|
Frequently
Asked Questions |
| |
| |
-
Skin prick testing- commonly asked questions
-
Do you see children?
-
Understanding immunotherapy (allergy shots)- commonly asked questions
-
Do you treat eczema/atopic dermatitis?
-
How long is the test for venom/bee sting sensitivity?
-
Do you do RAST testing in the office? Is the RAST more accurate?
-
My kids have food allergies. Where can I buy products
specific for food allergens?
-
Where can I buy a medical bracelet?
-
What are my pillow and mattress encasing options?
-
Do you test for nickel allergies?
|
|
|
Skin prick testing- commonly asked questions
Where do you do the skin prick test?
Prick/puncture tests are usually performed on the upper back
Do I need to stop any medications prior to the skin prick test?
Oral antihistamines need to be stopped 7-10 days prior to testing.
Antihistamines include Claritin, Clarinex, Allegra, and Zyrtec.
Short acting antihistamines such as Benadryl can be discontinued 3-5 days
prior to the testing. Also, be careful with all cold or cough remedies.
Most of them contain antihistamines.
What about an antihistamine cream? Is it going to interfere with the test?
Topical nasal antihistamines, such as Astelin, are okay to take for the skin prick test.
Avoid using anti-histamine cream on the back since that is where the skin prick test
will take place.
Will I get the skin test results on the same day of consultation?
Yes! Skin prick tests with allergens are read at the peak of the reaction, usually
15 to 20 minutes after application.
Will the skin prick test hurt?
The skin prick test is done with a plastic stick with a pointed end.
There are no needles involved for the prick test. It will be uncomfortable and itchy.
How long will I itch after the test?
The itchiness will resolve in 12-24 hours. You may use topical steroid cream as
needed or Claritin/Benadryl from over the counter after testing
How long is the test?
The initial consultation will take about 1 hour
How many prick tests do you do?
The prick testing can be specific to certain allergens in question. However, we have
a general adult and pediatric panel including common local environmental allergens such
as pollens (trees, grasses, weeds), dust mites, animals, molds, and a small food panel.
|
|
|
Do you see children?
Yes! We see very young infants to adults.
|
|
|
Allergy shots- commonly asked questions
Understanding immunotherapy (Allergy shots)
Think of allergy injections or immunotherapy as “vaccinations” against allergies. However,
unlike a single “shot” that you might get for tetanus or the flu, immunotherapy involves
injecting you with steadily increasing amounts of the substances that cause your allergic reactions
or symptoms. The whole idea of treating you with the very things that make you miserable may seem
a bit odd but, in most cases, it works.
Immunotherapy has been used for over 100 years. It tends to be most effective against pollens,
probably because they are present only during a brief period of pollination during the year. Other
allergens, such as dust mites, mold spores and animal dander are likely to be encountered on a
continual basis.
How does it work?
Receiving regular amounts of the substances that cause your allergies actually makes you less
sensitive to them. In other words, allergy injections seem to build up your resistance to
the things that cause your symptoms so the next time you run into them, they give you less trouble.
What’s involved in immunotherapy?
First, you will undergo a number of tests to pinpoint the substances that cause your allergies.
The results of these tests will help guide your efforts to avoid substances to which you are allergic
and aid in the decision whether immunotherapy might help you.
Initially, you will receive injections once or twice a week. Treatment starts with a tiny amount
of the substances that bother you. The dose or amount in each injection is increased until it
reaches a level that can really help you. This may take four to six months to reach the
effective “maintenance” dose.
The reason treatment is initiated with a small amount is because you may develop a severe reaction to
an allergy injection before protection builds up. Rarely, the reactions have been serious enough to
cause hospitalization and death. That’s why immunotherapy is always given in a place equipped to handle
a severe reaction quickly. That’s why you must stay for 30 minutes after each injection. Rarely does a
serious reaction such as generalized itching/hives or asthma begin more than 30 minutes after injections.
If this happens, you must return immediately to the injection room or proceed to the nearest Emergency Room.
At each visit you will be asked about reactions such as local swelling, hives, wheezing, etc., that you may
have experienced from the previous set of injections. Your report and the reactions noted by the nurse after
the previous injections determine the strength of doses for subsequent injections.
