Conditions & Treatments
An allergy is your body’s overreaction to something that doesn’t cause a problem for most people. One of the marvels of the human body is its ability to defend itself against harmful invaders, such as viruses and bacteria. With allergies your immune system overreacts by attacking harmless things such as dust, molds, or pollen. The body treats these as invaders and releases chemicals to defend itself. It is these chemicals that cause allergic reactions from mild to severe.
An allergic reaction can affect any part of the body, but its symptoms are most often felt in the nose, eyes, lungs, lining of the stomach, sinuses, throat, and skin,. These are places where immune system cells stand ready to fight off invaders that come into contact with the skin, are inhaled or swallowed. An allergist can work with you to determine what causes your problems and to develop a tailored plan that matches your lifestyle and provides the most effective treatments. Learn more, by clicking on the allergic disease, reactions, testing, and treatment links below.
More than 50 million people in the United States have allergies. Finding out what you are allergic to is an important first step to effective allergy treatment. When combined with a detailed medical history, allergy testing can identify the specific things that trigger your allergic reactions.
Numerous types of tests are available and can be performed by non-allergy providers. Some testing may lead to false diagnoses of allergies, or even false negatives. Scientifically proven and recognized allergy testing combined with the knowledge of our board certified allergists to interpret these tests, can give the most precise information as to what you are or are not allergic to.
Depending on your individual situation, our allergists may perform a specific type of allergy test for you, like skin testing, or may rely on a combination of testing types to provide the most accurate diagnosis and best treatment plan for you.
Testing done by an allergist is safe and effective for adults and children of all ages. The appropriate age to test a child may depend on the individual and their symptoms. Our allergists can help you to determine the proper age and type of testing for your child. It is often recommended to retest a child as they mature. Many times certain foods can be reintroduced that once caused an allergic reaction.
Skin Testing (Prick Testing)
The most reliable and common test for allergies is a skin test. A skin test is a simple, in office procedure, that is best described as tiny pricks that are made on the surface of the skin on your back. The pricks are conducted with a small device called a Multitest, which is similar to a plastic toothpick. The device contains small amounts of allergens, and the skin is lightly punctured on the surface with a tiny amount of the allergens. The allergens (such as pollen, dust mite, animal dander, mold, and/or foods) will be selected by the allergist based on your medical history and symptoms. If you are allergic to an allergen, a small mosquito bite-like bump will appear. The results are available within about twenty minutes, allowing your allergist to develop a treatment plan immediately.
Skin tests are best performed in an allergist’s office to assure the test results are read properly and to minimize the risk of rare side effects. Certain medications containing antihistamines should be stopped at least five days prior to skin testing. Do not stop taking your asthma medications or other routine medications without checking with your prescribing physician.
Blood tests called RAST (radioallergeosorbent test) may be performed when skin testing cannot due to medications or skin conditions. Results are not available immediately as it generally takes a week or more to obtain results of RAST testing.
Which tests are better, skin or blood?
Allergy skin testing is the most accurate and preferred method of evaluating allergies. These tests are safe, minimally invasive, and easily interpreted. Blood assays or RAST may present the clinician with diagnostic challenges. Studies have shown variability between different labs so that results can be difficult to interpret. Blood tests also may have decreased sensitivity compared to skin testing. Depending on the individual patient, more than one type of test may be utilized for an accurate diagnosis.
For those patients who do not react to suspected allergens during a skin test, an intradermal process may be performed. This is applied using a small gauge needle. The allergen is placed just under the top layer of skin. Similar to a skin test, after 20 minutes, the nurse measures the size of any reactions on the skin.
Our allergists may also perform patch testing for common contact allergens such as nickel, latex, and other chemicals.
On day one of testing, tiny amounts of up to 25 or more substances are applied as actual small “patches” to your skin. This is usually on your upper back. They are fixed on with non-allergic tape.
After two days you return to the office and the patches are removed. The skin is examined to see if there is a reaction to any of the tested substances.
After a further two days the skin is examined again in case you have a delayed reaction to any substance.
Sometimes, even after performing skin prick and blood tests, an allergist may ask you to undergo an challenge, a highly accurate diagnostic test for allergy. For example, our allergists may order the test to find out if a patient has truly outgrown a food allergy. A challenge, or challenge test, is where a very small amount of an allergen is actually inhaled or taken by mouth little by little . Following each dose, you are observed for a period of time for any signs of a reaction. If there are no symptoms, you will gradually receive increasingly larger doses. If you show any signs of a reaction, the challenge will be stopped. Challenges are done mostly with potential food or medication allergies. It is very important that they be supervised by a physician with specialized training and experience, such as an allergist, should a reaction occur.
Because it is often impossible to avoid allergens that can trigger your allergies, immunotherapy, or allergy shots, have become the most effective treatment plan for inhalant allergens and stinging insect allergies. While there is not a currently known “cure” for allergies, allergy shots are the only way to suppress the underlying allergy response for long-term relief. While allergy shots have been proven to be effective against inhalant allergies and stinging insect allergies, they can not used for food allergies.
Allergy shots increase your body’s tolerance to allergens. By injecting gradually increasing doses of the offending allergen extract, the immune system builds up a tolerance to that allergen. Allergy shots slow down and reduce the production of the IgE antibody. You can think of each shot as adding a brick to the “wall of protection” against things that trigger your allergies.
Studies have shown that allergy shots are a very cost-effective way to treat allergies. They have been shown to reduce medication requirements and improve the quality of life in those patients who take them. They are the only long-term way to bring symptoms under control in those patients who have significant allergic disease.
Speak with our board certified allergy and asthma physicians to determine the best treatment option for your allergic triggers.
How do allergy shots work?
Allergy shots are usually administered two to three times weekly at the beginning of the treatment procedure. With this rapid build up, improvements can occur within three to four months and will usually be at its full benefit within the first 12 to 18 months. In a typical treatment schedule, shots are tapered to weekly intervals once maintenance is reached (usually at three to six months) then every two weeks at 12 months, then every three to four weeks after 18 to 24 months. Over time, and as the dosage is increased, the patient will gradually develop a stronger tolerance for his or her allergic triggers. During this time symptoms can be decreased, minimized or even eliminated. Most people can discontinue the treatment after about five years.
