How do I know whether an Allergist or an ENT (Ear, Nose & Throat or Otolaryngologists) specialist is the best specialist for me? Aren’t Allergists and ENTs the same type of doctors? At Charleston Allergy & Asthma these are common questions patients ask us. Board-certified Allergists and ENTs are different types of doctors with different training paths and areas of focus.
Charleston Allergy & Asthma’s providers are all board-certified Allergists and Immunologists. To become a board-certified Allergist, medical school graduate physicians must complete a three year residency in pediatrics or internal medicine and then pass a rigorous written examination to become board certified in pediatrics or internal medicine. Following residency, the physician will continue training in a two to three year Allergy and Immunology fellowship followed by passing a second board certification examination. The Allergy and Immunology fellowship focuses on disorders of the immune system that lead to allergies, asthma, chronic lung disease, skin diseases, and immune deficiencies that can lead to recurring and life-threatening infections.
Because of an allergist’s extensive medical training in pediatrics or internal medicine, they are best equipped to discover the most relevant allergens and recognize other conditions that can masquerade as allergies; however unlike ENT’s they do not practice surgery. Lifestyle and environmental modifications, medications and allergen immune therapy are most commonly used to treat patients. Charleston Allergy & Asthma physicians follow nationally accepted guidelines for allergen immune therapy (allergy shots), as well as, FDA approved oral allergy therapy for grass or ragweed that are both tailored to provide the patient with the maximally effective dose to maintain long lasting improvement in allergy symptoms, reducing medication use and improving quality of life.
According to the American Association of Otolaryngology – Head and Neck Surgery, “otolaryngologists are physicians trained in the medical and surgical management and treatment of patients with diseases and disorders of the ear, nose, throat (ENT), and related structures of the head and neck.” These physicians train in a five year residency with focus on hearing loss, ear ringing, balance disorders, nasal polyps, deviated septum, chronic sinus disease, voice, swallowing, cancers and injury. Much of their training is spent in surgical areas of care. After residency training, they must pass an ENT specialty specific examination to become board certified in Otolaryngology. Otolaryngologists can pursue additional training in a number of areas, including allergy.
The American Academy of Otolaryngic Allergy (AAOA) requires the physician complete four courses (three days in length) in allergic diseases and manage 10 patients on immune therapy before being eligible to take their examination and earn AAOA “certification.” Due to the substantially different training, AAOA recognized ENTS are not eligible to take the exam offered by the American Board of Allergy & Immunology or be recognized by the American Board of Medical Specialties as an Allergist/Immunologist.
Allergists and ENTs frequently work together to take care of patients. Allergists often refer to ENT physicians for assistance when there are structural problems or surgery may be the best option. Allergists are your best option if you would like to avoid surgery, explore other available treatments or have immune system related issues such as asthma, insect allergy, food allergy, medication allergy, recurrent infections or concern of immune deficiencies.
Children can be allergy tested at any age. Even newborn infants can make allergic antibodies that result in allergic reactions. These antibodies can be detected by allergy skin tests or allergy blood tests. While hayfever is relatively uncommon in infants, allergies to foods, insect stings, or indoor allergens such as dust mites and animal dander occur and can be detected with allergy testing. These tests can be helpful in guiding dietary restrictions, environmental avoidance measures, and medical therapy for children of all ages. Infants and toddlers with recurrent wheezing are more likely to have persistent asthma as they grow up if they have allergies to airborne allergens which can be detected by allergy testing.
Allergies to airborne allergens such as dust mites, molds, animal danders, and pollens will often develop over the first several years of life. Because of this, it is common to wait until a child is at least 1 year old before testing for allergies causing nasal symptoms such as hayfever or sinusitis. On the other hand, there is no medical reason why children with bothersome nasal symptoms cannot be tested before 1 year of age. Children with recurrent wheezing, reactions to foods, eczema, or reactions to stinging insects may require allergy testing during infancy.
