Allergy: Frequently Asked Questions
What is an Allergy?
An Allergy is a condition in which one’s body reacts in a specific and undesirable way to a substance to which it should not react. The word ‘allergic’ is a very specific term used to describe a sensitivity to an allergen that causes the release of histamine (and other substances) that lead to the symptoms you know of as ‘allergies’ (itching, stuffy nose, sneezing, etc). In contrast, a ‘sensitivity’ is a condition in which a person reacts to a substance in an undesirable manner without being technically allergic to it. A person can be sensitive to several substances in that they cause irritating symptoms without being truly allergic to these substances. This is despite the fact that the symptoms caused by the sensitivity may be very similar to true allergic symptoms. This difference is important because true allergy is often treated differently than sensitivity. We can do tests to differentiate allergies from sensitivities.
What is an Allergist?
An allergist is a physician who attended medical school followed by a three-year residency in Internal Medicine or Pediatrics. To become an allergist requires two additional years of subspecialty training wherein the intricacies of adult and pediatric allergy and immunology are learned.
What does an allergist treat?
Of course, allergists treat hay fever (allergic rhinitis), sinus problems and other nasal and eye allergies but allergists are also specialists in the treatment of asthma and immunologic diseases. Some other allergic conditions allergists treat are medication allergy, insect allergy, food allergy, chronic cough conditions, hives and other rashes, chronic or recurrent sinus infections, and a multitude of other conditions. Allergists are also expert in the management of non-allergic nasal symptoms.
Are ENT (ear nose and throat) doctors and Allergists the same?
No. ENT doctors are excellent at the surgical treatment of ear, nose and throat problems. The ideal situation is one in which your allergist and ENT work together to manage your nasal, sinus and ear symptoms. The correct diagnosis and treatment of allergy, asthma and immunologic deficiencies is a subtle art that requires subspecialty training for maximum competence.
What is involved in allergy testing?
Skin testing is the method by which we discover to what you are (and are not) allergic. Essentially, substances that are common allergens (pollen, mold, dander, and food) are placed on the back and the skin is pricked, disrupting the top layer of skin cells (the skin is not broken and no blood is drawn). The pricking process takes about a minute. The skin rests for 15-20 minutes then is evaluated to see if there are any reactions. Reactions consist of small areas of redness that fade over minutes to hours. There is no scarring and the test is not painful, although if you are allergic you will probably experience some temporary itching (which we will treat before you leave).
I’ve heard of blood testing for allergies, does it work?
Well, it sort of works. Blood testing for allergies is less sensitive (misses some allergies) and less specific (overestimates some allergies) when compared with skin testing. Blood testing is also open to more error in interpretation than is skin testing. Blood testing is appropriate in some clinical situations for some patients that can be explained by the doctor but the vast majority of patients are better served by skin testing.
Does skin testing hurt?
No. The pricking sensation is similar to placing a fingernail to your skin to cause a slight indentation. If you are allergic, you may have itching but this is treated before you leave. Small children may cry when the pricking is done but this is typically due to their being frightened by the strangeness of the situation rather than being hurt.
What if my skin test is positive?
If your skin test is positive, you will be counseled about what items to which you are allergic. Some allergens may be avoided. There are some environmental measures that can be done to limit exposure to some allergens. Results of testing will help guide medication recommendations as well as whether or not you may benefit from allergy shots
What if my skin test is negative?
That is good news. Nevertheless, clearly you have symptoms or you would not have sought out an allergist in the first place. Knowing that you do not have allergies will help us to make recommendations regarding how to control the symptoms that are bothering you
Is knowing what I am allergic to important if I have asthma or eczema?
Yes. Skin testing can help identify triggers for both of these conditions and help you know what you need to avoid. Treatment of allergies with medications and allergy shots can help in the control of both of these conditions.
Does everyone with positive allergy tests need allergy shots?
No. Medications and allergen avoidance will work in many cases. Also, if allergy tests are negative, obviously allergy shots will not help.
Why would I want allergy shots and how do they work?
Allergy shots are the closest thing we have to a cure for allergies. The purpose of allergy shots (or Immunotherapy – IT for short) is to retrain your immune system to not react to things to which it should not be reacting. Allergy shots work for pollens, molds and environmental allergens but not yet for food (although research is being done in this area). IT markedly improves allergy symptoms in excess of 85% of patients treated with recommended doses of allergens by trained allergists. Treatment with IT can help reduce your reliance on allergy medications and new evidence suggests that treatment with IT can inhibit the development of new allergies. Many patients view allergy shots as a more natural alternative than daily medications (and in many cases less expensive and less hassle).
What is involved in getting allergy shots (IT)?
If you desire IT, your skin test results are reviewed so that an allergy extract can be tailor made for you to counter your specific allergies. Shots are then given (usually in the arm) in escalating doses (very, very small doses at first) at intervals of either twice weekly or weekly until you have built up to a full dose (usually takes several months). After reaching your full target (or ‘maintenance’) dose, shots may often be spaced out to every other week or even monthly. Some patients find that they feel better if they continue to take shots weekly. A newer process called ‘RUSH’ immunotherapy shortens the time it takes to get to maintenance doses of allergy extract and provides somewhat quicker relief of symptoms. This is accomplished by giving several allergy shots in one day during an all-day visit at the office. While very effective and generally well tolerated, the reaction rate is higher for RUSH immunotherapy, at least in the beginning of treatment.
Are allergy shots safe?
In general, very safe. Because you are being given an extract to which you are allergic, there is always the chance of a reaction. Usually these are mild but occasionally they can be severe (although they are always treatable). Because of this, you must wait in the office 20 minutes after your shots so that if you have a reaction, you are where we can immediately help you. If you live far away you may want to get allergy shots at a local doctor, but you will still need to wait in their office for 20 minutes after the shot to be safe.
I’ve heard of people giving themselves allergy shots at home. Can I do this?
Unfortunately, no. Many years ago doctors used sub-optimal doses of allergy shots that never caused reactions but also seldom worked correctly or adequately. The governing bodies that oversee the administration of allergy shots have all agreed that shots must be given only in a doctor’s office with an adequate waiting and observation period after each shot. This is to protect you and your family.
Are there any new treatments on the horizon?
The field of allergy is developing rapidly and exciting new therapies are just around the corner. Dr Haden has been involved in more than 40 research studies in the past few years helping evaluate some of these new treatments. Stay tuned.
Where can I find more information of allergies and their treatment and asthma and immune deficiencies?
Reliable information can be obtained from the American Academy of Allergy, Asthma and Immunology and the American College of Allergy, Asthma and Immunology. Of course, our office is always happy to answer any questions you may have.