Per the American Academy of Pediatrics, age is not a barrier to skin testing – even infants can benefit. Children can also receive allergy shots. The age in which shots may be recommended to young children is done on a case-by-case basis. While there has been some disagreement in the medical community about the role of allergy shots in children younger than 5, there have been multiple studies showing effectiveness for this age group. Research has also shown that allergy shots can prevent children who have allergic rhinitis from getting asthma.
You should always consult with an allergy and asthma specialist before beginning a series of allergy shots. Your shot schedule will be individualized by our board certified allergists. They are the only providers who receive specialized training in this procedure.
Who is an ideal candidate for allergy shots
If you are able to avoid the trigger of your allergies or if usual doses of medications control your symptoms, then immunotherapy might not be needed. You may benefit from allergy shots if:
- medications to control your symptoms (i.e., antihistamines, decongestants) do not work
- medication used to control your symptoms produces too many side effects
- complications (i.e., sinus infections, ear infections) develop
- you have asthma triggered by allergies
- you are at risk of developing anaphylaxis (a severe reaction that, in some cases, may be fatal) when exposed to an allergen (As noted above: Allergy shots are not used for food allergy)
- medications control your symptoms, but your symptoms flare back up every time you try to reduce your medications
- you can’t effectively avoid things that trigger your allergies
- you would rather take a series of allergy shots than daily medications
- you would rather treat the actual problem rather than just use medications to control symptoms
- cost of the medications is a burden, allergy shots are very cost effective compared to the use of daily prescription medications over several years
What happens if my allergies go untreated?
Allergies can be the underlying cause of frequent sinus, ear and upper and lower respiratory tract infections. Untreated allergies can even exacerbate or cause asthma; The Academy of Allergy, Asthma and Immunology states “approximately 80 percent of all asthma in children and half of all asthma in adults is caused by allergies.”
Allergies are responsible for symptoms that may make it difficult for you to stay productive in your work, school and home life. Don’t let your allergies control you, take control of your allergies.
What are allergy drops and tablets?
Allergy drops (Sublingual immunotherapy or SLIT), is a desensitization treatment in which patients’ self-administer allergen drops under their tongue on a daily basis. Although not as effective as allergy shots, medical research done both in Europe and the United States has found that SLIT therapy is quite safe and effective at building a patient’s tolerance to allergic triggers and ultimately improving symptoms. SLIT may be an option for certain types of allergy patients, but SLIT is not yet approved by the FDA. Therefore at this time, insurance companies are not reimbursing for this form of immunotherapy.
Allergy Tablets are another form of oral immunotherapy and have recently been approved by the FDA for use in the United States. These fast-dissolving tablets are placed under the tongue and work to help the body build tolerance to allergens through consistent exposure. In general they are less effective than allergy shots. Allergy shots have an effectiveness of over 80%. Allergy tablets are in the range of 40-60% effective. The tablets only contain one type of allergen and are indicated for people with allergies to grass or ragweed. Allergy tablets require a prescription, and it is required that a patient be allergy tested prior to being prescribed the tablet(s). The cost of the tablets will vary based on your insurance. At this time, we expect the cost to be comparable to allergy shots for most patients.
Speak to one of our board certified allergists to determine what the best possible individualized care is for you.
An allergy is an abnormal sensitivity or exaggerated reaction of the immune system to a substance. The substance that triggers the allergy is known as an allergen. The body’s immune system mistakes these allergens as harmful foreign invaders. When exposed to the specific allergen the body makes an antibody, a protein called IgE, that in turn creates your symptoms or reactions.
An allergic reaction typically triggers symptoms in the nose, lungs, throat, sinuses, ears, lining of the stomach or on the skin. Reactions can range from annoying to life threatening.
Types of Triggers
A number of different allergens are responsible for allergic reactions, but the most common include:
- Insect stings
- Animal dander
A food allergy is a dangerous immune response triggered by foods that cause an allergic reaction or anaphylaxis. Very few people have a real food allergy, most have a food intolerance. Common food allergies include peanuts, milk, eggs, tree nuts, fish, shellfish (crab, lobster, shrimp), wheat and soy.
Food allergy reactions range in severity from mild symptoms to a severe, life-threatening reaction known as anaphylaxis.
Symptoms may include:
- Itching, hives, eczema flare
- Swelling of the face, lips, throat, tongue or other parts of the body
- Breathing problems such as wheezing, coughing, shortness of breath
- Gastrointestinal symptoms such as vomiting, diarrhea, abdominal pain/cramping
- Light headedness, fainting, drop in blood pressure
- Feeling that something bad is about to happen
The first step in managing food allergy is to correctly identify food allergens. Ask your allergist about food allergy testing. There are several types of food allergy tests including skin tests, blood tests (also known as RAST) and patch tests. Your doctor will help to decide which test will be most appropriate for you.
The standard treatment for food allergies right now is avoidance of the allergen and having epinephrine available for emergencies. Families with food allergies must follow strict avoidance with constant observation and preparation for any accidental reaction.
Talk to your allergist about available emergency medications:
- Injectable epinephrine (such as EpiPen, Auvi-Q, Adrenaclick)
- In some cases, steroids (oral, intramuscular or IV)
Food Allergy Treatment Center
We are proud to now offer peanut allergy treatment to both children and adults. Peanut oral immunotherapy (OIT), or oral desensitization, is a safe and effective treatment that retrains the immune system to tolerate peanut. Treatment involves eating small, gradually increasing doses of peanuts each day under the careful and strict supervision of our board certified allergist/ immunologist, Dr. Carolyn Comer. The goal of treatment is to improve our patients’ overall quality of life and help them obtain a lifetime of freedom from peanut allergy fear and stress. As the leading caregiver in the state for allergies and asthma, Alabama Allergy & Asthma Center is committed to patient safety and offering innovative quality care to all of our patients. Oral peanut desensitization has been extensively researched in an academic setting for over a decade with proven success.
Skin conditions are one of the most common forms of allergy treated and managed by an allergist, a physician with specialized training and expertise to accurately diagnose your condition and provide relief for your symptoms. Skin allergies are caused by allergic reactions that occur on or under the skin. Irritated skin can be caused by a variety of factors. These include immune system disorders, medications and infections. Our thorough testing process can help pinpoint any allergies you may have and lead the way toward an effective treatment strategy.
