Spring time is coming soon or is already here for many parts
of the country. Along with the warm weather and birds singing we also see large
amounts of tree and grass pollen. For those of us that suffer from spring time allergies
this can be a really tough time of year with symptoms
such as runny/congested noses, itchy/watery eyes, and (in some) increased cough
and wheezing. We manage allergies in three ways:
Pollen is prevalent in the southeast for 9 – 10 months a year. It’s difficult
to avoid pollen, but simple avoidance measures such as keeping bedroom windows
closed, using central or window air conditioning and changing filters monthly
can help. Also, shower and shampoo hair as soon as you are done working or
playing outside, and keep animals outdoors as they carry pollen on their coats.
to see our Environmental Control Handbook. Keep track of pollen counts
to know when allergen levels are high.
A variety of medications are useful in treating symptoms. Antihistamines are
useful for alleviating itching and sneezing, while decongestants alleviate
congestion. Nasal sprays (both steroid and antihistamine) effectively treat
many nasal symptoms while a variety of antihistamine eye drops are available
for eye symptoms. Many allergy sufferers start their medication regimen before
pollen season begins to prevent symptoms from becoming too severe. If you
suffer from asthma,
there are different types of inhaler
medications that can treat ongoing symptoms and others that help prevent
symptoms from occurring in the first place.
Immunotherapy is a very effective treatment for allergic rhinitis, allergic
conjunctivitis and asthma. Unlike medications that treat symptoms only,
immunotherapy desensitizes the immune system and prevents symptoms from
developing in the first place. Immunotherapy is effective in approximately 85%
of patients and reduces symptoms, decreased the need for medications and may
prevent asthma in young children. There are multiple studies that show that immunotherapy
decreases health care costs in both adults and children. Immunotherapy also
has the potential to create long term relief from allergy symptoms even after
the treatment is completed. Immunotherapy is traditionally given as allergy
immunotherapy), but a newer method is with allergy drops under the tongue (sublingual
immunotherapy). For those patients that are only allergic to grass pollen (which
pollinates in the late spring and early summer) there are even sublingual grass
immunotherapy tablets that have been approved by the FDA. If you have symptoms that are uncontrolled please talk to
your trusted health care provider. If you haven’t already seen an allergist
consider doing so, they can provide you with detailed information on what you
are actually allergic to and give you the best customized treatment options available.
As always, you can also follow us on Facebook and Twitter for daily pollen counts, office
information and more. If you enjoyed this post please “Like” us on Facebook and
“Share” the article.
Dr. Ananth Thyagarajan (Dr. T.)
Congratulations to Dr. Blumberg and Dr. Thyagarajan (Dr. T.) for being named Richmond Top Docs for 2014!
If you have had allergies for a period of time, at some point you may be faced with the option of starting allergy shots as suggested by your doctor. Here is at least a partial list of things you should consider before going ahead with them:
1. Your philosophy: allergy shots are in a way a more “natural” treatment than medications. They are like vaccinating you for your allergies. With allergy shots, you are given small but increasing quantities of the specific pollens, dust, pet dander and/or molds to which you are allergic. It changes the way your immune system responds, thus reducing the allergic response and therefore the amount of medications you will need to control your symptoms. Also, after 3-5 years of adequate doses of allergy shots, studies have shown continued benefit from the shots for 3-10 years even after stopping them. So if your philosophy is that you want to minimize the use of medications, then you should choose allergy shots.
2. Skin tests: Your allergist will most likely only recommend shots if a) your skin tests are positive and b) the specific allergens that are positive correspond to your symptoms. For example, if your symptoms are present only in the fall, but your skin tests are positive only to spring pollens, allergy shots would not be appropriate. Conversely, if you have symptoms all year around but worse in the spring and your skin tests are positive for spring and fall pollens in addition to allergens which may affect you year-round, such as dust mite and pet dander, then you are a good candidate for allergy shots. There are some people who suffer with nasal symptoms all year around or have asthma all year around who have completely negative skin tests. These people have non-allergic rhinitis or non-allergic asthma and shots will not help them.
