FIRST OFFICE VISIT:
What to expect during your first visit:
New patient appointments are allotted 2- hours for the initial evaluation/ consultation. It is the patient/ guarantor’s responsibility to confirm that they are keeping the scheduled appointment. If our office does not receive confirmation 48- hours prior to the appointment, your appointment will be cancelled. We do not except walk- ins.
During your first visit at our office is when the doctor will evaluate the patient based on information presented to us through the patient history you fill out and other medical referrals from prior physicians. Please allow up to 2- hours for this first appointment, as the doctor may need to do appropriate testing, such as skin testing, spirometry, or breathing treatments. Do not take any antihistamines* 48-hours prior to your allergy appointment, as this is crucial for skin testing results to be accurate. If you are unsure about what medications you should stop, please call our office for more information.
*Antihistamines include but are not limited to Allegra, Claritin, Zyrtec, and Benadryl.
Pollen/Food/Venom (bee stings): Skin testing that is done by a board certified allergist is generally safe and effective for adults and children of all ages. The allergen extracts or vaccines used in allergy tests performed by allergists meet U.S. Food and Drug Administration (FDA) requirements.
Symptoms which usually prompt an allergist to perform testing include:
• Itchy eyes, nose or throat; nasal congestion, runny nose, watery eyes, chest congestion, cough or wheezing
• Skin: itchiness or eczema
• Abdominal: vomiting or cramping and diarrhea consistently after eating certain foods
• Severe reactions to stinging insect stings (other than swelling at the site of the sting)
• Anaphylaxis: a serious allergic reaction that affects many parts of the body at the same time (such as swelling of tongue, lips, throat, or inability to breathe.)
It is important that allergy testing is directed by a healthcare professional with sufficient allergy/immunology training and is conducted in a professional healthcare facility.
IgE Skin Tests: This type of testing is the most common and is relatively painless. A very small amount of selected allergens are placed onto the skinwith a small “prick” to the surface of your skin. These allergens are chosen based on personal history or prior medical referral to suggest there may be an allergy.
If you have allergies, just a little swelling that looks and feels like a mosquito bite will occur where the allergen(s) to which you are allergic was introduced. Reactions occur within about 20 minutes. And you generally won’t have any other symptoms besides the small hives where the tests were done, which go away within 30 minutes. All skin testing procedures are observed very closely and monitored accordingly to avoid any rare side effects. All results are then interpreted so you/ the patient can understand what may be triggering your symptoms.
“There are methods of allergy testing that the American Academy of Allergy, Asthma & Immunology (AAAAI) believes are not useful, effective or may lead to inappropriate diagnosis and treatment. These include: allergy screening tests done in supermarkets or drug stores, home testing, applied kinesiology (allergy testing by testing muscle strength or weakness), cytotoxicity testing for food allergy, Rinkel skin titration method, provocative neutralization testing, Immunoglobulin G (IgG) testing for food allergy or sublingual provocation.” (http://www.aaaai.org)
Blood Tests: This test involves drawing blood, so results may not be readily available such as with skin testing. IgE blood tests are generally used when taking certain medications, such as antihistamines, or have a skin condition that may interfere with skin testing. Blood tests need to be interpreted by the doctor.
Patch: This testing is helpful if the patient is experiencing contact dermatitis, or has a potential allergy to metals. This testing is done in the office with several follow- ups in order to successfully read the patch tests.
Spirometry: This is a lung function test that measures how much air you can inhale, as well as how much and how fast you can exhale air. It is an important tool to diagnose and understand asthma severity and control.
Spirometry for asthma can be used:
- During your first visit with an allergist / immunologist if there is evidence of asthma or breathing problems
- After treatment has started and your symptoms and peak expiratory flow have stabilized
- To document (near) “normal” airway function, depending on the patient
- To evaluate the response to a change in therapy/medication
ALLERGY INJECTIONS/ IMMUNOTHERAPY:
Allergy injections are considered after a complete consultation and skin testing has been done in the office and previous medications have not been overly successful. Allergy injections are not a cure to allergies, but can help minimize reactions to various grasses, weeds, dander, & trees as long as the patient is committed to a prolonged treatment regiment, as allergy shots are not a quick solution. Regular medications should be used in conjunction with allergy injection and improvement depends on the individual patient and their commitment to a regular shot scheduled.
This information applies to both patient receiving allergy shots in our office and patients who are receiving their injections in another office.
- EFFECTIVENESS: Immunotherapy is very effective because it changes the immune response of the allergic patient. The patient will no longer respond to an allergic substance with an IgE allergic antibody, and therefore the allergic reaction is “turned down”. The initial 6-12 months of treatment gradually decreases that patient’s sensitivity and continuation of the injections lead to further improvement. It may take up to 12- months of shots before any improvements in symptoms are noted. The shots do not cure patients of allergy and most continue to require some medication; however, over 80% of allergic individuals on immunotherapy get significant improvement of their system.
- SHOT HOURS: Please schedule an appointment for all allergy shots.
- MANDATORY 30 MINUTE OBSERVATION IN THE OFFICE AFTER RECEIVING AN ALLERGY SHOT: After allergy shot(s) are given, the patient is required to wait in the office/ facility for 30 minutes. A parent/ guardian must wait with the patient (if minor). There are no exceptions to this rule. Your appointment will be rescheduled if the 30 minute wait time cannot be scheduled. This policy is strongly enforced for the patient’s safety and is policy of the National Allergy Association.
- PATIENTS UNDER 18 YEARS OLD: Children less than 16 years old must be accompanied the entire time by a parent or guardian. Minors 16-18 must have a consent form signed by a parent or legal guardian in order to receive injections without the presence of a parent or legal guardian. Other arrangements can be made with the physician as needed.
