Allergy & Asthma

Our Specialties

If you're not sure what treatment is associated with symptoms you may be experiencing, we are here to help! Book an appointment and we will walk you through an initial consultation and treatment plan.

Asthma

Your lungs are a system of branching tubes that carry the air you breathe. When you have asthma, the tubes become swollen and red. Just like a rash on your skin is itchy and painful, asthma is essentially a rash on the inside of your lungs. This is called inflammation. When your lungs are inflamed they become extra sensitive to many different things. These things are then called your asthma triggers. A trigger could be an infection, heavy exercise, the weather, smoke or allergies.

It is important to realize that inflammation is always present in asthma, even when you feel good. When you are exposed to your triggers, the inflammation gets worse. The airways of your lungs swell and produce extra mucous. This clogs the airways and makes it harder to breathe. Sometimes the muscles around the airways will tighten up and make it even harder to breathe. This is known as an asthma attack.

Some people think an attack is only a severe episode that sends the patient to the emergency room or to their doctor. But even mild symptoms are considered an attack and mean that your asthma is not under good control.

Asthma can begin at any age. Many people have asthma starting when they are very young. Others develop it later in life.

What causes Asthma?

The exact cause of asthma is not known. There are probably many different factors that cause it to develop. There is definitely a genetic factor as asthma usually runs in families. But there are probably other factors that determine how it presents. Certain exposures in the environment or infections may predispose people to asthma. There is still much to learn.
How can Asthma be controlled?

There is no cure for asthma but fortunately it can be controlled. The first step is identifying what triggers your asthma and taking steps to reduce or eliminate these things. Reducing allergic triggers and irritants such as cigarette smoke are both very helpful.

Reducing infections by getting the recommended vaccinations and maintaining good health is also beneficial.

Exercise is good for your health so if this is an asthma trigger taking the proper precautions and treatments can allow almost any asthma patient to exercise as much as they want. There are many professional and Olympic athletes who succeed despite asthma!

When asthma persists despite reducing the main triggers then medications are used to reduce the airway inflammation and prevent attacks. There are many excellent medications which are used every day to control asthma and “as needed” medications designed to stop an attack in progress.

For information on Biologics, click here.

A few things to keep in mind...

Asthma is always there. Even when you feel fine your asthma is still present and can worsen unexpectedly at any time!

Even a patient with mild asthma can have a severe attack at any time. An attack can even be life threatening!

There is no cure for asthma, but it can be treated and controlled so you live a normal, healthy life with no limitations!

Is your asthma under control?

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Allergies

When most people are exposed to the various things that float through the air it causes them no distress. These are things like pollens, mold spores, pet dander or insect (cockroach or dust mite) particles. But in some people inhaling these specific substances can lead to immediate and distressing symptoms. We don’t know why some people develop these allergies but there is definitely a genetic factor. Allergies tend to run very strong through families.

We also don’t know why people develop reactions to only certain things. Why to cat but not to dog? There must be some additional signal that determines when and why a person becomes allergic to a specific substance.

But we do know what happens when an allergic person is exposed to one of their triggers. The particle enters through the nose, mouth or eyes where the immune system recognizes it as an allergen (any particle that causes an allergic reaction). A reaction is initiated that causes certain cells in the body to release histamine and a host of other chemicals. These chemicals cause itching, swelling, mucous drainage and inflammation. This reaction is often limited to the local area (such as the nose or eyes) but it severe cases it can spread to other areas like the lungs or skin.

How are Allergies Diagnosed?

Sometimes it’s easy to know what triggers an allergic reaction. If you pet a cat and instantly have strong symptoms then it is pretty obvious! But sometimes allergy symptoms happen just by walking outside or in the middle of the night. Your Allergist can perform special tests to identify your allergic triggers.

Most common is a skin test where very small doses of allergens are applied to the skin and a small reaction occurs within minutes. This test is quick and easy with results obtained in about 20 minutes. Some patients love to tell horror stories about allergy testing with “hundreds of needle pokes!” but if it’s done by a trained and certified specialist it should be relatively painless. Most Allergists only test for about 50-60 things using a light scratch on the skin with a plastic toothpick-like device. Even babies can be tested (although usually for a smaller panel of possible triggers)!
How are Allergies treated?
There are usually three main ways to combat allergies:
- Avoidance – Identifying and staying away from the things that triggers your allergies is the best therapy! You can’t have allergy symptoms if you aren’t exposed to your allergens!! This works best for indoor allergens like dogs, cats, cockroaches and dust mites. Not everything in the air is easily avoided though.
- Medications – Medications simply work to block your symptoms. Antihistamines have been around for a long time and try to block the chemical histamine that causes most of the symptoms. Nasal steroid sprays are highly effective and work to reduce the inflammation inside your nose and stop your symptoms. These medications and others work best if they are taken BEFORE the allergy symptoms become severe. For people with many different allergies they work best if taken every day.
- Allergy shots – Also called allergy immunotherapy, this is the most effective therapy as it is the only one that actually changes your allergies. Small amounts of the things you are allergic to are injected into your body in gradually increasing doses to build up your tolerance to these things. While not a complete cure it is typically highly effective in reducing your symptoms and need for medications. Allergy drops are a variation of this therapy where drops are placed under the tongue instead of being injected into the arm.