3. The severity of your symptoms: If your symptoms are mild and/or last only a few weeks per year, then the commitment of taking allergy shots may be too much for you. But if your symptoms last several months during the year, for example all spring and all fall, then allergy shots would make more sense. Or, on the other hand, your symptoms are severe and you have tried several kinds of antihistamines in addition to nasal steroid sprays with only partial relief, then allergy shots would be the next step even if they only last for a short time during the year.
4. Cost: your cost for the allergy shots will depend upon your insurance plan. Our office will submit your information to your insurance company to get an estimate of what your out of pocket costs will be. Since allergy shots reduce your need for medication, some studies have shown that allergy shots are cheaper than taking medications. Click here to read about a study that shows this.
5. Effectiveness vs. medication: Over the long term, allergy shots are more effective than medication. In fact, allergy shots are effective approximately 85% of the time. Compare that to the most effective type of medication, steroid nasal sprays, which are effective 37% of the time. With allergy shots, you are likely to be able to decrease the amount of medication that you need, or even eliminate medication.
6. Commitment: Although allergy shots have many advantages over medication, they do require more commitment. You need to start getting injections once per week. Traditionally, this goes on for 4-6 months, depending upon how well your body tolerates the rate of increasing doses. After that, you continue on maintenance every 2 weeks for 3-5 years. There are two other types of schedules. One is called the Cluster Method. If your schedule allows you to come in for 2 hours for several weeks in a row, you can complete your build up to maintenance in as little as 9 weeks. There is a third schedule that is in between those first two.
This is a lot to think about. Hopefully, these considerations will make your decision easier. As always, you can also follow us on Facebook and Twitter for pollen counts, office information, patient education and more. If you enjoyed this post please “Like” us on Facebook and “Share” the article.
By Elaine S. Turner, MD
Dr. Thyagarajan, Dr. T, presents on the topic of Food Allergy and then provides a live Q&A session with the audience. Watch it now on our YouTube channel, www.youtube.com/myallergypartners.
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More than 20 years ago in Asheville, North Carolina, Allergy Partners was founded on a simple premise: by working together, allergists can identify and implement best practices, which will result in improved patient care. By following that premise, we have grown to almost 100 allergists and 800 team members in 17 states. We are proud to provide care for more than a half-million patients. We are even more proud of the quality of care we provide.
All Allergy Partners physicians are certified by the American Board of Allergy, Asthma, and Immunology. That certification requires certification by the American Board of Internal Medicine or the American Board of Pediatrics followed by a minimum of two years of fellowship training. As a result, our physicians are uniquely qualified to manage conditions including:
• allergic rhinitis
• allergic conjunctivitis
• chronic cough
• chronic sinusitis
• urticaria and angioedema
• atopic dermatitis
• contact dermatitis
• anaphylaxis(bee sting, drugs, food, or other causes)
• immune deficiencies
To make certain we remain on the cutting edge of our specialty, we created the Clinical Excellence Committee. Under the oversight of Dr. Spencer Atwater, our Chief Medical Officer, the Committee identifies opportunities for improvement, reviews pertinent medical literature and current standards, develops recommendations for optimal treatments, and engineers systems to make sure that treatment is delivered consistently. A perfect example of that is our state-of-the-art allergen immunotherapy program and extract lab. In many ways, immunotherapy is the cornerstone of the allergy specialty. To ensure that immunotherapy is as safe and effective as possible, we worked in conjunction with nationally recognized experts to develop our formulation processes and dosing recommendations. We invested in building our extract lab after seeking input from industry experts as well as the Center for Biologics Evaluation and Research. Today we produce over a quarter million vials of allergy extract annually following USP 797 guidelines for sterile allergenic extract processing. It is through this attention to detail that we can provide you assurance that the patients you entrust to us will be provided safe and effective therapy.
