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February 10
Allergies, Treatment and Prevention

Dr. Friedman, Allergy Partners of Arizona, was featured on Wake Up! Tucson


Click to listen to Dr. David Friedman discuss allergies, treatment and prevention with callers on Wake Up! Tucson 1030 KVOI The Voice






February 10
Breaking News: Occupational or Workplace Asthma





Patients that suffer from occupational asthma (asthma caused by breathing in hazardous substances in the workplace) may not realize their symptoms are work-related. It can also affect their ability to work, overall quality of life, and even threaten their lives.
Full Release:
What is Occupational Asthma?
Asthma caused by breathing in hazardous substances in the workplace is called "occupational asthma." Asthma can affect your ability to work and overall quality of life.  It can even threaten your life.
How Does it Work?
Patients suffering from occupational asthma often may not realize their symptoms are work-related. Symptoms of occupational asthma are the same as regular asthma and may include any or all these chest symptoms: cough, shortness of breath, wheezing and chest tightness. An asthmatic patient my fail to recognize the work relationship to their asthma as symptoms often begin several hours after exposure. Occupational asthma symptoms usually become worse during the workday and throughout the work week. Symptoms may be immediate (less than 1 hour), delayed (more commonly, 2 to 8 hours after exposure), or nocturnal. They usually decrease over the weekend, or days off and during vacations, but may take a week or more. However, workplace exposure to sensitizing chemicals or dusts can induce asthma often persisting after the exposure has stopped. Initial symptoms may occur after high-level exposure (spill).
What Causes It?
Several hundred substances found in the workplace have been found to be respiratory sensitizers with more being identified all the time. The list below is a broad indication of substances known to be respiratory sensitizers and their common work activities.  It is not exhaustive and many known sensitizers are not identified here:
Substance Groups                                                    Common Activities
Isocyanates                                                                        Vehicle spray painting, foam manufacture
Flour/grain/hay                                                          Handling grain at docks, milling, malting, baking
Electronic soldering flux                                           Soldering, electronic assembly, computer manufacturing
Latex rubber                                                      Gloves in health care, laboratories
Laboratory animals                                          Laboratory animal work
Wood dusts                                                                        Saw milling, woodworking, and furniture manufacture
Glues/resins                                                                      Curing glues and epoxy resins in joinery and construction
Gluteraldehyde                                                           Health Care
Hair dyes                                                                             Hairdressers
Penicillins/cephalosporins                                            Pharmaceutical industry
Chromium compounds                                  Welding stainless steel
Platinum salts                                                                    Catalyst manufacture
Cobalt                                                                                   Hard metal production, diamond polishing
Nickel sulphate                                                                 Electroplating
Subtilisin/enzymes                                                          Detergent manufacture
What Should I Do If I Have Occupational Asthma?
If you are having work-related air flow limitation make an appointment with your Allergy Partners Physician telling him/her your symptoms, where you work, what your job is and what chemicals and materials you work with daily. Take chemical fact sheets to your Allergy Partners Physician. Lung function monitoring may include serial charting with a peak flow meter for 2 to 3 weeks (2 weeks at work and up to 1week off work as needed to identify or exclude work-related changes in peak expiratory flow.) Record when symptoms and exposures occur and when a rescue inhaled bronchodilator is used. Measure and record peak flows every 2 hours at work and away from work.
What is the Treatment?
Allergy Partners Physicians are trained in additional, specialized evaluations to include immunologic testing and confirmatory evaluations such as detailed pulmonary function testing and bronchial challenges.
The patient is encouraged to work with on-site health providers or managers/supervisors discussing avoidance of the initiating agent, ventilation, respiratory protection, and tobacco smoke-free environments.
If your Allergy Partners Physician tells you that you have occupational asthma, you should be removed from the work area or job to prevent it from getting worse. Occupational asthma is a serious illness. Lack of appropriate treatment can lead to permanent disability.  Early recognition and treatment are paramount in keeping this illness from getting worse.
Patient confidentiality issues are particularly important in work-related asthma. As even general inquires about the potential adverse health effects of work exposures may occasionally result in reprisals such as job loss, occupational asthma patients need to be informed of this possibility and be full partners in the decision to approach management regarding the effects or control of workplace exposures.
Dr. Brian Dantzler
Allergy Partners of Charleston






