ALLERGY

So what are allergies? Allergies are the result of your body’s abnormal response to an allergen; a normally harmless substance in your environment. Allergens include molds, dust mites, animal dander, some foods, and pollens from grasses, trees, and weeds. Some allergens, such as pollens and molds, vary in the environment from season to season. Other allergens, like animal dander and dust mites, are present year around. When people who are affected by allergies are exposed to these allergens their body may produce a wide range of symptoms. These symptoms may include a runny nose, nasal congestion, recurrent ear fluid, itchy eyes, sneezing, recurrent sinus infections, hives, or asthma exacerbations.

Unfortunately there is no cure for allergies at this time. All treatments are focused on decreasing the frequency and intensity of the allergic reaction a person has when exposed to the allergens that affect them. There are three basic ways to treat allergies. The first is avoidance of the things the patient may be allergic too. This works well for people who have cat or dog allergies; they can simply avoid these animals. For people with allergies to pollens and molds, this does not work so well since these allergens are so prevalent.

The second treatment option is allergy medications. These medications include antihistamines, nasal steroid sprays, and anti-leukotrienes. Many antihistamines (Zyrtec, Allegra, Claritin) and nasal steroid sprays (Flonase, Nasacort) are now available as over the counter medications, while the anti-leukotrienes (Singulair) are available as prescription medications only. People with very mild allergies may only need to take an antihistamine when their symptoms flair up. For people with more severe, chronic allergies a daily regimen of allergy medications often works best. We often recommend people start with a daily antihistamine and nasal steroid spray as the first line of treatment. Singulair can be used to treat patients with severe allergies as well. While it was originally used as an asthma medication, it is now used for allergies as well.

The third treatment option is immunotherapy (i.e. allergy shots). This is often the best treatment option for patients with severe allergies that are poorly controlled on medications or for patients who prefer not to take daily medications. Immunotherapy has been proven to have many benefits. People on immunotherapy are found to use less medications to control their allergies, have fewer upper respiratory or sinus infections requiring antibiotics, have fewer asthma exacerbations, and have an overall improvement in their quality of life when compared to allergy patients on medications alone. Immunotherapy is also more cost effective in long run when compared to daily medication use. Most patients can expect to see these benefits after 3-6 months of immunotherapy.

Allergies can have a significant negative impact on patients who suffer from this problem. Luckily for these patients, with the discussed treatments their symptoms can usually be controlled. If you suffer from poorly controlled allergies call and make an appointment with one of our physicians to discuss what treatment option may be best for you.

What are allergies?

Allergies are the result of the body’s abnormal response to an allergen, a normally harmless substance in your environment. Allergens include molds, dust mites, animal dander, some foods, and pollens from grasses, trees, and weeds. Some allergens, such as pollens and molds, vary in the environment from season to season. Other allergens, like animal dander and dust mites, are present year around. When people who are affected by allergies are exposed to these allergens their body may produce a wide range of symptoms. These symptoms may include a runny nose, nasal congestion, recurrent ear fluid, itchy eyes, sneezing, recurrent sinus infections, hives, or asthma exacerbations.

How were the allergens chosen for which I was tested?

You were tested for a wide variety of allergens to determine which you are allergic to and how to best treat these allergies. The pollen and mold allergens you were tested for are specific to our area. We have identified the most common trees, grasses, weeds, and molds in this area and these are what we test for in our office. We also test for more universal allergens such as animal dander, dust mites, and foods.

What is immunotherapy?

If multiple allergies are identified during allergy testing, immunotherapy may be your best treatment option for this condition. With immunotherapy you will be given scheduled injections. These injections are made up of very small amounts of the allergens you were found to be allergic to. Each patient’s treatment vial is individually formulated and mixed in accordance to your specific allergy testing results. At the beginning of your treatment you will be given very small doses of your offending allergens. Each week your dose will be increased, until you reach your maintenance dose. When this maximum tolerated dose is reached, your body produces blocking antibodies, which in effect immunizes your body against these offending allergens. After you reach your maintenance dose your injections are typically continued for 3-5 years. During this time you will be required to see your doctor at least once a year to make sure immunotherapy is controlling your symptoms. After 3-5 years you and your doctor will determine if you can be tapered off your injections or if they should be continued.

What are the benefits of immunotherapy?

Immunotherapy has been proven to have many benefits. People on immunotherapy are found to use less medications to control their allergies, have fewer upper respiratory or sinus infections requiring antibiotics, have fewer asthma exacerbations, and have an overall improvement in their quality of life when compared to allergy patients on medications alone. Immunotherapy is also more cost effective in long run when compared to daily medication use. Most patients can expect to see these benefits after 3-6 months of immunotherapy.

What are the drawbacks or risks of immunotherapy?

Immunotherapy is not a quick fix and patients must wait 3-6 months to begin experiencing the benefits of this treatment. Immunotherapy requires initial frequent visits to a physician’s office for administration of the injections. Patients are also required to continue some allergy medication during the initial phases of treatment. The main risk of immunotherapy is that of having a local or systemic reaction to the injections. A large local or systemic reaction may occur in 1-5% of patients and usually occur during the build up phase of treatment.

What do I do if I have a reaction to my treatment?

