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June 11
Exercise-Induced Asthma

Exercise-Induced Asthma

Do you have problems with coughing, wheezing, or chest tightness when you exercise? Do you feel very tired and short of breath when you exert yourself? Some people wrongly believe that they are just out of shape when, in fact, they may have exercise-induced asthma. About 18 million Americans have asthma and, of those, 80% will have increased symptoms with exercise. In non-asthmatics, up to 15% experience asthma symptoms with exercise and 40% of people with nasal allergies may experience exercise-induced asthma symptoms.
What is Exercise-Induced Asthma?
Exercise-induced asthma (EIA) is a reaction of the lungs caused by exercise. The bronchial tubes become irritated and constrict, also known as bronchospasm. Excess mucus is also formed contributing to the blockage of the airway and congestion. It is thought that when you exercise the airway is cooled and dried rapidly which sets off the reaction in some people. Although chronic asthma sufferers are more likely to have EIA, the presence of EIA does not lead to chronic asthma.
Symptoms and Triggers
Symptoms of EIA include shortness of breath during or after exercise, coughing, wheezing, chest tightness or pain, and extreme fatigue. Symptoms usually start within 5-20 minutes after starting exercise and may last for 30-60 minutes. Sometimes symptoms start only after activity has stopped however. “Locker room cough”, or a cough that occurs after exercise, is a common form of exercise induced asthma. Shortness of breath, from poor conditioning, usually resolve within a few minutes of rest. People with EIA are overly sensitive to sudden changes in temperature and humidity. Colder, drier air is usually more of a problem. Nasal breathing helps warm and humidify the air you breathe so mouth-breathing with exercise reduces the moisture and humidity of the air that reaches your lungs. Air pollution, high pollen counts, and viral upper respiratory infections can also worsen wheezing with exercise.
You should talk to your doctor if you think you may have EIA. You will need a good history and physical which often leads to the diagnosis. You may have a resting lung function test to make sure you have no chronic asthma. You may also have a breathing test after exercise, although this test may not be positive in everyone with EIA. A trial of bronchodilator therapy prior to exercise may be used to help determine whether you have EIA. Chest pain may be a symptom of EIA, but it is important for your doctor to rule out cardiovascular disease as well.
Treatment and Practical Tips
There are things that you can do to reduce the chance of having symptoms. Staying out of cold, dry air is a big fac­tor so train indoors if possible. If you do exercise in the cold, try to breathe through the nose as much as possible, wear a mask or scarf, and avoid exercise in the cold if you have a respiratory infection. Warming up 45-60 minutes before training or playing may help. Taking frequent, short breaks can help. Avoid training or playing outside on days with high pollution or pollen counts. Certain sports are tolerated more than others. Swimming is usually tolerated well due to the humidity of a pool. Lower intensity sports like golf, baseball, and weight lifting are better tolerated. Sports with short bursts of energy such as baseball, football, wrestling, gymnastics, and short-term tack events are better tolerated than soccer, basketball, hockey, skiing, and long-distance running. Always have your asthma medications with you!
The first step of treatment is the use of an inhaled short-acting bronchodilator medicine 15-20 minutes before exercise. These include albuterol, pirbuterol, and levalbuterol and are effective in 80-90% of patients, have a rapid onset of action, and last for 4-6 hours. If symptoms are not controlled by these short-acting medications, a daily medication may have to be used to prevent inflammation and responsiveness of the airway.
Most importantly, you should be evaluated and continue to exercise. Exercise and training will improve fitness, reduce the amount of breathing needed with exercise, and allow you to exert yourself at a higher intensity before symptoms begin.


