Overview of evaluation
An examination usually begins with a comprehensive history and physical examination performed by a board-certified allergist-immunologist. The specialist may order skin testing for environmental or food allergens, spirometry to evaluate your lung function, and if required, perform endoscope examination of the nose and postnasal areas. To optimize efficiency, all tests that are required and safe to perform to determine the best treatment option are performed on the same day. In some cases, such as when you need "testing and challenge" with penicillin and other drugs to determine if you are allergic to them, the procedures require scheduling for a later date. At the end of the visit, the Allergist will discuss the finding of all the testing performed and may order blood tests to examine your immune system, CT scans of sinuses or lungs, and other tests. Finally, the specialist and you will jointly develop a management plan that is best suited for improving your health. If you are allergic to environmental allergens, the Allergist may recommend allergen immunotherapy, also called allergy shots.
Testing and Diagnosis
Environmental allergies. We test for 52 different allergens popular within the Houston area. These allergens include molds, grass weed, and tree pollens, indoor allergens like dust mite, cockroach, and animal dander. Testing involves a series of prick skin tests which involves scratching the skin surface with a small plastic device that can perform 10 pricks simultaneously for rapid, accurate, and safe results for individualized patient treatments. We use positive results from this gold standard method of testing as a guide to make highly specific allergen immunotherapy (allergy shot) mixes for each patient.
Food allergies. We also test for 22 food allergens. However, the results of food allergy tests are only used to guide avoidance.
Other tests. As needed, we can perform other procedures such as spirometry to evaluate your lung function, endoscope examination of the nose and postnasal areas, patch testing to evaluate contact-induced skin rash and evaluation of drug allergies.
Treatment and Management
Allergy testing does not always mean allergy treatment is necessary. We analyze the results from the allergy skin testing, and factor in the patient’s history and symptoms, and comprehensive physical examination, to determine what is causing the allergy symptoms and develop an appropriate patient-specific treatment plan.
Environmental allergies. Avoidance is always the first step in any kind of allergen sensitivity. Knowing what triggers your allergy symptoms can lead to accurate avoidance methods that may be sufficient to relieve seasonal allergy symptoms. Reducing exposure to household dust, dander, and mold are effective ways to reducing allergy symptoms such as runny nose, congestion and itchy/watery eyes.
Food allergies. We use the results of food allergy tests together with a detailed history to develop a plan for avoidance of specific foods, and rapidly treat reactions from accidental exposures.
Medications are often prescribed to treat symptoms where avoidance is not enough. An effective medication to treat nasal allergy symptoms is to take over-the-counter intranasal steroids, such as fluticasone. Other medications that can be effective in treating allergic symptoms are over-the-counter antihistamines like cetirizine and fexofenadine. We can prescribe antihistamines and intranasal steroids if required. Long-term use of medications is usually necessary to control symptoms. We also prescribe inhalers for management of asthma, medications to control contact or allergy-induced skin rash, and medication to treat chronic sinus disease. We prescribe biologics when more commonly used medications do not work.
Subcutaneous Immunotherapy (SCIT)
Injections of highly specific allergy-serums is another approach that we can prescribe.
Based on your skin test result and your history, we make individualized patient serums that can only be used for you. This serum modifies your immune response to these allergens in a highly specific manner. To ascertain patient safety, this treatment is administered and monitored by our highly trained staff. Over time, SCIT is very effective in altering a person’s allergic response to these allergens, both improving allergy symptoms and decreasing the need for medications. The usual duration of treatment is four years, and the effect of this treatment can last long after it has been stopped.
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