Expert allergist care
for children and adults
Frequently Asked Questions
What is sublingual immunotherapy for airborne allergies and do you offer it?
What conditions do you treat?
We evaluate and treat the following conditions using the up-to-date research and treatment guidelines:
Seasonal and year-round allergic symptoms, including irritation of the nose, eyes, skin, and lungs
Asthma and other recurrent respiratory symptoms
Rhinitis (allergic and non-allergic nasal inflammation) and sinusitis related to allergies
Eye allergies (allergic conjunctivitis)
Atopic dermatitis (eczema)
Insect sting allergies
What does an allergist do?
The word "allergy" was coined from Greek to represent the idea of the immune system making "other" or "different" "action" than a usual physical reaction to our environment. Our field involves identifying and treating abnormal reactions the body makes towards typically normal things. Some people think of "having allergies" as a mild irritation, like sneezing and having a little runny nose to the outdoors. But the field of allergy/immunology has a fascinating diversity of issues, from mild sensitivities to life-threatening and debilitating chronic diseases. The immune system is intricately involved with every system of the body, so we often find ourselves as consultants for multiple health issues in each patient. For example, it is common for a patient of ours to need help with managing life-threatening food allergies, nagging eczema, unpredictable asthma, and exhausting rhinosinusitis.
Some people may need to visit an allergist once, such as for identifying allergic triggers for a milder issue or discussing hypersensitivities that do not require follow-up. On the other hand, we develop long-lasting relationships with many patients who get to know us as well as a primary care physician. For example, caring for the chronic conditions of food allergies or asthma often requires lots of education, fine-tuning our management, regular check-ups, and having an emergency medical contact available for unpredictable reactions or flare-ups.
To become a board-certified allergist, a physician has to complete medical school, a full residency in Pediatrics or Internal Medicine training, and a fellowship training program in Allergy/Immunology. This fellowship provides training in conditions affecting children and adults, so allergists are certified to treat patients of all ages. Because it is common to share a genetic risk for allergic conditions in a family, we often care for multiple family members as we navigate their conditions with time.
In addition to consultation services, we also provide allergy skin or blood testing (when appropriate), spirometry and FENO tests for asthma evaluation, allergy shots ("subcutaneous immunotherapy"), "food challenges" for proving a food allergy does or does not exist, and injections for "biologic" medications that can greatly improve the control of long-term asthma, eczema, and chronic hives (urticaria).
What happens at an allergist visit?
What we do is guided by your story. We pride ourselves in being detail-oriented, active listeners. Expect to discuss your child's history or your history and symptoms at length, and we can then decide if testing will help us understand more about your condition and risks. Skin and/or blood tests investigate for allergy triggers, such as for environmental, food, insect venom, or drug allergies. Breathing tests help us understand if you have asthma, and if so, how severe it may be. Some consultations do not require any kind of test during the visit. For example, there are no proven tests for some food reactions (like sulfite or MSG sensitivity) or drug reactions (like antibiotics other than penicillins), but we understand such hypersensitivities and can discuss them and create a game plan for your future wellness.
What is skin testing?
Skin testing aids in diagnosing a patient's specific allergy triggers. We perform this for different foods, environmental allergens, and penicillin antibiotics. This testing is generally performed on the forearm or the back, applying a small, plastic skin prick device for each allergen we choose to test, based on your history. If you are allergic to a particular item tested, you will develop an itchy bump (hive) in that area in the next 15 minutes of observation in our office. This reaction is like having a mosquito bite, but it often resolves within an hour and is so safe that you may leave the office after we discuss what the results mean for you.
For older children and adults, we sometimes perform a second round of skin testing called intradermal testing. A small amount of the allergen is injected just below the surface of the skin. A hive will form if you are allergic. We can perform this for various environmental allergens, insect venoms, and medications.
*Skin Prick Test Demonstration from Mayo Clinic: https://www.youtube.com/watch?v=atOI5c_uNIs
What is a food allergy?
