Allergy and Asthma Treatments

What is Allergy?

Allergy is a genetic condition causing the body to respond to harmless substances in the environment as though they were dangerous invaders. This response produces symptoms that may be mild to life-threatening in susceptible people. The most common symptoms of allergy are hayfever, asthma and eczema.

“Hay fever” was named because of nasal symptoms developing during hay season, but most nasal allergies are called “hay fever”. In hay fever, the lining of the nose becomes irritated, causing the sufferer to sneeze and the nose to become stuffed-up or to run. Eyes may itch or turn watery. Sometimes the ears feel blocked up. Hay fever occurs most frequently during the spring, summer or fall when trees, grasses and weeds produce pollen.

In S. California, pollens are present most of the year because we do not experience frost as in other areas of the country.

Asthma is a condition which affects breathing and the lungs. The patient wheezes, coughs and is short of breath.

Eczema is an inflammation of the skin. It can take the form of red patches, crusts and scales. The affected area generally itches. The condition generally occurs from eating certain foods.

What is Asthma?

Asthma is a chronic lung disease that affects more than 20 million Americans. Asthma is characterized by inflammation of the airways with intermittent bronchospasm. A bronchospasm is a narrowing of the bronchial tubes and is caused by inflammation of the muscles surrounding the air passageways. The inflammation makes the airways smaller, making it more difficult for air to move in and out of the lungs.

Asthma and allergies afflict 1 out of 4 Americans and more than 70% of people with asthma also suffer from allergies. In 2004, there were 13.6 million physician office visits and 1 million outpatient department visits due to asthma. Children ages 5-17 missed 14.7 million school days due to asthma in 2002 and 24.5 million missed work days for adults annually. Every day in America 40,000 people miss school or work, 30,000 people have an asthma attack, 5,000 people visit the ER, 1,000 people are admitted to the hospital and 11 people die due to asthma.

As illustrated above, asthma is one of the most common health problems in the United States and it can significantly affect patient’s lives. It is essential that asthma patients be diagnosed and treated effectively. It is equally important for patients to know the course and treatment of this disease.

Chronic nasal congestion and post nasal drip, seasonal or constant, is often allergic and may be complicated by chronic sinus and middle ear disease.

Allergy and Asthma - Girl blowing her nose.

Allergy and Asthma Resources

Why does Pacific ENT treat allergies?
Patient instruction for allergy skin testing
Allergy immunology FAQ’s
What is immunotherapy
Financial statement about allergy therapy
Asthma triggers
Why asthma in an ENT office?
Asthma treatments
Is your asthma under control?

Allergy (PDF) Downloads

NOTE: All pdf documents below open in a new browser window.

Why does Pacific ENT treat allergies?

As otolaryngologists, Pacific ENT specializes in the treatment of ear, nose and throat diseases. Half of the problems she encounters are probably due, either directly or indirectly, to allergy. Chronic nasal congestion and post nasal drip, seasonal or constant, is often allergic and may be complicated by chronic sinus and middle ear disease. Hearing loss, dizziness, headaches, weeping ear canals, and chronic sore throats may be due to allergy. We do our own allergy treatment and is able to follow the patient’s progress with specialized examinations of the ears, nose and throat. We can manage those conditions with medical therapy or surgical procedures such as polyp removal, placement of middle ear ventilating tubes, straightening of the nasal septum, and treatment of sinus infections. Although allergy training is an integral part of their training not all otolaryngologists provide allergy care as part of their practice.

Our Physicians are Fellow of the American Academy of Otolaryngic Allergy. This requires passing a rigorous oral and written exam and demonstrating competence in the field of immunology and otolaryngic allergy.

We provide diagnosis and treatment of allergic disease, including skin testing, immunotherapy (shots or drops under the tongue).

The American Academy of Otolaryngic Allergy (AAOA) was founded in 1941, and is one of the oldest and most experienced organizations in dealing with issues relating to allergic disorders. As a professional association, the AAOA represents over 2000 Board certified otolaryngologists and other health care providers who devote part of their practice to the diagnosis and treatment of allergic and other related disorders. As otolaryngologists, members have a unique expertise in the medical and surgical treatment of sinusitis, allergic rhinitis, and related disorders.

Learn more about The American Academy of Otolaryngic Allergy

Patient instructions for allergy skin testing

Please review all of your medications with the nurse or doctor when you schedule your allergy testing.

