ALLERGY INFORMATION
Allergies affect more than 50 million people in the United States. Almost anybody can be tested for allergies. These tests can be done using either a skin test, or using a blood sample. The skin test can be done using one of several methods. One method places a small amount on the surface of the skin that is either pricked or scratched. The allergen is allowed to sit for 15 - 20 minutes and the reaction is noted. Occasionally, an additional test may need to be done. This test involves placing a small amount of the allergen just beneath the surface of the skin. Again, after 15 - 20 minutes the reaction is noted. Below are links to information and some commonly asked questions regarding allergies and allergy testing.
What should I expect on my first visit?
Your first visit to Allergy & Asthma Specialists, PSC may take 60 - 90 minutes if you are being allergy tested. During this visit we will get a complete patient history (past medical history, family history, and medications), evaluation of both your symptoms and living environment, and if appropriate conduct allergy skin testing. Once your history is complete our staff will test you for some common allergens associated with our region, in addition to household and food allergens (if applicable). These allergens include inhalant allergens such as dust mite, molds, pollens, and pet dander.
Please note: a list of medications that should be avoided prior to testing are listed in the New Patient Packet. If you take these prior to your appointment, testing may not be able to be conducted, and you will need to reschedule your appointment.
Once the testing has been completed, Dr. Clore will discuss with you your treatment options, which may include avoidance, medicines, environmental control, and even immunotherapy (allergy shots).
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Is testing painful?
In short, no. However you may experience some discomfort. The discomfort you may have will generally come in the form of itching to the local reaction to a specific allergen. Below is a picture of a patient's back that is being tested. The red bumps are reactions to allergens.
Roll your mouse over the picture to see how the reaction is measured.
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Are there risks involved?
It is possible that you may react to the allergens being placed on your skin. Common reactions include inflammation and irritation around the site of the skin prick test.
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Anaphylaxis
According to the American College of Allergy, Asthma and Immunology, anaphylaxis is defined as “a life-threatening, often unexpected, allergic reaction that affects many parts of the body at once.” And, is “the body’s reaction to a foreign substance that is ordinarily harmless.”
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Outdoor Allergies
Outdoor allergies are usually caused wind-pollinated plant pollens that are inhaled. These may include pollens from grass, trees, or weeds. These allergens usually cause a condition called Allergic Rhinitis (Hay Fever).
Most of the outdoor allergens are seasonal. So, you may only be affected part of the year.
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Indoor Allergies
For some in the Ohio Valley region, even when allergy season is over, they still experience allergy symptoms. These symptoms may come from common indoor allergens, such as dust mites, mold, cockroaches, and pets.
House dust is common and is even in the cleanest of homes. It is actually a combination of the allergens listed above (dust mites, mold, cockroaches, and animal dander). In fact, vigorous cleaning may place more dust into the air.
The dust mite is the most prevalent allergen in house dust. Mites thrive in warm (above 70 degrees), humid places (relative humidity of 75 – 80 percent). They live in couches, bedding, stuffed animals, and carpet. It is important to note the high levels of dust mite exposure contribute to the development of childhood asthma. Those allergic to dust mites react to the proteins located in the bodies and fecal matter of the mites. Fortunately, dust mites do not bite, carry diseases, or live on people. In fact, they only become harmful when the patient is allergic to them.
Molds come from outside, but can develop in the home. Even though you can’t see it sometimes, it may be there. Those with mold allergies may experience heightened symptoms during the spring to late fall. Two common indoor molds are Penicillin and Aspergillus. Allergy sufferers are allergic to the spores of the mold, which are spread through air currents.
Pets can also cause allergies, with dogs and cats being the most common. It is possible to see allergy to other household pets, such as gerbils, guinea pigs, and hamsters. The allergens in these animals are found in the dander, but can be found in both the saliva and urine. The best way to avoid these allergens is to remove them from the home. There are no breeds of dogs or cats that are known to “non-allergenic.”
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Food Allergies
Food allergy is the body’s reaction to a food it mistakenly thinks is harmful. Fortunately, only one to two percent of adults, and five to eight percent of children are affected by food allergies.
Symptoms of food allergy may appear within minutes to hours after eaten. Additionally, these symptoms may be mild, while others can be as extreme as anaphylaxis. Other symptoms may be runny nose, itching in the mouth, stomach cramps and vomiting.
The development of food allergy is believed to be mostly hereditary. And, the allergy usually develops at an early age. Avoidance is the only known treatment for food allergy. However, there are studies that are looking at possible treatments for some common food allergies. Since there is no known cure, the patient must be aware of the ingredients of all the foods he or she eats. Some may outgrow these allergies. However foods such as peanuts, tree nuts, shellfish, and fish are less likely to be outgrown.
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Hives (Urticaria)
Raised, red welts or bumps that can be itchy are known as urticaria, or hives. Hives are caused when histamine is released in the skin, which can cause mild to severe itching. This condition seems to be very common. There are severaltypes of urticaria.
Acute urticaria often results from ingestion of foods, stings, infections, or medications. Hives can often be treated with common over-the-counter medications such as anti-histamine. Also, symptoms tend to diminish when the allergen is removed.