Atopic Dermatitis (Eczema)
Atopic dermatitis, also known as eczema, is an itchy, red rash often associated with allergies. It commonly begins in the first year of life. The rash frequently appears in skin crease areas such as the elbows, knees, and wrists. It often affects the ankles, hands, feet, and face as well. The skin is usually dry and scaly, and red bumps may appear. The skin can become raw or weepy when it is scratched, and skin thickening may develop in areas of chronic involvement. Affected skin may also be prone to bacterial and viral infections. Eczema usually gets better as children get older, but it may persist into adulthood. Children with eczema often have other allergic issues. Approximately 75% of children with eczema go on to develop other allergies such as allergic rhinitis (hay fever) and/or asthma. Up to 50% of children with eczema have an allergy to a food, and eating that food may make the skin rash worse.
- Patches of red, inflamed skin
- Skin bumps that may leak fluid when scratched
- Thickened, cracked, dry, scaly skin
There is no cure for eczema, but good daily skin care is essential to controlling the disease.
- Brief soak in bath once/day (10-15 minutes)
- Use mild skin cleansers
- Keep bath water lukewarm
- Gently pat skin dry (avoid rubbing)
- Use creams or ointments free of dyes and fragrance to seal in moisture
- Apply moisturizers immediately after a bath and several times/day
Stop itching and scratching
- Use antihistamines to relieve itching. Several are available over the counter or by prescription.
- Keep fingernails trimmed and filed
Treat the rash
- Apply topical steroids or other topical medications as directed by your doctor. These vary in potency.
- In severe cases, your doctor may prescribe oral medications or medication injections to treat the rash.
Hives and Angioedema
Urticaria, or hives, is an inflammation of the skin triggered when the immune system releases histamine. This causes small blood vessels to leak, which leads to swelling in the skin. Urticaria is itchy, red and white raised bumps or welts that range in size and can appear anywhere on the body. There are two kinds of urticaria, acute and chronic. Acute urticaria occurs after eating a particular food or coming in contact with a particular trigger. It can also be triggered by non-allergic causes such as heat or exercise, as well as medications, foods or insect bites. Chronic urticaria is rarely caused by specific triggers and so allergy tests are usually not helpful. Chronic urticaria can last for many months or years. Although they are often uncomfortable and sometimes painful, hives are not contagious.
Angioedema is swelling in the deep layers of the skin. It is often seen together with urticaria (hives). Angioedema many times occurs in soft tissues such as the eyelids, mouth or other parts of the body. This deeper layer of swelling can also occur on hands, feet, genitals, or inside the bowels or throat. Angioedema is called “acute” if the condition lasts only a short time such as minutes to hours. Acute angioedema is commonly caused by an allergic reaction to medications or foods. Chronic recurrent angioedema is when the condition returns over a long period of time. It typically does not have an identifiable cause.
Hereditary angioedema (HAE) is a rare, but serious genetic condition involving swelling in various body parts including the hands, feet, face, intestinal wall and airways. It does not respond to treatment with antihistamines or adrenaline so it is important to go see a specialist.
If the cause of your hives can be identified, you can manage the condition by avoiding that trigger. Treating hives or angioedema is often successful with oral antihistamines that control the itch and recurrence of the rash.
If the rash is not controlled with a standard dose of the antihistamine, your doctor may suggest increasing the dose for better control of your symptoms. If antihistamines do not control the rash, or if it leaves bruises, then it is important that your doctor rules out other causes which may need alternative therapies.
If you are on certain blood pressure medicines (ACE inhibitors) and develop angioedema, it is important to consult your doctor. Changing to another blood pressure medicine may help the angioedema go away.
When certain substances come into contact with your skin, they may cause a rash called contact dermatitis. There are two kinds of contact dermatitis: irritant and allergic.
Irritant Contact Dermatitis
Irritant contact dermatitis occurs when a substance damages the part of skin the substance comes in contact with. It is often more painful than itchy. The longer your skin is in contact with the substance, or the stronger the substance is, the more severe your reaction will be. These reactions appear most often on the hands and are frequently due to substances contacted in the workplace.
For irritant contact dermatitis, avoid the substance causing the reaction. Wearing gloves can sometimes be helpful. Avoiding the substance will relieve your symptoms and prevent lasting damage to your skin.
Allergic Contact Dermatitis
Allergic contact dermatitis is best known by the itchy, red, blistered reaction experienced after you touch poison ivy. This allergic reaction is caused by a chemical in the plant called urushiol. Reactions can happen from touching other items the plant has come into contact with. However, once your skin has been washed, you cannot get another reaction from touching the rash or blisters. Allergic contact dermatitis reactions can happen 24 to 48 hours after contact. Once a reaction starts, it may take 14 to 28 days to go away, even with treatment.
Nickel, perfumes, dyes, rubber (latex) products and cosmetics also frequently cause allergic contact dermatitis. Some ingredients in medications applied to the skin can cause a reaction. A common offender is neomycin, an ingredient in antibiotic creams.
Treatment depends on the severity of the symptoms. Cold soaks and compresses can offer relief for the early, itchy blistered stage of a rash. Topical corticosteroid creams may be prescribed. For severe reactions such as poison ivy, oral prednisone may be prescribed as well.
To prevent the reaction from returning, avoid contact with the offending substance our allergist may conduct allergy tests to help identify the cause.
Allergic rhinitis is also known as hay fever. It is a common condition affecting up to 30% of American adults and 40% of children.
Allergic rhinitis occurs when a person’s immune system incorrectly identifies harmless particles in the environment such as pollens, dust mites, mold spores and animal dander as foreign invaders. When the immune system reacts to these airborne allergens, it creates inflammation that leads to symptoms of allergic rhinitis.
- Nasal congestion
- Runny nose
- Sinus pressure
- Itching of the nose, throat and/or ears
- Itchy/watery eyes
Speak with your allergist about various treatment approaches to combat allergic rhinitis including:
- Allergen Avoidance – Learn ways to modify your environment to reduce exposure to airborne allergens.
- Medications – There are many over the counter and prescription medications that alleviate the symptoms of allergic rhinitis including eye drops, nasal sprays, decongestants and antihistamines.
- Immunotherapy – Immunotherapy, also known as allergy shots, involves the administration of doses of allergens over time to allow the immune system to switch from an allergic response to a protective response for each allergen treated.
