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September 30
Benefits of Immunotherapy (Allergy Shots)


Allergic rhinitis, better known as hay fever, is one of the most common chronic illnesses and is estimated to affect 20% or more individuals at some point in time. An allergy can be considered an exaggerated immune response where the body is trying so hard to keep the allergens out that undesirable symptoms such as sneezing, rhinitis, congestion, and wheezing occur.   Allergic triggers include seasonal pollens and year-round allergens such as house dust mites, mold, and animal dander.


Many allergy sufferers also suffer from asthma. Upwards of 70% of all asthmatics have underlying allergies. In children, the numbers are even more staggering as 80-90% of asthmatic children are allergic. Conversely, allergic children have a 40-60% risk of asthma.  Allergies also can negatively impact quality of life with malaise, fatigue, loss of sleep, and loss of school and work days.  The resulting expenses for treatment and lost wages are very substantial, ranking high on the list with medical expenditures.
Fortunately, many allergy and asthma patients respond well to symptomatic treatment and avoidance.  Education about allergen avoidance and control and the ongoing use of an effective medication can lead to excellent results for many. 
For those patients for whom conservative treatment proves inadequate because of severity, chronicity, and complications, an evaluation by a board certified allergist is in order.  An allergist will use a thorough history and exam to establish the best available options for treatment.  When indicated, allergy skin tests identify specific sensitivities to seasonal and perennial allergens.  Such testing provides the most cost effective answers, which can then be correlated with that particular patients’ history and physical findings. 
In a patient with such severe chronic respiratory allergy, subcutaneous immunotherapy (SCIT) or “allergy shots” may offer the best opportunity to modify, in a sustained fashion, the underlying problems.  SCIT helps up to 80% of pollen allergic and 60-65% of environmentally allergic patients.  By a variety of mechanisms, SCIT teaches the body to “block” or decrease the exaggerated immune response. 
In the office, this process takes place by formulating an allergen vaccine targeted against a person’s allergy triggers. Initial doses are very small and administered in increasing doses. As the dose is increased, the immune response begins to change. After a build- up period, immunotherapy is continued at a targeted optimized dose every 2-4 weeks for a 3-5 year course.
Allergy shots have been shown to result in less symptoms, severity, and complications of both asthma and allergies over time. Additionally, successful SCIT leads to less need for medication and less need for medical attention. 
Current medications for allergies and asthma are very effective in treating the symptoms and preventing asthma flares. However, they do not alter the underlying cause of asthma. When the medicines are stopped, allergy and asthma symptoms recur. 
This is one of the key differences between immunotherapy and other treatments. By fundamentally changing the immune process to underlying allergies and asthma, immunotherapy can change the disease process. After 3-5 years of immunotherapy, many patients are able to stop allergy shots and their symptoms remain controlled without more medication.
In young children, allergy shots may also prevent the development of new allergies and asthma. One study by DeRoches, et al showed that children on SCIT were much less likely to develop new allergies after 3 years. The Prevention of Asthma by Immunotherapy (PAT) study also showed that immunotherapy can prevent the development of asthma in allergic, at-risk children. Children receiving immunotherapy were 48% and 60% less likely to have developed asthma at 3 and 5 years respectively than the children who did not receive SCIT.
By its nature, immunotherapy carries with it the risk of allergic reactions. While most reactions are localized with some swelling, itching and pain, more severe allergic reactions can occur. Immunotherapy, therefore, should always be administered in a doctor’s office and patients should be monitored for 30 minutes after all injections. Fortunately, these reactions are rare and Allergy Partners strives to ensure the safety of all patients.
Learn more about immunotherapy by contacting your trusted Allergy Partners Allergist.






September 14
Allergy Myth Busters: Food Allergy Causes ADHD

Our very own Allergy Myth Busters!


Inspired by one of our favorite television shows, Allergy Myth Busters looks at a number of popularly held beliefs about allergy. But are these myths just urban legends or are they true?
The Myth:
Food Allergy causes ADHD. 
What is ADHD?
Attention deficit hyperactivity disorder (ADHD) manifests in early childhood as a behavioral disorder characterized by hyperactivity, impulsivity and/or inattention and affects cognitive, emotional and social functioning.
What does science say?
Feingold reported that children with learning difficulties and behavioral problems improved on a diet eliminating artificial colors, preservatives, and fruits and vegetables containing salicylates. 
So is the myth busted or true?


