Allergy Testing and Treatment

Allergy Testing

Your doctor will have many questions about your overall health history and your allergic symptoms. This information will help your doctor determine what type of allergy you have. It is important for your doctor to know what kind of symptoms you have and how severe they are. Since you may not have symptoms on the day you see the doctor, you may want to think about your symptoms and write down as much as you can before your visit. Then, be sure to bring your notes with you to your next visit to the doctor’s office. Since your doctor may ask about your family history of allergies, it is a good idea to talk with other family members about that before your visit to the doctor. You may find that some family members do not have any obvious allergic symptoms, such as sneezing, runny nose or itchy eyes, but may have severe headaches or chronic nasal congestion that may be related to an allergy. Any information you are able to obtain will be helpful to your doctor. Be sure to stop taking any antihistamines like claritin, benadryl, clarinex, allegra or zyrtec that you may be currently on if you are expecting to have an allergy test. Tests done with antihistamines still in your body may turn out false negative and may need to be repeated.
skin-prick-test When you first arrive at your doctor’s office, you may be asked to fill out forms about your symptoms. These forms will also ask about any known triggers, as well as any pattern of symptoms.
Your doctor will examine you and focus on the areas of the body that are affected by allergy symptoms. You may also have allergy testing done at this time to identify specific substances you are allergic to. These tests may include skin or blood tests. Skin tests may include a prick test or a patch test. In the prick (scratch) test, a few drops of the purified allergen are gently pricked on to the skin surface, usually the forearm or the back. This test is usually done in order to identify allergies to pet dander, dust, pollen, foods or dust mites.
intradermal-injectionIntradermal injections are done by injecting a small amount of allergen just beneath the skin surface. The test is done to assess allergies to drugs like penicillin or bee venom.
patch testThe patch test simply uses a large patch which has different allergens on it. The patch is applied onto the skin, usually on the back. The allergens on the patch include latex, medications, preservatives, hair dyes, fragrances, resins and various metals. When a patch is applied the subject should avoid bathing or exercise for at least 48 hours. A positive reaction may cause itchiness, swelling although less commonly shortness of breath wheezing or symptoms of anaphylaxis may also occur.
patch-test-300x177 Blood tests usually screen for the antibodies that cause allergic responses – they are not always accurate in telling whether you are or are not allergic to a particular allergen. Dr. Dagan routinely performs a blood test that is called the Northeastern blood allergen test. It tests for all the common varieties of tree pollen, grasses, weeds, molds, house dust and house dustmite, pet dander, goose and duck feathers (contained in down comforters), common insects and the gamut of food groups including various shell fish, fish, meats, milk, soy, fruits, vegetables, nuts.
If there is a specific substance that you are interested in testing for let us know, our lab can usually accommodate nearly every request.
You may also undergo breathing tests or x-rays to see if your allergies may be affecting your lungs or your breathing.

Allergy Treatment

There are basically 3 ways to manage your allergies: avoidance of allergens, medications, and allergy immunotherapy (“allergy shots”).Avoidance
The cornerstone of allergy treatment is avoidance of the allergens. You have to be exposed to allergens in order to have symptoms. Therefore, if you don’t ever come into contact with your allergens, you won’t have allergy symptoms. Your doctor will provide you with important steps to take to reduce exposure to offending allergens. Avoiding contact with irritating chemicals, such as tobacco smoke, air pollution, insect sprays, can also help keep allergy symptoms in check. It is not always possible or feasible for some people to completely avoid their allergens without making major changes in their lives. This is especially true of outdoor airborne allergens, such as pollens and molds or indoor airborne allergens such as dust mites or the family pet.Medications
You are probably already familiar with the various kinds of medications that are used to treat allergies. Antihistamines, decongestants, topical nasal steroids, eye drops, and cromolyn may help relieve symptoms temporarily. Some of these medications are available without a prescription while others require a prescription. Medications may need to be taken several times a day, may cause side effects, and only treat the symptoms of allergies, not the actual cause of the problem.

Medications may be divided into over the counter medications and prescription medications. Currently, antihistamines such as allegra, zyrtec, claritin, clarinex and others may be obtained from the shelf at your local pharmacy. They will help counter allergy symptoms like Itchiness, sneezing, congestion and nasal discharge as well as itchy watery eyes and rashes. They do so by reducing the release histamine, a substance that causes all these familiar allergy type symptoms. These medications have versions with and without decongestants usually denoted by a capital D after the name of the medication (e.g. Allegra D). The advantage of decongestion is having a drier nose but keep in mind that the D’s also can cause you to be wired at night and have difficulties falling asleep as well as cause palpitations or a racy heart beat that may make you anxious.

Other over the counter medications that may be helpful include eye drops like visine allergy, alaway antihistamine eye drops, zaditor eye itch relief or Opcon-A Eye Allergy relief. They reduce the itchiness and watery eyes or even dry eyes due to allergies. Some people find it useful to use artificial tear drops for dry eyes resulting from allergies.