Generally, allergy injections are given year round. When you reach maintenance doses, you will need to
review your progress and benefits of immunotherapy with your allergist. You will also be required to
review your progress yearly with your allergy physician or if there is severe or repeated reaction to
allergy injections.
If immunotherapy helps you, your physician will usually have you continue it for three to five or
more years. After the initial buildup series, you will receive maintenance injections about every
two to four weeks. In some cases, if your symptoms return after allergy injections have been
stopped, it may make sense for you to start getting them again. Fortunately, most people don’t
need to continue getting their injections indefinitely.
Will my symptoms get better?
Maintenance therapy is reached when you are receiving injections of the maximum tolerated dose.
This usually occurs after four to six months of injections. Most people begin to notice improvement
after they have reached maintenance therapy. Be patient- it takes time to get results. Try not to
miss scheduled injections; if you do miss, the dose may need to be repeated or reduced and, if more
than several months pass, you may need to start all over.
Although most people (about 80%) benefit from immunotherapy, keep in mind that some people do not
benefit. Lack of benefit is more common when you continue to be exposed to allergens (usually pets
or molds). The only way to tell if you will benefit is to try it. If significant improvement is
not realized after one year, the treatment is usually stopped.
How much does it cost to have immunotherapy?
The costs are greatest during the first year of treatment. The first year of treatment requires
making dilutions of one or more sets of individualized allergy extracts, followed by weekly injections
until maintenance is achieved. Most insurance plans cover some of the cost of the solutions and the
injections. You should check with your provider so that you will know what your out-of-pocket expenses
may be. The costs for the remaining years are less than the first year for several reasons; dilutions
are not needed, shots are no longer weekly, and your use of allergy and asthma medications usually decreases.
It is important to check with your insurance provider to understand what your out-of-pocket expenses may be.
What can I expect from immunotherapy?
If immunotherapy is completely successful, you will have fewer allergy symptoms. Allergy injections may not
be a cure. However, they can usually improve your quality of life and reduce your need for allergy medicines
to control your allergies and/or asthma.
Can I get allergy shots if I am pregnant?
Allergen immunotherapy maintenance doses may be continued during pregnancy. When a patient
receiving immunotherapy reports that she is pregnant, the dose of immunotherapy usually
is not increased; rather, the patient is maintained on the dose she is receiving at that
time. Allergen immunotherapy is usually not initiated during pregnancy because of risks
associated with systemic reaction and its treatment.
Points to remember about immunotherapy
Understand the risk and benefits before starting. You need to get your injections regularly for
immunotherapy to work. This is a big time commitment. Be sure not to miss scheduled injections!
You may develop a severe reaction to an allergy injection. If this takes place outside the Clinic, go to
the nearest Emergency Care Department.
Immunotherapy is not a quick fix or a cure; you may need to receive it for several years. It may make your
allergies or asthma better, but it probably won’t make them go away entirely. Costs vary- talk to your
insurance company about your cost before starting.
|
|
|
Do you treat eczema/atopic dermatitis?
Yes!
|
|
|
How long is the test for venom/bee sting sensitivity?
Venom testing is in depth and is not usually done on the first consultation visit.
The allergens need to be prepared. The test may take up to 4 hours.
|
|
|
Do you do RAST testing in the office?
RAST (radioallergosorbent) test can detect IgE antibodies to specific allergens in the blood.
It is done in special cases. RAST tests are most commonly used in cases in which skin tests
can not be performed, such as on patients taking certain medications, or those with skin
conditions, such as severe eczema, that may interfere with skin testing.
Is the RAST more accurate?
The precise sensitivity of these tests compared with prick/puncture skin tests has
been reported to range from 50% to 90% with the average being about 70 to 75% for most
studies. Therefore, skin tests are presently the preferred tests/gold standard for
the diagnosis of IgE-mediated sensitivity. RAST may be
preferable to skin testing under special clinical situations:
-testing of patients with severe dermatographism, ichthyosis, or
generalized eczema
-testing in patients who have been receiving long-acting antihistamines,
tricyclic antidepressants, or medications that may put the patient at
undue risk if they are discontinued
-testing of uncooperative patients with mental or physical impairments
-the evaluation of cross-reactivity between insect venoms
-as adjunctive laboratory tests for disease activity of allergic bronchopulmonary
aspergillosis and certain parasitic diseases
-when clinical history suggests an unusually greater risk of anaphylaxis from skin
testing than usual (e.g., when an unusual allergen is not available as a licensed skin test extract).
|
|
|
My kids have food allergies. Where can I buy products
specific for food allergens?