- COMPLIANCE: For allergy shots to work, they must be given on a regular basis. We understand people get sick or occasionally are out of town, but the importance of maintaining a shot schedule helps the patient get the most benefits out of allergy shots.
- DO NOT COME IN FOR A SHOT IF: You have wheezing, coughing, have a fever, have flu- like symptoms, feel like a cold or ear infection is starting, or have decreasing peak flows. If you are taking an antibiotic, you can restart shots after being on the antibiotic for 5 continuous days and no more symptoms are present. If you are unsure whether to receive a shot, call our office prior to your appointment. Receiving allergy shot(s) when you are ill can cause additional systemic reactions or worsen your symptoms.
- EXERCISE: Do not exercise 1- hour prior and 2- hours after an allergy shot.
REACTIONS: IF SYMPTOMS ARE SEVERE, PLEASE GO TO NEAREST EMERGENCY ROOM!
- LOCAL REACTIONS: A normal reaction is itching, redness, and/or a small bump or hive at the injection site(s). It is very important for the nurse to check your arm(s) at the end of the 30 minute waiting period, as it is good indication of how the next dose will be tolerated.
- DELAYED REACTIONS: Some people experience reactions 2-12 hours after receiving an allergy shot. Be sure to let the staff know if prior to injections if a delayed reaction occurs including local reactions (bump), sneezing, itching, hives, or any breathing difficulties. Call our office immediately if any hives or shortness of breath occurs, as a systemic reaction may be occurring. You must be seen at the nearest Emergency Room for treatment.
- SYSTEMIC REACTIONS: There is a possibility of a systemic reaction with every injection whether or not it is your first injection or if you have been receiving them for an extended period of time. If you feel in any way different than when you did before the allergy injection, tell the staff IMMEDIATELY so we can appropriately evaluate what may be happening and give the necessary medical care.
Systemic reactions can be severe and life threatening. Symptoms may include:
- Immediate itching/ hives/ flushing
- Increased allergy symptoms/ asthma/ rapid, pounding heartbeat
- Difficulty breathing / shock/ swelling of the throat
IN EXTREMELY RARE OCCASIONS, FATAL REACTIONS FROM ALLERGY SHOTS HAVE BEEN REPORTED. IF YOU EXPERIENCE ANY OF THESE SYMPTOMS IN THE OFFICE OR WHEN YOU LEAVE, SEEK IMMEDIATE MEDICAL ATTENTION. THIS IS A MEDICAL EMERGENCY AND THE PATIENT SHOULD BE TRANSPORTED TO THE NEAREST MEDICAL FACILITY.
- ANTIHISTAMINES: Antihistamine medications should be taken on the day of injections. Effectiveness is at least 30-60 minutes before the injection.
- BETA- BLOCKERS: Allergy shots are not given to patients using beta- blockers. These medications are commonly prescribed for a heart condition, high blood pressure, migraine headaches, or nervous conditions. They are also used in glaucoma treatment eye drops. You must notify the office if you are taking any beta- blockers. Allergy shots cannot be continued while taking this kind of medication.
- ALLERGY REVIEW: An allergy review appointment with the doctor will need to be scheduled every 6-12 months.
- NO ALLERGY INJECTIONS MAY BE GIVEN AT HOME!
CONDITIONS AND SYMPTOMS:
Asthma: Asthma is a reoccurring disease of the lungs that constricts air flow into the lungs. It can cause shortness of breath, wheezing, and coughing. There are allergic and non- allergic triggers to asthma, such as exercise induced breathing difficulties, weather changes and change in temperature. Allergies can play a role in asthma control. Seasonal allergies can make breathing more difficult and harder to maintain proper control. This can be controlled with medication and breathing treatments.
Hay fever: typically, seasonal allergies to airborne pollens. Symptoms normally include: itchy eyes, runny nose, nasal congestion, sneezing, and excess mucus in throat and / or nose. This is a very common condition and has various forms of treatment.
Eczema: That is also known as Atopic Dermatitis; is a chronic, relapsing skin condition that causes itchiness, drying of the skin; crusty, cracking skin, or inflammation. There can be allergic and non- allergic triggers to eczema.
Sinusitis: Inflammation of the sinuses due to infection within the spaces of frontal bones. Sinus infections are common with changing seasons and in people with multiple allergies.
Hives: A skin reaction that causes localized redness, itching, swelling and a noticeable bump. There are multiple reasons for hives.
Food Allergy: An adverse response to a food protein. These reactions can range from mild itching of mouth/ throat, to hives and swelling, to cramping and stomach discomfort, to full anaphylaxis.
Drug reactions: Almost any drug can cause an adverse reaction and can be very common. Reactions can range from gastrointestinal symptoms (nausea, vomiting, and diarrhea) to allergic reactions (hives, rashes, and swelling.)
Insect Allergy: typical reactions that are common in most people when stung by an insect include local swelling, small bump, redness at the site, and mild itching. People who may have an allergy to sting insects can have these same symptoms; however, are generally prolonged and tend to be worse in nature. Patients who have insect allergies can have more serious systemic reactions that can cause diverse hives, trouble breathing, throat swelling, and anaphylaxis.
Immunodeficiency: This occurs when part of a person’s immune system does not work properly to defend against bacteria, viruses, or other pathogens as well as they should.
Vocal Cord Dysfunction: Closing or tightening of vocal cords, making breathing extremely difficult. This condition may cause reactions that range from shortness of breath to choking and complete inability to breathe properly. This is different from asthma and requires different treatment.