ALLERGEN SKIN TESTING
Skin testing can allow one to diagnose the cause of symptoms when the cause is an airborne allergen (pollen, mold, dust mite or animal), a food, a stinging insect or certain medications. A small amount of the allergen penetrates the skin by a puncture first and then, if necessary, by an injection into the upper layer of the skin. A reaction to the allergen occurs if that area of the skin becomes red and swollen over the next 15-20 minutes.
OUTDOOR AND INDOOR ALLERGEN DESENSITIZATION (Immunotherapy)
Injection desensitization (“allergy shots”) has been used for over 100 years to treat nose, eye and lung symptoms that are caused by various outdoor and indoor allergens. The injections can reduce substantially, and possibly eliminate, the need for medication to treat these symptoms. The procedure involves weekly gradual increases in the dose of the allergen so that the immune system no longer makes an allergic response on natural exposure. Once the highest dose is reached, this dose is administered at regular intervals of up to a month apart for at least several years.
Since 2014, a tablet containing grass allergen and a tablet containing ragweed allergen have been approved by the Food and Drug Administration for sublingual desensitization. The tablet is placed under the tongue until it dissolves. After the first dose is taken in a medical setting, a prescription is given for daily use at home for approximately six months per year.
FOOD ALLERGY EVALUATION AND ORAL DESENSITIZATION (Oral Immunotherapy)
A diagnosis of food allergy, such as peanut allergy, is made by evaluating the patient’s history of symptoms and by performing skin and/or blood testing, when appropriate. Proper management is discussed. If needed to confirm the absence or presence of a food allergy, an office ingestion challenge occurs in which the patient ingests (eats) increasing amounts of the food at certain time intervals over a specified number of hours.
In recent years, various clinical studies have shown that a gradual increase in the amount of a food eaten can desensitize a person who is allergic to that food. Protocols for desensitization to peanut and certain other foods have been developed. The food must be eaten daily during the period of gradual increase and must be eaten daily once a maintenance amount is reached. During the months of gradually increasing the amount of food eaten, a weekly office visit is needed at the time of the next increase to determine if the higher amount can continue to be eaten daily at home.
LUNG FUNCTION TESTING
When a person exhales as hard as one can into a computerized device, called spirometer, the device measures the amount of air and calculates numbers that reflect how open the airways are. Another device estimates the amount of inflammation of the airways by measuring the nitric oxide content in the air exhaled. This information can help to diagnose and monitor asthma.
IMMUNOMODULATOR & BIOLOGICAL RESPONSE MODIFIER MANAGEMENT
We can assess if immune globulin therapy is appropriate for an immunodeficiency and help to coordinate its administration. The office also can assess the need for and administration of Xolair, Nucala and Cinqair— biological response modifiers that treats allergic asthma and possibly other allergic/immune conditions.
STINGING INSECT VENOM SKIN TESTING AND DESENSITIZATION
Stinging insects in the Midwest include honeybees, yellow jackets, yellow hornets, white-faced hornets and wasps. Skin testing is performed to establish the specific cause. Blood testing may be needed in some instances. Allergy shots are then used to desensitize the immune system when the risk of a life-threatening reaction to the stinging insect is considered to be present. The procedure can also be used for desensitization to fire ants, which are prevalent in the Southeastern United States.
MEDICATION TESTING, CHALLENGES AND DESENSITIZATION
Certain medications have established procedures in the medical literature for diagnosing and managing adverse drug reactions. The testing may involve a skin test, blood test, or a challenge with increasing amounts of the drug at certain time intervals by injection or ingestion. Some medications have protocols for desensitization when medically necessary.
VACCINE TESTING, CHALLENGES AND DESENSITIZATION
The approach for some vaccines, such as the influenza vaccine, is similar to that of medications. However, blood tests are not utilized because blood tests only determine if one is properly vaccinated and immunized against the bacteria or virus.