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People are often confused when it comes to who should be taking care of patients with allergies, sinus problems, asthma, eczema (atopic dermatitis) or hives. This is partly due to the fact that there is more than one answer. Generally, mild allergies can be treated by primary care physicians; however, in order to obtain information on the exact cause of your allergy, as well as the latest and most effective treatment options, The New York Allergy and Sinus Center will be able to provide the correct diagnosis and treatment, rapidly, accurately and with compassion.

What is an Allergist?

Simply put, allergists are specialists who treat allergies. Allergies arise when our body’s defense system begins to react to everyday things as foreign invaders. These reactions, which occur in more than 20% of the population, cause symptoms like runny nose, itchy eyes, sneezing, wheezing, coughing, and various kinds of skin rashes. Allergic reactions can lead to such disorders as asthma, hay fever, sinusitis, stinging insect reactions, food allergies and drug allergies, allergic rashes, and hives. These conditions are best treated by the allergy specialist.

The allergist is a physician who is first trained in a basic specialty, such as internal medicine or pediatrics, and then completed a second training period, typically two years or longer, in allergic disease diagnosis and treatment. While any physician may treat allergies, it is the trained Allergist/ Immunologist who is an expert on allergies and the physician best able to apply the latest knowledge, techniques, and tools needed to not only determine what is causing the allergic problem but also how best to remedy it.

Dr. Nejat or one of his assistants will first interview you, take a detailed medical, environmental, and occupational history, evaluate your symptoms, and examine you. Then tests will be done to pinpoint the cause of your allergies. These tests may be skin tests or blood tests. Even though there may be a perception, even among physicians, that blood tests are more accurate than skin tests, this is not so. I believe the best and most accurate method -- the "gold standard " for allergy testing - is skin testing. New and improved techniques have now made skin testing rapid and relatively free of discomfort and pain. Testing results are obtained within 15-20 minutes. However, in order to achieve accurate results, you should not take any antihistamines for 48 hours prior to your testing visit. It is best to check with the staff at the New York Allergy and Sinus Center as to what medications are allowed in the days before your scheduled test. Breathing tests may be done to measure lung function and detect potential asthma. Your allergist may also order a CT scan of the sinuses in order to image your sinuses and make sure there is no chronic infection, polyps that may be blocking the passages or other anatomical abnormalities that may be contributing to sinus disease. Make sure that your CT scan of the sinuses uses conebeam technology which will give you a better image while using about 5-10% of the radiation of traditional “spiral” CT scans used by the hospitals which are better for imaging other parts of the body such as the brain chest or abdomen.

If you have previous tests such as allergy tests, CT scans and breathing tests please take them with you on your first visit.

Based on the information obtained a diagnosis is made and treatment is begun. The allergy treatment recommended to you may be divided into three types of programs: elimination or avoidance of the allergen (the substance that causes your reaction); medication; and vaccination (immunotherapy). Let’s look at these one by one:

Elimination and Avoidance

Identification of allergens allows for education on how to avoid allergens. Once you know to what you are allergic, you can put all of your energies into specifically avoiding what is avoidable. Then what?

For some allergic illness, allergy medication may be able to decrease most of the symptoms and return the patient to good health. Your allergy specialists are knowledgeable in the currently approved methods of treating allergic disorders. Recently, many new drugs have become available that improve allergic symptoms without making the patient forgetful or sleepy as did older medications. Most of these newer drugs are only available by prescription, and the allergy specialist has considerable experience in choosing the best medication for the individual patient.

Medication alone may completely resolve your allergic symptoms; on the other hand, they may only modulate or lessen your symptoms, and do that only so long as you continue to take your medication as prescribed. Should there be problems taking your medication, such as side effects or an unsatisfactory response, then you will need to take additional measures.

Immunotherapy

When neither elimination and avoidance nor medication are sufficient to solve the problem or control your symptoms, specific allergen immunotherapy - commonly known as "allergy shots" - may be used.

Immunotherapy has been available for allergy sufferers since 1911. There has been considerable research done to improve the materials and techniques used over the past 90 years. It is now a proven and effective method for decreasing allergy sensitivity to the specific substances causing your allergic disease. Immunotherapy is a natural method for increasing your tolerance to the substances in the environment that cause allergic illness.