Non-allergic rhinitis (vasomotor rhinitis) is a condition that causes chronic sneezing, congestion, or runny nose. While these symptoms are similar to those of allergic rhinitis (hay fever), non-allergic rhinitis is different because, unlike an allergy, it doesn’t involve the immune system. An allergic reaction occurs when the immune system overreacts to an otherwise harmless substance known as an allergen.
Airborne pollutants or odors, certain foods or beverages, some medications, changes in the weather or underlying chronic health problems can all trigger symptoms of non-allergic rhinitis. These symptoms can come and go, or be constant.
The most common symptoms of non-allergic rhinitis are:
- Stuffy nose
- Runny nose
- Postnasal Drip
Unlike the allergic form, non-allergic rhinitis rarely causes itchy nose, eyes or throat.
It is important to have an accurate diagnosis so you can manage your condition appropriately. Because the symptoms are so similar, allergy testing is often recommended to rule out allergic rhinitis.
Non-allergic rhinitis cannot be cured, but many people find relief by avoiding triggers, using a saline rinse solution or by taking over-the-counter or prescription medications. taking over-the-counter as well as prescription medications.
Sinus disease is a major health problem. It afflicts 31 million people in the United States. Americans spend more than $1 billion each year on over-the-counter medications to treat it. Sinus disease is responsible for 16 million doctor visits and $150 million spent on prescription medications. People who have allergies, asthma, structural blockages in the nose or sinuses, or people with weak immune systems are at greater risk. If you have nasal congestion, facial pressure, cough and thick nasal discharge, you may have rhinosinusitis, commonly referred to as sinusitis. Your sinuses are hollow cavities within your cheekbones, around your eyes and behind your nose. They contain mucus, which helps to warm, moisten and filter the air you breathe. When something blocks the mucus from draining normally, an infection can occur.
Types of Sinusitis
Acute sinusitis refers to sinusitis symptoms lasting less than four weeks. Most cases begin as a common cold. Symptoms often go away within a week to 10 days; but in some people, a bacterial infection develops.
Chronic sinusitis, also referred to as chronic rhinosinusitis, is often diagnosed when symptoms have gone on for more than 12 weeks, despite medical treatment.
- Postnasal drip
- Discolored nasal discharge (greenish in color)
- Nasal stuffiness or congestion
- Tenderness of the face (particularly under the eyes or at the bridge of the nose)
- Frontal headaches
- Pain in the teeth
- Bad breath
Sinus disease is often confused with rhinitis, a medical term used to describe the symptoms that accompany nasal inflammation and irritation. Rhinitis only involves the nasal passages. It could be caused by a cold or allergies.
Allergies can play an important role in chronic (long-lasting) or seasonal rhinitis episodes. Nasal and sinus passages become swollen, congested, and inflamed in an attempt to flush out offending inhaled particles that trigger allergies. Pollen are seasonal allergens. Molds, dust mites and pet dander can cause symptoms year-round.
Asthma also has been linked to chronic sinus disease. Some people with a chronic nasal inflammation and irritation and/or asthma can develop a type of chronic sinus disease that is not caused by infection. Appropriate treatment of sinus disease often improves asthma symptoms.
Sinusitis may also be caused by an infection, a fungus, deviated nasal septum, and nasal polyps or in rare cases an immune system deficiency.
If you think you have sinus disease, see our allergists for proper diagnosis. In most cases, sinus disease treatment is easy. By stopping a sinus infection early, you avoid later symptoms and complications.
Antibiotics are standard treatments for bacterial sinusitis. Antibiotics are usually taken from 3 to 28 days, depending on the type of antibiotic. Because the sinuses are deep-seated in the bones, and blood supply is limited, longer treatments may be prescribed for people with longer lasting or severe cases. Overuse and abuse of antibiotics have been causing a major increase in antibiotic resistance. Therefore, patients with sinus symptoms should consider taking an antibiotic only if symptoms (including discolored nasal discharge) persist beyond 7-10 days. Antibiotics help eliminate sinus disease by attacking the bacteria that cause it, but until the drugs take effect, they do not do much to alleviate symptoms. Some over-the-counter medications can help provide relief.
Nasal Decongestant Sprays
Topical nasal decongestants can be helpful if used for no more than three to four days. These medications shrink swollen nasal passages, facilitating the flow of drainage from the sinuses. Overuse of topical nasal decongestants can result in a dependent condition in which the nasal passages swell shut, called rebound phenomenon.
Antihistamines block inflammation caused by an allergic reaction so they can help to fight symptoms of allergies that can lead to swollen nasal and sinus passages.
Nasal Decongestants and Antihistamines
Over-the-counter combination drugs should be used with caution. Some of these drugs contain drying agents that can thicken mucus. Only use them when prescribed by your doctor.
Topical Nasal Corticosteroids
These prescription nasal sprays prevent and reverse inflammation and swelling in the nasal passages and sinus openings, addressing the biggest problem associated with sinusitis. Topical nasal corticosteroid sprays are also effective in shrinking and preventing the return of nasal polyps. These sprays at the normal dose are not absorbed into the blood stream and could be used over long periods of time without developing “addiction.”
Nasal Saline Washes
Nasal rinses can help clear thickened secretions from the nasal passages.
If drug therapies have failed, surgery may be recommended as a last resort. Anatomical defects are the most common target of surgery, and an allergist would usually refer you to an otolaryngologist.
Adverse reactions to medications are common, yet everyone responds differently. One person may develop a rash or other reactions when taking a certain type of medication, while another person on the same drug may have no adverse reaction at all.
Only about 5% to 10% of these reactions are due to an actual allergy to the medication.
An allergic reaction occurs when the immune system overreacts to a harmless substance, in this case a medication, which triggers an allergic reaction. “Sensitivities” to drugs may produce similar symptoms, but this type of reaction would not involve the immune system.
Certain medications are more likely to produce allergic reactions than others. Some common examples are:
- Antibiotics (such as penicillin)
- Aspirin and non-steroidal anti-inflammatory medications such as ibuprofen
- Monoclonal antibody therapy
Reactions to medications range from vomiting and hair loss with cancer chemotherapy to upset stomach from aspirin or diarrhea from antibiotics. If you take ACE (angiotensin converting enzyme) inhibitors for high blood pressure, you may develop a cough or facial and tongue swelling.
In many cases, it can be difficult to determine if the reaction is due to the medication or something else. This is because your symptoms may be similar to other conditions.