Food Allergies

Food allergies are a special kind of allergy. They are usually much more severe than a regular pollen allergy. This is likely because the food particle is absorbed into the person’s blood stream where it can trigger a whole-body (“systemic”) reaction. These reactions can be mild but have the potential to be very severe.

Mild reactions may involve just skin itching or hives. Sometimes there is some mild swelling. More severe reactions involve swelling of the tongue or throat which can block the ability to breathe properly. Sometimes patients have an asthma-like attack or they can pass out due to a sudden fall in blood pressure. In the most severe cases a patient can stop breathing or go into cardiiac arrest due to the severe reaction.

Food reactions must always be taken very seriously! A reaction can look very mild at first but quickly progress to a very severe reaction. Always treat food reactions quickly and aggressively!

How are Food Allergies Diagnosed?
- Food allergies are diagnosed much like regular allergies. A skin test can be done where small amounts of the foods in question are applied to the skin and a small skin reaction develops if an allergy is present. Due to the higher risk of a reaction with food skin testing sometimes a blood test is done that can give similar information.
- Food testing however is typically less accurate than the pollen, pet and mold testing done for regular allergies. Sometimes the testing will look like the patient is positive to a specific food even though they can eat it with having any symptoms.
- Because of this a food allergy can never be diagnosed based on a test result alone! Many patients show up in our clinic labeled with multiple “food allergies” based on a test result even though they have never actually had an allergic reaction!
- If there is any doubt about the accuracy of a test then the ultimate test is a food challenge. In this situation a patient is slowly and carefully fed small amounts of the food in question to see if an actual reaction develops. If the food is eaten without symptoms then a food allergy does not exist. If a reaction does develop it is typically mild due to the very small amount of food eaten and any symptoms can be treated in the clinic.
How are Food Allergies treated?

There is no cure for food allergies at this time. The only effective plan is to avoid the food that triggers a reaction. This can be difficult due to hidden ingredients and accidental ingestions.

All patients with a food allergy should carry injectable epinephrine (EpiPen or Auvi-Q) to quickly treat any significant symptoms triggered by a food ingestion. These devices need to be carried everywhere because a reaction can happen at any time.

Patient who only have very mild symptoms can often use Benadryl or another antihistamine but epinephrine should always be available in case a more severe reaction develops unexpectedly.

Researchers are constantly working on ways to build up a patient’s tolerance to their food allergy and reduce the likelihood of a severe or fatal reaction. These methods have shown some promise but are not felt to be quite ready for regular use at this time.

The next several years appear to hold great promise for food allergy sufferers!

Hives

Urticaria, commonly known as hives, is a skin condition that affects up to 20% of people at some point in their lives. That’s 1 out of every 5 people! The swelling that sometimes accompanies hives is called “angioedema” and can lead to swelling of the face, hands and feet. Hives usually feel very itchy and burning (although angioedema can even feel painful) or cause a tingling sensation — and these symptoms often make people miserable. Hives are caused by histamine being released into the skin, which causes raised, red itchy bumps of various shapes and sizes.

It’s nice to know that hives are a common problem but this isn’t much of a comfort to people when their lives are consumed with not knowing why they have their symptoms. Hives can truly turn a person’s life upside down. They’re uncomfortable and patients HATE not knowing what’s causing their hives, why they can’t sleep and why they don’t want to leave their homes to go to work or school — all of this can lead to emotional distress. Yet hives are usually easily treated with medications.

Some people have had hives for a few days while others have had symptoms for decades, and yet, each and every one of them is extremely bothered by their symptoms. Most hives are temporary and will resolve spontaneously after days, weeks or sometimes months. Only a small number of patients suffer with hives for an extended period of time. Through a proper evaluation and treatment plan almost all people who suffer from hives can achieve good control of their symptoms.

What causes Hives?

Most patients have suspicions about what is causing their hives. The majority are concerned with some type of food allergy. Some think that a medication or environmental trigger (such as an odor or chemical) is the cause, while others are concerned with a physical trigger, such as heat or cold.

