Diagnosis and Treatment

• How do we make the diagnosis?

  The initial or presumptive diagnosis of allergy is made through a patient's history and physical examination. To be certain of the diagnosis and prescribe effective treatment, findings must be confirmed by tests that identify the specific offending allergens.

• Current Treatment for Allergies
  • Avoidance of the offending allergens

    Unfortunately, avoiding some allergens (such as dust, molds, and animals) is often difficult and thus allergen avoidance alone may not be effective.

  • Pharmacotherapy

    Medications can often control allergy symptoms. These may include antihistamines, decongestants, prescription nasal sprays and other types of products. However, these medications may produce side effects in some people.

  • Immunotherapy

    When allergen avoidance and medications do not successfully control allergy symptoms, the otolaryngic (ear, nose and throat) allergist can alter the body's overactive response. This is done by carefully challenging the patient's immune system through regular injections of the actual allergens to which a patient is sensitive. This treatment, very similar to the vaccination for infectious diseases such as the flu, can be administered after allergy testing has determined what has triggered the allergic response. Over time, it may be possible to actually alter a person's excessive response to these environmental allergens, both improvingt symptoms and decreasing the need for medications and allergen avoidance for many years.

• Testing for Allergies

  Like all biological systems, the immune system is very complex. Many issues relating to accurate diagnosis and effective treatment of allergies remain unsolved. The immune reactions caused by airborne (inhalant) allergens, such as ragweed, grass pollen, and dust, are well understood and comparatively easy to diagnose and treat. However, the immune reactions caused by other allergens, such as industrial chemicals, pollution, molds, and foods frequently are more complex and difficult to accurately diagnose and treat with standard techniques. Although a number of methods are in use today to identify specific inhalant allergies, they all fall into one of two basic types:

  Skin testing, or
  Tests performed on the patient's blood

  Both methods attempt to determine if the patient's immune system has manufactured abnormally large amounts of antibody to specific allergens.
  • Skin Testing by Endpoint Titration

    There are several ways to skin test for allergies. No one test is perfect in every case. However, the experience of thousands of physicians in ear, nose and throat, and many other specialties, indicates that of all skin test types one form gives superior results in the majority of patients. That test procedure is called Skin Endpoint Titration.

    There is very little discomfort from the titration technique. A series of small injections, using very fine needles, is made in rows on the patient's arms. Only a small amount of the test substance (called the antigen) is injected. The result is a series of bumps that look like small mosquito bites. If the bumps enlarge significantly in a short period of time, it indicates the patient is likely allergic. If one receives allergy immunotherapy (shots), the proper dosing will be based according to these test results.

  • In Vitro Tests on Blood Sample (RAST)

    Using a tiny amount of blood serum, this test can be used to accurately measure increased levels of allergen antibodies. Although the results of In Vitro tests are not available immediately (need to be sent to a lab) as are skin tests, they offer the convenience of requiring only one sample of blood to obtain the results for several different allergens. In Vitro testing is especially advantageous for the testing of children, as their discomfort is minimized.