The most frequent types of allergic symptoms to medications are:
- Skin rashes, particularly hives
- Respiratory problems
- Swelling, such as in the face
- Anaphylaxis (Anaphylaxis is a serious allergic response that often involves more than one system of the body like swelling, hives, lowered blood pressure or in severe cases, shock. Anaphylactic shock is a severe condition and if it isn’t treated immediately, it can be fatal.)
If you have side effects that concern you or you suspect a drug allergy has occurred, be sure to contact your physician. If your symptoms are severe, seek medical help immediately. A serious anaphylactic reaction requires immediate medical attention because the results can be fatal.
If you have a history of reactions to different medications or if you have a serious reaction to a drug, an allergist/immunologist, often referred to as an allergist, has specialized training and testing experience to diagnose the problem and help you develop a plan to protect you in the future.
In most cases of adverse reactions, your physician can prescribe an alternative medication. For serious reactions, your doctor may provide antihistamines, corticosteroids or epinephrine.
When no alternative is available and the medication is essential, a desensitization procedure to the medication may be recommended. This involves gradually introducing the medication in small doses until the therapeutic dose is achieved.
Make sure your physician, dentist and pharmacist are kept current regarding your drug allergies. This will help determine which medications should be avoided.
Latex is a milky sap produced by rubber trees. The sap is blended with chemicals during manufacturing to give latex its elastic quality. Natural rubber latex is often found in rubber gloves, condoms, balloons, rubber bands, erasers and toys.
If you are allergic to latex your body treats latex as an allergen and sets off an allergic reaction. Latex allergies are most common in people who have regular exposure to latex products such as rubber gloves. That is why this allergy is most common among healthcare workers and people who have undergone multiple surgeries.
Approximately 50% of people with latex allergy have a history of another type of allergy. Certain fruits and vegetables such as bananas, chestnuts, kiwi, avocado and tomato can cause allergic symptoms in some latex-sensitive individuals.
Allergic reactions to latex range from mild to very severe. Every year, there are hundreds of cases of anaphylaxis, a life-threatening allergic reaction due to latex allergy. The severity of allergic reactions to latex can worsen with repeated exposure to the substance.
Given the potential for a very serious allergic reaction, proper diagnosis of latex allergy is important. An allergist has specialized training and expertise to accurately diagnose your condition and provide relief for your symptoms.
Anaphylaxis (an-a-fi-LAK-sis) is a serious, life-threatening allergic reaction. The most common anaphylactic reactions are to foods, insect stings, medications and latex.
Some people are at a higher risk of developing anaphylaxis. If you have allergies or asthma along with a family history of anaphylaxis then you are more likely to suffer from anaphylaxis. If you have experienced anaphylaxis your risk of having another anaphylactic reaction increases.
Early detection, accurate diagnosis and successful management of allergies are of absolute necessity to help avoid this type of life threatening reaction. Our allergists have specialized training and experience to diagnose the problem and help you develop a plan to guard against such life threatening reactions.
If you are allergic to a substance, your immune system overreacts to this allergen by releasing chemicals that cause allergy symptoms. Typically, these bothersome symptoms occur in one location of the body. However, some people are susceptible to a much more serious anaphylactic reaction.This reaction typically affects more than one part of the body at the same time.
Mild symptoms may include one or more of the following:
- Hives (reddish, swollen, itchy areas on the skin)
- Eczema (a persistent dry, itchy rash)
- Redness of the skin or around the eyes
- Itchy mouth or ear canal
- Nausea or vomiting
- Stomach pain
- Nasal congestion or a runny nose
- Sneezing Slight, dry cough
- Odd taste in mouth
- Uterine contractions
Severe symptoms may include one or more of the following:
- Obstructive swelling of the lips, tongue, and/or throat
- Trouble swallowing
- Shortness of breath or wheezing
- Turning blue
- Drop in blood pressure (feeling faint, confused, weak, passing out)
- Loss of consciousness
- Chest pain
- A weak or “thread” pulse
- Sense of “impending doom”
Severe symptoms, alone or in combination with milder symptoms, may be signs of anaphylaxis and require immediate treatment.
For patients at risk of experiencing a severe reaction (anaphylaxis), epinephrine is prescribed. Epinephrine is the only medication that can reverse the symptoms of anaphylaxis. It is available in an auto-injector (Auvi-Q™, EpiPen® or Adrenaclick®). If prescribed, use epinephrine at the first sign of an allergic reaction and call 911. Request an ambulance and tell the dispatchers that you have just used epinephrine for a suspected food-induced anaphylactic reaction. Patients should always go to the emergency room for further treatment, even if symptoms appear to resolve after epinephrine is administered.
Epinephrine is a safe drug, with the risks of anaphylaxis outweighing any risks of administering the medication. Extra caution is only needed for elderly patients or those with known heart disease where an increased heart rate could be problematic. Nonetheless, epinephrine should be used to treat anaphylaxis in these individuals. Patients should proceed to the emergency room after epinephrine is administered in case additional medication or treatment is needed to manage the reaction, not because epinephrine is a dangerous drug.
Once epinephrine is administered, other medications also may be used to control the reaction:
Steroids (e.g., cortisone) may be given, typically in the emergency room, to help reduce inflammation after an anaphylactic attack. Although steroids do not work fast enough for emergency treatment, they may help prevent a recurrence after the initial reaction has been treated.
Anaphylaxis requires immediate medical treatment, including an injection of epinephrine and a trip to a hospital emergency room. If it isn’t treated properly, anaphylaxis can be fatal.
Currently, the only way to prevent a food-allergic reaction is to avoid the problem food.
Once you have been diagnosed with an allergy, talk to your doctor about how allergic reactions should be treated. Have your doctor create a written Anaphylaxis Emergency Care Plan so that you and others will know what to do in the event of a reaction.
Antihistamines or Topical Steroids
Mild to moderate symptoms (e.g., itching, sneezing, hives and rashes) are often treated with antihistamines and oral or topical steroids.
Antihistamines, known as H1 blockers, are prescribed to relieve mild allergy symptoms, although they cannot control a severe reaction. Medications in this class include diphendydramine (Benadryl®) and cetirizine (Zyrtec®). An antihistamine should never be given as a substitute for epinephrine.
Short-acting bronchodilators (known as “rescue” inhalers), such as albuterol (Alupent®, Proventil®, Ventolin®), may be used to help relieve breathing problems once epinephrine has been given, particularly if you are experiencing asthma symptoms. They should not be depended upon to treat the breathing problems that can occur during anaphylaxis—use the epinephrine.