At Allergy Partners, we are committed to using the latest technology to improve patient outcomes. Each of our locations is not only using the same electronic health record, they are also configured as a single database. In this way, as opportunities to improve care become available, we can easily build and implement the forms that will encourage that care on an enterprise level. We can and do track the outcomes of that care delivery, and use that understanding to implement further change. We have published data in national allergy journals which we hope will help other practices with what we have learned.
We also use our information systems configuration to improve the quality of our consultations. We have an “All Doctors” listserv set up which enables our referring physicians to benefit from the expertise of not just one, but almost 100, practicing allergists. When any of our physicians confronts a particularly unusual or difficult case, he or she can immediately tap into the expertise of our entire network. With our current size, we see this opportunity utilized once or twice every day. It not only provides access to much broader expertise for our patients, it also serves to educate our own physicians on a daily basis.
At Allergy Partners we are proud of our history and proud of the care we provide today. We are even more excited about the future and the opportunities we have to deliver even better care. We have just implemented our patient portal, which increases our opportunities to interact with patients. We are in the process of developing more robust outcomes assessment capabilities. Additionally, we are exploring ways to integrate technology in ways that will help us work with our patients to make those outcomes even better. And most importantly, we are continuing to work as a group to build a patient-centered culture. As hard as we work behind the scenes to implement best practices and improve our specialty, we work just as hard to make sure our patients recognize that we care. We pledge to provide our shared patients the very best care and the best experience possible.
The next time you’re at the local pharmacy, you may be surprised to see your prescribed allergy nasal spray available over-the-counter. Many drug manufacturers are pushing for this move to make finding relief easier for some of the 50 million Americans with allergies. But this warrants caution for some.
Allergy sufferers may no longer need a prescription for certain allergy nasal sprays, but they might need an allergist’s advice. Some medications merely mask symptoms without tackling the root of the allergy. And often patients will find what medication once suppressed their symptoms, no longer does.
The over the counter availability of this new nasal spray may lead to questions from local allergy sufferers. To help eliminate confusion, the American College of Allergy, Asthma and Immunology (ACAAI) have answered the seven most common questions.
1. Is it safe? Not only can the new nasal allergy spray relieve congestion, sneezing and a runny nose, it also does not cause drowsiness and is non-habit forming. Improper use of nasal sprays may cause nasal bleeding. Follow the package instructions and inform your allergist if bleeding occurs.
2. Can I stop antihistamines? If you find solely using the nasal allergy spray is helping to suppress your symptoms, you may not need to take an antihistamine. Each person is different and they will have to be the judge of how they feel only using one medication. However, if you’re not finding relief from one or both medications, you should speak with your allergist.
3. Is it safe to give my child? The medication is approved for children two-years and older. But it may complicate some infections your child might have, so check with your allergist.
4. Can it be used year-round? Yes, it is approved for year-round use. Many allergy sufferers that have year-round allergies to pets, dust and mold often find nasal sprays are not enough for symptom relief. Many allergists prescribe immunotherapy (also known as allergy shots), which not only provides symptom relief, but can modify and prevent disease progression.
5. Will my insurance cover it? It is unlikely your insurance provider will cover over-the-counter nasal allergy sprays, even if it was covered when it was prescribed.
6. Do I need to continue following up with my allergist? Allergy sprays are merely a medication and not a cure for allergy. Because allergies can change over time, it’s important to be under the care of an allergist for proper testing, diagnosis and treatment that may go beyond over-the-counter medications. Allergies can also cause symptoms such as chronic sinus infections, nasal congestion or difficulty breathing.
As always, you can also follow us on Facebook and Twitter for pollen counts, office information, patient education and more. If you enjoyed this post please “Like” us on Facebook and “Share” the article.
Dr. Ananth Thyagarajan (Dr. T.)
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!