Symptoms of nasal allergies and viral upper respiratory tract infections can look similar and can be difficult to differentiate. Both problems can cause nasal obstruction, clear to yellowish runny nose, sneezing, and postnasal drip. These symptoms can be particularly common in children less than 5 years old who have frequent viral symptoms during the fall and winter viral season. Viruses usually last 4-7 days, more prolonged symptoms would indicate sinusitis or nasal allergies.
The presence of significant fever would indicate infection – allergies do not cause fever although for many years, allergic rhinitis was termed “hay fever.” One clue that nasal symptoms are allergic is the presence of nasal itch. Frequent rubbing of the nose can actually cause a small skin fold or line to develop (transverse nasal crease) when frequent rubbing of the nose flexes the nose. Additionally, eye symptoms of redness, clear discharge, and intense itch are very suggestive of allergic rhinitis and conjunctivitis. The consistent recurrence of nasal and eye symptoms during certain high pollen seasons in the spring and the fall usually indicates pollen allergies. Finally, a strong family history of allergic rhinitis, eczema, or asthma – added to any of the above symptoms – would point strongly to upper airway allergies.
See your board certified allergist for a proper diagnosis of exactly what’s triggering your symptoms and a treatment plan specifically targeting those allergens.
In general, allergy shots will provide greater relief of allergies for most patients. Unlike the allergy oral tablets, allergy shots can be tailored to a specific patient’s allergies. Allergy shots can include effective doses to most or all of the different substances to which a patient is allergic in order to desensitize them to each allergen (i.e. animal dander, pollens, dust mites, mold, etc.). Allergy shots can provide long lasting relief of allergies, reduce development of new allergic sensitivity and potentially reduce the development of asthma with decreased need for medications. After a course of immunotherapy patients can come off shots with ongoing relief.
It is important to see a Board Certified Allergist/Immunologist (a recognized subspecialty of both Internal Medicine and Pediatrics) when making your allergy and asthma healthcare decisions. Allergist/ Immunologists are trained in interpretation of laboratory and skin tests, know the effective allergen doses required and which can be combined together safely.
Allergy immunotherapy also known as “allergy shots” works by gradually exposing the patient to increasing doses of the substances to which he or she is allergic. Allergy shots are made up of allergy extract that desensitizes the patient so that over time their allergy symptoms are reduced or even eliminated. While allergy medications might control symptoms, when you stop taking medications, your allergy symptoms will return. Allergy immunotherapy on the other hand is the only treatment that can lead to permanent remission of your allergies.
After completing a course of immunotherapy, many patients can stop immunotherapy and still have excellent ongoing relief. Research shows that allergy immunotherapy can also help prevent the development of new allergies and asthma. Allergy immunotherapy has been proven to be effective in treating allergic rhinitis (hay fever), allergic asthma, insect sting allergy, and atopic dermatitis. Charleston Allergy & Asthma prescribes high dose allergy immunotherapy in line with guidelines from the ACAAI and AAAAI national allergy societies. Use of high dose allergy immunotherapy maximizes both the immediate benefits and the duration of those benefits.
Allergy shots should be considered for people who do not respond completely to treatment with medications, who experience side effects from medications, who do not want to take medications indefinitely, who have allergen exposure that is unavoidable, or who desire a more permanent solution to their allergic problem. For many patients, allergy immunotherapy can be a great option that allows them to come off of their allergy medications and to achieve long lasting relief.
In fact, published economic studies demonstrate that allergy shots can yield savings to insurance plans by reducing the number of sick visits and medications used over a 5 year period. Allergy shots also become less expensive over time as the number of shot visits and amount of extract purchased decreases year after year. Once the shots are discontinued the benefit goes on for years after at no additional cost.
Some providers have offered allergy drops under the tongue in order to try to treat multiple, different allergies. These providers use the immunotherapy extracts that are approved for allergy shots and allow patients to use them by mouth. It is difficult to get high enough doses under the tongue with multiple allergens to be effective. Additionally, since these extracts are not FDA approved in the United States for oral use they are not covered by health insurance.