An effective treatment plan includes all of the following:
- Strict avoidance of problem allergens
- Working with your doctor to develop an Anaphylaxis Emergency Care Plan
- Wearing emergency medical identification (e.g., bracelet, other jewelry)
- Carrying your epinephrine medication wherever you go
- Taking your medication at the first sign of a reaction
- Getting to an emergency room for follow-up treatment if you have a severe reaction
Again, early detection, accurate diagnosis and successful management of allergies are of absolute necessity. Our allergists have specialized training and experience to diagnose the problem and help you develop a plan to guard against such reactions in the future.
Most of us develop redness and swelling at the site of an insect bite. Yet people who are allergic to stinging insect venom are at risk for a much more serious reaction. This life-threatening reaction is called anaphylaxis.
Understanding differences in symptoms between a normal reaction and an allergic reaction can bring peace of mind. It is also important to have an accurate diagnosis so you can manage your condition and be prepared for an emergency.
An allergic reaction occurs when the immune system overreacts to an allergen. In stinging insect allergy, the allergen is venom from a sting. Most serious reactions are caused by five types of insects: yellow jackets, honeybees, paperwasps, hornets and fire ants.
Most people develop pain, redness and swelling at the site of an insect sting. This is a normal reaction that takes place in the area of the bite.
A serious allergic reaction occurs when the immune system gets involved and overreacts to the venom, causing symptoms in more than one part of the body such as:
- Swelling of the face, throat or tongue
- Difficulty breathing
- Stomach cramps
- Nausea or diarrhea
- Itching and hives over large areas of the body
This severe allergic reaction is called anaphylaxis.
Insect stings can cause serious symptoms that are not allergic. A toxic reaction occurs when the insect venom acts like a poison in the body. A toxic reaction can cause symptoms similar to those of an allergic reaction including nausea, fever, swelling at the site of the sting, fainting, seizures, shock and even death. A toxic reaction can happen after only one sting but it usually takes many stings from insects.
Serum sickness is an unusual reaction to a foreign substance in the body that can cause symptoms hours or days after the sting. Symptoms include fever, joint pain, other flu-like symptoms and sometimes hives.
If you think you might be allergic to stinging insects, an accurate diagnosis is essential. Our allergists have has specialized training and skills to help in determining the cause of your symptoms. Your allergist will conduct a thorough health history followed by allergy testing to determine what, if any, allergens put you at risk for serious reactions to stinging insects.
Avoiding contact with stinging insects is the key to successfully managing this allergy. These steps can help:
- Insects are most likely to sting if their homes are disturbed so have hives and nests around your home destroyed.
- Be very careful as this activity can be dangerous so you should hire a trained exterminator.
- If you spot stinging insects, remain calm, quiet, and slowly move away.
- Avoid brightly colored clothing and perfume when outdoors. Many stinging insects are searching for food and could confuse you with a flower.
- Be careful outdoors when cooking, eating or drinking sweet beverages like soda or juice. Cover food and drinks to keep insects out.
- Wear closed-toe shoes outdoors and avoid going barefoot to steer clear of stepping on a stinging insect.
- Avoid loose-fitting garments that can trap insects between material and skin.
If you have an anaphylactic reaction, inject epinephrine immediately and call 911.
Immunotherapy(allergy shots) may be an effective long-term treatment for stinging insect allergy. An allergist will give you shots containing small doses of your allergen, allowing your body to build a natural immunity to the trigger.
Some disorders may produce symptoms that are similar to those of food allergies. However, some related digestive diseases are conditions that do not involve IgE (immunoglobulin E), the antibody that causes potentially life-threatening reactions in people with food allergies. Our team of allergists is extremely experienced in managing patients with these diseases, and works closely with your primary healthcare provider or gastroenterologist to customize effective therapy for you or your child.
A person could possibly have both a food allergy and a related condition, such as eosinophilic esophagitis. Patients with allergy-related gastrointestinal disease may often have other allergic diseases, such as eczema or asthma. Our allergists can help with diagnosis of your symptoms and create an individualized treatment plan for you. To make an appointment, please call us at 205-871-9661.
Eosinophilic Esophagitis (EoE)
Our doctors care for a large number of patients with eosinophilic esophagitis (EoE). Eosinophilic esophagitis (EoE) causes large numbers of eosinophils, a type of white blood cell, to gather in the esophagus (the tube that connects the mouth to the stomach). As a result, the lining of the esophagus becomes inflamed, making it difficult for food to go down. EoE can be triggered by certain foods. Symptoms vary, depending on age. With infants and toddlers, families often note feeding difficulties, irritability, and occasionally poor weight gain. Older children typically have regurgitation, vomiting, heartburn and “belly pain.” Teenagers and adults may have chest pain, difficulty swallowing and a feeling that food “gets stuck” when they swallow. Some individuals complain that it takes a long time to eat meals and that large quantities of water are needed to help swallow food. They may also complain of feeling full rapidly and may stop eating before finishing a meal. Once a diagnosis of EoE is confirmed, food allergy testing is typically performed to determine if a food is triggering the condition. To learn more about EoE, please visit the website of the American Partnership for Eosinophilic Disorders.
Food Protein-induced Enterocolitis Syndrome (FPIES)
One of the more common allergy-related diseases we treat is milk protein allergy, which typically affects infants after the first few weeks of life. Food protein-induced enterocolitis syndrome(FPIES) is a serious, non-IgE-mediated type of food allergy. FPIES is usually triggered by cow’s milk or soy, though some cereal grains, especially rice and oat, and other foods may cause it. The symptoms typically include severe vomiting and diarrhea. Reactions are often delayed by 2-3 hours after the trigger food is eaten. Standard food allergy tests are not used for diagnosing FPIES. The primary test medical professionals use to diagnose this disease is an oral food challenge with the suspected trigger food. In most cases, FPIES is resolved by the age of three. More information about FPIES is available from the FPIES Foundation and the International Association for Food Protein Enterocolitis.