The immunization procedure begins with injections of small amounts of the purified materials that are causing your allergic reactions. Your allergist determines which materials to use through skin testing, and this program works best when the same allergens used for your skin testing are used for your immunotherapy. The vaccine allergens may be derived from pollens, mold spores, animal danders, dust mites, insect venom, and other substances.

The vaccine allergens which are injected into allergy patients are harvested and prepared by pharmaceutical manufacturer. Manufacturers’ facilities and procedures are inspected and meet approval by the Federal Drug Administration; in the past few years there has been considerable improvement in the quality of these allergens, and most of the important ones have been standardized. For the patient, this means that immunotherapy has become a safer, more effective, and reliable treatment.

The treatment program

The initial injections contain small doses of allergen; subsequent injections are gradually increased in strength. Injections are given in the arm, just below the skin surface once a week or once every two weeks. Typically, shots are given at this rate until the desired level (the "maintenance level") is achieved, and then a booster shot is given every few weeks. Under some circumstances, the injection schedule may be accelerated so that maintenance is achieved after one or two prolonged visits. This is called "rush immunotherapy."

Immunotherapy is frequently continued for several years. In some patients, allergy treatment can then be discontinued with maintenance of their symptoms for a number of years. For other patients, treatment may need to be continued for longer periods of time. A number of research studies have shown that allergy shots are not only effective but also produce changes that help direct our immune response away from allergic reactions in general and toward normal reactions.

With this type of treatment program, allergy symptoms are prevented. There is a decrease in the medications needed, fewer days missed at school and work, and a general improvement in the way allergy sufferers feel. Immunotherapy has been given to young patients, pregnant patients, and elderly patients with good results, and with no noted toxic effects or interactions with drugs.

Since immunotherapy deals with substances to which one is allergic, there is a possibility that one may experience local reactions or generalized reactions (like hives, asthma, or anaphylaxis) when first treated. This is why allergy shots should be given in a physician’s office where any unwanted reaction, if one occurs, can be safely and promptly handled. Nevertheless, you should know that there is an extremely small chance (1 in 65 million) that an injection can result in a fatality. Treatment with immunotherapy should, therefore, be undertaken only after a careful and correct diagnosis and under the supervision of physician who are qualified to administer and manage this type of therapy.

A case study

The following account shows how immunotherapy, by stimulating your immune system to fight allergies, can effectively and naturally restore you to good health.

Ella Johnson is a 31-year-old mother of 2 boys. Last spring, when the trees were pollinating, she developed severe allergic rhinitis (runny nose, continuous sneezing), and allergic conjunctivitis, with symptoms occurring up to 24 times on a day that tree pollen was high. Her eyes were so red and teary that she was miserable at her son’s soccer and baseball games. Over the counter medications were only partially effective but she couldn’t stay awake. She was trying to keep her job as an attorney while juggling motherhood, but was missing work because she was getting sick all of the time. She was miserable at her kids’ games as well. She saw an otolaryngologist that suggested repair of her Deviated Nasal Septum. Even though he stayed indoors for two weeks, took the newest antihistamine advertised on TV, used eye and nose drops, she still could not work. Allergy tests showed that he was allergic to oak, birch, and grass pollen along with ragweed and dust mites. She began immunotherapy last summer and now takes injections every two weeks. This recent spring, while many of her colleagues and fellow moms were missing work and miserable outdoors on the soccer pitch as had happened to her the year before, she was fine and needed no medication. Not only could she go out, but she went for walks in the park during pollen season, something she hadn’t done since childhood.

More Information for Allergy and Asthma Sufferers

The number of people with allergies, and asthma in particular, has been dramatically increasing in the past few years. In order to confront the asthma epidemic, the National Institutes of Health convened an "Expert Panel" of asthma experts to make recommendations. Allergists were an important part of the Panel and the Panel’s recommendations for the best standards of care for the treatment of asthma. Allergists/Immunologists have also written a number of allergy guidelines that have been approved by their National Societies for the treatment of a number of allergic illnesses.

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