A food allergy is an immune system reaction occurring shortly after eating a specific food your body incorrectly recognizes as harmful. In response, your immune system triggers cells to release an antibody known as immunoglobulin E (IgE) to fight the allergy-causing food. The most common triggers are peanut, tree nuts, egg, milk, soy, wheat, sesame seed, and seafood. The next time you eat even the smallest amount of that food, IgE antibodies sense it and signal your immune system to release a chemical called histamine, as well as other chemicals, into your bloodstream. These chemicals cause the rapid onset of symptoms that can be severe (called "anaphylaxis"), including rash, hives, itching, swelling, difficulty breathing, vomiting, diarrhea, and sometimes shock. Treatment for an allergic reaction includes an oral antihistamine (such as Benadryl or Zyrtec) and/or epinephrine (adrenaline) with an injector device. We often use blood and/or skin testing with the patient’s history to diagnosis a food allergy. We repeat testing regularly to assess when a patient may have outgrown their allergy, which can happen for many patients. When it appears that the patient has outgrown their allergy, we will perform an "oral food challenge" in our office. This is a lengthy office procedure in which the patient eats the food in gradually increasing amounts under observation. Please contact our office for additional information. See our Education page for great resources on food allergy education.
What is food immunotherapy and do you offer it?
Food desensitization is the process of introducing very small amounts of a known food allergen to a patient with the goal of increasing that patient's tolerance of accidental food allergen exposures. Oral Immunotherapy (OIT) and sublingual immunotherapy (SLIT) are the most available forms of food desensitization. In summary, OIT and SLIT typically involve feeding an allergic individual an increasing amount of an allergen (food protein known to be an allergy risk) every 1-2 weeks. The patient swallows a dose in the office with a safety observation period and takes that amount at home every 24 hours until the next office build-up visit. This build-up phase lasts approximately 6 months in most protocols. Strict compliance with the program is essential for the patient’s safety, because there is a risk of anaphylaxis occurring at home. Food desensitization is not considered to be a food allergy cure and must be continued to maintain tolerance of the allergen. Currently, there is no cure for food allergies.
We started recruiting small numbers of patients in 2021 for SLIT and OIT with different foods. It is going very well and has been exciting to see great progress! Unfortunately, we have to keep our recruitment of SLIT and OIT patients at a slow pace so we do not overwhelm our resources. If you would like to learn more about food immunotherapy and what details will be like in our office, please make an appointment.
*You can find additional information on OIT here https://www.oit101.org/.
What is allergic rhinitis?
Sometimes known as "hay fever", allergic rhinitis occurs when allergens come in contact with the mucus membranes lining the inside of the nose of a person who is sensitive to that particular allergen. Symptoms can include congestion, itching, sneezing, runny nose, and eye irritation.
Rhinitis is frequently aggravated by airborne microparticles we call "allergens", because exposure to these tiny proteins kick-starts classic allergy symptoms. Most patients will have allergens identified by skin tests in an office appointment. However, rhinitis inflammation is not always caused by an environmental allergen. Many patients with nasal or eye symptoms are significantly irritated by triggers that can't be revealed on tests, including respiratory infections, odors, pollution, smoke, weather changes, or nasal polyps. We are equipped to perform testing and consider medications to help us find the best way to manage your symptoms for allergic or nonallergic rhinitis. Check out this education link for more information.
Subcutaneous immunotherapy, a.k.a. "allergy shots", are tiny injections given in series over five years that help most people reduce their nasal allergies, asthma, and sometimes eczema and eye allergies. The purpose of subcutaneous immunotherapy is to decrease your sensitivity to airborne allergens, functioning like vaccines so future allergen exposures result in less severe and sometimes no symptoms. They are also used as the recommended treatment of insect sting allergy, since they sharply reduce the risk of anaphylactic reactions to baseline for most people. Allergy shots for airborne allergens do not replace our other forms of treatment for allergy symptoms, so we still teach allergen avoidance and using medications during the process until symptoms become more controlled over time. Check out this link for more information about allergy shots.