May 22
Dr. Fitzhugh Interviewed on My Carolina!
March 19
Allergy-Immunology Glossary

Allergy-Immunology Glossary

Here are definitions of some of the words frequently encountered in literature on allergy and asthma.
Allergies are inappropriate or exaggerated reactions of the immune system to substances that, in the majority of people, cause no symptoms. Symptoms of the allergic diseases may be caused by exposure of the skin to a chemical, of the respiratory system to particles of dust or pollen (or other substances), or of the stomach and intestines to a particular food.
Anaphylaxis, or anaphylactic shock, is a severe, frightening and life-threatening allergic reaction. The reaction, although rare, can occur after an insect sting or as a reaction to an injected drug - for example, penicillin or antitetanus (horse) serum. Less commonly, the reaction occurs after a particular food or drug has been taken by mouth.

An antibody is a protein (also called an immunoglobulin) that is manufactured by lymphocytes (a type of white blood cell) to neutralize an antigen or foreign protein. Bacteria, viruses and other microorganisms commonly contain many antigens, as do pollens, dust mites, molds, foods, and other substances. Although many types of antibodies are protective, inappropriate or excessive formation of antibodies may lead to illness. When the body forms a type of antibody called IgE (immunoglobulin E), allergic rhinitis, asthma or eczema may result when the patient is again exposed to the substance which caused IgE antibody formation (allergen).