Subsequent studies did not confirm this observation. In some children, food additives may aggravate hyperactivity, due to non-IgE-mediated histamine release and delayed degradation of histamine resulting in itching. Such effects, however, are not true food allergies but are food intolerances.  As such, this type of adverse effect cannot be diagnosed by food allergy testing either by skin testing or by blood work. In March 2011, the Food Advisory Committee of the US Food and Drug Administration determined that existing data do not support a causal link between consumption of color additives and hyperactivity or other problematic behaviors in children.


Final thought:
Food sensitivity (allergy or intolerance) may be present in some children with ADHD but generally do not impact behavior to a clinically significant level. A meta-analysis of 23 studies eliminating dietary sugar followed by challenges with sugar did not support a link between sugar intake and hyperactivity, attention span or cognitive function in most children. An elimination diet, limited to turkey, lamb, rice, potato, banana, apple, pear, a few vegetables, water, salt and pepper, did not improve symptoms more than a placebo diet.
Food sensitivity should be looked for, but plays no role in the majority of cases of ADHD. If considering dietary changes, it is always advisable to discuss it with your doctor and/or a nutritionist.
Feingold BF. Hyperkinesis and learning disabilities linked to artificial food flavours and colours. Am J Nurse 1975; 75:797-803.
Quick Minutes: Food Advisory Committee Meeting March 30-31, 2011.
Wolraich ML, Wilson DB, White JW. JAMA 1995; 274(20):1617.
Schmidt MH, et. al. Does oligoantigenic diet influence hyperactive/conduct-disordered children—a controlled trial. Eur Child Adolesc Psychiatry 1997; 6(2):88.






August 26
Allergy Myth Busters: Local Honey

Inspired by one of our favorite television shows, Allergy Myth Busters looks at a number of popularly held beliefs about allergy. But are these myths just urban legends or are they true?
The  Myth:
The use of local grown honey  can help relieve symptoms of allergic rhino-conjunctivitis and associated atopic (allergic) conditions including asthma.
What does the science say:
A literature search returns very few articles specifically addressing and using locally grown honey. A study published in the Annals of Allergy, Asthma and Immunology in February 2002 negates the benefits of local grown honey. The study followed a cohort of 64 people randomly assigned to one of three groups, with the first receiving locally collected, unpasteurized, unfiltered honey, the second nationally collected, filtered, and pasteurized honey, and the third, corn syrup with synthetic honey flavoring. They were asked to consume one tablespoonful of honey or substitute daily and to follow their usual standard care for the management of their symptoms. Neither honey group experienced symptom relief when compared to the placebo group.
To the contrary, a study in the International Archives of Allergy and Immunology in May 2011 appeared to show a benefit. In this study, Forty-four patients with physician-diagnosed birch pollen allergy consumed either no honey, regular honey or honey to which birch pollen was added (birch pollen honey or BPH) in incremental amounts from November 2008 to March 2009. At the conclusion, patients in the first 2 groups experienced no improvement of symptoms but the BPH group experienced a statistically significant improvement in symptoms scores.
So is the myth busted or true:
Essentially both articles are supporting the same conclusion i.e. locally grown honey is not beneficial for allergies. How so? Obviously in the first article there was no benefit obtained in the group consuming locally grown honey but the same result was actually shown in the second study. If the honey was not doctored with additional birch pollen, symptom improvement DID NOT occur.
Despite this, the second article is often cited as being beneficial in lay publications and websites promoting organic or naturalistic methods for treating allergies. They appear to ignore the fact that birch pollen HAD TO BE ADDED. The first article is cited often as being outdated or old and therefore given no credence, which is foolish. Otherwise most of what's available is purely anecdotal with little factual evidence supporting the claim. Surprisingly, some websites purport the benefit but contradict their own anecdotal evidence.
Remember that bees are in the business of collecting a flower's nectar, not pollen to produce honey. Therefore very little pollen is deposited in honey. Also, the pollen they handle is produced by flowers that require cross pollination by insects unlike the majority of allergy triggering tree, grass and weed plants that do not require insects to carry pollen for fertilization. They produce huge amounts of pollen and depend on the wind for distribution/pollination. They don't need the bees. Yes some of the allergen inducing pollen grains end up in the honey but they are in insignificant quantity.
Final thought :
Remember if you are experiencing difficulty with allergy, your local Allergy Partners specialist is available to administer immunotherapy which utilizes a natural pollen extract to alleviate symptoms. It is the only modality proven to statistically reduce the progression of atopy and potentially reverse the allergic IgE mediated mechanism preventing asthma and the progression of allergy. Also, the consumption of locally grown honey is fine, but should not be given to infants under 12 months of age. Diabetics will likely have difficulty with blood glucose control and if a person is allergic to bee venom they may be at an increased risk of developing anaphylaxis to locally grown honey.

