Our new office in Fountain City is now open and accepting new patients. Please call (865) 687-4447 to schedule your appointment.
Allergy Partners of Eastern Tennessee is proud to announce that Dr. Joe Wisniewski was voted as a “Top Doc” in Knoxville for 2013.
Votes are submitted by referring physicians in the medical community based on their interactions with the specialists.
Allergy Partners of Eastern Tennessee is honored to have Dr. Wisniewski as a provider with our practice. We invite you to read more about him in the “Provider” section of our website.
We are accepting new patients and are participating providers with most insurance companies.
Chances are that you or a family member have seasonal allergic rhinitis or hay fever. Allergies affect 40-50 million people in the U.S., so you are not alone! This spring’s allergy season is estimated to be intense due to the mild, wet winter that we had recently.
Allergy symptoms include runny nose, sneezing, nasal and eye itching, and stuffy nose. What people don’t always associate with allergies are the limitations of their daily activities. Allergies can affect the ability to concentrate and function at school or work. Some medications can contribute to this. Sleep impairment and fatigue are common and can affect memory and impair hand-eye coordination. Complications from allergies can include ear infections, sinus infection, sore throats, cough, headaches, and can trigger asthma attacks. Eighty per cent of childhood asthma and half of adult asthma is allergic. There are approximately 17 million outpatient medical visits per year for allergies or their complications and 11 billion dollars spent on allergy medications per year.
Why do people have allergy symptoms? Your body is just trying to clear something that it perceives as foreign. Mucus production increases to trap pollens or mold spores in the nose. Coughing is due to the drainage down the back of the nose and clears your airway. When you have allergies your immune system is working overtime to try and help but causes a lot of suffering in the process. Specific antibodies to allergens such as tree pollen, ragweed, or cat bind together with whichever thing you are allergic too and triggers a release of histamine which worsens the itching, sneezing, runny nose, etc.
The most effective treatment for allergies is avoidance of the allergens, but this is not always possible. Exposure to indoor allergens can be partially prevented by measures to control dust including dust covers for the bedding, using hardwood and blinds in place of carpet and curtains, and removal of animals from the house if you are allergic to them. You may say, “can I move to another place where I won’t be as allergic?”. The answer is probably not. Allergic people will usually develop a new allergy to a different or similar allergen within the next few years after moving. You can run but you can’t hide, so to speak. Outdoor allergens such as trees, grasses, weeds, and molds are present in the air almost year round unless it is freezing outside. This spring, trees and grasses will be the major allergens. Fall allergens are usually weeds and mold spores. A single ragweed plant can release 1 million grains of pollen in 1 day so complete avoidance is impossible.
There are numerous medications which can help the symptoms of allergies. Antihistamines, many of which are available over the counter, can help with itching, sneezing, and runny nose. Unfortunately, they do not help significantly with nasal congestion. There are several steroid, antihistamine, and combination nasal sprays available which may be more effective particularly for stuffy nose to prevent sinus infection. All medications come with costs, both literally in dollar terms and figuratively with side effects.
For those who cannot avoid what they are allergic too, don’t get relief with medications, have too many side effects, or costs are too high with the medications, immunotherapy is an option to consider. If you think you may be a candidate for allergy shots, ask your primary care physician or see a board certified allergist. An allergy evaluation includes a thorough history and allergy testing to make sure symptoms match what your testing shows. Allergy testing can be performed either by a blood test or skin testing. Skin testing is usually a more sensitive test, less expensive, and provides results on the day of the visit. An example of skin testing can be watched on our website under the patient education tab at www.allergypartners.com/et. If allergy testing is negative, an allergist can still help identify the cause of your symptoms, and provide a treatment to obtain relief.
Immunotherapy, or allergy shots, is the process of taking the specific allergens that you are allergic to, making a purified extract, and giving either small shots under the skin or drops under the tongue to desensitize you, or make you less reactive to your allergies. Allergy shots have been around for more than 100 years and provide a safe, cost-effective way to treat the root of the problem, decrease the need of medications, and decrease the secondary problems of allergies such as sinus infections in a non-surgical manner. They are an option for both adults and children. Usually, you receive small amounts of the extract under the skin of the arm and the dose is slowly increased over time until a maintenance dose is achieved. Once on full dose, you come for a shot every 2-4 weeks for a typical period of 3-5 years. Benefits from the therapy usually begin within 6 months of starting shots and last for many years after discontinuation in most people and sometimes for the rest of your life.
A Board Certified Allergist can help you…GET TESTED! GET TREATED! GET BETTER!
Eosinophilic esophagitis (EE or EoE) is a relatively newly recognized disease that has been increasingly diagnosed in both adults and children since 2000. It is characterized by a large number of white blood cells called eosinophils that cause inflammation in the esophagus (the tube that connects the mouth and stomach).
