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For Our Allergy Patients
As a patient in our office, you have consulted us for evaluation of your ear, nose, or throat problem. There is an indication that your health problem is caused by or seriously affected by allergic disease. You may be considering an allergic evaluation (tests,etc.) in our office. We have prepared the following information for you so that you may be better informed before you decide to undertake the expense and time required for proper allergic evaluation.
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What Are Allergies?
Common allergic problems that are easily recognized are “hayfever” and asthma. Skin eruptions from food ingestion (e.g., hives from strawberries and eczema from chocolate) are also commonly recognized as allergic problems. More recently, medical investigators have demonstrated that many common and puzzling ear, nose, and throat problems may be the result of chronic allergy.
Allergies are sensitivities that susceptible persons develop to normally harmless substances. The tendency to become susceptible to various things in our environment is usually inherited. Parents frequently deny any knowledge of allergy in the family history, but further questioning will usually reveal patterns of food intolerances, “sinus trouble,” and other changes to suggest long-standing, although mild, allergic disease. If the susceptibility to allergy is inherited, then it is the amount of exposure to an offending substance (allergen) that will determine whether the individual will develop a severe illness as a result of his allergy, or will only be aware of mild changes. The greater the time and/or amount of exposure, the greater the chances that a susceptible person will develop an allergic problem that will require medical management.
Allergens are substances that are capable of producing allergy. When an allergen enters the body, substances called antibodies are produced. The interaction of the allergen and the antibody produce an irritation in the affected tissue. The swelling of the nasal lining during the hay fever season would be an example of this interaction.
Allergens may enter the body by ingestion, inhalation, injection, and by external contact with the skin. It is then apparent that foods, dust, pollens, fumes, and almost anything in the environment may cause allergic diseases.
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Allergy Tests
There are several ways to test for allergies: the scratch test, punch or prick test, inhalation and ingestion tests, intradermal tests and RAST (radioallergosorbent test) done on the patient’s blood sample. In our office, we do titration testing using the intradermal method. We have multiple dilutions of our allergens that are used in testing. The intradermal test is made by injecting a minute amount of allergen just under the skin.
The resulting wheal resembles a small mosquito bite and after 10 minutes of observation, an increase in size generally indicates a positive reaction to that dilution. The number of tests required will depend on a patient’s detailed history and on the test reactions.
By establishing the endpoint dilution, we are able to reach the level of optimum relief of allergic symptoms more rapidly. We are also able to recheck the endpoint dilution when we fail to obtain optimum relief in a reasonable period.
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Allergy Treatment
Treatment of allergy is a cooperative venture with both patient and physician as participants. The goal of treatment is to produce an allergic balance so that the patient may be freed of existing allergic illness and avoid the development of new allergic problems. A basic part of management is teaching the patient to eliminate offending allergens whenever possible. Since certain allergens cannot be eliminated, the reaction of the patient to these substances is controlled by desensitization.
Desensitization is a technique of introducing small but increasing amounts of the allergen to control the allergic reaction so that the patient has little or no reaction when he is exposed to the offending substance. In our office, desensitization by injection is used for inhalant allergens. In conjunction with desensitization, patients will be taught to avoid and eliminate allergens.
As stated earlier, this is a cooperative effort with both the patient and the physician. The desensitization process can take 1 to 2 years. At the end of roughly 2 years, the patient will most likely be able to have maintenance injections which can be taught at home or by their family physician. Once again, the time frame is largely dependent on the patients’ commitment to weekly injections and individual response to immunotherapy.
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