Frequently Asked Questions 
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What is an allergist-immunologist?
Allergists and asthma
Sinusitis
Allergy shots
Urticaria (hives)
Atopic Dermatitis (eczema)
Food Allergies
Cough
Contact Dermatitis
What is an allergist-immunologist?
An allergist-immunologist is a physician who has specialized in either internal medicine or pediatrics, and then has taken additional training of at least two years in the field of allergy-immunology. All physicians in our practice are diplomats of the American Board of Allergy and Immunology, meaning that they have trained at accredited programs following strict training guidelines, and then have taken and passed a rigorous specialty board examination.
Allergists are trained in performing and interpreting several diagnostic procedures, including allergy testing (both skin testing and laboratory testing), pulmonary function and bronchoprovocation testing for asthma, food and drug allergy testing, drug desensitization, allergen immunotherapy (allergy shots), and testing of the immune system. In addition, they possess in-depth understanding of the management of several recurrent or chronic conditions, including allergic rhinitis, asthma, chronic cough, eczema, hives, angioedema, and acute and chronic sinusitis. The allergist-immunologist can provide education, including explanation of the disease process, risk and benefit of medications, and regular monitoring of individuals afflicted with the above problems.
Allergists and asthma
Asthma is a chronic condition affecting the lungs, causing inflammation inside the airways, as well as bronchospasm (constriction of the muscle around the airways). The cause of asthma is unknown. Those with asthma often have certain “triggers” that lead to attacks or asthma symptoms. This may include respiratory illness, air pollution, inhalation of cold air, exercise and allergies. Allergists have undergone rigorous training to evaluate for asthma triggers, and are experts in the diagnosis of allergic asthma and it’s treatment. We are able to perform pulmonary function testing in our office, and also have nebulizers to treat acute asthma attacks. An allergist can test for allergic triggers and educate patients in their avoidance, as well as provide regular care and follow-up for those suffering from both allergic and non-allergic asthma.
Allergen immunotherapy (allergy shots) can be a very useful adjunctive treatment for allergic asthmatics, and allergists are specifically trained in the proper prescribing and administration of allergy shots. There is also some evidence that allergy shots can prevent the development of asthma in children. Studies have also shown that asthmatic patients that receive care by an allergist have reduced emergency room visits, reduced rates of hospitalization, decreased asthma symptoms and improvement in their asthma-related quality of life.
Sinusitis
The sinuses are the normally hollow, air-filled cavities in the skull, located in the forehead area, behind the eyes and behind the cheek bones. Sinusitis refers to inflammation of the tissues in these areas, and can occur for a variety of reasons, including infection, medications, and anatomical reasons. In addition, chronic, undertreated allergies can ultimately lead to sinusitis.
While both otorhinolaryngologists (ear, nose and throat specialists) and allergists evaluate and treat patients with chronic and recurrent sinusitis, there are vast differences in their training. Otorhinolaryngologists are surgeons, and are trained in assessing the need for surgery and performing the operation in severe cases of chronic sinusitis. Allergists are not surgeons, but rather can evaluate if there is an allergic reason for the recurrent infection or inflammation, as well as perform testing to evaluate the competence of the immune system. Allergists and otorhinolaryngologists often work together to provide comprehensive care to those with chronic and recurrent sinusitis.
Allergy shots
Allergy shots, or allergen immunotherapy, is a form of treatment that involves administering (by injection) extracts containing the environmental allergens that an individual is sensitive to. In other words, once the allergist determines your allergic triggers, extracts of those particular triggers are used. Over time, your body develops a protective response, and when exposed to these environmental triggers, your allergy and/or asthma symptoms will be less severe.
Allergy shots should be considered in those that are not controlled by medications alone or are requiring excessive medications to control their symptoms, as well as in those who experience side effects of medications or have comorbidities of allergies (asthma, chronic sinusitis, serous otitis media).
Allergy shots can also be administered to those with history of severe allergic reactions to insect stings from bees, wasps, yellow jackets, hornets and fire ants. Allergy shots are not indicated as treatment for food allergies.
Urticaria (hives)
Urticaria,
or hives, are quite common in the general population. Those that come
on rapidly and resolve quickly are often due to an underlying allergic
cause, and may be brought on by triggers such as foods, environmental
allergies, insect stings or medications. Allergists are well-trained to
work with patients to diagnose and treat allergic urticaria, as well as
educate in avoidance measures to decrease future sympoms.