January 26
Allergy Myth Busters: Children Under Four Can't Be Skin Tested



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: Children less than 4 years of age can’t be skin tested for allergies.
First introduced in 1865, allergy skin testing remains the gold standard for diagnosing allergic sensitization. There are two types of skin testing. Skin prick testing involves placing a drop of a suspected allergen (or extract) on the skin and scratching or pricking the surface of the skin. Intradermal testing involves injecting a small amount of extract just under the skin, similar to how a Tuberculin skin test is performed. A positive reaction to either test will appear as a small, slightly raised red bump. Allergy skin testing has a number of positives:
·         Quick – Many allergens can be tested at the same time and results are read in 10-15 minutes.
·         Comfortable – Both skin prick and intradermal testing involve very minimal discomfort, although positive test can be itchy for several minutes.
·         Accurate – When performed with high quality extracts and by a trained technician, allergy skin testing is the most accurate test for allergy diagnosis.
Although the results of allergy tests are not affected by a person’s age, sex, or race independent, certain age (children younger than 2 years and adults older than 65 years) and racial (African American children) factors may affect their interpretation. This fact may explain why some people believe that children need to be a certain age before they can be skin tested. Generally speaking, skin testing can be performed even in infancy, and as young as one month of age. However, the skin of very young children may not be as reactive as older children and adults, and therefore the results need to be interpreted more carefully.
The reason for skin testing is probably more important than the age at which a child is tested.
In infants and toddlers, allergic disease most commonly occurs as food allergy and atopic dermatitis. In school-age children, allergic disease occurs more commonly as allergic rhinitis. Asthma can occur at any age, but occurs most commonly in adolescent boys and teenage girls. Because of this, skin testing should be aimed at identifying allergic triggers appropriate to the age of the child.
Skin testing, particularly prick skin testing, is virtually painless. There is no bleeding involved, as the needle only pricks the skin to the depth of a scratch. The worst part of skin testing is that the skin test sites may be quite itchy when positive results occur.
Allergy skin testing is a safe, accurate and virtually painless means of diagnosing allergy at all ages. All Allergy Partners physicians are Board-Certified and experts in the diagnosis, treatment, and management of allergies and asthma at any age. Learn more at




January 19
Use of Asthma Medication in Pregnancy



Maternal asthma during pregnancy has been associated with increased risks of several adverse outcomes, emphasizing the need for optimal asthma control during pregnancy.
Full Release:
The risks:


Maternal asthma in pregnancy has been associated with an increased risk of adverse outcomes, including preeclampsia, low birth weight, preterm birth and congenital abnormalities. This, compounded with the increasing prevalence of asthma in the general population, emphasizes the need for optimal asthma control during pregnancy. Of the associated adverse risks, there has not been a clear consensus as to whether the increased risk of congenital abnormalities is related to asthma itself or the medications used to treat asthma. A recent study in the Journal of Allergy and Clinical Immunology sought to identify whether this risk is associated with asthma medications in the first trimester.1


What is the underlying cause?
The study did find that there was an increased chance of congenital abnormalities including cleft palate and gastroschisis in those with exposure to inhaled B2 agonists (e.g. albuterol), the drug typically found in rescue inhalers. Though there is an increased risk, the individual risk remains low – less than 1 in 100 births. There was no increased risk seen with inhaled corticosteroids, which are often used in controller inhalers.
Despite these findings, both maternal asthma and asthma exacerbations during the first trimester of pregnancy have been found to increase the risk of congenital anomalies as well. Furthermore, asthma exacerbations during pregnancy have been associated with other unfavorable pregnancy outcomes for both the mother and infant. The study highlights these facts as the risks of uncontrolled asthma might be much greater than the studied specific risks. Ultimately, the study suggests that the use of prophylactic inhaled steroids seems to be the best approach for treating asthma in pregnancy to prevent asthma exacerbations and to reduce the need for β2-agonists.  For this reason, both those pregnant or considering pregnancy that have asthma would benefit from being followed by an asthma specialist.
1.       Garne et al. Use of asthma medication during pregnancy and risk of specific congenital anomalies: A European case-malformed control study.  J Allergy Clin Imuno.  Vol 136, Number 6. pp 1496-1502.
By Dr. Michael Alvares
Allergy Partners of Dallas-Fort Worth




January 12
Effects of Secondhand Smoke Exposure



There has been mounting evidence connecting exposure to secondhand smoke to illness and diseases due to the irritating nature of tobacco smoke on the non-smoker.
Full Release:
Despite significant educational efforts, epidemiologic evidence, and reports from the United States Surgeon General, smoking and smoking-related conditions are a major health concern.  The irritating nature of tobacco smoke on the non-smoker has long been recognized. Since the 1960’s, there has been mounting evidence connecting exposure to secondhand smoke to illness and disease. 