An antigen is a substance that can trigger an immune response, resulting in production of an antibody as part of the body's defense against infection and disease. Many antigens are foreign proteins (those not found naturally in the body). An allergen is a special type of antigen which causes an IgE antibody response.
Antihistamine drugs
Antihistamines are a group of drugs that block the effects of histamine, a chemical released in body fluids during an allergic reaction. In rhinitis, antihistamines reduce itching, sneezing, and runny nose.
Anti-inflammatory drugs
Anti-inflammatory drugs reduce the symptoms and signs of inflammation. Although not a drug, immunotherapy ("allergy shots") reduces inflammation in both allergic rhinitis and allergic asthma.
Asthma is a chronic, inflammatory lung disease characterized by recurrent breathing problems. People with asthma have acute episodes or when the air passages in their lungs get narrower, and breathing becomes more difficult. Sometimes episodes of asthma are triggered by allergens, although infection, exercise, cold air and other factors are also important triggers.
Bronchitis is an inflammation of the bronchi (lung airways), resulting in persistent cough that produces consideration quantities of sputum (phlegm). Bronchitis is more common in smokers and in areas with high atmospheric pollution.
Bronchodilator drugs
Bronchodilators are a group of drugs that widen the airways in the lungs.
Any of the larger air passages that connect the trachea (windpipe) to the lungs. The plural form of "bronchus" as "bronchi."
Contact dermatitis
Contact dermatitis is an inflammation of the skin or a rash caused by contact with various substances of a chemical, animal or vegetable nature. The reaction may be an immunologic response or a direct toxic effect of the substance. Among the more common causes of a contact dermatitis reaction are detergents left on washed clothes, nickel (in watch straps, bracelets and necklaces, and the fastenings on underclothes), chemicals in rubber gloves and condoms, certain cosmetics, plants such as poison ivy, and topical medications.
Corticosteroid drugs
Corticosteroids are a group of anti-inflammatory drugs similar to the natural corticosteroid hormones produced by the cortex of the adrenal glands. Among the disorders that often improve with corticosteroid treatment include asthma, allergic rhinitis, eczema and rheumatoid arthritis.
Digestive system
The digestive system is the group of organs that breaks down food into chemical components that the body can absorb and use for energy and for building and repairing cells and tissues.
An inflammation of the skin, usually causing itching and sometimes accompanied by crusting, scaling or blisters. A type of eczema often made worse by allergen exposure is termed "atopic dermatitis".
Epinephrine is a naturally occurring hormone, also called adrenaline. It is one of two chemicals (the other is norepinephrine) released by the adrenal gland. Epinephrine increases the speed and force of heart beats and thereby the work that can be done by the heart. It dilates the airways to improve breathing and narrows blood vessels in the skin and intestine so that an increased flow of blood reaches the muscles and allows them to cope with the demands of exercise. Epinephrine has been produced synthetically as a drug since 1900. It remains the drug of choice for treatment of anaphylaxis.
Extrinsic asthma
Extrinsic asthma is asthma that is triggered by an allergic reaction, usually something that is inhaled.
Hay fever
See Rhinitis.
Histamine is a chemical present in cells throughout the body that is released during an allergic reaction. Histamine is one of the substances responsible for the symptoms on inflammation and is the major reason for running of the nose, sneezing, and itching in allergic rhinitis. It also stimulates production of acid by the stomach and narrows the bronchi or airways in the lungs.
See Urticaria.
Immune system
The immune system is a collection of cells and proteins that works to protect the body from potentially harmful, infectious microorganisms (microscopic life-forms), such as bacteria, viruses and fungi. The immune system plays a role in the control of cancer and other diseases, but also is the culprit in the phenomena of allergies, hypersensitivity and the rejection of transplanted organs, tissues and medical implants.
Immunoglobulins, also known as antibodies, are proteins found in blood and in tissue fluids. Immunoglobulins are produced by cells of the immune system called B-lymphocytes. Their function is to bind to substances in the body that are recognized as foreign antigens (often proteins on the surface of bacteria and viruses). This binding is a crucial event in the destruction of the microorganisms that bear the antigens. Immunoglobulins also play a central role in allergies when they bind to antigens that are not necessarily a threat to health and provoke an inflammatory reaction.
Immunotherapy ("allergy shots") is a form of preventive and anti-inflammatory treatment of allergy to substances such as pollens, house dust mites, fungi, and stinging insect venom. Immunotherapy involves giving gradually increasing doses of the substance, or allergen, to which the person is allergic. The incremental increases of the allergen cause the immune system to become less sensitive to the substance, perhaps by causing production of a particular "blocking" antibody, which reduces the symptoms of allergy when the substances is encountered in the future.
Inflammation is the redness, swelling, heat and pain in a tissue due to chemical or physical injury, or to infection. It is a characteristic of allergic reactions in the nose, lungs, and skin.
Intrinsic asthma
Intrinsic asthma is asthma that has no apparent external cause.
A lymphocyte is any of a group of white blood cells of crucial importance to the adaptive part of the body's immune system. The adaptive portion of the immune system mounts a tailor-made defense when dangerous invading organisms penetrate the body's general defenses.
Mast cell
Mast cells play an important role in the body's allergic response. Mast cells are present in most body tissues, but are particularly numerous in connective tissue, such as the dermis (innermost layer) of skin. In an allergic response, an allergen stimulates the release of antibodies, which attach themselves to mast cells. Following subsequent allergen exposure, the mast cells release substances such as histamine (a chemical responsible for allergic symptoms) into the tissue.
RAST is an abbreviation for RadioAllergoSorbent Test, a trademark of Pharmacia Diagnostics, which originated the test. RAST is a laboratory test used to detect IgE antibodies to specific allergens.
Respiratory system
The respiratory system is the group of organs responsible for carrying oxygen from the air to the bloodstream and for expelling the waste product carbon dioxide.
Rhinitis is an inflammation of the mucous membrane that lines the nose, often due to an allergy to pollen, dust or other airborne substances. Seasonal allergic rhinitis also is known as "hay fever," a disorder which causes sneezing, itching, a runny nose and nasal congestion.
The sinuses (paranasal sinuses) are air cavities within the facial bones. They are lined by mucous membranes similar to those in other parts of the airways.
Sinusitis is inflammation of the membrane lining the facial sinuses, often caused by bacterial or viral infection.
Theophylline is a bronchodilator drug, given by mouth, that widens the airways to the lung. It also is used to prevent attacks of apnea (cessation of breathing) in premature infants and to treat heart failure because it stimulates heart rate and increases urine excretion.
Urticaria is a skin condition, common known as hives, characterized by the development of itchy, raised white lumps surrounded by an area of red inflammation
January 03
Spirometry Is Essential In Asthma!

​Don’t diagnose or manage asthma without spirometry.

[This is the one of five discussion points established by the American Board of Internal Medicine in conjunction with the American Academy of Allergy, Asthma, and Immunology​ for critical evaluation of the appropriate use of testing in our specialty.]


