Comprehensive Allergy Evaluation and Treatment

Allergy Skin Testing

INSTRUCTIONS FOR ALLERGY SKIN TESTING

Skin Testing is a procedure which helps determine which substances (allergens) cause an allergic reaction in your body. Small doses of allergic extracts are administered into the skin of your upper arm or forearm.

Skin testing takes approximately one hour. After testing, your physicians will review the results with you and recommend a treatment most suitable for you.

¬ Certain medications interfere with an accurate skin testing response and therefore, should not be taken prior to testing.

¬ Antihistamines (ex. Claritin, Zyrtec, Allegra, Tavist, Semprex D, Clarinex, Meclizine) should not be taken at least 60 hours prior to testing. If in doubt about any medication-call us. You may resume antihistamine use after all skin testing is completed.

¬ Discontinue over the counter (otc) medications that contain an antihistamine 60 hours prior to testing.

¬ All medication for Asthma, including inhalers should be taken unless otherwise directed by your physician.

¬ If you are taking any tranquilizers, antidepressants or sleeping medication, let the nurse or allergy receptionist know when making your appointment.

¬ If you are pregnant or suffer from any chronic illness, please discuss it with the allergy staff prior to your appointment.

Please eat breakfast or lunch as you normally would and wear a short sleeved shirt.

Children under 18 must be accompanied by an adult.

Our testing is done by trained medical assistants and physicians. Due to the intradermal injection of allergens into your system the potential of an anaphylactic reaction is always possible, although extremely rare.

We perform modified quantitative allergy testing which is a combination of prick and intradermal testing. This method has been shown to be one of the most accurate, sensitive, and specific methods of allergy testing.

Allergy Treatment

Environmental Avoidance

Allergy education videos for environmental avoidance measures.

Medications

Allergy medications: Know your options

How to use your Sinus Rinse

Immunotherapy (Both injection and sublingual are options)

Allergy shots or sublingual drops are a forms of treatment called immunotherapy. Each allergy shot or sublingual drops contain a tiny amount of the specific substance or substances that trigger your allergic reactions. These are called allergens. Allergy shots or sublingual drops contain just enough allergens to stimulate your immune system — but not enough to cause a full-blown allergic reaction.

Over time, your doctor increases the dose of allergens in each of your allergy shots or sublingual drops. This helps get your body used to the allergens (become desensitized). Your immune system builds up a tolerance to the allergens, and your allergy symptoms diminish over time.

Evidence-based studies by COCHRANE REVIEWS

Injection Immunotherapy (Allergy Shots)

Allergen injection immunotherapy for seasonal allergic rhinitis

Authors: Calderon MA, Alves B, Jacobson M, Hurwitz B, Sheikh A, Durham S

http://www2.cochrane.org/reviews/en/ab001936.html

Immunotherapy by allergen injections for seasonal allergic rhinitis ('hay fever')
Seasonal allergic rhinitis ('hay fever') is a global health problem and its prevalence has increased considerably in the last two decades. Treatment includes allergen avoidance, drugs such as antihistamine tablets and nasal sprays, and immunotherapy (vaccination). For those patients whose symptoms remain uncontrolled despite drug treatment, specific allergen immunotherapy (SIT) is advised.

Specific allergen immunotherapy is most commonly administered as subcutaneous (under the skin) injections by specialists requiring a building-up period followed by a maintenance period of three to five years. Immunotherapy may also be delivered by the oral, nasal or sublingual route and these will be studied in separate Cochrane reviews, as will immunotherapy for perennial (all year round) allergic rhinitis. In this review we aimed to evaluate the efficacy and safety of injection immunotherapy, compared with placebo, for reducing symptoms and the need for medication.

We identified randomised, double-blind, placebo controlled trials of specific allergen immunotherapy in patients with seasonal allergic rhinitis due to tree, grass or weed pollens. Fifty-one studies satisfied our inclusion criteria. In total there were 2871 participants (1645 in the treatment groups and 1226 in the placebo), each receiving on average 18 injections. The duration of treatment varied from three days to three years.

This review has shown that injection immunotherapy in suitably selected patients with hay fever results in significant reductions in symptom scores and medication use. Injection immunotherapy has a known and relatively low risk of severe adverse events. We found no long-term consequences from adverse events and no fatalities.

Sublingual Immunotherapy (Allergy Drops)

Sublingual immunotherapy for allergic rhinitis.

Authors: Calderon MA, Alves B, Jacobson M, Hurwitz B, Sheikh A, Durham S

http://www2.cochrane.org/reviews/en/ab002893.html

Sublingual immunotherapy for allergic rhinitis (including hay fever)
Allergic rhinitis is characterised by red itchy eyes, a blocked and runny nose, and sneezing. The most common causes of allergic rhinitis are different pollens (grass and tree), house dust mites, mould and animal dander. Allergic rhinitis can be intermittent (such as hay fever) or persistent (all year round). The treatment of allergic rhinitis depends on its severity and duration, and is usually based on the use of antihistamines and nasal corticosteroids. If these drugs cannot control symptoms immunotherapy is recommended. Immunotherapy involves the administration of gradually increasing doses of the allergen over a period of time to desensitise the patient. It is the only known treatment that modifies the immune response and treats the cause rather than the symptoms.

In reviewing 60 trials we found a significant reduction in symptom and medication scores in patients treated with sublingual immunotherapy compared to placebo. There were no serious adverse reactions reported in the included trials and no patient needed the use of adrenaline. This updated Cochrane Review therefore reinforces the conclusions of the earlier review in confirming the efficacy and safety of sublingual immunotherapy.

John Hopkins Podcast on Sublingual Immunotherapy

Sandra Lin, M.D., associate professor of otolaryngology-head and neck surgery at Johns Hopkins, discusses the pros and cons of sublingual immunotherapy

http://www.hopkinsmedicine.org/news/audio/podcasts/LinPod.html