Oral Allergy Syndrome (OAS)
Oral allergy syndrome (OAS), also known as pollen-food syndrome, is a term used to describe itchy or scratchy mouth symptoms caused by raw fruits or vegetables in people who also have hay fever. Symptoms are typically limited to the mouth. This reaction is caused by an allergic response to the pollen that crosses over to similar proteins in the foods. Because these proteins are sensitive to heating, most people affected by OAS can eat cooked fruits or vegetables. Symptoms usually resolve within minutes after the food is swallowed or removed from the mouth, and treatment generally is not necessary. OAS typically presents in older children, teens or young adults. Often, patients have been eating the offending foods without problems for many years.
Common pollen-food associations:
*These are potential associations. Not every individual allergic to pollen develops symptoms with cross-reacting fruits or vegetables. Individuals may react to a few but not all of the above.
With the exception of celiac disease (see below), food intolerances do not involve the immune system. Although food intolerances may cause some of the same symptoms as a true food allergy, they cannot trigger anaphylaxis, a potentially life-threatening reaction. Common intolerances include:
Lactose intolerance occurs when a person’s small intestine does not produce enough of the lactase enzyme. As a result, affected individuals are not able to digest lactose, a type of sugar found in dairy products. The symptoms of lactose intolerance typically occur within 30 minutes to two hours after ingesting dairy products. Large doses of dairy may cause increased symptoms
An adverse reaction to gluten is known as celiac disease or “celiac sprue.” This chronic digestive disease requires a lifelong restriction of gluten, which is found in wheat, rye, barley, and perhaps oats. People with celiac disease must strictly avoid these grains and their by-products. When people with celiac disease eat gluten, they experience an immune reaction in the small intestine. IgE, the antibody responsible for life-threatening reactions (anaphylaxis) does not play a role in this disorder. However, the immune response in celiac disease may damage the lining of the small intestine, preventing proper absorption of the nutrients in food. Over time, patients may become malnourished. Celiac disease can cause many symptoms, including bloating and gas, diarrhea, constipation, headaches, itchy skin rash, and pale mouth sores, to name a few. The symptoms may vary among affected individuals. More information about celiac disease is available from the Celiac Disease Foundation and Beyond Celiac.
Gastroesophageal Reflux Disease (GERD)
Gastroesophageal Reflux Disease (GERD) is a digestive disorder that occurs when acidic stomach juices, or food and fluids back up from the stomach into the esophagus. GERD affects people of all ages—from infants to older adults. People with asthma are at higher risk of developing GERD. Asthma flare-ups can cause the lower esophageal sphincter to relax, allowing stomach contents to flow back, or reflux, into the esophagus. Some asthma medications (especially theophylline) may worsen reflux symptoms. On the other hand, acid reflux can make asthma symptoms worse by irritating the airways and lungs. This, in turn, can lead to progressively more serious asthma. Also, this irritation can trigger allergic reactions and make the airways more sensitive to environmental conditions such as smoke or cold air.
Everyone has experienced gastroesophageal reflux. It happens when you burp, have an acid taste in your mouth or have heartburn. However, if these symptoms interfere with your daily life it is time to see your physician. Other symptoms that occur less frequently but can indicate that you could have GERD are:
- acid regurgitation (retasting your food after eating)
- difficulty or pain when swallowing
- sudden excess of saliva
- chronic sore throat
- laryngitis or hoarseness
- inflammation of the gums
- bad breath
- chest pain (seek immediate medical help)
Several tests may be used to diagnose GERD including: x-ray of the upper digestive system, x-ray of the upper digestive system, endoscopy (examines the inside of the esophagus), ambulatory acid (pH) test (monitors the amount of acid in the esophagus), esophageal impedance test (measures the movement of substances in the esophagus).
If you have both GERD and asthma, managing your GERD will help control your asthma symptoms.Studies have shown that people with asthma and GERD saw a decrease in asthma symptoms (and asthma medication use) after treating their reflux disease.
Lifestyle changes to treat GERD include: elevate the head of the bed 6-8 inches, lose weight, stop smoking, decrease alcohol intake, limit meal size and avoid heavy evening meals, do not lie down within two to three hours of eating, decrease caffeine intake, avoid theophylline (if possible). Your physician may also recommend medications to treat reflux or relieve symptoms. Over-the-counter antacids and H2 blockers may help decrease the effects of stomach acid. Proton pump inhibitors block acid production and also may be effective.In severe and medication intolerant cases, surgery may be recommended.
Asthma describes an inflammatory condition involving the airways of the lungs that causes breathing problems. We know now that there are many types of asthma, including allergic asthma and non-allergic asthma. Most asthma, especially in school aged children, have and allergic cause and are commonly associated with other allergic diseases such as allergic rhinitis and eczema. Asthma can also occur in people who do not have allergies. We believe that asthma occurs due to complex interactions among a person’s genes, the environment, and infections. However, the exact mechanism for the development of asthma remains unknown.
People with asthma experience symptoms such as:
- Chest tightness or pain
- Shortness of breath
- Trouble sleeping due to coughing, wheezing, and/or shortness of breath
Asthma attacks are caused by a variety of triggers. These can vary from person to person and include: allergens, infections (such as colds and sinus infections), pollution, tobacco smoke, gastroesophageal reflux disease (GERD), stress and strong emotions, physical exercise, and exposure to cold air.
The severity of asthma can vary. Some people have very mild disease that rarely causes symptoms. Others have asthma that interferes with daily activities and can lead to severe – even life-threatening – attacks.
Many treatments are available to control asthma and reduce flares including:
Long acting (controller) medications
- Inhaled steroids
- Inhaled long-acting beta agonists
- Combination inhalers (inhaled steroid + long-acting beta agonist)
- Leukotriene modifiers
Short acting (quick relief) medications
- Short-acting beta agonists
- Oral, intramuscular, and IV steroids
Treatments to control allergic inflammation
- Allergy immunotherapy (allergy shots)
- Allergy medications
- Omalizumab (Xolair)
An allergist/immunologist has specialized training and expertise to accurately diagnose your condition and provide relief for your symptoms.
Chronic Obstructive Pulmonary Disease (COPD) is a group of lung diseases (including emphysema and chronic bronchitis) that block airflow in the lungs. This makes it increasingly difficult to breathe. Many of the symptoms of COPD are similar to asthma symptoms.
Although COPD is the leading cause of death and illness worldwide, it is often preventable. That is because long-term cigarette smoking is the primary cause of this life-threatening disease. Additionally, smokers are particularly likely to suffer from a combination of both asthma and COPD.