Spirometry is an essential component to the diagnosis and management of asthma.  Spirometry, defined, is the measurement of lung volumes and airflow.  Properly performed, it is extremely helpful to distinguish among various conditions which might cause clinical symptoms of asthma (cough/wheeze/shortness of breath) which overlap with many disease processes with similar symptoms (COPD and vocal cord dysfunction among them).


Furthermore, because one of the hallmarks of asthma is reversible airflow obstruction, what would typically be performed for a full diagnostic spirometry if asthma is considered is a pre- and post-bronchodilator spirometry.jpgspirometry.  From a practical standpoint, this involves a maximal forceful exhalation into a small device linked to a laptop and then inhalation after full exhalation.  For the clinician, this generates a “flow-volume loop”, the curves of which are diagnostically important. See image to the left for a good example of bronchodilator improvement in a likely asthmatic.)  For the pre- and post- tests, this procedure is performed twice: both before and then after treatment with a short-acting bronchodilator (inhaled albuterol or a version of it).  The amount of improvement (or lack thereof) after bronchodilator treatment helps us with a possible diagnosis of asthma.


Diagnosing asthma without spirometry would be akin to trying to manage a patient’s high blood pressure just by feeling their pulse.  You might be successful, but you could wind up dramatically over or undertreating such a patient without empiric data to guide you.  Moreover, I’m quite confident no one would want their blood pressure managed just based on a clinician’s instincts!  If we were to rely just upon patient’s symptoms without airflow data from spirometry, the result would often be supobtimal care in those patients who tolerate their symptoms well (but have significant impairment) or those with mild impairment but who might tend to overreport their symptoms.


The bottom line is that we always want the lowest dose of the fewest number of the most efficacious medicines.  In order to achieve this goal, the history and physical exam are of enormous importance in evaluating possible asthma or managing known asthma.  However, well-performed spirometry can ensure that we have not only the correct diagnosis, but also that we are managing this complex disease as intelligently as possible!


Note that spirometry does not assess one of the key aspects of asthma, airway inflammation.  I’ll discuss an important new tool (exhaled nitric oxide) for evaluating airway inflammation in an upcoming post.


Best wishes to everyone for a healthy, happy, and prosperous 2013!  Breathe well!



Dave Fitzhugh, MD​

October 23
Food Allergy


Food Allergy
Reactions to food are common, and can be divided into two categories, those caused by food allergy and all other reactions. Food allergies develop when the body's immune system has an abnormal reaction to one or more proteins in a food. Food allergies can lead to serious or even life-threatening allergic reactions. Food allergies can be further divided into “classic” and “non-classic” types. Other food reactions are not caused by the immune system. These reactions cause unpleasant symptoms and are far more common than food allergies. Examples include lactose intolerance, heartburn (gastroesophageal reflux), bacterial food poisoning, and sensitivity to caffeine.


Although 20-30% of people report food allergies, only 6-8% of children and 3-4% of adults have “classic” food allergy. The most common foods causing allergy are cow’s milk, egg, peanuts, soy, wheat, tree nuts, fish, and shellfish.

In people with "classic" food allergies symptoms typically occurs quickly, within minutes to two hours after eating. The most common symptoms of food allergy include:

Skin: Itching, flushing, hives (urticaria), or swelling (angioedema)
Eyes: Itching, tearing, redness, or swelling of the skin around the eyes 
Nose and mouth: Sneezing, runny nose, nasal congestion, swelling of the tongue, or a metallic taste 
Lungs and throat: Difficulty getting air in or out, repeated coughing, chest tightness, wheezing, increased mucus production, throat swelling or itching, hoarseness, change in voice, or a sensation of choking 
Heart and circulation: Dizziness, weakness, fainting, rapid, slow, or irregular heart rate, or low blood pressure 
Digestive system: Nausea, vomiting, abdominal cramps, or diarrhea 
Nervous system: Anxiety, confusion, or a sense of impending doom
Some individuals suffer from “non- classic” food allergies. The symptoms of this type of food allergy are usually slower to develop and longer lasting than those of classic food allergies. Symptoms commonly include vomiting, diarrhea, abdominal pain, and/or blood in the stool. Food protein-induced enterocolitis and proctitis/proctocolitis are common types of non-classic food allergy that are seen often in infancy.