This inflammation prevents the esophagus from functioning normally and leads to symptoms. EE commonly occurs in people with other allergic diseases such as allergic rhinitis (hay fever), asthma and/or eczema.
Reflux that does not respond to usual therapy:
- Dysphagia (difficulty swallowing)
- Food impactions (food gets stuck in esophagus)
- Nausea and vomiting
- Failure to thrive (poor growth, malnutrition or weight loss)
- Abdominal or chest pain
- Feeding refusal/intolerance or poor appetite
- Difficulty sleeping
The only way to definitively diagnose EE is through endoscopy with biopsies, usually done by a gastroenterologist. The endoscopy is often performed after treatment with reflux medications have failed to relieve symptoms. During the endoscopy, the gastroenterologist looks at the esophagus, stomach and duodenum (the first part of the small bowel) through an endoscope (small tube inserted through the mouth) and takes multiple biopsies (small tissue samples) which a pathologist reviews under the microscope. A high number of eosinophils (>15 per high power field under the microscope) suggests a diagnosis of EE.
Once EE is confirmed, allergy testing is recommended as many patients with EE have underlying food and possibly environmental allergies that are contributing to the abnormal inflammation seen in the esophagus. The most common type of allergy testing is skin prick testing, but patch testing to certain foods can be useful as well. In patch testing, a small amount of the foods is placed on the skin (usually the back) and covered with tape for 48-72 hours. At that point, the site is assessed for evidence of redness and inflammation indicating food allergy.
At present the two main treatments recommended are dietary management and topical corticosteroids.
Elimination Diets – All “positive” foods on allergy testing are removed from the diet. Often this is the only treatment needed.
Six-food Elimination Diet – Patients eliminate the top 6 most allergenic foods (dairy, eggs, wheat, soy, peanuts/other nuts, fish/shellfish).
Elemental Diets – All sources of protein are eliminated from the diet except for an amino acid (building blocks of protein) formula. These diets are mostly used in young children with EE.
Food Trials – This involves adding back one ingredient at a time to one’s diet to determine specific foods causing a reaction. They begin after symptoms resolve and eosinophils have cleared.
Medications - Medications most commonly include steroids to control inflammation and suppress eosinophils. They can be taken orally (a form of prednisone) or topically (swallowed asthma inhaled steroid such as fluticasone or budesonide).
How We Can Help
The diagnosis and treatment of eosinophilic esophagitis requires a multidisciplinary team approach involving gastroenterologists, allergists, nutritionists. As part of the nation’s largest allergy practice, Allergy Partners’ physicians provide the expertise needed to accurately diagnose underlying allergic triggers to EE. With this information, a personalized and comprehensive treatment plan aimed at alleviating symptoms of EE can be formulated.
ECZEMA (Atopic Dermatitis)
Atopic dermatitis, also known as eczema (pronounced “EK-zema”), is a skin condition that causes dry, scaly, red, and itchy skin. It can occur at any age, and is more frequent in some families.
Eczema affects 10-20% of children and 1-3% of adults. The cause of atopic dermatitis is unknown, but genetic factors play a strong role. The symptoms are secondary to a dysfunctional outer layer of the skin known as the epidermis. Normally, an intact epidermis keeps out environmental irritants, allergens, and microbes. Because the skin is not working properly, these substances get into the body which lead to inflammation. In children with moderate to severe atopic dermatitis, up to 2/3 of them may have some underlying food allergy.
Most people with atopic dermatitis have symptoms before the age of five. Intense itching of the skin, patches of redness, small bumps, and skin flaking are common symptoms. Scratching can lead to additional inflammation, which causes a cycle of itching and scratching that worsen the disease and can potentially lead to decreased sleep and quality of life. In severe exacerbations, the skin may actually start oozing which can be a sign of infection.
There is no specific test to diagnose atopic dermatitis. The diagnosis is based on clinical information like the patient history and physical examination. Testing done by a well-qualified allergist can identify potential triggers like environmental or food allergens.
SKIN CARE, SKIN CARE, SKIN CARE! Appropriate skin care is the cornerstone of treatment for atopic dermatitis. Aggressive moisturizing with a good quality, hypo-allergenic lotion or cream is the key to preventing skin dryness.
The lotion should be applied at least twice a day and within 3 minutes after bathing. Both intermittent and daily bathing are appropriate, but a fragrance free soap and pat-down drying should be used.
Avoiding known triggers can reduce the intensity of atopic dermatitis. Irritants, stress, heat/sweating, infections, and allergens can all cause exacerbations.
Topical steroids or anti-inflammatory creams should be used as needed on red inflamed areas of skin. Only low potency creams should be used on the face because the skin on this part of the body is thin.
Medications like oral anti-histamines can be prescribed to attempt to control itching, but this is controversial.
Treatments like bleach baths and wet wraps can be used in select cases as determined by your physician.
