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 Allergy Immunotherapy/Desensitization
— 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.
To treat food allergies, we use oral immunotherapy, or OIT. Oral food allergy immunotherapy is the most effective form of food allergy desensitization currently available. The oral immunotherapy process involves starting with micro-dosing, gradually increasing doses till a much higher dose is tolerated. For example, if using OIT to treat a peanut allergy, this may involve eating one peanut a day every day. The patient’s risk of severe anaphylaxis is greatly reduced in the case of accidental ingestion. It relieves anxiety or fear of accidental ingestion and provides a peace of mind.
— 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.
— 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.