Allergy Evaluation and Management

Allergy is when one’s immune system is hypersensitive to certain substances (allergens). A reaction is triggered when one inhales, ingests, injects, or comes in contact with certain allergens. Our immune system predictably reacts in two ways to explain symptoms of allergic disease: IgE- mediated and non-Ig-E mediated.

Ig-E mediated Allergy: Individuals who develop sensitivity to certain allergens develop allergy-type antibodies (IgE). The intensity of the allergic reaction is usually directly proportional to the level of antibodies in the blood. When one is exposed to the allergen, it binds to the Ig-E and a cascade of events follows including the release of histamine, leukotrienes, prostaglandins, interlukens, and others in the blood and tissues. The tissues of the respiratory tract (upper and lower), the skin, and gastrointestinal tract which are all “end organs” of allergy. Symptoms shortly follow such as sneezing, watery eyes, nasal congestion and drainage, possibly headaches, cough, wheezing, and gastrointestinal and/or skin reactions as well. The most severe form of this type of allergy is anaphylaxis which can be life threatening.

Non-Ig-E mediated Allergy: Other things in the environment can cause allergic responses that do not depend on Ig-E. These include smoke, chemicals, cold moist weather, psychological and/or physical stress, and occupational allergies. Symptoms can mimic the more serious type, but medications poorly treat the non-Ig-E mediated type.

In order to diagnose the exact cause of symptoms one must undergo a thorough evaluation. The evaluation involves obtaining a medical history, an ear, nose, and throat exam, possibly sinus CT scans, and usually allergy testing. Allergy testing is done via skin tests and/or blood tests. More information about these tests is on the back side of this sheet.

Allergy Treatment:

Contemporary allergy management includes three methods: medication therapy (antihistamines, nasal sprays, etc.), avoidance therapy (limiting your exposure to what you are allergic), and desensitizing immunotherapy or IT (also known as: allergy injections).

With regards to immunotherapy (IT), it is available in two forms of administration: injections subcutaneously in a physician’s office weekly OR orally (sublingual) at home daily. The medical literature is inconsistent as to which method is superior. Not all patients are candidates for home therapy nor do all patients improve with home therapy. Dr. Speyer will discuss the options, benefits, and risks with you.

Allergy Testing:

Skin Prick Testing: The preferred screening method for allergies involves creating several pricks in the skin along with a droplet of various allergens that are commonly found in this area. The tests are read after 20 minutes. If one screens positive, additional quantitative testing is necessary as below.

Intradermal Dilutional Testing (IDT): IDT is a particular technique of skin testing that is very sensitive and specific for allergy. It is more labor intensive and time consuming than prick testing. Very small amounts of allergen (extracts from pollens, dust, mold, etc.) are injected under the skin of the upper arm. There will be up to 30 different allergens tested. It is not a particularly painful test, but if you are apprehensive about the injections, we can prescribe an anesthetic cream to apply to your arm an hour prior to testing. The testing takes approximately 3 hours. Not everyone is a candidate for skin testing. Individuals younger than 10 years of age, individuals taking Beta blocker medications, and those with certain skin conditions are not eligible for the tests. Also, those with brittle or uncontrolled asthma should consider alternative methods of testing.

Modified RAST (mRAST): mRAST testing can be performed on your blood. The test measures the amount of Ig-E specific to each allergen. It is not a perfect test. In fact, many people with significant allergy symptoms can have low to normal values noted on the test. Confirmatory skin testing may still be necessary. To perform mRAST we simply draw a blood sample in the office and send it to a lab for analysis. It takes about 2-3 weeks to get the results back.

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