August 17
Of Pharaohs and Bee Stings

Of Pharaohs and Bee Stings

Was the death of a pharaoh the first report of an insect sting reaction?  In 1989, an article in Hospital Practice by Ovary  stated that the death of Pharaoh Menes after a wasp sting in 2600 BC was the first reported account of an anaphylactic reaction to insect stings.  According to Krombach, this was based on hieroglyphs found on his sarcophagus and tomb. Dynasties that came after Menes believed him to be the first Pharaoh and he is credited with many things, including the introduction of papyrus and writing.  But Krombach and his fellow authors argue that he was likely a mythical figure who may not have even lived.  Oh well -- so much for exotic origins.  No matter when the first reaction was, it is likely that insect sting allergy started a very long time ago.

A review article in the June 2015 Journal of Allergy and Clinical Immunology In Practice spoke about the state of the art in treating stinging insect allergy. Reactions to stinging insects account for 10% of all cases of anaphylaxis presenting to emergency rooms and there are about 40 deaths per year in the US due to these reactions. The estimate is that 0.4% to 0.8% of children and 2% to 3.5% of the general adult population experience systemic reactions to insect stings at some point in their lives.
The Players
The Hymenoptera are the most studied stinging insects, with purified, commercial venoms for testing and treatment in the United States. Hymenoptera include the Apidae (honeybee) and Vespidae (aerial yellow jacket or New World hornets) which include Vespinae (yellow jackets and aerial yellow jackets) and Polistinae (wasps). There are also a number of types of stinging ants. The most common in the US and best studied is the Imported Fire Ant (IFA), Solenopsis  invicta. Since inadvertent importation through Mobile, Alabama during 1930-1940, this fire ant has spread throughout the Southeast of the US as far north as Maryland and even into the arid southwest.


What are the different kinds of reactions to insect stings?

There are five types of reactions to insect stings, according to Koterba and Greenberger. These include:
·       A normal reaction with less than 2 inches of redness and swelling right around the sting and which subsides in less than a day.  For this, cold compresses and analgesics (pain medication) are sufficient treatment.
·       A large local reaction with extensive redness and swelling, generally more than 5 inches in size and lasting 1-10 days.  These reactions can involve large areas – for example, a whole arm. Analgesics, ice and sometimes prednisone is the usual treatment.
·        Anaphylaxis includes swelling that skips a joint area or occurs at areas of the body distant from the site of the sting.  Hives can also accompany this reaction.  The patient may have life threatening symptoms such as swelling of the larynx (which may cut off breathing) or cardiac involvement.  Treatment includes urgent use of epinephrine (generally administered by an automatic injector such as EpiPen or Auvi Q) and calling EMS for a trip to the emergency room. Patients who have these reactions should be skin tested and considered for desensitization to the venom or venoms to which they are shown to be allergic.  If the reaction is only hives in a child less than 16 years old, life threatening reactions usually do not develop on re-sting so desensitization may not be necessary in this case.
·       Rare reactions: These include serum sickness with hives, fever, malaise and joint pain that occurs 7 days after the sting.  Some of these patients may experience anaphylaxis on subsequent stings, so desensitization is suggested.
·       Toxic  reactions: These happen with multiple simultaneous stings such as may occur in an attack by Africanized honey bees. Hypotension, cardiovascular collapse and death may occur.

How can you tell which kind of insect stung you?

