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.
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.
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.
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
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
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.
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.
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
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.
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.
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?
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
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
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
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
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.
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
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
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.
and Bee Stings
Was the death
of a pharaoh the first report of an insect sting reaction? In
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
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
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
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
What are the different kinds of reactions
to insect stings?
· 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
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.
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.
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
• 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
• 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.
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
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.
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
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.
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.
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.
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
Myth: Radiocontrast media reactions are related to
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.
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.
College of Radiology Committee on Drugs and Contrast Media. ACR Manual on
Contrast Media, 5th ed, American College of Radiology, Reston VA
R, Khan DA. Drug Allergy: an updated parameter. Ann Allergy Asthma Immunol.
P. Prophylaxis against repeated radio contrast media reaction in 857 cases.
Arch Intern Med. 1085;145:2197-200.
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.
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
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.
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.
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
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.
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.
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!