of blood is usually collected to evaluate the allergic cell levels in the blood to help determine the severity of the allergic condition. Although blood tests can be used to determine allergic sensitivities (R.A.S.T) this test is less sensitive, time consuming, and 10-20 times more expensive than skin testing and as a way to evaluate allergies is disallowed by most insurance companies and health plans. It is only used in cases where skin testing can not be performed (ie. skin rashes, very young children, or in patients with severe life threatening allergic conditions where injecting an allergen can put a patient at risk).
Pulmonary Function (breathing test):
Breathing tests are performed in patients with respiratory problems such as wheezing, shortness of breath or chronic cough. This test is performed by instructing the patient to blow into a computerized lung function machine to measure the volume and speed with which air is expelled from the lung. If there is an abnormality of this test a nebulized (misted) medication to open the airway is administered and pulmonary functions are repeated to see if any improvement is noted. If asthma is suspected, but not present at the time of the patient’s visit, a different (nebulized) medication, methacholine, may be used to elicit asthma symptoms to make an appropriate diagnosis.
Many treatments are available for patients with allergic disease. Avoidance of the offending allergen (such as house-dust or cat) is very effective. Many medications are available to treat allergies. Prescription antihistamines, decongestants, and topical anti-inflammatory medications are available to treat allergies. Several inhaled bronchodilators and anti-inflammatory medications are available to help asthma patients with acute symptoms and can be used preventatively. Allergy injections (immunotherapy) are often helpful in managing acute diseases such as allergic rhinitis, asthma, urticaria (hives), and stinging insect allergies.
Allergy injections are a method of treating patients with hayfever and asthma. Small amounts of an allergy extract (pollens, molds, animal danders, or dust) are injected at regular intervals to build up protective antibodies and decrease the patients sensitivity. Injections are administered in the side of the arm with a very short small guage needle. These injections are given just under the skin in the subcutaneous layer. After a buildup period, a high percentage of patients respond with favorable results and are able to tolerate exposure to offending allergens without a significant allergic reaction. Since a small percentage of patients can have a reaction to the injection, patients usually wait 10-20 minutes in the doctor’s office after the injection.
Cluster or rush therapy allows patients to build up on allergy injections within a few weeks, rather than months. This type of treatment is usually only offered by Board Certified Allergists.
In the past, allergists have relied on written records and memory to ensure that the patient receives the proper allergy injection. Severe life threatening reactions can occur if the patient is given the wrong extract and patients with the same name used to present a problem. Before, patients requiring weekly injections would encounter a long wait to get their injection.
However, now computer scan-in and Universal Product Code label on patients’ allergy extracts are used to address these problems. This scan-in registration system allows rapid safe administration of allergy injections. Injection errors are minimized through a digitized photo activated by UPC code on the patients scan card and UPC code on extract vials. Allergy Associates is proud to have developed and be the first to use this unique system for injections and allergy extract. Scanning the patient card, checking patient photo ID, and scanning the extract vial helps to prevent administration errors. SAFETY IS OUR FIRST PRIORITY.