Allergic reactions range from minor to life-threatening. To prevent potentially harmful situations, it is important to receive a proper diagnosis of what allergens may cause serious reactions. Dr. Benjamin Close and Carol Netherland, CFNP, are specially trained to help diagnose a wide range of allergies. Once diagnosed, one of our certified specialists will develop a plan to protect you from future allergic reactions. We specialize in, but are not limited to, diagnosing and treating varying allergic reactions to the following allergens in children and adults:
- Rhinitis (Hay Fever)
- Sinusitis (Rhinosinusitis)
- Stinging Insects
Allergic rhinitis (also frequently known as “allergies” or hay fever) affect a significant portion of our population and can lead to significant reductions in quality of life. These issues can affect sleep, concentration, and can lead to significant school and work absences. The complications of allergic rhinitis include sinus/ear infections, worsening asthma, and sleep disorders.
In Louisiana, many of our patients suffer from nasal symptoms year-round. In the spring, tree pollen seems to predominate gradually giving way to grass pollen allergy in the late spring and generally through September with weed pollen allergy (predominantly ragweed) being predominate from late August until the first frost. Indoor allergens such as cat dander, dog dander, cockroach, house dust mites, and even mouse allergy and mold allergy contribute to ongoing symptoms.
It is important to have a careful history obtained to assess triggers and then perform allergy testing to confirm this and develop a treatment plan. This includes addressing known exposures, medications (including intranasal steroids, nasal antihistamines, oral antihistamines, and leukotriene modifiers). Allergen immunotherapy (also called “allergy shots”, allergy vaccines, and desensitization vaccines) is recommended for many patients. In some cases, oral allergen immunotherapy can be given, ( currently these are available for house dust mites, winter grass pollens, and ragweed).
Allergy testing also helps us to decide whether the problem is related to allergy or another problem such as non-allergic rhinitis, structural problems (such as deviated nasal septum), and possible chronic inflammation of the sinuses / chronic sinusitis or nasal polyps. Many medications used for other conditions may also contribute to nasal congestion.
Food allergy is an expanding problem in the United States and includes adults and children. Symptoms of severe reactions to foods (typically termed anaphylaxis) generally occur within a few minutes after eating the offending food. These can include generalized itching and rash (such as hives), nausea, vomiting, breathing problems, and in some severe instances decreased blood pressure and other cardiovascular problems. Other patients, especially children, manifest food allergy by worsening eczema. The most common offending foods in children are wheat, egg, milk, peanut, and soy. In adults, in addition to those, tree nuts (i.e. pecan nut, almond, and walnut), fish, and shellfish can play significant roles.
Many patients suspect that they have a food allergy when, in fact, they may have a food intolerance. An example of this could include lactose intolerance. There is another form of food allergy that is called food / pollen allergy syndrome. This is caused by cross reactivity of substances in certain foods as well as pollens. Certain fruits and vegetables are the most common foods implicated with this which usually lead to burning and itching of the mouth and upper throat. Exposure to passive cigarette smoke, exercise, and upper respiratory tract infections. Aspirin exacerbated respiratory disease (can also involve other medications in this group) can be seen as well.
It is important for patients to have a thorough evaluation including pulmonary function testing as well as identification of triggers and other factors that could influence asthma ( chronic sinus disease, certain types of acid reflux, heart problems, and vocal cord problems).
Our clinic is proud to have one of the few certified asthma educators in the State of Louisiana (Carol Netherland, FNP-C, AE-C.) We encourage all of our asthma patients to have contact with Ms. Netherland to develop an asthma action plan. Allergy vaccines (“shots”) are appropriate in some patients with asthma. In addition to inhaled medications to treat asthma, there are other medications that fall in the category called “biologics” that are available (Xolair, Nucala, CinqAir, and Fasenra.) Our clinic has an extensive experience with the use of these medications.
Allergic Skin Problems
Most allergy immunology specialists have extensive experience in identifying the type of skin problems such as allergic eczema (atopic dermatitis) and hives (urticaria.) Atopic dermatitis typically (not always) starts as an infant. Food allergy can be a trigger in approximately 30% of patients with atopic dermatitis. Long term treatment plans for atopic dermatitis including the use of moisturizers and topical anti-inflammatory creams or ointments (both steroid and non-steroid creams), bathing techniques, and the use of other biologic medications (most recently Dupixent) may need to be considered.
Many people suspect that urticaria is related to an allergic reaction. In fact, they are surprised to find that only a few percentage are “allergic reactions”. These are usually due to the chronic release of histamine in tissues just underneath the skin and lead to pink to red slightly raised wheals and intense itching. This can be quite troublesome and affect someone’s quality of life. If there is a food allergy or medication allergy suspected, this is evaluated further. Usually a thorough medical history is the initial first step, along with selected labs. Auto immune thyroid problems (such as Hashimoto’s thyroiditis) can be seen in some patients with chronic urticaria.
We develop a treatment plan for chronic urticaria that would generally involve antihistamine therapy, leukotriene modifier therapy (montelukast or Singulair), and possibly an H2 blocker (ranitidine.) In some severe cases, we consider other medications that affect immune cells (i.e. cyclosporine, tacrolimus, hydroxychloroquine). Xolair, previously approved for asthma, has been recently approved for treatment of urticaria and results have been gratifying. Our clinic has extensive experience in using these medications.
Anaphylaxis (Severe Allergic Reactions)
Allergic reactions (“anaphylaxis”) can be “allergy emergencies” and have the potential to be life threatening. Symptoms usually occur a few minutes (in a few instances can be an hour or two later) and include generalized itching, rash, difficulty breathing (coughing, wheezing, chest tightness, and shortness of breath), feeling of airway closure, nausea and vomiting, and feeling faint. Many people, in some instances, will have a feeling of “impending doom”.
Because of the seriousness of these problems, it is essential that the patient receive an allergy immunology evaluation to identify triggers. Occasionally, there may be other factors involved that may mimic an allergic reaction and some of these may be spontaneous or idiopathic (cause unknown.) In patients with anaphylaxis, injectable epinephrine (i.e. EpiPen, Auvi-Q, etc.) is prescribed.
An action plan to treat anaphylaxis should be developed and family members, friends, teachers, coaches, and co-workers made aware. MedicAlert® or equivalent identification is advised. Although the list of potential causes of anaphylaxis (severe allergic reactions) is long, there are some common triggers as follows:
- Certain drugs and medications. Frequently implicated are antibiotics, (especially penicillin and sulfa-type antibiotics). Non-steroidal anti-inflammatory medications (NSAIDs) are common causes as well.
- Foods. Although any food can be implicated, the most common causes of anaphylaxis are fish / shellfish and peanut/ tree nuts. Other common causes of food reactions include wheat, egg, milk, and soy.
- Stinging insects (fire ant, honey bee, wasps, hornets, and yellow jackets.)
Many patients seek our help with problems with chronic sinus disease. This can occur either by itself or as a complication of allergy. Once identified, appropriate treatment plans are discussed. This could involve consultation with an ENT physician for consideration of surgical procedures. In addition to allergy, some patients may require evaluation for other problems such as primary immune deficiency.
Allergy vaccines, in patients that have allergic triggers for their sinusitis, may be very helpful.