How We Can Help
An allergist can help identify environmental or dietary triggers and work with patients and their families in creating an effective and practical treatment plan. Skin testing to identify these potential triggers should be performed by a trained professional.
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.
Are allergies giving you a rough time this fall? Allergy symptoms can occur any time of year, but the fall is one of the seasons when allergy sufferers have a big spike in symptoms such as itchy eyes, runny nose, nasal congestion, and sinus symptoms. Those with asthma may also note increased problems with cough, wheeze and shortness of breath.
So why is the fall of the year so problematic? One of the most symptom promoting allergens is present during the fall. Ragweed pollen plays a strong role in producing allergy symptoms. Combine this with the other weed pollens and with mold spores, which are also worse in the fall, and you have a potent recipe for allergy misery.
Many antihistamines are available over the counter and may be very helpful with controlling the itchy eyes and runny nose. Many times they don’t adequately help with the nasal and sinus congestion. Fortunately, there are several prescription medications that may help as well. This includes medications that help with controlling inflammation in the nasal and sinus tissue due to allergy. Nasal sprays that contain a topical steroid medication or a topical antihistamine are particularly helpful. There is also an oral medication that helps block leukotrienes which are a type of chemical that promotes inflammation and causes runny nose and nasal congestion.
For many allergy sufferers, these medications, while helpful, don’t give adequate relief. In those cases, immunotherapy, or allergy shots or drops, help to reduce the immune system reaction to allergens. This works to reduce the severity of a person’s allergy and prevent allergy symptoms through this reduction in reactivity. Patients become more resistant to the allergy causing substances and usually are able to significantly reduce their medication usage due to reduced symptoms.
At Allergy Partners of Eastern Tennessee we can help you with fashioning a customized treatment program to help you live a life free of allergy symptoms. Visit our website at www.allergypartners.com/easterntennessee to get more information and make an appointment, or call us at 865-692-2027.
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.
Knoxville is consistently listed as one of the worst allergy and asthma cities in the country.
Knoxville has just the right mix of high pollen counts due to the climate and lush vegetation, and pollution, mostly ozone that is trapped in the valley due to the surrounding mountains. This results in high levels of exposure to allergens that cause those who are allergic to have allergy and asthma symptoms. The pollution magnifies the effect of the allergens on the nose and airways, making the symptoms even worse.
Fortunately, there are treatments available that can significantly reduce the suffering. Antihistamines and decongestants can be bought over the counter and provide some allergy sufferers with relief. However, for many allergic people, over the counter medications don’t adequately control their symptoms. A visit to your doctor for a prescription medication such as an intranasal steroid spray will often reduce the allergic inflammation in the nasal tissue to provide additional improvement. Yet, some patients still don’t get enough relief, are having frequent sinus infection, have persistent asthma, or cannot tolerate the medications. Testing to find which allergens such as pollen, mold or animals, are giving you trouble will allow you to avoid or reduce your exposure to those things. Allergy shots or sublingual drops, also known as immunotherapy can reduce your allergy by changing your immune systems response to those allergens. This helps to significantly reduce or eliminate your allergy symptoms as you become less allergic. Many patients find they no longer need medications to control symptoms once they have been on allergy shots for a few weeks to months.
Paul M. Carter, MD, MHCM
Allergy Partners of Eastern Tennessee
With the warmer weather of summer, we are enjoying more time outside. Along with the summer weather comes a dramatic rise in the number of stings from bees and fire ants. For many people these stings are painful and annoying but not dangerous. However, approximately 1 in 100 people has a potentially life-threatening allergy to insect stings. The insects most often responsible for serious allergic reactions are honey bees, wasps, hornets, yellow jackets, and fire ants. Although intimidating by virtue of their size, bumble bees rarely sting.
An allergic reaction can involve the entire body and advance rapidly after the sting. Common symptoms include itching, hives and swelling distant from the site of the sting. Dizziness, asthma symptoms, nausea, vomiting and a drop in blood pressure, shock and unconsciousness may also occur. Severe reactions may be fatal if medical treatment is not obtained immediately.
Once an individual has experienced a severe reaction, they have a 60-70% chance of experiencing a similar or more severe reaction with each future sting. Therefore, anyone who has experienced any of the above symptoms following a sting should carry an EpiPen at all times. However, with insect venom allergy, epinephrine is not enough. Using an EpiPen is critical for treating a severe reaction. However, it cannot prevent future reactions. Anyone with an allergic reaction to a sting should be evaluated by an allergist for testing and consideration of immunotherapy. Allergy shots to stinging insect venom are 98% effective in preventing future stings and are the standard of care treatment for venom allergy.
Stinging insect allergy is potentially fatal. Fortunately, current treatment is very safe and highly effective. Allergy shots to venom can be life-saving. Don’t let the fear of stings keep you indoors this summer. If you have a history of reactions to stings, see us for an evaluation.