There are five types of stinging insects to which allergists test – Yellow Jacket, Honeybee, White Faced Hornet, Yellow-Faced Hornet,  and Wasp.  According to the American Academy of Asthma, Allergy and Immunology, here are some of the characteristics of these insects:
•    Yellow jackets are black with yellow markings, found in various climates. Their nests are usually located underground, but sometimes found in the walls of buildings, cracks in masonry or in woodpiles.
•    Honeybees have round, fuzzy bodies with dark brown and yellow markings. They can be found in honeycombs in trees, old tires or other partially protected sites. Honeybees are the only Hymenoptera insects that leave their stinger in the skin after a sting.
•    Paper wasps are slender with black, brown, red and yellow markings. They live in a circular comb under eaves, behind shutters or in shrubs and woodpiles.
•    Hornets are black or brown with white, orange or yellow markings. Their nests are gray or brown and are usually found in trees.
Why is it important for you to be able to identify the type of insect that stung you when you have had a reaction?  It is important because your allergist at Allergy Partners uses this information in conjunction with skin tests to determine which type of venom to use for desensitization.
It is very important for the doctor to get a good history, including what type of insect was involved and the details of the reaction. Identification of the type of insect that caused the reaction through history and skin testing as well as the nature of the reaction can be lifesaving.

Is there anything that can be done?

Skin tests to stinging insects can show false negatives in up to 20% of cases, and so blood tests may then be helpful.   In some cases, it is important to get a baseline tryptase level.  If elevated, it may make the sting reaction more severe.  If you are skin test positive to one or more venoms after you have had a systemic or anaphylactic reaction to an insect sting, your allergist can prescribe desensitization injections which will reduce the likelihood of a reaction to 3% from 60%. The exception is in children  under 16 who have only had skin reactions (usually hives) as these patients generally do not progress to more severe reactions with subsequent stings.  It takes about 15 injections, barring local or systemic reactions to the shots, to get to a “maintenance” dose.  Once maintenance is reached, injections can be given once per month during the first year and every 6-8 weeks during the subsequent years. Venom immunotherapy is typically given for 5 years, but may be continued for a longer duration in certain instances. Your Allergy Partners physician will work with you to determine the best course for you.


August 17
New Rescue Inhaler Available

A new type of inhaler is now available to deliver albuterol for patients with asthma or reversible COPD.  The inhaler is called ProairRespiclick and is available for patients 12 years or older to treat acute symptoms of airway constriction (bronchospasm) or as prevention of exercise induced asthma symptoms.  Most patients refer to albuterol inhaler as the “rescue” or “emergency” inhaler.


Current albuterol inhalers (Ventolin, Proventil, Proair HFA) are all aerosol propelled meter dosed inhalers that most patients need a spacer or holding chamber to deliver medicine effectively.  Respiclick inhaler is a dry powder inhaler and requires no spacer.  The medicine is released and delivered into your lungs by your own breath effort (breath-actuated).   This eliminates the need to coordinate dispensing the medicine with breathing in the medicine.  This step frequently results in poor delivery of the medicine from traditional inhaler into your lungs.


There are 200 doses per inhaler with dose counter to track doses remaining.  No priming is required that would result in lost doses.  Respiclick must stay dry at all times.  Patients with severe cow’s milk allergy may not be candidate for this inhaler.  Consult your Allergist to see if dry powder albuterol inhaler is right for you.  Dosing directions and training on how to use this new style inhaler will be necessary to discuss with your doctor.  Opening the mouth piece guard will generate a “click” and load the albuterol to inhale from the Respiclick.  Educating patients with asthma on how and when to use their inhalers is a critical feature to a successful asthma management plan developed by Allergy Partners physicians, nurses, and asthma educators.


July 14
Allergy Myth Busters!

Inspired by one of our favorite television shows, Allergy Myth Busters looks at a number of popularly held beliefs about allergy. But are these myths just urban legends or are they true?


Myth: Some breeds of dogs are hypoallergenic, so dog allergic patients can tolerate having these dogs in the home.
Busted! For many of us dog allergies interfere with our love for these furry companions. Exposure to the allergens from our beloved pets can lead to nasal, eye, skin and breathing symptoms which can make life miserable. That makes the innovation of the “hypoallergenic” dog an amazing breakthrough! Unfortunately what is well known to allergists is that the existence of a hypoallergenic dog is a MYTH.