Secondhand smoke is a term used for the involuntary exposure of nonsmokers to tobacco smoke from smokers.  Another commonly used term is Environmental Tobacco Smoke.  Secondhand smoke is a mixture of side stream smoke given off by the smoldering cigarette, pipe, or cigar and mainstream smoke exhaled into the air by active smokers.  Third hand smoke refers to smoke components deposited on surfaces. 


In the News.
The Global Burden of Disease Study done in 2010 estimated that exposure to secondhand smoke is responsible for 601.000 premature deaths annually worldwide.  It is estimated that 28% of the mortality and 61% of the morbidity is seen in children. Secondhand smoke has been found to be a cause of lung cancer by several epidemiologic studies.  Cardiac disease has also been causally associated with secondhand smoke exposure in adults.  Mounting evidence also points to secondhand smoke exposure as a cause or aggravator of a variety of adverse respiratory conditions including asthma, pneumonia, bronchitis, reduced lung function, sinusitis, and COPD.  Secondhand smoke exposure is also implicated as a cause of middle ear disease, sensorineural hearing loss, sudden infant death syndrome, prematurity, impaired fetal growth and development, dental caries, cancers in locations other than the lungs, renal disease, and atherogenesis. 




How it can affect your family.
The level of tobacco exposure of the fetus of a mother who smokes is the same as the level for an active smoker.  There is a higher risk of stillbirth and neonatal deaths among newborns of smoking mothers.  Maternal smoking during pregnancy reduces birth weight on an average of 200 grams.  Active smoking of the mother during pregnancy is also associated with an increase in a large variety of non-chromosomal birth defects.  Cognitive deficits tend to be more prevalent in children whose mothers smoked during pregnancy.  Exposure of the non-smoking mother to secondhand smoke during pregnancy has been associated with an increased incidence of low birth weight, stillbirth, and congenital malformations.
The Global Study of Disease Burden from exposure to secondhand smoke estimates that 165,000 children under the age of 5 worldwide die annually because of lower respiratory infections attributed to secondhand smoke exposure.  Chronic exposure to secondhand smoke is linked to an increased prevalence and severity of asthma.  There is also evidence that secondhand smoke exposure promotes and facilitates allergic sensitization. Children with chronic secondhand smoke exposure enter adulthood with less pulmonary reserve and decreased lung function.
Exposure of children and adolescents to parental smoking has been associated with advancement of the vascular age by 3.3 years by measurement of carotid artery thickness.  This increases the risk of developing carotid atherosclerotic plaques in adulthood even with adjustments being made for other risk factors such as blood pressure, lipid levels, and personal smoking status.  There is growing concern about increased risks of coronary artery disease in adults and children exposed to secondhand smoke.
What can I do?
Reducing and preferably eliminating secondhand smoke in the home and in vehicles is critical since these are the major locations of exposure for children and non-smoking adults.  Secondhand smoke cannot be controlled by air cleaning and filtration, or building ventilation.  These findings on the effects of secondhand smoke are the foundation for the drive for smoke-free indoor environments and for educating parents and the community on the adverse health effects.  Policies that ban all indoor smoking in workplaces and public places are highly effective in reducing smoke exposure. Only complete bans of smoking in indoor environments are effective.  Segregation of smokers and non-smokers within the same indoor environment may reduce some of the exposure, but does not eliminate it.






December 21
Allergy Myth Busters: Regular use of inhaled corticosteroids to treat asthma will weaken my lungs.

The myth: Regular use of inhaled corticosteroids to treat asthma will weaken my lungs.