These sublingual tablets are a safe & convenient option for patients who are only allergic to grass or ragweed or for those patients who have one of these allergens as their major allergic trigger. There is some risk for an allergic reaction to the tablets so it is recommended that the first dose be given in a medical facility with a 30 minute wait time afterwards. The subsequent doses would be given at home, but it is recommended that patients have a self-injectable epinephrine device (EpiPen or AuviQ) available in case of a severe allergic reaction. To be effective, the doses must start 3 months before the pollen season.
If you have multiple allergies, like the majority of patients who seek medical care, this type of immunotherapy will only work on the specific allergen treated and is not known to be effective for other allergens. In addition, studies have not been done on patients with moderate or severe allergic asthma. Please keep in mind that it is uncommon for people to be mono allergic, meaning allergic to only one allergen. Most people, especially in the South, are poly allergic, allergic to multiple allergens.
The FDA has recently approved the first formulations of sublingual immunotherapy (SLIT) in the United States. Currently approved are two different formulations one for grass allergy and one for ragweed. It is likely that a formulation to treat dust mite allergy will also be approved in a couple of years. These come in the form of a dissolvable tablet that is placed under the tongue daily. Similar to allergy shots, sublingual immunotherapy exposes patients to the substances which they are allergic to in a way to decrease their sensitivity over time.
Allergy shots are usually given in the back side of the upper arm just under the skin. They are not as painful as a flu shot or other vaccination. The needle is typical of what is used for insulin injections. Even young children rarely have issues with the pain from the shot. Charleston Allergy & Asthma nurses witness children and adults receiving shots with little concern for pain daily. Having a small local reaction of redness and itching in the hours after the shot is somewhat common but well tolerated by most patients.
It can be difficult to determine if your nasal symptoms are secondary to allergies or from a sinus infection or structural abnormality. Allergy symptoms can be seasonal or year-round and can last months at a time, just as a chronic sinus infection can. A careful medical history, physical exam, allergy testing and, at times, a Sinus X-Ray or CT scan, can help define the cause of the symptoms.
Chronic sinusitis symptoms can interfere with your daily life and many people who suffer from this condition find it difficult to concentrate at work or enjoy social activities. Seeking the help of a board certified allergist is essential to finding the underlying cause of this chronic health problem. Call us to help you find you relief!
The allergist will conduct a medical history, including an assessment of your symptoms and a relevant physical exam to look for polyps or changes in the anatomy of the nose (if necessary, a CT scan will be ordered). The allergist may also conduct skin testing to determine which triggers are causing nasal swelling. Once the allergist knows the triggers that are causing your chronic symptoms, a treatment plan will be recommended. Most treatment plans include:
When the underlying cause of chronic sinusitis is treated effectively, it frequently disappears or becomes less of a problem. Since allergies can lead to chronic sinusitis, immunotherapy (allergy shots) is the most effective long-term approach towards a cure. In essence, it is a vaccine against allergies. As you receive immunotherapy, you gradually decrease your sensitivity and build up a tolerance to your allergens.
Sinusitis is an inflammation of the sinuses, the hollow cavities within the cheekbones, around your eyes and behind your nose. It is often caused by a bacterial infection and may occur following a respiratory infection such as the common cold. When something blocks the mucus in these cavities from draining normally, an infection can occur. People with allergic rhinitis (allergies) or asthma are more likely to suffer from chronic sinusitis because the airways are more likely to become inflamed when allergies or asthma are present.
Acute Sinusitis refers to sinusitis symptoms lasting less than 4 weeks. Most cases begin as the common cold. Symptoms often go away within a week to 10 days, but in some people, a bacterial infection develops and antibiotics may be required.
Chronic Sinusitis is often diagnosed when acute symptoms have gone on for more than 8 weeks despite medical treatment.
Approximately one in four individuals in the United States feels that they have an allergy to food. With closer scrutiny for food allergy however, the actual number of individuals with food allergies confirmed is about 2-3% of adults and 6-8% of infancy and young children. The reason for this disconnect between perception of food allergies and confirmed food allergies is the fact that adverse reactions to foods can be caused by a number of different mechanisms. Food reactions can be caused by bacteria or toxins in food, food additives or preservatives, or food intolerances such as lactase deficiency.