In a study published in 2012, investigators from the Utrecht University in the Netherlands compared Can f 1 levels (the major dog allergen) in the pet hair/coat samples and the home environment of various alleged hypoallergenic (Labradoodle, poodle, Spanish Waterdog, and Airedale terrier) and non-hypoallergenic dogs (Labrador retriever and a control group composed of 47 different non-hypoallergenic dog breeds and several crossbreeds.)They found that that Can f 1 levels in hair and coat samples were related to the breed, BUT there was a high variability within individual breeds. Can f 1 levels were significantly higher in hair and coat samples in dog breeds considered hypoallergenic thus they are not less allergenic than any other dogs. Similar findings were published in another study from 2011 which examined dog allergen levels in homes of hypoallergenic versus non-hypoallergenic dogs. It, too, showed that there was no evidence of decreased shedding of allergens by dogs grouped as hypoallergenic.


The myth of the hypoallergenic dog has been debunked. For those people who do suffer from dog allergy, this does not mean that they have to get rid of their pet. Those people who don’t want to give up “man’s best friends” can always try allergy medications or be evaluated for immunotherapy/ allergy shots.  If you suffer from allergies to your pets, Allergy Partners can help you find relief.
1. Vredegoor DW, Willemse T, Chapman MD, Heederik DJJ, Krop EJM. Can f1 levels in hair and homes of different dog breeds: lack of evidence to describeany dog breed as hypoallergenic. J Allergy ClinImmunol 2012;130:904-9.


2. Nicholas CE, Wegienka GR, Havstad SL, Zoratti EM, Ownby DR, Johnson CC.Dog allergen levels in homes with hypoallergenic compared with nonhypoallergenic dogs. Am J Rhinol Allergy 2011;25:252-6.


July 06
Our Very Own Allergy Myth Busters

Inspired by one of our favorite television shows, Allergy Myth Busters looks at a number of popularly held beliefs about allergy. But are these myths just urban legends or are they true?
Myth: Radiocontrast media reactions are related to shellfish allergy.
Busted!  Patients with a history of allergy to shellfish are not at increased risk for anaphylaxis from iodinated contrast media.  This myth stems from the false assumption that an iodine allergy is the common cause of contrast media and shellfish allergy.  In fact, iodine is not an allergen and is structurally unrelated to the tropomyosin proteins which can cause anaphylactic reactions to shellfish.  Although it is clear that contrast media can cause a variety of reactions, the mechanism of most of these is poorly understood and is not due to ‘iodine allergy’.  Individuals with any allergic condition are at higher risk of contrast media reactions, regardless of a history of allergy to seafood. Fortunately, reactions to contrast media are quite low.
In some patients scheduled for procedures using contrast dye, precautions should be taken, such as premedication with antihistamines or steroids or using low osmolal contrast material (LOCM) agents.  So who deserves these precautions? Empiric use of LOCM agents for all intravascular procedures has become widespread and has largely eliminated the need for premedication.  In settings where LOCM agents are not routine, nonionic LOCMs or iso-osmolal agents should be considered for patients with asthma and patients taking beta-blockers, interleukin-2, or NSAIDS (eg. Aspirin, ibuprofen).  In addition, nonionic LOCM agents should be considered in patients with a previous history of serious reactions to radiocontrast media, patients receiving contrast by power injector, or any other circumstance in which the clinician believes that it is indicated.  In the absence of a history of immediate hypersensitivity reactions to contrast media in the past, empiric premedication with antihistamines and steroids is generally not indicated.
American College of Radiology Committee on Drugs and Contrast Media. ACR Manual on Contrast Media, 5th ed, American College of Radiology, Reston VA 2004. p.5.
Solensky R, Khan DA. Drug Allergy: an updated parameter. Ann Allergy Asthma Immunol. 2010 Oct;105(5):259-73.
Greenberger P. Prophylaxis against repeated radio contrast media reaction in 857 cases. Arch Intern Med. 1085;145:2197-200.
Lang DM, Alpern MB, Visintainer PF, Smith ST. Elevated risk for anaphylactoid reaction from radiographic contrast media associated with both beta blocker exposure and cardiovascular disorders. Arch Intern Med. 1993;153:2033-40.

