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 to 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.
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 and 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 and Asthma’s providers are all board-certified in allergy/immunology. 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/immunology fellowship followed by passing a second board certification examination. An allergy/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. Once this fellowship is completed all allergists are double-boarded to treat children and adults.
Because of an allergist’s extensive medical training, they are best equipped to discover what is causing your symptoms and how to help your immune system respond positively toward your triggers. They are also trained to recognize other conditions that can masquerade as allergies; however, unlike ENT’s they do not practice surgery. An allergy/immunology fellowship focuses on disorders of the immune system that develop into allergies, asthma, chronic lung disease, skin diseases and immune deficiencies that can lead to recurring and life-threatening infections. Charleston Allergy and Asthma physicians follow nationally accepted guidelines for allergen immunotherapy (allergy shots), as well as FDA approved oral allergy therapy for grass, ragweed, and dust mites. Immunotherapy is individually tailored to provide the patient with the minimum effective dose to maintain long lasting improvement in allergy symptoms, reducing medication use and improving quality of life.
Do you need to see a board-certified allergist? Schedule your appointment today!
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 hay fever 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 dander, 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 hay fever 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.
Allergies are Genetic
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 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.
How Allergy Shots Improve Your Quality of Life
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 and maintain excellent ongoing relief. Research shows that allergen 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 and 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 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 five-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 and often indefinitely at no additional cost.
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 typically come off shots with ongoing relief. It’s the closest thing we have as a cure and is often more cost effective than a lifetime of meds.
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, skin, and lung function tests and know the effective allergen doses required and which allergens can be combined together safely.
How Allergy Shots Improve Your Quality of Life
You should consider allergy shots if you:
- Have moderate to severe allergies
- Have frequent respiratory tract infections
- Do not respond to or do not tolerate allergy medications
- Would prefer to avoid a lifetime fo allergy medication use
- Are willing to commit to a regularly scheduled treatment plan
- Have chronic sinusitis or asthma due to allergies
- Are interested in a long-term allergy treatment option
- Have anaphylaxis from insect stings
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 and 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.
The FDA has approved three different formulations of sublingual immunotherapy (SLIT), grass, ragweed, and dust mite. 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.
Sublingual tablets are a safe and convenient option for patients who are only allergic to grass, ragweed, and/or dust mite or for those patients who have one of these allergens as their major allergic trigger. However, most individuals are poly allergic meaning allergic to multiple allergens.
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.
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 and/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.
We can help determine if your nasal symptoms are secondary to allergies, from a sinus infection or from a structural abnormality. Allergy symptoms can be seasonal or year-round and can last months at a time, just as a chronic sinus infection can. Our board-certified allergists will do a careful review of your medical history, conduct a physical exam and conduct allergy testing to help define the cause of your symptoms. At times, additional tests such as a sinus x-ray or CT scan may be needed.
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. Contact us to find relief!
The board-certified 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 issues. Once the allergist knows the triggers that are causing your chronic symptoms, a treatment plan will be recommended.
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. As you receive immunotherapy, you gradually decrease your sensitivity to your triggers and build up a tolerance to your allergens.
Allison Finds Relief from Sinusitis
Approximately one in four individuals in the United States feels that they have an allergy to food. With closer scrutiny for food allergy, 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 to ingredients such as lactose or gluten.
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, eggs, fish, shellfish, tree nuts, peanuts, wheat, and soy. 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. 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). Correctly identifying food allergies is critical. If a patient is found food allergic they need to be armed with life saving epinephrine along with education on their allergen(s), avoidance measures, and understanding their symptoms.
Food Allergies
Food allergies are confirmed through a combination of carefully assessing a patient’s history and skin and/or blood testing. Allergy skin and blood test results do not immediately identify if a patient is allergic or not. Instead, these test results must be carefully reviewed by a board-certified allergist who will take into consideration the food being tested, the age of the patient and the patient’s history. All of these factors are taken into account when interpreting an allergy test.
Recently, testing for individual allergenic proteins in foods has become available. This new protein component testing can provide more information in determining the likelihood of an actual allergy. Protein component testing for some foods can help determine if a food may be tolerated in a specific form, such as in an extensively heated form, like a baked muffin made with milk or egg. In some instances, an oral challenge is necessary to confirm clinical sensitivity to foods that are difficult to avoid. Food oral challenges are procedures in which the allergenic food is eaten in increasing amounts under close supervision in the board-certified allergist’s office to determine if a clinical allergy is present.
Food allergies are managed through avoidance of the identified allergenic foods while ensuring nutritional needs are met for the allergic individual, particularly infants and small children. Very small amounts of foods to which the patient is allergic may cause serious allergic reactions in sensitized individuals. Education is required to teach families about hidden food allergens in a variety of foods. The patient also needs an epinephrine autoinjector (EpiPen) and a food allergy action plan to help guide caregivers when a reaction occurs.
Allergic reactions to foods often occur away from the home environment, such as 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% of individuals with soy, eggs and cow’s milk allergies will outgrow them within 6-8 years of diagnosis. Less than 20% of individuals will outgrow peanut, tree nut or crustacean allergies).
While there is no true “cure” for food allergies, food oral immunotherapy, also known as food OIT, is a newer treatment alternative that can improve a food allergic patient’s tolerance to their food allergy. Through carefully developed protocols, the allergenic food is introduced to the patient. The amount of the allergenic food is gradually increased over time, which encourages the production of immune system messengers that increase the tolerance for the food. It is important that food oral immunotherapy is conducted by a board-certified allergist who is experienced in food allergy and desensitization therapy. Food oral immunotherapy has provided freedom to many patients and their families who have chosen to embark on this path.
Living with Food Allergies
Asthma can be caused by a combination of environmental and genetic factors. While sometimes the true cause may be unclear, asthma is often triggered by a variety of irritants, that can vary from person to person. Oftentimes, asthma is developed due to underlying allergies, which is why treatment for allergies and asthma go hand-in-hand.
Some of the most common asthma triggers include (but are not limited to) airborne allergens, respiratory infections, cold air, physical activity, air pollutants, emotional stress and medications.
What is Asthma?
The first line of asthma treatment is to reduce exposure to your asthma triggers. A majority of patients with the disease are also living with allergies, which trigger their asthma. Avoiding known asthma triggers, when possible, is important in helping prevent asthma attacks.
For those experiencing asthma symptoms without a full understanding of what their triggers are, allergy testing is a recommended next step. Allergy testing can not only determine the cause of allergic reactions but also makes it possible for a board-certified allergist to provide a custom-tailored treatment plan made just for you.
Your treatment plan may include a combination of allergy shots, maintenance prescriptions and quick relief medications. Allergy immunotherapy (allergy shots) is the one treatment that has 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 that keeps their asthma controlled.
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 70% 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.
All of the physicians at Charleston Allergy and 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.
Learn What We Do
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:
- Do I have allergy and immunotherapy benefits? If so, what are they?
- Do I have any riders on my policy for allergies or asthma?
- If I were to be tested would it be covered?
- Will any of my services need prior authorization?
- What will be my patient liability?
- Do I have a copay on the consultation?
- Do I have to meet a deductible on any office procedures? (Deductible, co-pay, or coinsurance)
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.