You may experience a small area of redness and itching after an injection. This may be treated with a cold compress and by taking an antihistamine. A reaction should be reported if the area of redness, itching, or swelling is larger than a 50-cent piece. If this occurs, the allergy office should be notified so your next injection can be adjusted appropriately. Failure to report a reaction like this does not allow us to provide the safest and best treatment. You can call 325-437-3610 twenty four hours a day to report a reaction. Rarely a systemic reaction may occur that could include symptoms such as facial swelling, hives, wheezing, or changes in your heart rate or blood pressure. Since this type of reaction usually occurs within minutes of receiving an injection, you should wait in the allergy office for 15-20 minutes after each shot is given. All minors should be accompanied by an adult during this time, unless other arrangements have been made. If these symptoms occur after you leave the office you should immediately return to the office or go directly to your nearest emergency room.

ALLERGY TESTING

In preparation for your upcoming allergy test there are a few pieces of information we would like you to be aware of. The day of your testing you should wear a short sleeve or sleeveless shirt. If testing is required on your back, a gown will be provided for you. We also request that you fill out the attached questionnaire and any other paperwork you may be given prior to your appointment. Please bring this information with you the day of the test. If it is necessary for you to cancel your test, please notify the allergy office at least 24 hours prior to your appointment. Please call (325) 437-3610 if you need to cancel or reschedule your appointment. You may call after hours and leave a message with the answering service if necessary. Please arrive promptly the day of your testing. Testing on average takes 2-3 hours. If you are more than 5 – 10 minutes late for your appointment, your testing may have to be rescheduled.

Many medications can interfere with the testing process. You may be asked to stop some of your medications 3-7 days prior to the testing.

-Many medications are safe to take prior to your testing. These include medications for asthma, blood pressure, cholesterol, and thyroid disorders. You may also continue to take Tylenol, birth control pills, hormones, fluid pills, Singulair, and nasal steroid sprays.

-Medications to avoid three days prior to your testing include muscle relaxants, sedatives, ibuprofen (Advil, Motrin), Aleve, aspirin, Excedrin, Alka-Seltzer, herbal medications, vitamins, medications containing antihistamines, and anti-depressants. A list of anti-depressants and medications containing antihistamines that your should avoid is attached.

-Medications to avoid seven days prior to your testing include Benadryl, Allegra, Allegra-D, Astelin, Brovex, Brovex-D, Clarinex, Claritin, Claritin-D, Nalex, Palgic, Zytrec, Zyrtec-D, Xyzal, Excedrin PM, Midol PM, Tylenol PM, Astepro, Patanase, and plain decongestants.

Special arrangements also have to be made for patients on a class of blood pressure medications called Beta Blockers or a class of psychiatric medications call MAOIs (monoamine oxidase inhibitors). Your testing can be done if you are on these medications, but your immunotherapy may have to be placed on hold until you can be switched from these medications to another class of medication. These medications interfere with our ability to treat you in the case you had a severe reaction to an allergy injection. A list of these medications are also attached.

If you have any questions in regards to what medicines you can or cannot take prior to your testing please contact our office. New medications are constantly being added to the market, so please do not hesitate to call if one of your medications is not listed.

Anti-Depressants

Atarax (Hydromyzine)
Ativan (Lorazepam)
Buspar (Buspirone)
Desyrel (Trazadone)
Valium (Diazepam)
Vistaril (Hydroxyzine)
Prozac (Fluoxetine)
Remeron (Mitazapine)
Serzone (Nefazodone)
Zoloft (Sertraline)
Surmontril (Trimipramine)
Tofranil (Imipramine)
Trancopal (Chlormezanone)
Trazene (Clorazepate)
Effexor (Venlafaxine)
Nardil (Phenelzine)
Paxil (Proxentine)
Welbutrin (Bupropion)
Xanax (Alprazolam)
Sinequan (Doxepin)

Tricyclic Antidepressants *Please advise the allergy staff if you are taking a tricyclic antidepressant.

Adapin (Doxepin)
Anafranil (Clomipramine)
Etrafon (Perphenazine / Amitriptyline)
Norpramin (Desipramine)
Surmontril (Trimipramine)
Tofranil (Imipramine)
Limbitrol (Chlordiazepoxice / Amitriptyline)
Triavil (Perphenazine / Amitriptyline)
Asendin (Amoxapine)
Elavil (Amitriptyline)
Pamelor (Nortriptyline)
Sinequan (Doxepin)
Vivactil (Protriptyline)

Medications Containing Antihistamines

Actifed
Atarax
Atrohist
Chlorpheniramine
Chlor-Trimeton
Comhist
Deconamine
Dimetapp
Kronofed A (Jr.)
Marax
Naldecon
Nolahist
Novahistine
Nolamine
Optimine
Phenergan
Poly-Histine
Ritalin
Rondec
Ru-Tuss
Isoclor
Tagamet
Tavist I or II
Teldrin
Vasobid
Zantac

Beta-Blockers

Betapace (Sotalol)
Brevibloc (Esmolol)
Corgard (Nadolol)
Inderal (Propranolol)
Kerlone (Betaxolol)
Lopressor (Metoprolol)
Normozide (Labetalol)
Tenormin (Atenolol)
Toprol – XL (Metoprolol)
Tenoretic (Atenolol)
Timolide (Timolol)
Blocarden (Timolol)
Cartrol (Cateolol)
Corzide (Nadolol)
Inderide (Propranolol)
Levatol (Penbutolol)
Normodyne (Labetalol)
Sectral (Acebutolol)
Trandate (Labetalol)
Visken (Pindolol)
Zebeta (Bisoprolol)
Ziac (Bisoprolol)
Coreg (Carvedilol)

*Eye drops for glaucoma containing beta blockers including betagen (levobunolol), betoptic (betaxolol), timoptic (timolol), optipranolol (metipranolol). 

MAOI’s (Monoamine Oxidase Inhibitors)

Isocarboxazid (Marplan)

Moclobemide (Aurorix, Manerix, Moclodura)