A complete and detailed medical history is essential for initiating the proper work up for food allergy. Specific skin and blood testing gives providers added information on determining the likelihood of “classic” food allergy. If a person had a reaction after eating peanuts, but has never reacted to wheat or eggs and eats them regularly, it is not necessary to test for allergy to wheat or eggs. The gold standard test for all food allergy is the oral food challenge, where the food is ingested by the patient in a controlled setting (clinic or hospital) to monitor for reaction. It is important to note that neither the size of the skin prick test nor the level on blood tests translate into severity of allergy. These tests only speak to the likelihood of any reaction.

Once a food allergy is certain, the best treatment is to avoid the food. Patients must carefully check ingredient labels for all food products. The most important aspect of the treatment plan is to have emergency medications available at all times in case of an allergic reaction. In the case of a severe allergic reaction, timely administration of self-injectable adrenaline is the cornerstone of treatment.

How We Can Help
Your Allergy Partners board-certified provider can assist in determining whether or not a food allergy exists, what type of food allergy it is, and what treatment plan is appropriate.  Your allergist will help you understand the potential testing options as well as directing you to helpful resources like special food allergy cookbooks, patient support groups, and registered dieticians.


September 13
Food Allergy Testing - Not So Simple!


[In the upcoming series of posts, I will discuss each of the 5 “Choosing Wisely” talking points.  These were established by the American Board of Internal Medicine in conjunction with nine subspecialty boards as well as Consumer Reports to educate patients regarding the appropriate use of diagnostic tests and procedures.  Each specialty was asked to discuss 5 commonly used tests or procedures in their respective field whose use should be questioned or at least evaluated critically.  Here is a link to the Allergy/Immunology talking points:]


Don’t perform unproven diagnostic tests, such as immunoglobulin G (IgG) testing or an indiscriminate battery of immunoglobulin E (IgE) tests, in the evaluation of allergy.


Often, in the quest for answers, both patients and physicians alike place an enormous amount of stock in laboratory testing.  While very helpful diagnostically when used rationally, there are numerous scenarios where inappropriate use of diagnostic testing can lead to confusing results or worse yet, unnecessary or even potentially harmful interventions.  That’s why it is critical for any laboratory testing to be coupled with a thorough patient history to answer a clinically relevant question.  For any lab test, in order for it to have much utility, I would argue at least two conditions should be met: a) it should be a good test to detect what you are looking for and not show positive for irrelevant conditions (both sensitive and specific) and b) it should provide actionable data.  By “actionable”, I mean that you should do something based on the result, whether this is prescribe a medicine, recommend a treatment, etc.  There is zero point in arbitrary testing if the clinician does not change the course of action based on the testing.


An excellent example of such inappropriate testing can be seen in the realm of food allergy testing.  It is not uncommon for an allergist to receive a referral to evaluate a child for food allergy after a large panel of IgE-specific food allergy testing was performed.  While IgE-specific food allergy tests can be useful, I would add several caveats:



  • For only a few commonly allergenic foods (milk, soy, wheat, fish, peanuts, tree nuts) is there reliable data available to know how to interpret a specific value from the test, i.e., for peanut, a value of > 14 kUA/L is highly predictive of a likely reaction to peanut




  • IgE-based testing is available for many, many foods and other substances, but all I could reasonably say about about a positive value for something like eggplant, for instance, is that you have IgE antibodies against eggplant in your system.  This does not mean you will have a reaction to eggplant, nor should you necessarily restrict eggplant from your diet.