While any of the above triggers are possible, overwhelmingly the most common cause of acute hives (those lasting less than 6 weeks) are viral infections (such as the common cold), and the most common cause of chronic hives (those lasting greater than 6 weeks) are autoimmune causes. An allergic trigger, surprisingly, is almost never the cause for chronic hives.

High levels of stress can worsen hives, although it’s probably not the main underlying reason for the problem.

Physical causes for hives occur in up to 20% of people with chronic hives. These physical triggers may include skin pressure, heat, cold, sunlight and exercise. Each one of these forms of physical hives has unique features that warrant special consideration.
How are Hives treated?

Most often, a simple avoidable cause of hives cannot be found. In these cases, medications are used to control symptoms until the problem resolves on its own. Antihistamines, taken by mouth every day, are the medications of choice for the treatment and prevention of hives. Many times, a higher than normal dose of an antihistamine can be used safely and effectively. Corticosteroids are often given to people with severe problems, but this medication can have strong side effects if used too often.
Xolair for Hives:

Xolair was initially approved for the treatment of allergic asthma but, several years ago, patients with hives (urticaria) noticed that their hives would disappear when they received their Xolair shot. As a results the medication was investigated for the treatment of hives and, in April 2014, it was approved by the FDA for this purpose. This medication has led to dramatic reductions in hives for many patients and improvements in their quality of life.

Is your urticaria (hives) under control?

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Atopic Dermatitis

Atopic dermatitis is a chronic skin condition that causes itchy, scaly patches to form all over the body. Atopic dermatitis is diagnosed by the history of the symptoms and the appearance of the rash. There is no test that will diagnose eczema although tests may be done to help identify triggers for the problem.

Unlike many other skin conditions, eczema is not a rash that causes itching. Rather it starts as itchy skin that only forms a rash after the patient scratches at it. This scratching damages the skin and leads to the characteristic appearance of the rash. This is very important since if the itching can be blocked or controlled then the rash will not appear!

The rash itself is not unique to eczema but appears as redness with small bumps or even blisters. The skin may crack and some clear fluid may ooze out of the openings. With chronic scratching the skin may thicken and form leathery patches.

More unique to eczema is the location of the rash. In infants the rash is localized to areas where the child can scratch such as the face, chest and abdomen, arms and legs. Often there is no rash in covered areas such as under the diaper. In older children and adults the rash is classically found in front of the elbows and behind the knees but in more severe cases may be found anywhere within reach of scratching.

What are the triggers for itching?

There are many triggers for the skin itching that leads to the rash. Irritants such as harsh soaps, chemicals, rough fabrics, heat and sweating are common problems for eczema patients. Avoidance of these irritants through use of gentle soaps, wearing cotton clothing, and keeping cool and dry can help prevent itching.

People with atopic dermatitis are more susceptible to skin infections by various bacterial, fungal and viral infections.

Many patients have large amounts of a common skin bacterium, called Staphylococcus aureus, which can worsen the itching and eczema.

Allergies are also a significant trigger of eczema. Indoor allergens that directly touch the skin, such as pets and dust mites, cause the most problems, although pollens and mold spores in the air can also worsen the condition.

Food allergies are also a major trigger particularly in children. Egg and milk allergy are the most common food allergies in children with worsening eczema, although other food allergies are also common.

Identifying allergic triggers in eczema patients is very important. Allergy testing using a skin test or blood test can be very revealing and avoidance of these triggers, both environmental and food allergens, can significantly improve the problem.
How is Eczema treated?

In addition to avoiding any known triggers, the key step in treating eczema is moisturization. Soft, smooth skin tends to itch less and be less irritable than dry skin. Moisturizing every day, especially after bathing, is critical. If eczema still flares up despite moisturization then using an anti-inflammatory cream or ointment such as a topical steroid or calcineurin inhibitor may be used. More advanced measures for severe eczema are available.

Non-allergic Rhinitis

Non-allergic rhinitis has symptoms very similar to allergic rhinitis (“hay-fever”). The difference is that it is not caused by allergic triggers! About half of all people with chronic nose symptoms have non-allergic rhinitis and are usually very surprised to find out that they don’t have “allergies.” Some patients actually have a combination of allergies AND non-allergic rhinitis!

Non-allergic rhinitis patients typically have more complaints of congestion, sinus pressure and thick post-nasal drainage and less of the classic sneezing, itching and clear, watery drainage seen with true allergies. Although all ages can be affected by non-allergic rhinitis, it becomes much more common as we get older.

