ALLERGY TESTING & TREATMENT
Allergies are a common problem that impacts approximately 20% to 30% of all patients. They occur when our immune system reacts to external triggers called “allergens” which then results in a wide variety of symptoms that impacts a patient’s wellbeing and health on many levels. The immune system releases IgE and histamines which then interact with the allergen to cause an inflammatory response that causes the symptoms.
Allergies can present at any age and with a wide range of symptoms and severity. There is often a genetic predisposition to allergies and having parents or other family members with allergies increases your chances of having them.
Over the years of treating thousands of patients for nasal, sinus and sleep problems, Dr Jafri has come to see the importance of also addressing allergy symptoms in his patients. Every patient is different and needs a different and wide range of solutions. Often a combination of surgery and allergy treatment provides the best outcomes. In other cases, dedicated allergy treatments by itself or surgery by itself can resolve the problems. Patient that usually aren’t fully better with one treatment modality often require combined treatments to get best resolution of their problems.
The nasal turbinates are the most impacted structures in the nose by allergens. When the surfaces of the turbinates are exposed to allergens, they cause immediate and delayed responses including sneezing, runny nose, itchy nose, sinus congestion and blocked breathing. By evaluating and treating both the anatomic (nasal turbinates) and physiological causes (allergies) of a patient’s symptoms we are better able to arrive at long-lasting solutions versus “band-aid” treatments.
Common Allergens that impact the Nose:
trees, grasses, molds, pollens, weeds, dust, dust mites, pets, ragweed, cockroaches, and mouse urine. Dr Jafri can utilize a panel of up to 80 allergens to test his patients for based on their symptoms and history.
Common Allergy symptoms:
sneezing, runny nose (clear and watery), itching nose and eyes, nasal blockage and congestion, sinus pressure, ear pressure and popping, scratchy throat, postnasal drip, coughing, poor sleep quality, fatigue, and headaches. Many patients have more subtle symptoms such as trouble breathing through their nose only. A through exam and history with dedicated allergy testing can help arrive at answers to resolve these symptoms.
Allergies can be diagnosed through testing. The various testing options are:
Allergy Skin Testing:
this type of testing can check for environmental and seasonal allergies, food allergies, stinging insect allergies and some drug /medication allergies. This testing is done in the office by placing a very small amount of the suspected allergens into the skin (no needles or sharp instruments are used). Results are known within 15 to 20 minutes and insurance plans do provide coverage for this testing (your insurance benefits can be checked before proceeding with the testing). There are two main types of skin testing – Intradermal Skin Testing and Prick Skin Testing. Dr Jafri prefers Intradermal Skin Testing as the initial test as it can check for 80 different allergens with high safety and comfort for the patient.
this type of testing requires a blood sample from the patient which is then sent to the lab to check for various allergens, IgE levels and other markers of allergic reactions found in the blood. It can be used for patients who are not candidates for skin testing or if more specific diagnostic information is needed.
Lung Function Tests, Drug challenges, Aspirin Desensitization:
more advanced and complex testing for asthma, angioedema, anaphylactic reactions and checking for allergies to medications are referred out to Allergy practices that Dr Jafri has worked with over the years to make sure patients are receiving the most advanced care for these more involved allergy patients.
Allergies can be treated through various modalities. They are as follows:
Avoidance of Allergens:
the first step in treating allergies is avoidance of the allergen in the first place. This can be done by thoroughly cleaning living and workspaces. Using an air purifier can work very well. Rinsing the nose out with saline solutions before and after exposure helps as well. Using dust covers in the bedroom helps with exposure during sleep. While not always easy this is a good starting point.
numerous medications can be used to treat allergy symptoms. While they do not cure allergies, they can help alleviate the symptoms caused by them to a great degree. Various nasal sprays (Flonase, Azelastine, Mometasone) can be used in conjunction with oral antihistamines (Claritin, Zyrtec, Allegra, Xyzal) to provide relief for patients. Medications like Montelukast (Singulair) work on the cellular level to help stop symptoms before they start. Oral steroids can be used in acute cases where symptoms need to be treated quickly. Epi Pens can be used in emergency situations where breathing is compromised, or the patient is having an anaphylactic response. Every patient is different in how well they respond to medications and for how long / often they need to use them. By utilizing testing and clinical follow up the goal is to always utilize the medications as little as possible while getting the maximum benefits.
this type of treatment helps to sensitize a patient’s immune system to their allergy triggers. By giving the patients small exposure to their allergens over time, the immune system “gets used to” the allergens and has a diminished allergic response which results in decreased allergy symptoms. There are two main types of immunotherapies – allergy shots (SCIT – subcutaneous immunotherapy) and allergy drops (SLIT – sublingual immunotherapy). SCIT are small injections that contain the allergens in them. SLIT is where drops containing small amounts of the allergen are placed under the tongue to be absorbed into the body. SLIT tablets are currently available for dust mites, grass, and ragweed. Both treatment modalities can be done in the office or at home. There is usually a period of weeks to months before results are noted and the goal is to always have a finite time for using immunotherapy. Insurance covers SCIT and has variable coverage for SLIT. Your coverage can be checked and verified by our office before proceeding with any treatment plan.
this class of medication is offering an exciting new phase and approach in how allergies are treated. Biologics are medications that are derived from living organisms and are designed to target specific parts of the immune system that cause allergy symptoms. While highly effective they do need to be monitored for side effects. For patients that are candidates for biologics, Dr Jafri will refer to an Allergy Group to help manage these medications. Biologics have also shown great promise for treating nasal polyps both instead of and after surgery. Common biologics include Xolair, Dupixent and Nucala.
often treating the allergies medically alone is not sufficient due to anatomical factors in the nose such as enlarged turbinates or a deviated septum. Other patients wish to be treated without shots or long-term medications. The nasal turbinates are the most common part of the inner nose that is impacted by allergies. By reducing their size (turbinate reduction) or their ability to cause congestion (posterior nasal nerve ablations) many patients have great improvement with their allergy symptoms without further or reduced need for medications. Procedures can be done in the office or in the operating room based on specific patient anatomy and symptoms. Turbinate procedures can provide better relief than medications or shots for patients with nasal blockage and congestion related to their allergies. These procedures are covered by insurance plans and coverage can be checked before proceeding.