Occurrences lasting more than six weeks are called chronic urticaria. Quite often, the cause of these episodes is unidentifiable.
Some urticaria is caused by irritation to the skin by physical means, which is called physical urticaria. The causes can be from itching, exposure to cold, exposure to the sun, pressure caused by clothing, and rises in body temperature.
Since the diagnosis of chronic urticaria is quite difficult, a combination of treatments may be used. Anti-histamines are still the mainstay of treatment.
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Insect Stings 
In general, the vast majority of people are not allergic to insect stings. It is important that you should recognize the difference between a normal and allergic reaction. Recognition between the two will help to reduce concern and may even prevent an unnecessary trip to the emergency room. Please note if you feel you are having a reaction, you should err on the safe side and go to the emergency room.
Insect stings come from a variety of insects, but are mainly wasps, hornets, yellow jackets, and bees. Fire ant populations are on the rise and now infest more than 260 million acres of the southern United States. They may even be the number one source of insect stings. Currently, there are no fire ants in this area of Kentucky.
While no two people will react the same to a sting, the normal reaction is pain, inflammation, and redness limited to the site of the sting. Normal treatment includes cleaning the sting site then applying ice to reduce swelling.
Bees have barbed stingers and can only sting once. Scrape the stinger to remove it, opposed to pulling it out which may inject more venom into the sting site. Hornets, wasps, and ants can sting multiple times. You should try to immediately leave the area if you encounter one of these insects.
If you have experienced what you would consider an "allergic reaction" to an insect such as a yellow jacket, yellow hornet, white-faced hornet, wasp, honey bee, or even a fire ant, you should strongly consider a formal allergy evaluation.
If you are having an allergic reaction to a sting you should immediately seek medical attention. Symptoms of an allergic reaction include: itching, hives, and swelling in areas other than the sting; difficulty breathing and tightness in the chest; and swelling of the tongue and hoarseness in the voice. Further reaction could lead to more severe symptoms such as anaphylaxis, dizziness, and even cardiac arrest.
Treatment for insect sting allergy includes a combination of avoidance, emergency medication kits which included epinephrine (EpiPen, and Twinject), and often immunotherapy (allergy shots) to the offending insect. In fact, vaccinating patients against these pests can reduce the subsequent risk for "severe" reactions by greater than 95%!
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Rhinitis
Allergic rhinitis can either be seasonal, or perennial. Seasonal allergic rhinitis occurs from spring to early fall, while perennial lasts throughout the year. Seasonal symptoms are brought on by the various pollens in the air. Perennial symptoms are due to indoor allergens such as house dust, and dust mites.
An allergic patient that inhales an allergen starts the allergic cascade in motion. Antibodies known as immunoglobulin E (IgE) cross-link at the surface of specialized cells (mast cells) producing histamines. This cross-linking causes the mast cell to burst open releasing preformed mediators like histamine. Histamine and its friends cause runny nose , itching, watery eyes, and other common allergy symptoms.
Hay fever is a turn-of-the-century term used to describe the symptoms since it usually occurs in late summer, which is consequently the time hay is usually cut. Ironically, the mold that grows in wet/damp hay is the cause of hay fever.
Most cases of allergic rhinitis can be taken care of using medications along with avoidance and environmental control. These may include nasal steroids, anti-histamines, and nasal decongestants. Patients with more severe cases of allergic rhinitis may be directed to begin immunotherapy (allergy shots).
There are also other forms of rhinitis that are worthy of noting.
Perennial non-allergic rhinitis, also known as irritant rhinitis or vascular rhinitis is very common, particularly in adults. Common causes include weather change, tobacco smoke, perfumes,colognes, paints, potpourri, candles, cleaning supplies, and other environmental irritants.
Gustatory rhinitis is most often seen in adults and is characterized by clear, watery, runny nose during or after meals. Of note, it is thought that the mechanism probably involves the nerves in the nose.
Rhinitis medicamentosa is another type of rhinitis with severe nasal congestion caused by dependence on topical nasal decongestants such as Afrin.
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Allergy Injections (Immunotherapy)
If you and Dr. Clore have decided Immunotherapy is right for you, great! Immunotherapy is used as a preventive treatment against allergic substances such as grass pollen, or bee venom. You will begin your immunotherapy regimen by receiving small doses of the substances to which you are allergic. This is done weekly and the dose is gradually increased. Once you make it to your maintenance dose, you will receive injections less frequently. The gradual increases allow your body to develop tolerance that reduce the symptoms of allergy. The duration of therapy lasts approximately 3-5 years. Therefore, you must carefully consider this treatment as it requires strict compliance.
The risks of immunotherapy include local reactions to anaphylaxis, which only happens in very rare cases. This is why immunotherapy requires medical supervision.
Immunotherapy has been shown to be effective in the treatment of the symptoms of current allergic disease, helps to treat allergic asthma, often reducing the need for oral/topical medicines, and can often prevent the development of new allergies. This happens by reducing the allergic reactions that may trigger an asthma attack.
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