Meticulous attention to one’s medical history is usually the most important tool in determining appropriate diagnoses and treatments. We will take the time to discuss all relevant details with you. When medications are indicated, we do our best to balance effectiveness with safety, convenience and cost.
Asthma can develop at any age and may present in many ways: chest tightness, wheezing, coughing, recurrent bronchitis, trouble breathing with exercise, and pneumonia serving as prime examples. Environmental allergens are common but not universal triggers and are often only fully appreciated when allergy testing is completed. Treatment consists of avoiding triggers if possible and use of appropriate medication. Allergy shots are indicated in some cases.
Nasal allergy and sinus problems
Nasal allergies and sinus problems are often a much greater quality of life issue than is asthma. These conditions often coexist, and allergy testing for common environmental allergens, such as pollens, dust mites, mold spores and furred pets, is a central part of the assessment.
Food Allergy has become epidemic over the past 2 decades, particularly in children. The scope of indicated allergy testing is very much guided by one’s history and is accomplished by skin and/or blood testing. Most confirmed food allergies justify one’s carrying an epinephrine auto-injector. It is important for you to know situations that would warrant use of the auto-injector, and (of course!) how to use it. Not all convincing reactions to foods involve allergic antibody, however. We can sort out these details with you. Most food allergic reactions start within 2 hours of ingesting the culprit food. In the past few years, however, a newly described condition called “alpha gal allergy” has been described that manifests 3-6 hours or so after ingesting beef, pork, lamb or other such mammalian meats.
Drug Allergies are diagnosed most commonly by history alone. No standardized diagnostic tests exist for most drug allergies. One major exception is penicillin allergy, for which we can provide skin testing. If penicillin skin tests are negative, it is common for the evaluation to then include a challenge dose of amoxicillin given in the office, followed by one or more hours of observation.
Atopic Dermatitis (or atopic eczema) is the source of great discomfort, especially in young children, where almost half of afflicted kids have one or more food allergens contributing to the skin disorder. Seldom are such food allergens apparent based on simple observation. Food allergy testing allows us to zero in on foods that should be removed from the diet on a trial basis. To flip the coin, allergy test-negative foods seldom are truly triggers and can remain in the diet. Environmental allergens, especially furred pets and dust mites, can be major contributors, too. Like food allergens, this is seldom obvious on observation alone. Topical therapy is essential and is individualized based on severity of the condition.
Chronic Hives and/or Swelling
Chronic Hives and/or Swelling (chronic urticaria and/or angioedema) occurs more commonly in adults than children. This condition is seldom caused by food or environmental allergens, so allergy testing is not often indicated. That is also why your first appointment with us is typically for consultation only, meaning no testing of any sort would be planned for that visit. Although hives/swelling usually ends up resolving as mysteriously as it first came on, there are some lab tests that are appropriate based on one’s history. In 2014 the FDA approved a new therapy for this condition, Xolair injections; the first new therapy for hives in many decades.
Stinging Insect Venom Allergy
Stinging Insect Venom Allergy (bee sting allergy) afflicts far more adults than children. There are well established guidelines for who should be tested, based on the nature of the reaction. Intense swelling around the site of the sting does not warrant allergy testing, but an adult’s history of hives distant from the sting site is enough to justify allergy assessment. Testing is indicated at any age if there are acute respiratory, gastrointestinal, cardiovascular, or central nervous systems symptoms following a sting. Skin testing is accomplished for honey bee, yellow jacket, hornets and wasp.
RECURRENT INFECTIONS, most commonly manifesting as recurrent sinus, lung, and occasionally ear infections, may sometimes look a lot like respiratory allergies and/or asthma. When suspicion for immune deficiency arises, diagnostic testing can be done, most of which is accomplished by blood testing. Various facets of the immune response, especially antibody levels and white blood cell numbers and types, can be assayed. Significant immune deficiency is very uncommon, however, and if your screening is distinctly abnormal, we would likely refer you to a tertiary center for even more extensive work-up and treatment.
Contact Rashes or contact dermatitis, can be caused either by irritants or allergens. It is often difficult to distinguish these based on the appearance of the rash. Contact allergy can be assessed with a commercially prepared panel of patch tests that are placed on one’s back for 48 hours. The test sites are assessed when the patches come off and again 2-3 days later. Common contact allergens include active ingredients, preservatives and fragrances found in many topical creams and lotions; metals found in jewelry and joint replacement implants; adhesives, glues, and dyes found in hair colorants.
Anaphylaxis which is a life-threatening systemic allergic reaction, can occur following exposure to ingested or injected allergen (food, drug, bee sting, allergy shot); but can also happen without any discernible trigger (idiopathic anaphylaxis). Spoken tongue-in-cheek, it is our least favorite diagnosis, as we wonder “is there something we’re missing?” History is especially critical, as is diagnostic testing and epinephrine auto-injector contingency.
Information provided with the expressed consent of The American College of Allergy, Asthma and Immunology.