What are the different forms?
1. Vasomotor rhinitis is triggered by irritants such as strong odors, perfumes, changes in temperature and humidity, smoke, fumes and bright sunlight.
2. Rhinitis medicamentosa is related to overuse of over-the-counter decongestant sprays, such as Afrin. People who over-use these sprays essentially become “addicted” to the medication, needing more and more medication to control their symptoms. Only stopping the medication will resolve the problem.
3. Gustatory rhinitis can be related to food or alcohol intake, but is not due to an allergic cause. Patients experience a profuse runny nose, particularly after eating hot or spicy foods.
4. Rhinitis related to acid reflux disease is particularly common in young children. Symptoms tend to occur after heavy meals or in the morning after the person has been lying flat all night.
5. Medication-induced rhinitis can occur in some patients using high blood pressure medication, birth control pills and non-steroidal anti-inflammatory drugs (such as aspirin and ibuprofen).
6. Hormonal rhinitis can occur during pregnancy and in patients with low thyroid function. Pregnant women usually have symptoms of severe nasal congestion during their second month of pregnancy, and this can persist until the baby is born. Symptoms typically disappear shortly after delivery.
How is Non-allergic Rhinitis treated?

Avoiding the non-allergic triggers listed above is the best way to treat non-allergic rhinitis, but it is not always possible. Typically, non-allergic patients do not respond well to antihistamine pills.

Some helpful medications include both steroid and antihistamine nose sprays. Patients with a constant runny nose and post-nasal drip usually benefit from the drying effect of an anti-cholinergic nasal spray, particularly in vasomotor and gustatory rhinitis.

Rhinitis during pregnancy can respond to saline nose sprays. Rhinitis medicamentosa requires stopping the over-the-counter topical decongestant and usually replacing it with a prescription nasal spray.

Allergy shots (“immunotherapy”) only work for allergic triggers and are not helpful in non-allergic rhinitis.
How is it diagnosed?

A diagnosis is usually based on the history of symptoms, medication use, other known medical problems plus a physical examination. Allergy testing will be negative in patients with non-allergic rhinitis and this testing is usually required to make sure that true allergies are not present.

Nasal Saline Irrigation

Nasal saline irrigation has been shown to be helpful for the prevention and treatment of allergic rhinitis and sinusitis. Saline solution is a natural decongestant (decreases the swelling of the nasal tissue) and it also helps to clean the nasal passages of mucous, pollens, dirt and other irritants.

Dust Mite Allergens

House dust contains a mixture of tiny pieces of fabric, dander, plant matter, and creatures so small that they are not visible to the human eye. These tiny creatures are called “house dust mites”. Dust mites are present in all homes and live in bedding, upholstered furniture, carpet, and stuffed toys. They thrive in hot, humid places (greater than 50% humidity), and feed on the dead skin that falls off the human body, as well as other organic matter. Mite proteins are a very strong allergen (something that causes allergies). If dust mite proteins are inhaled or come in contact with the skin of a person who is allergic, they may cause symptoms such as runny nose, itchy eyes, cough, wheezing, and/or dry, itchy skin.

What is a drug allergy?

A drug allergy is a reaction that happens when the body's immune system responds to a medication as if it were a dangerous invader and tries to fight it off.

The immune system’s job is to fight off infection. Normally, it should not react to a drug as though it were an invader, but some drugs can cause that response in certain people.

The symptoms of a drug allergy can include a skin rash, itching, swelling, or – in severe cases – trouble breathing or a drop in blood pressure that can cause a person to pass out.

A drug allergy is not the same as a drug side effect. Side effects are unintended or unwanted effects that drugs can cause. These effects are bothersome but usually not dangerous. Side effects can affect anyone who is given enough of a drug. Drug allergies, on the other hand, affect only a small number of sensitized people.
How is a drug reaction evaluated?

The safest option is to use an alternate drug. This is the best option if the initial reaction was very serious and it could be dangerous to take the drug again. However in some cases there is no effective alternative.

Sometimes an allergist can do a skin test to the drug. This test can be helpful in some cases to identify a patient who is clearly allergic. However the test is not 100% accurate so many times a drug challenge is ultimately needed.