How do allergy shots work?
The allergy shot is a mixture of the allergens you are allergic to (confirmed on skin and/or blood testing). We start with a diluted mix and gradually increase the concentration of the allergen with each injection over time. This leads to a gradual decrease in allergic antibodies, or proteins in the blood that can trigger your bothersome symptoms. The end result of this is an increasing tolerance of the allergen(s). While a great majority of our patients see improvement in their symptoms, a small number may not be able to tolerate this therapy.
Improvement in your allergy symptoms is not immediate. It may take over six months to see initial improvement, and benefits may not be evident for 12-24 months. Most patients will feel significantly better on allergy shots, which means that symptoms are reduced or eliminated.
The dose is injected with a very small needle in the shallow subcutaneous tissue on the back of your upper arm or arms. The content of the shot serum and number of shots needed depend on results of your allergy tests. Doses are given in the office, because we need to observe you for 30 minutes when the risk of an allergic reaction is present, though small. Appointments are not necessary for simple injection visits. Doses are increased on a regular basis, every 3-7 days, until your full-strength allergy shot ("maintenance dose") is achieved. Once you achieve your maintenance dose, you will receive this dose every 4 weeks. The time it takes you to achieve a maintenance dose will vary but typically takes 6-12 months. The process can be delayed if you miss shots due to illness or other disruptions, such as vacation or other time commitments. If you experience allergic reactions to your shots, we may need to reduce your dose and rebuild your desensitization, which is often successfully tolerated. We encourage strict compliance with the recommended schedule to save you both time and healthcare costs. It is currently recommended that immunotherapy be continued for a period of 3-5 years, at which point the need for further allergy shots is reassessed. It is very important to have an annual follow-up visit with your allergy healthcare provider during this time.
What is cluster immunotherapy and do you offer it?
Our clinic offers cluster immunotherapy as an alternative to conventional allergy immunotherapy. Clustering shots helps you to achieve your maintenance dose more rapidly, decreasing the number of visits to the office and allowing you to experience the benefits of immunotherapy sooner. Depending on the strength of the allergy shot dose, two to three doses of allergy shots may be received in one visit, waiting a minimum of 30 minutes after each dose. There is an increased risk of anaphylaxis, a life-threatening allergic reaction, when a patient undergoes cluster immunotherapy. We require patients to carry an automatic epinephrine injector with them (AuviQ, EpiPen, etc.) on days of clusters of injections. Due to the high risk involved, there is an increased cost that is charged through your insurance. You will be responsible for any charges not covered by insurance. We reserve the right to stop cluster immunotherapy at any time. We do not offer "rush" immunotherapy, which accelerates dosing very quickly over very few visits. This can be done successfully when done correctly, but most allergists do not offer this due to the time and risk involved. Please call our office if you would like to learn more about cluster immunotherapy.
What is sublingual immunotherapy for airborne allergies and do you offer it?
Sublingual immunotherapy (SLIT) is a way to treat allergies by administering a small dose of allergen in tablet or liquid form under the tongue.
Currently, the only FDA-approved therapies for environmental allergies are Odactra (dust), Oralair (grass), Grastek (grass), and Ragwitek (ragweed). Click on the name of each product to learn more from their website. We provide SLIT for these products, but we do not offer SLIT for other airborne allergens that are not approved by the FDA, like animal dander and molds. Non-FDA-approved SLIT is usually not covered by insurance, and we have less data about their effectiveness long-term.
What is asthma?
Asthma is a chronic lung disease in which airflow in and out of the lungs may be blocked by muscle squeezing, tissue swelling, and excess mucus. Patients with asthma may have an increased response to factors in the environment, called triggers, which do not affect non-asthmatics. Triggers can include allergens, smoke, pollutants, strong odors, changes in weather, illness, exercise, medications, food, emotional stress, and reflux. In response to a trigger, an asthmatic's airways become narrowed and inflamed, leading to shortness of breath, chest tightness, wheezing and/or coughing. The goal of treatment is to manage symptoms so that you do not have to change your lifestyle to suit your asthma.