June 09
Immunotherapy (Allergy Shots):  The Allergy Partners Way

Allergy immunotherapy, more commonly referred to as allergy shots, is the most effective treatment available for environmental allergies. By reducing your reactions to pollens, pet dander, molds and dust mites, allergy shots reduce symptoms and your need for medication.  While it is a highly effective treatment, immunotherapy does not contain medication and is composed of natural protein extracts from allergens. By giving gradually increasing doses of the allergen, immunotherapy teaches your immune system to tolerate exposure to the allergens in the environment. It is highly effective in treating sinus and eye symptoms along with asthma, sinusitis and allergy induced eczema. To assure that proper treatment is provided, immunotherapy should always be prescribed by a board certified allergist. Certification by the American Board of Allergy, Asthma and Immunology assures that your doctor has received at least 2 years of additional training specifically in treating allergic diseases.  Only through this intense training can a doctor gain full knowledge of immunotherapy treatment.


While immunotherapy is the cornerstone of the allergy specialty, not all allergy shots are created equally. Allergy Partners strives to provide the most effective, safe and cost effective care possible.  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 this premise we have grown to over 100 allergists across the United States, and our shared knowledge and experience is unsurpassed in allergy and asthma care. We have applied this knowledge to create a state of the art immunotherapy program. To produce optimal results, immunotherapy protocols must follow national guidelines which are based on the latest research. These guidelines include proper patient selection, allergy testing, and immunotherapy dosing.  As the leader in allergy and asthma care, Allergy Partners has compiled the largest collection of data and information about allergy shots in the world. We are continually utilizing this experience to further improve patient care. Furthermore, our Clinical Excellence committee continually reviews the medical literature and assures that our treatment program is state of the art.

The Allergy Partners immunotherapy protocols strictly adhere to national practice guidelines and were developed in collaboration with nationally recognized experts. To maintain the highest quality standards throughout the immunotherapy treatment process, we compound our immunotherapy extract at our centralized lab in Asheville, NC.  Our lab was planned and built in collaboration with industry experts and the FDA Center for Biologics Evaluation and Research. Today we produce over a quarter of a million vials annually of the highest quality allergy extract possible.  Allergy Partners extract labs strictly follows USP 797 guidelines for sterile allergenic extract processing, and it is through this attention to detail that we can provide you will be provided safe and effective treatment.
We invite you to learn more about Allergy Partners, the conditions we treat and our immunotherapy treatment program by browsing our website or contacting your local Allergy Partners practice.




May 27
Peanut Allergy: Advances in Diagnosis and Treatment


It is estimated that food allergy affects approximately 5% of adults and 8% of children, with peanut allergy nearing approximately 2% of the population. A peanut allergy is when the immune system makes a type of antibody called IgE towards specific proteins in peanut. When a person with peanut allergy is exposed to these peanut proteins, the peanut specific IgE antibodies cause allergy cells (mast cells, basophils, eosinophils, etc.) to create an allergic reaction. The symptoms of an IgE mediated allergic reaction generally happen within minutes to two hours after exposure to the food and can include: itching, flushing, hives, swelling, difficulty breathing, repeated coughing, chest tightness, wheezing, hoarseness, change in voice, dizziness, weakness, fainting,  low blood pressure, nausea, vomiting, abdominal cramps, or diarrhea. Such reactions can be life threatening.