If you have a reaction that is not too serious (such as a skin rash) your allergist might want to do challenge. For this test, the allergist will have you take a small amount of the suspected drug while they observe you. That way the doctor can find out if you will have the same reaction again. Doctors usually do drug challenge tests only with certain medicines that are used a lot and can't easily be replaced with a different medicine. This is often done with antibiotics as they are important for treating common infections.
How can I control dust mite symptoms?
- Cover mattresses, box springs, and pillows in zippered dust mite proof covers.
- Wash sheets and pillowcases every 1-2 weeks in hot water (120°), and dry in a hot dryer.
- Large blankets/comforters can be placed in a hot dryer for 1 hour to kill mites.
- Keep the humidity level in the home less than 50%. Use a dehumidifier or air conditioner, if needed. Do not use humidifiers or vaporizers unless indoor humidity is less than 20-30%.
- Wood or vinyl floors are preferable to carpet. If carpet is present, vacuum at least weekly when the dust mite allergic person is not in the room.
- Vacuum using a double thickness HEPA filter bag.
- Buy stuffed toys for children that can be washed by machine.
- Limit clutter in the room. Remove most stuffed toys from the child’s bed.
- Wear a mask while you vacuum if you are allergic to dust mites.
- Dust furniture weekly with a damp cloth.
- Cover windows with blinds rather than curtains and clean with a damp cloth.
More Dust Mite Facts
- Dust mites live where people spend most of their time – in beds or in plush furniture.
- Dust mites need food to survive. Their food is your dead skin flakes!
- Dust mites thrive in warm, humid places.
- Dust mites do not live in air ducts in homes. Duct cleaning will not reduce exposure to dust mites. It is not helpful to install HEPA filters on your air conditioner or heater vents for dust mite control.
- Cleaning the home will reduce “dust”; but it will not get rid of dust mites in the bedding!
- Freezing stuffed toys will kill the dust mites but will not remove the dust mite protein (the part that triggers your allergies). These toys still need to be washed in hot water to remove the protein.
- Chemicals and sprays (acaricides) are not needed, and will not have a lasting effect on the number of mites.
- Portable air filters may offer a small benefit but most of the mite allergen is in the bedding, furniture and carpet where the air filters can not clean!

Stinging Insect Allergies

Yellow jackets, honeybees, paper wasps, hornets, and fire ants can all be significant threats to those who enjoy the outdoors. Most people who are stung by one of these insects develop redness, swelling, and itching at the site of the sting. However, a small number of people may actually be allergic to these insects. Symptoms of a severe reaction may include widespread itching and hives, swelling in the throat or tongue, difficulty breathing, dizziness, stomach cramping, nausea, vomiting, or diarrhea. Rarely, patients may even experience shock and loss of consciousness, which may be fatal. If you experience any of these severe symptoms, you should seek emergency medical treatment right away. Following this treatment, a referral to an allergist can help you to learn how to stay safe in the future.

How can I prevent stings?

If a stinging insect is spotted, remain calm and slowly move a safe distance away from it. Avoid wearing brightly colored clothing. Wear closed-toe shoes outdoors and avoid going barefoot. Be careful around food outdoors, including soda and juice, as the smell of food can attract insects. Keep food covered until eaten and watch for insects inside straws or canned drinks.
How do you treat an insect allergy?

Beyond insect avoidance, patients with a history of insect allergy should carry auto-injectable epinephrine and know when and how to use it. An allergist can confirm your allergy through proper testing and offer the best form of treatment. Insect venom allergy shots are a very effective option for most patients.

Drug Allergies

Adverse reactions to drugs are common. (adverse means unwanted or unexpected.) Almost any drug can cause an adverse reaction. Reactions range from irritating or mild side effects such as nausea and vomiting to life-threatening anaphylaxis. A true drug allergy is caused by a series of chemical steps in the body that produce the allergic reaction to a medication.

Eosinophilic Esophagitis

Eosinophilic esophagitis (EoE) is a disease that may mimic typical reflux. In this condition, a type of white blood cell, the eosinophil, appears in high numbers in the lining of the esophagus (the tube connecting the throat to the stomach). Patients with EoE may have a family history of this condition, or other allergic disease such as asthma, nasal allergies, eczema, or food allergy. Symptoms can be similar to heartburn, but may also include difficulty swallowing, a sensation of something “being stuck in your chest,” choking or vomiting, or even an impaction, where food must be removed from the esophagus with the aid of a camera (endoscopy). Currently, the only way to confirm the diagnosis of EoE is by a gastroenterologist taking a biopsy of the esophagus via endoscopy.

What does research say about EoE?

Researchers aren’t sure what causes some people to develop EoE, but for many people, particularly kids, food allergies seem to play a role. Environmental allergies may play a role in some people as well. Allergists can help patients with EoE identify potential triggers and improve their symptoms by educating patients on how to avoid those triggers.
How do you treat EoE?

For many patients, dietary avoidance of identified food triggers may be enough to control their symptoms. Other patients may require medications such as swallowed steroids (typically used for asthma) or specific antacids (known as proton pump inhibitors) to help control their symptoms.