Finally, Nasal saline sprays like Ayr, Simply saline or even the nettipot can be helpful to irrigate the inside of the nose from the allergens within.

Prescription medications that may be given by your doctor may include singulair which works on both allergies as well as asthma. Singulair works on reducing the population of a cell called the eosinophil which contributes to allergy symptoms. Nasal sprays prescribed by physicians include either steroid or antihistamine sprays like flonase, nasonex, veramyst, rhinocort, nasacort, patanase, astelin, Dymista.

Prescription eye drops may be used if the over the counter versions are not helpful including patanol or pataday as well as others.

Allergy Immunotherapy (Allergy Shots)
Unlike medications that provide temporary relief, allergy immunotherapy does not mask symptoms, but can actually improve the course of allergic disease for the long term. This can mean that the burdens of allergy, such as taking daily medications and missing work or school, may be reduced. Allergy immunotherapy has even been shown to reduce the risk of developing asthma in patients with allergic rhinitis and prevent the development of new sensitivities in people who already have an allergic disease.

Immunotherapy, also known as “allergy shots” or “allergy injections” is a form of treatment that uses extracts of natural allergens, such as pollen, mold spores, dust mites, and animal dander, that cause allergic reactions in sensitive people. Allergen extracts are made up of tiny amounts of these allergens collected from their source in nature and dissolved in sterile liquid solutions for use by your doctor.

Allergen injections strengthen your immune system and increase your tolerance to unavoidable allergens. Once your doctor has identified your specific allergen(s), you start the initial build-up phase by receiving a low level of exposure to those allergens injected into the skin. Over time, the amount of allergen exposure is gradually increased so that your body gets used to it and does not react with allergy symptoms. In this way, your body can become desensitized to the allergens that once caused problems for you.4 Then, you continue to receive the effective allergen dose during the maintenance phase of therapy.

Allergy immunotherapy is a particularly good choice for:

  • People with allergy symptoms that cannot be controlled by avoidance or medications
  • People who have unacceptable side effects with medications
  • People who want to reduce their use of long-term medications

Benefits of immunotherapy:
Through over 100 years of use, allergy immunotherapy has been well studied and proven to be effective in patients with allergic rhinitis, allergic conjunctivitis, and allergic asthma. There is some evidence that this therapy may also be useful to treat other forms of allergy, such as atopic dermatitis, that affects the skin.

Medical studies have shown that up to 85% of people treated with immunotherapy for hay fever may achieve symptom relief within the first year of starting immunotherapy. Many people also benefit from being able to reduce the use of allergy medications and an improved quality of life. As mentioned before, allergy immunotherapy may prevent the development of asthma in people with hay fever and may prevent the development of new allergies in people who already have one kind of allergy.

Since allergy immunotherapy has been around for so long, the safety profile of this therapy is well known. This therapy can be used to treat children and adults, and even pregnant women. Minor reactions, such as a red, itchy bump at the injection site, may occur immediately following a treatment. A similar kind of reaction may occur 6 to 24 hours after treatment in some cases. These reactions can be managed by the doctor who administers the treatment. These kinds of reactions do not interfere with treatment in the great majority (96%) of patients.1 In rare cases, more severe, reactions may occur. For this reason, allergy immunotherapy is always given under close medical supervision.

Doctors know that the benefits of allergen immunotherapy can last for many years. Some people who complete 3 to 5 years of immunotherapy can stop without further treatment or symptoms. Other people may require longer immunotherapy or experience symptoms after stopping immunotherapy. So, treatment must be tailored to each person’s

As with any kind of medical treatment, there are many factors to consider before starting. Allergen immunotherapy requires a series of office visits for injections of allergen extracts into the skin over several years. Therefore, people considering allergen immunotherapy need to know that they are committing to long-term therapy, and need to keep up with office visits as scheduled to get the best results.

During the initial build-up phase of therapy, you will need to plan on 1 or 2 office visits per week. After each allergy injection, you will be monitored in the office for at least 30 minutes. The purpose of the build-up phase is to establish a target dose that will control your allergy symptoms, which can usually be reached within 3 to 6 months. Faster schedules can also be used.

Once your target dose is reached, the maintenance phase begins. During the maintenance phase, the time interval between office visits is typically lengthened. Injections may be given every 2 to 4 weeks.

The exact duration of therapy cannot be predicted for any one person starting therapy, but is often around 3 to 5 years. The length of treatment is based on each individual patient’s need. Overall, the benefits of allergen immunotherapy can last many years – even life-long – after stopping therapy.

Allergen immunotherapy is generally well tolerated. Minor skin reactions may occur after injections. There is a low risk of serious reactions, but they can occur.3 Therefore, people who are considering allergen immunotherapy need to discuss the potential risks of having a reaction versus the benefits of reducing or eliminating allergy symptoms.

Allergen immunotherapy can be a cost-effective treatment for allergies. Be sure to check with your health plan or insurance company so that you know what benefits will be provided for you. You may need to get prior approval before you go to see a specialist. If so, be sure to get that approval before your first visit.