DON’TS:

Do not take beta blockers (Spectral, Tenormin, Zebeta, Cartro, Coreg, labetalol, metoprolol, Corgard, Levatol, Visken, Inderal, Betapace, Blocadren). This includes beta blocker eye drops like Timolol. ACE inhibitors and calcium channel blockers are OK.
Do not take over-the-counter antihistamines, cold tables or cough syrup for 48 hours prior to the test. This includes Benadryl, Chlor-Trimeton, Tavist, Dramamine and Atarax and cold and flu medications such as Nyquil orThera-Flu.
Do not take antihistamines for 5 full days prior to test. This includes Allegra, Atarax, Astelin, Benadryl, Chlortrimeton, Claritin, Clarinex, Meclizine, Zyrtec.
Do not take prescription or over-the-counter sleeping medications for 48 full hours prior to the test. This includes Nytol, Tylenol PM and Excedrin PM. These medications often contain antihistamines.
Do not take any stomach medications such as Zantac, Tagamet, Pepcid and Axid, for 48 hours prior to your test. Prilosec, Pevacid, Nexium and Aciphex or OK to take.
Do not take any stomach medications such as Zantac, Tagamet, Pepcid and Axid, for 48 hours prior to your test. Prilosec, Pevacid, Nexium and Aciphex or OK to take.
Do not take any stomach medications such as Zantac, Tagamet, Pepcid and Axid, for 48 hours prior to your test. Prilosec, Pevacid, Nexium and Aciphex or OK to take.
Do not take any anti-anxiety or antidepressant medications such as Elavil, Thorazine, Sinequan, Pamelor, Tofranil, Despiramine, or Haldol.
Do not take or use any corticosteroids such as prednisone, cortisone.
Do not use any herbal supplements such as Licorice, Green Tea, Saw Palmetto, St John’s Wort, or Feverfew.

DO’S:

You may continue to use prescribed nasal sprays, such as Flonase, Nasonex, Nasacort or Rhinocort. The only exception is Astelin, which is an antihistamine.
Medications for other medical conditions, such as asthma, diabetes, heart disease or arthritis may be taken. Oral inhalers such as Alupent and Advair are OK.
Please wear a sleeveless shirt, or a shirt that can be pushed to the top of your shoulder (like a t-shirt), and feel free to bring a book if you like, as you will be here for approximately one hour.
You may resume all of your medications after you have completed your testing.

Download Allergy Skin Testing Instructions (PDF)

Allergy immunology FAQ’s

What is allergy therapy?

The goal of allergy therapy is to increase your body’s natural immune defenses and increase your ability to tolerate allergens in the environment that may cause your allergy symptoms. There is often less need for mediations such as antihistamines and decongestants with treatment.

You will be allergy tested to determine which substances you may be sensitive to and if you would benefit from allergy therapy. Based on the results of your allergy testing, we will offer you, if appropriate, a course of treatment that typically includes a combination of medications, environmental allergy controls, and allergy therapy. This treatment may include either allergy shots or allergy drops.

What are allergy shots?

Allergy shots are FDA-approved allergy extracts that are administered weekly at a prescribed dose.

What are allergy drops?

Allergy drops use the same FDA-approved allergy extract used in allergy shots, but the treatment is given under the tongue.

What is the advantage of Allergy Shots vs. Allergy Drops?

Shots – Advantages of allergy shots include treatment vials that are covered by most insurance companies and this has been the standard of care for many years. Disadvantages include the drive to our office, co-pay for shot administration, having to receive a shot, and the 20 minute wait after administration.

Allergy drops – Advantages of allergy drops include the personal convenience of no weekly trips to the office, no waiting in the office, no co-pay for administration, and no reports of anaphylaxis. There is very little disadvantage of allergy drops except that at this time, most insurance companies are not covering the cost of the vials. Your first treatment must be given in the office.

How will I receive my treatment?

Allergy shots are given in the office once a week. We ask that you wait in the office for 20 minutes after each injection while building your immunity.

Allergy drops will be taken at home on a daily basis.

Both allergy shot and allergy drop patients require periodic evaluations in the office every 3 – 6 months to monitor your progress.

How long will I have to receive my treatment?

The average treatment lasts 2 – 5 years. However, everyone is different, and it is entirely dependant upon how you personally respond to the treatment.