The science:
Systemic corticosteroids were first shown to be effective in the treatment of acute asthma in 1956.  Since the 1970s the use of inhaled corticosteroids (applied directly to the lungs with inhaler devices) has been proven to treat asthma with fewer side effects than systemic corticosteroids. Inhaled corticosteroids have consistently been shown in studies to decrease asthma symptoms, improve lung function, reduce asthma exacerbations (resulting in less emergency department visits and hospitalizations), decrease risk of death and reduce the need for rescue asthma medications and oral corticosteroids. Inhaled corticosteroids are the preferred medications for managing persistent asthma in all ages, and the dose is based on the severity of the asthma. 
When used appropriately, inhaled corticosteroids have few adverse effects at low and medium doses. The most common side effects include hoarseness of voice and oral thrush, both of which can be reduced with proper inhaler technique and rinsing of mouth after use. The higher dosages of inhaled corticosteroids can have more important side effects, including the ability to suppress the adrenal axis and even have long term effects on height when used in childhood (approximately 1.2 centimeters in the best study).  However, the higher dosages of inhaled corticosteroids are used to treat only severe asthmatics, who would often require repeated doses of oral corticosteroids to open their airways and the risk to benefit ratio may still be in favor of the use of inhaled corticosteroids.  Each patient is always unique and asthma is best cared for by a physician who specializes in asthma care. 
So is the myth busted or true?


Thankfully though, there is no dose of inhaled corticosteroid that has been shown to weaken lungs. 


To learn more, please visit: blog


December 14
The Importance of Clinical Trials

Do you ever wonder how a new medication comes to market?  Ever hear someone claim that a new drug literally changed their life?  The answers stem from the results of clinical research trials … which are quite important for drug development, and something that you may want to consider participating in, if asked at some point in the future.
What is a Clinic Trial?
A clinical research trial, or “drug study,” is a scientific study that has been carefully designed to answer a very specific medical question.  Typically, the maker of the drug, usually a pharmaceutical company and commonly referred to as the “sponsor,” generates the research question.  Some studies test medications that are currently unavailable for treatment, referred to as investigational new drugs, whereas others examine medications that can be prescribed today.  The sponsor develops a set of guidelines, or protocol, that research sites must follow in order to answer the question.
How Does it Work?
The US Food & Drug Administration (FDA) oversees all research activities in the US.  Its goal is to ensure that medications available to the public are both safe and effective.  The FDA works closely with the sponsor to ensure that the protocol is appropriately designed to answer the question(s).  Typically, the FDA will request results from several studies, each answering a different question, before approving a new medication for release.  All new medications are tested first in animals, then healthy human volunteers, and finally in patients with a specific disease.
Can I help?
Most clinical trials need large numbers of patients to answer the research question.  Sponsors, however, do not have direct access to patients, so they ask medical practices with research experience, or investigative sites, to help.  Depending on the number of patients needed for a trial, some studies require hundreds of sites located all across the US, and in some studies all over the globe.
Participating in a trial is a partnership or commitment between you and the study team.  It requires more time and effort than just “going to the doctor” for a check-up.  Patient volunteers are typically asked to keep careful record of their symptoms along with other conditions that might develop while in the trial.  Most protocols require periodic visits to the site for exams, lab tests, and to receive new supplies of study medications.  In short, patient volunteers receive a great deal of personalized medical attention, while at the same time, learning a fair amount about their underlying disease.
Patients participate in clinical research trials for different reasons.  Most appreciate the detailed medical attention.  Others do so to in order to potentially receive a new medication that others with the same condition are unable to receive today.  Some do so solely for altruistic reasons – to be a part of advancing medical science.  In addition, study-related medical care is provided at no cost, and for most protocols, patient volunteers are compensated for their time and travel. 
Is It Safe?
Many people who consider participating in a clinical research trial will ask, “Is it safe?”  In a nutshell, yes.  With any investigational medication, however, where clinical experience is limited, extra safeguards are in place.  First, most protocols require careful patient monitoring, which often involves serial lab tests, EKGs, breathing tests and physical exams.  For many protocols with electronic recording systems, the site can even track your progress on-line between scheduled visits.  Patient volunteers are not allowed to continue in a trial if any worrisome changes occur.  Second, an independent group called an institutional review board, or IRB, ensures that all patients’ rights and welfare, are protected.  The IRB approves the protocol, the site, and the consent form for the trial.  The site will report any serious adverse events to both the sponsor and the IRB, whether felt related to the study medication or not.  For events that are felt to be related, the sponsor must distribute the report to all sites participating in the trial.  In addition, the IRB has the authority to immediately suspend any research activities if they have concerns regarding patient safety.
With the evolution of electronic medical records and the development of sophisticated databases, there is a good chance that you may be asked to participate in a clinical research trial at some point in the future.  Think it over carefully. 