  • A positive allergy test to food does not mean that the patient has a food allergy.  A food allergy is established when there is a clear clinical history of an immediate reaction (usually respiratory, GI, or skin symptoms) after ingestion of a specific food which is then confirmed with a positive test to that food.  For the classic food allergy, this would almost always happen within minutes to at most half an hour of eating the food.  There are rare examples of delayed reactions to certain foods, but these are uncommon.




  • Dietary restriction of certain foods based on IgE testing alone without any clinical history of a food reaction is at best unnecessary, and at worst, potentially harmful if nutritious foods are being excluded from the diet.




  • ​The gold standard to prove a food allergy is an oral food challenge, where the suspected food is given in a controlled medical setting.  This is often not necessary if the diagnosis is clear from the clinical history coupled with intelligent confirmatory testing, but can be used in circumstances where the history is more nebulous and the clinician would like to rule out a certain food from having a role.  It might also be pursued if a child is suspected of having lost a sensitivity to a food (which occurs over time for most food allergens, in fact, with the notable exception of peanut) and the parents would like to establish that the child can eat that food safely.  If a patient has a very clear-cut and serious reaction to a certain food, a food challenge is unnecessary and in fact potentially dangerous.



It is important to distinguish IgE-based testing from IgG-based testing.  IgE is the antibody that provokes immediate-type reactions, and is relevant for food allergy testing.  IgG tests for many foods are available commercially, and while many people will have detectable IgG antibodies to any number of foods, there is no relevance of IgG to foods in food allergy.  Despite that, these tests are readily available and are ordered routinely in non-expert assessment of “food allergy”.  IgG-based food allergy testing is just one of a very large spectrum of unproven diagnostic tests that are available, but unhelpful.


As you can see, diagnosing food allergy is much more complex than one might imagine.  It is certainly not just a matter of “ordering the test”.  Choosing wisely implies ordering a scientifically validated test that works to confirm clinical suspicion based on a thorough history and importantly, understanding how to interpret that test based upon knowledge of the efficacy and limitations of that test.


I, like all the physicians at Allergy Partners, strive to practice the highest quality, evidence-based, and cost-effective medicine by utilizing effective and intelligent testing.  You can rest assured that we will never use unproven tests, and that we adhere to rigorous standards when choosing what tests to order and how to interpret these tests.  This is the only way we can ensure that we continue to deliver consistent, scientifically driven care when there are so many poorly validated and frankly worthless tests available.


Thanks and I hope this was informative!  I will continue to discuss the other points in the “Choosing Wisely” document in future posts.



Dave Fitzhugh, MD




August 03

Urticaria, or hives, is a common reason to see an allergist. It can be incredibly distressing to be covered with red welts, and the itching can disrupt sleep, school, and work. Hives appear quickly when special skin cells, called mast cells, are triggered to release chemicals that cause the rash.
Most cases of hives last only a short time and are triggered by allergic reactions, medications, or viral infections.  Allergic reactions are possible to foods, bee stings, medications, or airborne substances. Hives can also be part of a severe, whole-body allergic reaction called anaphylaxis.
In some people, the skin mast cells can react and cause hives due to pressure, cold, heat, vibration, and exposure to the sun or water. Dermatographism (Latin for “skin writing”) refers to hives that pop up for only minutes after a scratch or irritation to the skin.
It is also possible to have hives lasting for weeks or months. This “chronic urticaria” is usually not due to a particular trigger, but instead it can result from abnormal immune reactions involving the mast cell. The severity of chronic hives can be affected by factors such as stress, medications, temperature, and illnesses.
It is important to identify the cause of hives if possible, and the first step is a careful interview and physical exam with an experienced medical professional. Episodes of hives due to foods, bee stings, medications, or allergens can often be sorted out with allergy testing. A simple cause is not often found for chronic urticaria, but laboratory testing can help sort out any source of inflammation or infection that could lead to long-lasting hives.
Once the cause is determined, it is important to avoid the cause of your hives if possible.  Hives usually respond to medications that block histamine -- the major chemical released by the mast cell. These “antihistamines” include the commonly used diphenhydramine (Benadryl®), but mild or ongoing cases of hives can also respond to longer-lasting and less sedating antihistamines, such as loratadine (Claritin®), cetirizine (Zyrtec®), or fexofenadine (Allegra®). 
Under the care of an allergist, severe or persistent cases of urticaria can be treated with high dose antihistamines, the addition of other histamine blockers (ranitidine or similar drugs), or the temporary use of corticosteroids (such as prednisone). In severe cases of chronic urticaria, is it sometimes necessary to use other drugs that act on the immune system.
The physicians at Allergy Partners are experts in evaluating and treating the many possible causes of hives and allergic reactions. The evaluation begins with a careful interview and physical examination, followed by any necessary tests. These may include skin testing, which can be done during the initial visit if the patient is not taking antihistamines. For more information on Urticaria and skin testing, please visit our Patient Education page on our website or contact our office.