It is important to distinguish between asthma, COPD or a combination of the two, as the treatment approach will differ. An allergist/immunologist has specialized training and experience to accurately diagnose these conditions.
Both asthma and COPD may cause shortness of breath and a cough. A daily morning cough that produces a yellowish phlegm is characteristic of COPD. Episodes of wheezing and cough at night are more common with asthma. Other symptoms of COPD include fatigue and frequent respiratory infections.
To make an accurate diagnosis of COPD, your doctor should spend time with you discussing your medical history and perform a physical examination. Chest X-rays, spirometry, CT scans or blood work may also help in diagnosing your condition.
There’s no cure for COPD. But proper medications and lifestyle changes can control symptoms and reduce the progression of damage to the lungs.
If you smoke, stop. It is the only way to prevent COPD from getting worse. Quitting isn’t easy, so talk to your doctor about medications that might help.
Medications are used to treat symptoms of COPD. These include:
- Bronchodilators that relax the muscles around the airways
- Inhaled corticosteroids can be helpful for people with moderate to severe COPD
- Antibiotics are prescribed during symptom flare-ups because infections can make COPD worse
People with COPD are susceptible to getting lung infections, so get flu and pneumonia shots every year.
Avoid things that can irritate your lungs, such as smoke, pollution, and air that is cold and dry.
The immune system is a collection of cells and proteins that works to protect the body from potentially harmful, infectious microorganisms (microscopic life-forms), such as bacteria, viruses and fungi. The immune system plays a role in the control of cancer and other diseases, but also is the culprit in the phenomena of allergies, asthma, and recurrent infections such as sinus infections, pneumonia, ear infections, and bronchitis. Our allergists/immunologists have specialized training and expertise to accurately diagnose and coordinate a treatment plan for you. Our physicians also assist in the general diagnosis and treatment of diseases like Primary Immunodeficiency Disease (PIDD) or Hereditary Angioedema (HAE),a unique enzyme deficiency disease, and may require collaboration with your primary physician and other specialists to provide the best possible individualized care plan for you.
Hereditary Angioedema (HAE) is a very rare and potentially life-threatening genetic condition that occurs in about 1 in 10,000 to 1 in 50,000 people. HAE symptoms include episodes of edema (swelling) in various body parts including the hands, feet, face and airway.
HAE patients have a defect in the gene that controls a blood protein called C1 Inhibitor. The genetic defect results in production of either inadequate or non-functioning C1-Inhibitor protein. Normal C1-Inhibitor helps to regulate the complex biochemical interactions of blood-based systems involved in disease fighting, inflammatory response and coagulation. Because defective C1-Inhibitor does not adequately perform its regulatory function, a biochemical imbalance can occur and produce unwanted peptides that induce the capillaries to release fluids into surrounding tissue, thereby causing edema.
HAE is called hereditary because the genetic defect is passed on in families. A child has a 50 percent chance of inheriting this disease if one of his or her parents has it. The absence of family history does not rule out the HAE diagnosis, however. Scientists report that as many as 20 percent of HAE cases result from patients who had a spontaneous mutation of the C1-Inhibitor gene at conception. These patients can pass the defective gene to their offspring.
Patients often have bouts of excruciating abdominal pain, nausea and vomiting that is caused by swelling in the intestinal wall. Airway swelling is particularly dangerous and can lead to death by asphyxiation.
Because the disease is very rare, it is not uncommon for patients to remain undiagnosed for many years. Many patients report that their frequent and severe abdominal pain was inappropriately diagnosed as psychosomatic, resulting in referral for psychiatric evaluation. Unnecessary exploratory surgery has been performed on patients experiencing gastrointestinal edema, because abdominal HAE attacks mimic a surgical abdomen. Before therapy became available, the mortality rate for airway obstruction was reportedly as high as 30 percent.
FDA-approved medication for treating the symptoms of HAE became available in the US for the first time in late 2008. Our immunologists have specialized training and expertise to accurately diagnose your condition and provide relief for your symptoms. Great strides have been made within the last decade to help manage this life-long condition, and in an attempt to stay at the forefront of care options, Our Clinical Research Center of Alabama continues to conduct clinical research studies for HAE therapies.
According to the leading experts in immunology, when part of the immune system is either absent or not functioning properly, it can result in an immune deficiency disease. When the cause of this deficiency is hereditary or genetic, it is called a primary immunodeficiency disease (PIDD). Researchers have identified more than 150* different kinds of PIDD.
The immune system is composed of white blood cells. These cells are made in the bone marrow and travel through the bloodstream and lymph nodes. They protect and defend against attacks by “foreign” invaders such as germs, bacteria and fungi.
In the most common PIDDs, different forms of these cells are missing. This creates a pattern of repeated infections, severe infections and/or infections that are unusually hard to cure. These infections may attack the skin, respiratory system, the ears, the brain or spinal cord, or in the urinary or gastrointestinal tracts.
In some instances, PIDD targets specific and/or multiple organs, glands, cells and tissues. For example, heart defects are present in some PIDDs. Other PIDDs alter facial features, some stunt normal growth and still others are connected to autoimmune disorders such as rheumatoid arthritis.
Serious PIDDs typically become apparent in infancy. In milder forms, it often takes a pattern of recurrent infections before PIDD is suspected. In some cases, a PIDD is not diagnosed until people reach their 20s and 30s.
Important signs that may indicate a PIDD include:
- Recurrent, unusual or difficult to treat infections
- Poor growth or loss of weight
- Recurrent pneumonia, ear infections or sinusitis
- Multiple courses of antibiotics or IV antibiotics necessary to clear infections
- Recurrent deep abscesses of the organs or skin
- A family history of PIDD
- Swollen lymph glands or an enlarged spleen
- Autoimmune disease
Some immunodeficiency disorders are not primary (hereditary or genetic). A secondary immune deficiency disease occurs when the immune system is compromised due to an environmental factor. Examples of these external causes include HIV, chemotherapy, severe burns or malnutrition.
Research in primary immunodeficiency is making great strides, improving treatment options and enhancing the quality of life for most people with these complex conditions.
If you or your child have symptoms of these sometimes critical conditions, you want the best care available.
An allergist/immunologist or a clinical immunologist has specialized training and expertise to accurately diagnose and coordinate a treatment plan for PIDD. A treatment plan may require collaboration with your primary physician and other specialists to provide the best possible individualized care for you.