The term “food allergy” is reserved for immunologic sensitivity to foods, usually caused by the allergy antibody, IgE. IgE food allergy in children and adults is usually caused by milk, egg, peanut, soy, tree nuts, or seafood (fish, crustaceans, mollusks). Typically, IgE-type food allergy reactions occur within two hours of ingestion of the food and can be manifested by a variety of symptoms including hives, swelling, flushing, itching, swallowing or breathing difficulty, and vomiting or diarrhea. IgE-mediated food allergies can be fatal (usually from peanuts or seafood). Food allergy reactions can also be caused by proteins present in certain fruits, vegetables, or nuts which cross react with inhaled pollens to which the individual is allergic (oral allergy syndrome).
Food allergy is usually confirmed by careful history and testing, either by skin testing or blood testing termed RAST testing. Positive skin tests and positive RAST tests to foods do not necessarily confirm clinical sensitivity, particularly if values are on the low side. At times a graded oral challenge is necessary to confirm clinical sensitivity to ubiquitous foods that are difficult to avoid. Recently, testing to individual allergenic proteins in foods has become available and this new protein component testing can aid with determining clinical sensitivity and the possibility for safe ingestion of foods to which the patient is allergic – if extensively heated (baked).
Therapy for food allergies includes complete avoidance of specific food allergies while assuring nutritional needs for the allergic individual, particularly infants and small children. Very small amounts of foods to which the patient is allergic (as little as 1/1000 of the peanut) can cause generalized food reactions in sensitized individuals. Education is required to teach families about hidden food allergens in a variety of foods. The patient also needs an automatic epinephrine injection device and a food allergy action plan for school or daycare. Allergic reactions to foods usually occur away from the home environment, usually in restaurants, parties, or at school. With individuals who have confirmed food allergies, periodic reevaluation is important to monitor for possible loss of clinical sensitivity (70-80% individuals with soy, eggs, and cow’s milk allergy within 6-8 years of diagnosis; less than 20% of individuals with peanut, tree nut, or crustacean allergy).
With allergy to common foods, unfortunately, careful avoidance of food allergens may not completely eliminate accidental exposure to these foods with anaphylactic reactions. The allergy field is currently involved in intensive research on active desensitization to common foods including peanut, egg, and cow’s milk. These trials are ongoing at various sites in the United States however, these procedures are currently “not ready for prime time.” It remains to be seen whether these desensitization procedures will provide long-term tolerance – active immunologic change in the allergic individual to allow long-term ingestion of the food.
In most patients, there are a variety of contributing causes. There are hereditary causes, as people are more likely to develop asthma if they have a family history of allergies or asthma. A personal history of having allergies also increases the chances of developing asthma. Exposures in the environment can also increase the risk for asthma. Triggers for asthma can include allergies, exercise, viral respiratory illnesses, or irritants such as dust, smoke, strong odors, or air pollution. Most people who have asthma also have allergies.
*Exercise-induced asthma is triggered by exercise or physical activity.
*Nocturnal asthma can occur with any asthmatic. Asthma symptoms will often increase or worsen at night.
Allergy testing is safe and effective for adults and children of all ages. Your board certified allergist has the knowledge and expertise to interpret your allergy test so you have precise information as to what you are or are not allergic to.
The most reliable test for allergies is a skin test. This simple, in office procedure introduces a very small amount of specific allergens selected by your allergist based on your medical history. If you are allergic, a small, mosquito-like bump will appear on the test site. Your results are available within 15 minutes allowing your board certified allergist to develop a treatment plan for you on the same day.
Blood tests called RAST may be performed when skin testing is not available due to medications or skin conditions. Results are not available immediately as it generally takes a week or more to obtain results of RAST testing.
The first line treatment for asthma is trying to reduce exposure to triggers of asthma. A majority of patients with asthma also have allergies that can trigger their asthma. If patients can limit their exposure to the substances they are allergic to through environmental control measures this can help their asthma. Allergy testing can identify an individual patient’s allergies in order to help guide avoidance measures. Avoiding other irritants such as strong odors, respiratory viruses, and tobacco smoke can also help.