July 15
Welcome to Allergy Partners of Chapel Hill

Allergy Partners of Chapel Hill is the newest Allergy Partners practice to open in North Carolina. Dr. ​Fitzhugh and his staff are very excited to begin seeing patients this summer.

April 02
Weight affects response to asthma medications

There have been multiple studies showing the negative influences of being overweight for asthmatics. These studies have shown evidence that overweight asthmatics have uncontrolled asthma that is characterized by increased symptoms, more medications and higher disease burden.


Investigators from Scotland, United Kingdom, recently published a study that may partially explain this trend. They examined 72 patients with mild to moderate persistent asthma from a previously reported trial. They divided the patients into 2 groups: overweight or not. Each group received 4 weeks’ treatment with an inhaled steroid. Significantly greater improvements were seen in the normal weight group for 2 different measurements of response to inhaled steroids compared with the overweight group. This study shows why medications alone are not the only avenue of treatment for asthma. Lifestyle changes are a key component to improved asthma health.
As always, you can also follow us on Facebook and Twitter for daily pollen counts, office information, patient education and more.
Dr. Ananth Thyagarajan (Dr. T.)


April 02
New Advances in Immunotherapy


Recent and exciting changes to our immunotherapy program include the development of a cluster immunotherapy program that allows patients to reach maintenance immunotherapy in as short as four weeks. Allergy Partners is also excited to offer sublingual immunotherapy to appropriate patients. Compared to traditional immunotherapy, sublingual immunotherapy has a reduced risk of reactions that allows patients to receive immunotherapy at home.
What is Cluster Immunotherapy?
Cluster immunotherapy is an accelerated version of traditional immunotherapy. Our standard immunotherapy build up schedule calls for 27 incremental doses given once or twice a week. In Cluster, this build up period is condensed into 8 ‘sessions’ held once or, ideally, twice a week. At each session, the patient will receive 2-3 doses of immunotherapy separated by a 30 minute waiting period.  While sessions may last up to 90 minutes, a patient can reach maintenance dosages in as little as 4 weeks. Such a schedule is very appealing to patients desiring to see results more quickly or whose schedule is better suited to a more intensive initial phase of immunotherapy.
What is Sublingual Immunotherapy?
Sublingual immunotherapy utilizes allergens administered in a liquid or tablet form under the tongue to achieve immune changes as seen in traditional immunotherapy. Sublingual immunotherapy is currently not FDA approved in the United States, but research in both the US and abroad, demonstrate that sublingual immunotherapy can be a safe and effective treatment for allergic rhinitis.  Allergy Partners physicians have been deeply involved in sublingual immunotherapy studies and development. After a careful review of all the current available data, Allergy Partners is pleased to announce that we will begin offering this form of immunotherapy to appropriate patients. Patients for whom this treatment may be a good option include those who are needle phobic, those who have not tolerated traditional immunotherapy well, and those with isolated seasonal symptoms. In addition, sublingual immunotherapy appears to be an exciting option for young children.
Talk with your Allergy Partners physician today to determine which method may be best suited for your individual situation.


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Welcome to our blog site! Stay tuned to get the latest news. We will share tips and techniques for living with and managing your Allergies & Asthma. We look forward to sharing useful resources with our patients!