*Additional information: https://www.aaaai.org/conditions-and-treatments/asthma
How will you determine if I have asthma?
This diagnosis is made by evaluating a patient's symptoms, performing a physical exam, and undergoing breathing tests. We offer two kinds of asthma tests that are best performed by adults and children with very good respiratory coordination, usually over five years of age. One common pulmonary function test is called spirometry. This test measures the volume of air in the chest and the flow of air through a patient's airways. Results are compared to expected normal values. We often repeat this test at follow-up appointments or if a medication has been started or changed in order to measure a patient's response. We may also use another breathing test called fractional exhaled nitric oxide (FeNO). This measures the level of inflammation within the lungs and is helpful in guiding medication therapy.
***Due to the COVID-19 pandemic, we are offering spirometry and FeNO for most patients. These procedure require deep breathing techniques that can spread respiratory droplets over a wide area. We will offer these routinely again when the pandemic is more controlled. We can administer these in a safe way for select patients during the pandemic, but this will depend on the status of each patient and the discretion of the medical practitioner.
Atopic dermatitis is commonly referred to as eczema. Symptoms of this chronic skin inflammation include itching, redness, thickening, and flaking or peeling of the skin. Symptoms begin in early childhood for 80% of patients. Dermatitis often precedes other allergic disorders such as asthma, food allergies, and environmental allergies. This is often referred to as the “atopic march”. Treatment includes a good skin care regimen which include avoiding skin irritants and allergens, moisturizing aggressively and frequently, and sometimes using topical, oral, or injectable medications. See the first link for a good intro to eczema, and the second link is a video for additional information:
Urticaria (hives) and Angioedema (swelling)
Urticaria are itchy, red bumps that can be large or small and may occur as single areas or in groups. Some triggers include infection, foods, insect stings, or medications. Angioedema is a big word for a type of swelling, which may occur with hives or can occur alone. It commonly occurs on the face, eyelids, and lips but can be present in other areas of the body. Some treatments that can be used include antihistamines, oral steroids, and injectable medications.
*See this video for additional urticaria/hives information: https://www.aaaai.org/conditions-and-treatments/videos/skin-allergy/chronic-urticaria
Penicillin and Other Drug Allergy (see our Penicillin Allergy page for more info regarding our office procedures)
Penicillin is an antibiotic class that is commonly prescribed to treat bacterial infections. Amoxicillin is a penicillin antibiotic that is commonly used in people of all ages and frequently causes side effects. A penicillin allergy occurs when your immune system reacts against the antibiotic, mistaking the antibiotic for a harmful substance. Common symptoms of penicillin allergy include hives, rash, and itching. Severe reactions include anaphylaxis, a life-threatening condition that affects multiple body systems. This website offers good FAQ info about penicillin allergies: https://www.aaaai.org/conditions-and-treatments/library/allergy-library/penicillin-allergy-faq
There are also many types of adverse reactions to drugs that are not true allergies but may still cause mild to severe side effects if the medicine is taken again. We take time at an office visit to review the history of a suspected drug reaction in detail so we can decide if further evaluation and avoidance are warranted.
Research has shown that penicillin allergies may be over-reported, a problem that can result in the use of less appropriate and more expensive antibiotic treatments. This makes an accurate diagnosis of penicillin allergy even more important. Penicillin allergies also may be outgrown, even as early as five years from the allergic reaction. In our office, we can perform a penicillin testing procedure to determine if a true allergy exists. First, you will have an appointment with a provider to establish the history in detail. If appropriate, you will return at a separate, longer visit for skin testing and then a "drug challenge" if the skin tests are normal. The challenge involves taking a dose of the penicillin antibiotic in our office. We will monitor the patient over a prolonged period for any sign of allergic reaction.
Though there is no standardized testing for antibiotics other than penicillins, in some cases we perform other drug challenges in our office. Please contact our office or make an appointment for if you would like to discuss your specific case and treatment options in detail.