What is sublingual immunotherapy

Sublingual immunotherapy (also known as SLIT) is the next generation therapy for allergy sufferers. Historically, the only way to treat allergies was avoidance of the offending substances, taking medications, or to submit to allergy shots. Now, the same beneficial therapy provided by allergy shots can be administered as drops under the tongue in the comfort and convenience of your home. Sublingual therapy has been used successfully in Europe for over thirty years, but has only recently come to the United States. The drops work in the same way as the shots, by desensitizing you to the very substance that causes your allergy symptoms. With SLIT, we can treat a wide variety of allergies, including dust, grass and tree pollens, and animal dander.

How Do I Know if Sublingual Therapy Is Right for Me?

The first step is to perform allergy testing, to determine what substances may be responsible for your allergy symptoms. We then perform further testing, to determine how sensitive you are to those substances. Based on this information, allergy drops are custom made to treat your specific allergies.

Will I Have to Come to the Office to Get My Drops?

Once the personalized vials are made, you will be notified to come to the office to pick them up. You will be given instruction on how to use the drops when you are at home. You will self-administer the first drops while you are here in our office. After you receive the drops, plan on waiting in the office for 20 minutes so we may observe you for any untoward reactions. After that, you will administer the drops daily at home. When your vials get low, notify us so that we can make new vials. These will be mailed directly to your home. You will only return to the office every three months to evaluate the effectiveness of the treatment plan.

How Long Will I Have to Take the Drops?

Although many people notice some relief of their symptoms after only a few weeks of treatment, it is important to continue the therapy. Each new vial will contain stronger doses, allowing your body to become further desensitized. Most must remain on the therapy for 2 to 5 years.

How Do I Get Started?

Notify the receptionist, and she will make an appointment for you as soon as possible.

Financial statement

Allergy testing is a covered service through most insurance carriers. However, although sublingual immunotherapy has been the standard of treatment in Europe for many years, it is relatively new in the United States. The insurance industry has yet to identify a specific billing or reimbursement code for this treatment, therefore sublingual immunotherapy is currently not covered by most insurance carriers. At this time, the cost of the vials of medication will be the sole responsibility of the patient.

Pacific E.N.T. Medical Group, Inc. reserves the right to change this policy following patient notification asthe insurance industry change their policies regarding coverage of sublingual therapy.

Asthma triggers

Asthma symptoms (wheezing, shortness of breath, coughing) can be brought on by a variety of triggers such as allergens (pollens, mold, dander, dust mites), irritants (smoke and strong smells), respiratory infections, sinus or viral infections, weather changes, exercise, stress, acid reflux, medications, foods and emotional anxiety.

Why asthma in an ENT office?

Here at Pacific ENT, Dr. Davis specializes in the treatment of ear, nose and throat diseases. Many of the patients present with nasal congestion and post nasal drip attributed to sinus disease or allergic rhinitis, both of which are major triggers for asthma. Many people do not even realize that they have reactive airways or asthma. If warranted, a pulmonary function test will be performed to evaluate the status of the patient’s lungs and to determine if treatment is needed.

Asthma treatment

Asthma is a chronic disease that requires continuous management, appropriate treatment and patient compliance. Each person will have his/her specific goals and treatment plan. Asthma management includes using the proper medications to prevent and control asthma symptoms.

Asthma medications are categorized into two classes, quick-relief (rescue) and long-term (controller) medications. Quick relief medications provide temporary relief of symptoms and include bronchodilators. These medications open up the bronchial tubes so more air can flow through. This class of medications includes Albuterol, Proventil and Ventolin.

Long-term medications need to be taken daily to control airway inflammation in persistent asthma. This class includes inhaled corticosteroids and is considered the gold standard for persistent asthma. Examples of this type of medicine include Asmanex, Pulmicort, and Flovent. Combination therapy is a mixture of an inhaled corticosteroid and a long acting bronchodilator. Examples include Advair and Symbicort. Leukotriene modifiers act against leukotrienes, which contribute to airway inflammation. Leukotrienes can be found in the lungs as well as in the nose, therefore it is effecting in treating both asthma and nasal allergies. Singulair is an example of this type of medication.

Whichever treatment plan you are on, it is important to carefully follow the appropriate use and dosage of the prescribed medications.

Is your asthma under control?

The Rules of Two
Do you take your quick relief inhaler (Albuterol, Proventil) more than TWO times per week?
Do you wake up at night with asthma symptoms more than TWO times per month?
Do you refill your quick relief inhaler more than TWO times per year?

If you answer YES to any of these questions, your asthma may not be in good control. You must contact your health care provider to assess your treatment plan.

Asthma Control Test www.asthmacontrol.com If you have asthma, take this test to see if you are well controlled with your current treatment plan.