Allergy is a condition of hypersensitivity in certain persons to substances usually harmless to most individuals. Some people have characterized allergy as immunity “gone wrong”. In the immune reaction, contact with a disease-producing microorganism or an antigen prompts an individual to build up antibodies against the offending organism or antigen so that he or she will be protected against further exposure. All normal people are able to produce such protective antibodies, but in some persons the capacity to differentiate potentially harmful substances from harmless is altered. When an antibody reacts with an antigen, (a substance that stimulates the formation of antibodies) an allergic reaction results. The symptoms of that reaction will depend on where it takes place. If it occurs in the nose, it may cause sneezing and running of the nose. In the air passages it may cause spasms, leading to wheezing, coughing, and difficulty in breathing, as in asthma. In the skin, it may produce itching spots, hives, or welts (urticaria). The allergen, the substance producing the reaction, is usually a protein or protein-carbohydrate complex. It may be inhaled, as dust or pollen; it may be eaten, as eggs or shellfish; it may be injected, as penicillin; or it may act by mere contact, as wool, adhesive tape or metal.
Substances to which a person may be allergic
The variety of substances to which a person may be allergic is almost infinite; diagnosis involves discovering the particular substances to which the patient is hypersensitive (reacting excessively). A careful history of the development of the allergic reaction may give a clue, particularly when it is seasonal, when it is associated with an exposure to a specific substance, or when it occurs only in a particular place. Often it is possible to remain unaffected merely by avoiding the particular allergen to which the person reacts allergically, but common allergens such as dust or pollen cannot easily be avoided.
An allergic individual may develop new hypersensitivity, or an old hypersensitivity may die out. Allergies usually first appear in childhood, adolescence, or early adulthood, but may develop later in life. The mechanism of allergic reactions is not fully understood. Most likely the antigen becomes localized in a particular tissue, such as the cells lining the nasal passages or the bronchial tubes. The antibody reacts with the antigen at these sites, causing the release of certain chemical substances, including histamine, which mediates, or brings about, the reaction. Sometimes testing the skin with a wide variety of common allergens can pinpoint the specific causative factors leading to symptoms.
The simplest and best treatment is, when possible, to avoid contact with the allergen. A person allergic to feathers, particular pollens, foods, or medicines, for example, should avoid them. Where this is not feasible, because the allergen is unknown, because it affects more than one part of the body, or because too many allergens are present, drugs such as antihistamines or, in more serious cases, adrenal cortical steroids may be used to decrease the reaction. In other cases, desensitization (the process of making the patient able to tolerate the antigen without having a reaction) may be accomplished by giving injections of the antigen, first in minute doses and then in gradually increasing doses until tolerance builds up. Skin testing is almost always needed when desensitization treatment is being considered. Symptomatic treatment, such as the administration of drugs to relax spasms in the walls of the bronchi in asthmatics, decongestants for hay fever sufferers, or local ointments to relieve itching for hives may also be useful.
- Methods of Allergy Testing:
- Inhalant Testing
- Inhalant testing is usually done for antigens such as grass, tree, and weed pollens as well as molds, animal dander, and dust mites.
- Testing is usually done for approximately 30-60 antigens and takes approximately 1hour, based on a patient’s level or positive responses.
- The testing is accomplished with tiny injections under the skin (similar to a tuberculin skin test) and is usually done on the upper arm (unless skin condition necessitates testing on the back).
- Inhalant Testing
- Treatments Following Allergy Testing:
- If positives are identified on testing, desensitization therapy (“allergy shots”) will be recommended.
- Depending on the positive antigens found at testing, environmental avoidance recommendations will be made by the allergy staff.
- Desensitization therapy is currently a 3-5 year treatment course.
- Patients can elect to be treated on a shorter or longer basis after discussion with their physician.
- The shots are given on a weekly basis usually in the upper arm. The patient is observed for 20-30 minutes to watch for adverse reactions.
- Every 4-6 months the patient’s treatment vial will be “escalated” in concentration as directed by your physician. Based on the severity of allergies there may be many escalations over the 3-5 year treatment period.
- Financial Considerations:
- Allergy Testing is covered under most insurance plans, including Medicare. There are sometimes exclusions by certain plans and as such, our staff will try to delineate the coverage by your plan and communicate that to you prior to any scheduling or testing.
- Allergy shots are drawn out of a vial, which is made for each individual patient based on their test results.
- Patient Responsibilities Regarding Allergy Testing and Treatment
- Patients will be required to sign a “Consent for Allergy Testing/Treatment”.
- Patients will be required to adhere to treatment protocol as directed by their physician and the allergy staff including, but not limited to, shot dosage and frequency, vial escalation, environmental controls, and regular physician visits.
- Physician visits will be expected every 4-6 months during the initial 3-5 year.
- Patients will be required to notify physician or allergy staff of any suspected adverse reaction to their testing or ongoing treatment
- Patients are required to notify allergy staff or physician of any change in medications or medical conditions during treatment. Patients are especially cautioned about the use of “beta-blocker” medications and desensitization therapy (see “beta-blocker” sheet)
- Once begun, shots must be taken consistently, weekly.
- Patients will be required to have an “epi-pen” available while undergoing self-desensitization therapy and advise the allergy staff when a new prescription is needed.
- Benefits of Allergy Management with Desensitization:
- Significant reduction of upper and lower respiratory symptoms in vast majority of patients.
- Significant reduction in “sinusitis”.
- Significant reduction in physician office visits and co-payments.
- Significant reduction in need for medications with ultimate pharmacy savings and minimization of medication side effects.