All patients with asthma should have quick relief medicines available which are used as needed when they have symptoms. Patients who have recurrent symptoms or need for quick relief medicines may also need controller or preventive medications to keep their asthma under control and prevent asthma attacks.
Allergy immunotherapy (allergy shots) are the one treatment that have the potential to provide a long term cure for patients for their allergies and asthma. Patients with asthma need regular follow up with their physician to have pulmonary function testing done periodically and to monitor their level of control. Patients need to work with their allergist to find the right combination of therapy for them that keeps their asthma controlled while minimizing potential side effects of treatment.
With nearly 17 million adults and 7 million children suffering from allergies, it is no wonder that allergies have a strong genetic component. If you suffer from allergies, it is likely that others in your family suffer as well. If one parent has allergies, a child has a 40% chance of having allergies and if both parents have allergies, there is a 75% chance that they will pass the allergic component on to their children. Even though children may be born with a predisposition to develop allergies, they do not always develop the same allergies as their parents.
Unlike eczema and food allergies which may start at a young age, inhalant allergies usually require several pollen seasons to develop. However, allergies can develop at any age with symptoms occurring later in life.
Children with allergies are also more likely to develop asthma. It is estimated that 80% of children with asthma have evidence of allergies. Therefore, recognizing and treating allergies can have a significant impact on reducing asthma symptoms.
While the allergy office visit and testing are covered benefits under most insurance plans, the amount of patient responsibility will vary considerably between different insurance companies and plans.
Insurance companies are not required to disclose the amounts that are covered and the amounts that the patient will be responsible for to the provider of service. Therefore it is difficult for us as the provider to determine what portion of the bill will be the patient’s responsibility.
There are many types of allergy testing. A person can be tested to any of the following: inhalants, foods, pharmaceutical drugs, stinging insects, metals, chemicals, or other specific agents. You are billed for the number of substances you are tested to and by the method of testing. We will only test for what we deem medically necessarily.
Prior to your initial visit, you may want to contact your insurance company and ask the following questions:
We hope this helps clarify some of the questions you may have concerning coverage of allergy testing. Please remember to document who you speak with when you call your insurance company and the date of the conversation.
If you have any questions or concerns, please feel free to contact our billing office at (843) 972-2048.
All of the physician’s at Charleston Allergy & Asthma are certified by the American Board of Allergy and Immunology and participate in the rigorous Maintenance of Certification program required by this board. This ensures that we continue to provide the most up to date, state of the art care for our patients.
With more than 30 years of serving the Lowcountry we are committed to providing our patients with the best care and resources for their allergies, asthma, food allergy and immune diseases. Take the first step toward improving your health and quality of life. Schedule your appointment today.
In addition to treating potentially serious consequences of allergies and asthma, Allergists also focus on preventative care, ensuring that patients achieve and maintain optimal health and quality of life. They develop management plans and follow patients over time, providing them with the most up to date treatment options available.
It is critical to identify what is causing your symptoms. In many cases, it can be difficult to accurately determine the specific allergic triggers and at times, more than one type of test is required. Allergists have the appropriate tools and understand the intricacies of the various tests and analysis required to diagnose allergies and allergy-related problems.
For more information on the importance of seeing a board-certified allergist, please visit: http://acaai.org/about/the-specialty/Pages/default.aspx
An allergist has specialized training in the diagnosis and treatment of allergic conditions including asthma, sinusitis, seasonal allergies, food allergies and severe allergic reactions.
In the United States, becoming an Allergist / Immunologist requires at least an additional nine years of training beyond a bachelor’s degree. After completing medical school, physicians undergo three years of training in internal medicine or pediatrics and pass the exam of either the American Board of Internal Medicine (ABIM) or the American Board of Pediatrics (ABP).
To specialize in Allergy-Immunology, it is then necessary for Internists and Pediatricians to complete an additional two-three years of study, called a fellowship, in an accredited allergy/immunology training program. They are then qualified to sit for the American Board of Allergy and Immunology (ABAI) certification exam. This board certification demonstrates that the Allergist/Immunologist has the knowledge, skills, and experience to provide high-quality care and superior clinical outcomes for patients with allergic and immunologic disorders.