Allergy

One in five people in the US have allergy or asthma symptoms. North Texas has a mild climate which allows us to enjoy many outdoor activities. Children with allergies may have difficulty playing outside. Adults may struggle at work controlling allergy symptoms. Lost work and activity time as well as money spent on over-the counter allergy medications may be overwhelming. Consideration of allergy testing and treatment is the next step. We offer an honest assessment and treatment of allergies.

Conditions:

• Nasal and eye allergies
• Asthma and reactive airway ( We do not treat asthma primarily, but will help control asthma related allergy and sinus disease).
• Swelling of throat (angioedema)
• Itchy ears

Diagnostic:

• Skin prick and intradermal testing - Two commonly used methods to test allergens (substance that causes an allergic reaction) on the arms or back (at Texas ENT Center we perform allergy testing on the arms). Skin prick uses a small device to prick the skin with several different allergens allowing the tester to visualize a reaction (wheel and flare response). Intradermal testing involves placing more allergen into the dermis (deeper than prick testing). We find both methods of testing beneficial. The AAOA (American Academy of Otolarygnic allergy) has endorsed a testing method (modified quantitative testing - MQT) which uses both testing methods in a simple format that is completed in about 1.5 hours. Results are provided to you at the conclusion of your test. Testing may be completed on children, but it is important to remember that children under 3-4 years of age do not yet have true seasonal allergies (they may have perennial allergies - dust mites, mold, cats, dogs etc.). Your current medications will need to be screened prior to testing (some medications such as antihistamines will block a response to the test and some medications prohibit safe skin testing (Beta blockers - medication for high blood pressure).
• Blood testing (RAST) for food allergies - The best test for non-life threatening food allergies (not for anaphylaxis) is elimination with reintroduction of the food. A supplemental test is blood testing for specific foods. Blood testing for food allergy can be difficult to interpret and the results (positive or negative) do not necessarily mean the patient has an allergy. A physician should be consulted as food allergy can be complex and analyzing lab work together with a complete history is essential in making a correct diagnosis.

Treatment:

• Subcutaneous immunotherapy (SCIT) - A regimen of injections that are completed in the office once per week for the first year and then every other week for 2 more years (3-4 years total). The treatment is effective and safe but does have a very low risk of a “whole body reaction.” There is a long record of significant improvement in allergies and asthma with allergy shots, making it the main treatment option in the United States.
• Sublingual immunotherapy (SLIT) - SLIT is an alternative way to treat allergies. It is the preferred treatment option in Europe. Safety is well established in other countries and therefore home therapy is acceptable. The FDA has not approved this treatment, but many physicians in the USA are using it “off label.” We follow a regimen established by the AAOA which involves placing drops under the tongue once daily (at home) for 3 years. The therapy is most helpful for patients who can not come into the office or who would rather avoid shots. SLIT is not covered through insurance as it is not FDA approved. Merck has released two sublingual tablets that are FDA approved. Grasteck and Ragwitek.