In addition, long lasting, chronic hives are often not due to an
allergic cause, and may be related to other underlying conditions. The
management of chronic urticaria is often frustrating for both the
patient and the healthcare provider, and may involve trying several
different medications. Allergists can help to rule out other underlying
conditions causing or contributing to the urticarial outbreaks, and
have vast experience in the medical management of hives.
Atopic Dermatitis (eczema)
Atopic Dermatitis, also known as “eczema”, is one of the most common rashes of childhood. It is chronic, and can be a challenging condition for both the person suffering with this rash and the care providers. The involvement of an allergy specialist is helpful in confirming the diagnosis in difficult cases and in identifying triggers, including environmental allergens and foods, that might be aggravating the condition. In approximately 1/3 of more serious cases, a food allergy is an important trigger. Management continues to require regular use of moisturizing agents and anti-inflammatory medications for exacerbations. Patients with eczema often go on to develop other allergic conditions including allergic rhinitis (e.g. “hayfever”) and asthma. An allergist is capable of providing comprehensive care for all of these conditions.
Food Allergies
Eating should be one of the great simple pleasures of life. Unfortunately, food allergies are becoming an increasingly common problem. Additionally, the reactions can be life-threatening. There are varying types of food reactions, and misperceptions about food allergies are rampant in the public at large.
One common misconception is that developing hives after food ingestion is not serious. In fact, a person who has had hives after food ingestion is at notable risk for a more severe food reaction. Characterizing types of food reactions and specifying the foods of concern is essential. The allergist can also navigate the food allergic individual away from potentially cross-reactive foods and discuss food safety. Identification of food allergens, teaching, setting up networks of support, discussing repercussions of diagnosis, and the use of emergency epinephrine are all cornerstones of food allergy evaluation.
Some food-allergic individuals lose their food sensitivity over time. An allergist is able to track, identify and confirm the loss of sensitivity in these individuals. Moreover, we often identify individuals who have been needlessly avoiding foods and are able to expand their diets. When there is a strong family history of food allergies, the allergist can provide guidance to the expecting parent. There are a number of dynamic early studies ongoing in food allergy spreading optimism about future modalities to control food sensitivities.
Cough
A cough is the body’s way of removing mucus, irritants and fluid from the airways, and therefore is not always indicative of a serious medical problem. A cough that is present less than three weeks that is not associated with shortness of breath is most often secondary to a viral infection and usually does not warrant medical attention. However, a cough which persists longer than three to four weeks or occurs during sleep should be evaluated.
Cough is one of the most common complaints that an allergist treats in the office. Chronic cough can be secondary to a number of conditions. The most common causes of chronic cough are postnasal drainage, asthma and gastroesophageal reflux disease (GERD), or acid reflux disease. Postnasal drainage occurs when mucus from the nose and/or sinuses travels to the back of the throat, and can be due to allergies, irritants or a chronic sinus infection. Cough is a common symptom of asthma, usually along with wheezing and shortness of breath. In children, however, cough is often the only asthma symptom noted. Similarly, acid reflux may present with cough alone and no other typical “heartburn” or gastrointestinal symptoms. Less common causes of cough can include lung conditions, infections, or certain medications.
Allergists have extensive training in the evaluation and treatment of chronic cough in both children and adults. A detailed history, allergy skin testing, lung function testing and radiologic studies can all be helpful in the diagnosis. At times, there may be several etiologies for a cough, and allergists can successfully treat all of them.
Contact Dermatitis
Contact dermatitis is a rash that is caused by a substance which comes in direct contact with the skin. The majority of cases are due to an irritant effect of the substance, but about 20% are due to an allergic reaction. Common, well-known causes of allergic contact dermatitis are poison oak or ivy, latex and nickel, but other common chemicals that may be implicated are those added to many cosmetics and perfumes. In addition, the rash may be due to chemicals used in the workplace, and allergic contact dermatitis is the most common occupational disease.
Contact dermatitis can mimic eczema by the fact that both rashes are very itchy and often similar in appearance. Differentiation and diagnosis can be difficult, but allergists are experts in identifying and treating contact dermatitis. We sometimes perform patch testing to common allergens in order to determine the causative agent, as avoidance of the allergenic substance is the best treatment for allergic contact dermatitis. Allergists can also prescribe medications such as antihistamines and corticosteroids to provide symptomatic relief.
Disclaimer: The content on this website is for informational purposes only. This content is not meant to replace the advice of a trained medical professional. If you have any questions about the content, please contact the practice. In case of a medical emergency, call 911.