November 02
Breaking News: Sublingual Immunotherapy

What is Sublingual Immunotherapy (SLIT)?


There has been a lot of press recently as well as television and print advertisements touting the availability of sublingual immunotherapy (SLIT).  Unlike traditional allergy shots (called Subcutaneous Immunotherapy or SCIT), SLIT is taken as either drops or tablets under the tongue.




Does it Work?
A recent meta-analysis (a study that statistically analyzes multiple other studies to identify trends and confirm positive effects) of SLIT for seasonal allergies show that it may offer only small benefit. Danilo Di Bona and colleagues looked at 13 studies enrolling over 4000 patients and in 7 of 13 studies the group taking the immunotherapy reported improved symptoms with decreased use of medications.  In six of the thirteen studies there was no more improvement than in the placebo (no medication) group.  The conclusion was that while some patients will benefit, many may not, and it is not possible to identify those that will respond prior to initiating therapy.
What Are the Side Effects?
Over half of the patients in the treatment group reported either oral or GI/stomach side effects. Seven patients had allergic reactions requiring epinephrine.
In the not so recent past, immunotherapy or “allergy shots” was a fairly narrow topic for discussion.  Those patients with nasal allergy and allergic asthma who were not well controlled on medications were offered subcutaneous immunotherapy (SCIT) as a better alternative to medication and a potentially disease modifying intervention.  The injection therapy works directly on the patient’s response to allergens which results in short term symptom control, reduced medication requirement, and a durable long term improvement.   The downside was a significant commitment to receiving injections in a medical setting on a regular basis.
Fast forward to the past few years.  Sublingual immunotherapy (SLIT) utilizes allergen as drops or dissolving tablet under the tongue.  This approach has been common in Europe for a number of years for patients symptomatic from a single allergen. It is also available off label in the United States for single or multiple allergens using conventional allergen extracts. Tablets for grass and ragweed have become available by prescription. These require at least pre-seasonal therapy beginning three months prior to the pollen season and may be more effective if continued all year.  The major advantage of SLIT is that the allergens can be self-administered at home with the availability of epinephrine as the risk of serious systemic reactions is low. 
Traditional subcutaneous immunotherapy allows the inclusion of multiple allergens in a single injection, and in the large majority of studies, has been shown to be more or equally efficacious when compared to the sublingual program.  Since many of our patients are allergic to multiple environmental allergens, this may be their best choice.




Fortunately, Allergy Partners physicians are able to offer sublingual and injection therapy and select the type of immunotherapy that best serves your individual needs.






October 19
Allergy Myth Busters:  IgG Testing Is An Effective Means To Identify Food Allergies

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:
IgG RAST testing is an effective means to identify food allergies. 
What does science say?
It is estimated that 15 million people in the United States have food allergies.  This includes up to 1 in 13 children.  Therefore, appropriate evaluation and treatment of these allergies are essential.  Various methods have been described to test for food allergies since the 1970s.  These include skin prick testing to possible offending foods, ImmunoCAP IgE blood testing, and IgG RAST blood testing. 
So is the myth busted or true?
Detection of IgG antibodies has been discredited as a reliable diagnostic tool since the 1980s.  Unlike IgE antibodies, which are responsible for allergies, IgG antibodies can be found in allergic and non-allergic people regardless of whether they are healthy or sick.  IgG antibodies are the normal antibodies made by the body to fight off infections. Increase in levels of IgG antibodies present in the circulating blood is thought to be a normal response to the ingestion of food.  In fact, IgG antibodies have actually been found to go up during successful research studies on food immunotherapy.  Also, allergy testing to foods using IgG RAST testing has been shown to lack clinical relevance.  These tests are not validated and lack sufficient quality control. 
These unproven tests may lead to false diagnoses, increased anxiety, and a useless strict avoidance diet.  If a food allergy is suspected, evaluation, diagnosis, and treatment should be performed by a board certified allergist.  The evaluation should include a thorough medical history and a physical exam.  The allergist may perform tests including skin prick tests and ImmunoCAP IgE blood tests to help identify a food allergy.  Both methods are highly sensitive and useful to help exclude a diagnosis of food allergy.  An oral food challenge or even a trial elimination diet may be necessary.  These tests have all been proven to be effective diagnostic methods which the board certified allergist may use in conjunction with the information from the clinical history and physical to provide a diagnosis of a food allergy.

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.






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