Treatment of allergies with allergy injections
-- Effective optimal doses with more effective results --
Allergy injection therapy offers a way to "turn off" allergies. After receiving monthly
desensitization injections for at least 3 years, patients have much fewer allergy symptoms
requiring none or much less medications. This effect persists for many years after stopping
the injections. This greatly improves the quality of life. Many patients prefer this treatment
instead of relying on daily medications for many years or decades.

In the past few years, the optimal doses of the allergy injections (Allergy shots, or allergen
immunotherapy) for many allergens are known, like grass pollens, dust mites and cats. The
optimal doses are generally much higher than the doses allergists used in the past. With the
optimal doses, allergy injections are more effective.

We are using these optimal doses in the injection therapy.

We also now know not to mix certain allergy extracts together, like mixing molds and grasses.
Molds contain enzymes that would destroy the grass and other allergens and make the allergy
injection therapy to grasses and other allergens less effective.

We also offer desensitization with sublingual liquid extracts. All allergens available for allergy
injections also can be mixed and place under the tongue once a day to desensitize the
allergies. It works similar to allergy injection therapy. The sublingual liquid extract treatment is
nearly as effective as allergy injections; it offers the advantage of the convenience of
treatment at home and much less concern for treatment reactions. One major drawback is
that most insurance companies do not pay for the treatment as it is considered off-label use.

Another kind of allergy treatment is using sublingual tablets one tablet a day under the tongue
similar to sublingual liquid. This is available only for grass allergens.
Chronic sinus problems and recurrent sinus infections
-- Evaluation of immunity defects and treating sinus
inflammation improve sinus management --
About 10% of American adults have sinus problems, with nasal congestion, postnasal
drainage, sinus headache or pressure, reduced sense of smell and often fatigue. The major
risk factors for developing sinus problems include allergies and immunity defects. Ten to
twelve percent of patients with sinus problems (medically called chronic rhinosinusitis) have
immunity defects.

The management of these risk factors often leads to improvement of chronic sinus problems.
This includes diagnosing and managing the immunity defects.

Our office is also experienced in treating sinus problem with anti-inflammatory treatment using
low dose macrolide (like azithromycin, clarithromycin) for an extended period from a few weeks
to 2 or 3 months. Macrolides are used for chronic sinus inflammation, not infection, as chronic
sinusitis is now recognized as a disease of sinus inflammation, not infection.

Using macrolides to treat chronic sinus problem is a standard procedure used in European
countries. European and British guidelines indicate that this treatment should be used. Sinus
surgeries are considered only after medical therapy fails.
Food allergies
-- Precise prick through the drop skin test and in-office food
challenge improve diagnosis accuracy of food allergies --
The optimal use of diagnostic skin testing for food allergies has been newly defined,
particularly by British and Australian researchers. They use a single-tip prick through the drop
methods which offer greater precision than a stamp type testing (called Multi-test) which is
commonly used in the United States. We use the prick through the drop method for more
accurate evaluation of food allergies.

We also offer "in-office" food challenges to determine whether a patient is allergic to a certain
food when the history and current skin or laboratory tests suggest the patient may not be
allergic to that specific food, or may no longer be allergic to that food if there was a history of
allergic reaction.

We emphasize to patients that a positive food allergy skin test or a positive blood test (called
IgE) only indicates the risk of a reaction, but not an allergy to that food. The higher the level
of the test results, the higher the risk. For example, 77% of patients tested positive for
peanut are not at risk of a systemic reaction.

Food component IgE blood testing is now available for cow’s milk, egg and peanut
components. With special arrangement, hazelnut nut component allergy can also be evaluated.
With knowledge of the degree of allergies to the components, the risk of reactions can be
more precisely defined. For example, many patients with major allergies to the heat-sensitive
components of milk or eggs can be desensitized with baked milk or baked eggs procedure,
which is safe and effective.
-- Treating underlying causes improves asthma control, and the
use of inhaled steroids that are not likely to have systemic effects
reduces the risk of inhibiting growth of children and developing
diabetes in adults --
We have extensive knowledge in the management of asthma. We identify the causes of
asthma including allergen exposure, virus infections, sinus infections and chronic sinus
inflammation, and manage these causes accordingly. Besides making patients well, we avoid
using many kind of inhaled steroids that may cause more side effects, like slowing the growth
in children and developing diabetes in adults.

We have identified and described in the medical literature a pattern of asthma that may last for
a few months to a few years following a cold or sinus infection. We call it a prolonged episode
of asthma.
Immunity defects
-- Besides causing recurrent sinus infections, pneumonia and
other infections, it is also a risk factor for chronic sinus problem
(chronic rhinosinusitis) --
We also evaluate and manage immunity defects that cause recurrent infections, such as
recurrent sinus infections or pneumonia.
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