Local health food stores such as Healthway Natural Foods,
Whole Foods,
Harris Teeter,
and Trader Joe's carry products that exclude common allergens such as wheat, eggs, dairy, etc.
We also recommend a local bakery, Chantel's Cakes & Pastries, located in Sterling, VA.
A variety of foods and other food allergy related products can be purchased at the following websites:
Enjoy Life Foods
Allergy Free Foods
Kid's Allergy Stop
'Cause You're Special
AllerGators
Kids With Food Allergies: Food Allergy Support and Allergy Free Recipes
|
|
|
Where can I buy a medical bracelet?
Medical ID bracelets can save your life. Important information on medical conditions, drug and food allergies, prescribed medicines and
emergency contacts can be engraved onto the surface of a medical identification jewelry piece.
There are several companies available online that sell medical IDs. Here are just a few:
Medic I.D.
American Medical ID
|
|
|
What are my pillow and mattress encasing options?
An encasing is an allergen-proof barrier that completely surrounds a pillow, mattress or
boxspring, preventing the escape of allergy causing particles. There is much confusion
about the types of encasings on the market today. There are three basic types; vinyl,
polyurethane laminates, and microfiber.
Vinyl encasings are the oldest type. They are inexpensive and effective, but
often uncomfortable. Unfortunately, these encasings are usually what come to mind
when people think of allergy barriers for bedding. They are stiff, often noisy, and
sweaty. As a result, many people tend to remove them in a few days. However, they
are suitable as an economical cover for boxsprings since they are not slept on directly,
so comfort or noise is not an issue.
Laminate encasings were the next generation of allergen-proof barriers. They
are still widely used and are the type generally available at places like Bed, Bath
and Beyond, Walmart, and even many allergy supply companies. When first developed,
they represented a significant advancement over vinyl. They’re made by fusing a
plastic-type membrane (usually polyurethane) to a fabric. The membrane side is
against the pillow or mattress so that the fabric side is exposed. Thus, sleeping
on these encasings is more comfortable than vinyl. Laminates have several problems,
however, that have made them somewhat outdated. First, although they are less rigid
than vinyl, they are still somewhat stiff (this is more noticeable in pillow encasings).
Second, they are not only allergen proof, but airtight. Although some better quality
laminates are advertised as “breathable,” this only refers to their ability to allow a
minute amount of water vapor to pass through the membrane. No laminates are truly
breathable in the sense that they allow the passage of air. This is especially a problem
for pillows since, once they are sealed, the air becomes sealed in also, making them
like a balloon. The biggest problem with these types of encasings is that they often
de-laminate after repeated washing and drying. The membrane separates from the encasing
making it unusable.
Microfiber encasings are the newest type of allergen-barrier encasing. They
are made from micro-fiber fabrics. These new high-tech fabrics are made of fibers so thin and
yarns so tightly woven that there is no space between the weaves of yarn large enough
to allow the passage of allergen molecules. Since the fabric itself acts as a filter,
no membrane is required. Without the membrane, they are truly breathable, allowing
air and water vapor to pass freely through the fabric even though allergens cannot.
Therefore, they are extremely comfortable and make no noise.
Not all microfiber products are equal. Studies show that a microfiber fabric must have
a pore size of no more than six microns to block all allergens. Many encasings on the
market have pore sizes of ten microns or more. Also, better quality encasings are
manufactured with interior flaps of barrier fabric, preventing the escape of allergens
through the zipper.
Microfiber encasings should be wiped down or vacuumed when soiled but should not be
washed frequently. Pillow cases and sheets, washed regularly in hot water, should be
used over the encasings to keep them clean.
|
|
|
Do you test for nickel allergies?
Yes! We do perform an allergen patch test to common allergens, including nickel, to identify contact dermatitis.
The test panel is placed on day 1. Results are interpreted at 72-96 hours.
|
|