The history of a previous reaction is one of the most important diagnostic tools in determining if an IgE mediated food allergy is present. If the history is consistent with an IgE mediated food allergy (timing and symptoms), then further testing may be needed to confirm this allergy, or to determine if a patient has grown out of their food allergy. The gold standard for food allergy diagnosis is an oral food challenge, which is when the food thought to cause an allergic reaction is given to the patient in a medical facility in small increments and increased until either an allergic reaction occurs, or a serving size is reached. Realistically, however,  this is mainly performed to rule out a food allergy, and is performed if the likelihood of having an IgE mediated food allergy reaction is low. In order to determine the likelihood of an IgE mediated food allergy the following tests are available: specific IgE towards peanut, peanut component testing to proteins in peanut (Ara h 1, 2, 3, 8 and 9), and skin prick testing. Screening with panels of different food IgE’s without a previous history of a reaction to that food is poorly informative, and should not be done for routine evaluation of allergy. This is because a positive serum food specific IgE test may show sensitization, but not necessarily clinical allergy. This is an important distinction because a patient may have an elevated serum IgE to a food and have no allergic reaction when eating this food.
Skin prick testing is usually done first, as it is a less invasive test. Sometimes specific serum IgE to peanut is also obtained to determine the likelihood of IgE mediated peanut allergy. The level that is considered to be associated with a clinical allergy is different for each food. Peanut component testing may also be helpful. This looks at the specific IgE levels of different peanut proteins. If the Ara h 8 level is elevated, this is associated with less likelihood of a clinical allergy to peanut, whereas elevated IgE levels to Ara h 1, 2, and 3 are associated more with clinical allergy. It is important to have a board certified allergist evaluate these tests and determine if an oral food challenge is warranted.
The current approach to managing peanut allergy is avoidance and treating allergic reactions promptly and appropriately. However, there are ongoing trials to investigate the potential of treating peanut allergy. The most promising trials include: Oral Immunotherapy (OIT), Sublingual Immunotherapy (SLIT), Epicutaneous Immunotherapy (EPIT), and a Chinese herbal formula.  OIT has been studied the longest (more than 10 years) and has shown both short term and longer-term responses to therapy. However, it does have its limitations due to safety issues. In one trial, after receiving 4g of peanut for 5 years through OIT, 50% of subjects passed an oral food challenge and were able to re-incorporate peanut into their diets. The most limiting side effect from OIT is that 10-15% experience gastrointestinal symptoms that prevent the continuation of therapy. Other more severe symptoms have also been reported. SLIT is similar to OIT, but smaller doses of allergen are administered under the tongue. This has been shown to have fewer side effects than OIT. In one study, after 44 weeks of therapy, 70% of patients were able to consume 5g of peanut powder, or at least 10-fold more peanut powder than at baseline. EPIT uses delivery of peanut allergen to the skin, called a peanut patch. A large study is currently ongoing for the peanut patch in the United States and Europe. No safety concerns have been noted after 11 months of EPIT. A Chinese herbal formal is also being investigated that has shown no significant side effects.


Peanut allergy diagnosis and determining if a patient has out-grown this allergy can be difficult and requires specialized training from a board certified allergist. At Allergy Partners, all of our physicians are board certified or eligible allergists and we stay up to date with the latest in diagnostics and treatment.




April 28
Ask the Expert: "I have hives. I must have allergies."

Your Allergy Partners physician would likely respond to the above statement with a cautious “maybe.”  Hives, like many of the responses of the body, can be caused by many stimuli, not just allergies.  Take, for instance, the similar example of sneezing.  Sneezing is a common allergic symptom; however, we all know that non-allergic stimuli can cause sneezing, from infections due to the common cold to irritants in the air (pepper, for example). In a likewise fashion, hives can be due to allergic and non-allergic causes. 


Your Allergy Partners doctor will take a careful history and perform a thorough examination when considering whether your hives are due to an allergic reaction.  Be prepared to answer questions on how long your symptoms have lasted, any recent exposures to new foods or medications, and whether you have experienced any other symptoms. 
If you have had hives almost daily for six weeks or more, your allergist may use the term “chronic” to describe your condition.  Hives lasting less than six weeks are called “acute”.  The distinction between “acute” and “chronic” is important, as acute hives are more frequently associated with identifiable causes.  If supported by the details of your history, allergy testing may be helpful in identifying causes of acute hives. 
Many non-allergic conditions have been reported to be associated with chronic hives, including various infections, connective tissue diseases, thyroid dysfunction, and endocrine disorders.  If your symptoms do not readily suggest one of these conditions, extensive laboratory testing is not typically warranted or necessary.  Extensive testing is not cost-effective and does not appear to improve patient outcomes.  In light of an unremarkable clinical history and physical examination, laboratory evaluation and allergy testing rarely identifies a cause for chronic hives. 
Hives can be incredibly uncomfortable and frustrating.  Hives typically improve with a regimen of antihistamines, regardless of the cause.  For cases of chronic hives that do not respond to antihistamines, alternative treatments are available. A newly approved approach to chronic hives utilizes the medication Xolair (omalizumab). This medication was initially developed for patients suffering from moderate to severe allergic asthma, but has shown to be effective in chronic hives. With your input, your Allergy Partners physician can decide what testing and treatment options are best for you. 




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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!