Allergy

Allergy Overview

Allergy Care
Our providers bring incredible expertise in identifying and diagnosing common allergy symptoms, which is the key to effective treatment and the alleviation of your allergy issues. Our specialty includes providing world-class allergy diagnosis and treatment solutions for residents of the Greater Detroit Metro area.

Allergy Overview
At Ear, Nose and Throat Consultants, we are proud to be your Greater Detroit Metro area specialists in allergic disease. We offer comprehensive testing and treatment in a variety of areas using the purest materials to get to the bottom of your allergy concerns. Many of the common disorders that are treated by the ear, nose and throat specialist are complications of allergic disease.

Allergy Symptoms   
Allergies are a problem with our bodies’ own immune system. Allergies occur when our bodies overreact to non-harmful substances which then create harmful symptoms. Most allergy symptoms are not life-threatening, but rather significantly reduce our quality of life affecting both work and leisure.

Could you be suffering from allergies?

Environmental allergy symptoms

  • Sneezing, itching, watery eyes
  • Nasal congestion, poor nasal breathing
  • Runny nose, post nasal drainage
  • Wheezing, asthma
  • Sinus pressure, sinus congestion
  • Frequent sinus infections
  • Headaches
  • Fatigue, tiredness, sleep problems
  • Irritability, impaired concentration
  • Mouth breathing 

Allergy Testing

Properly testing for allergies is the important first step towards addressing and ultimately eliminating any allergy or related symptoms. For allergy testing to be conclusive, it is critical your testing be conducted by a highly skilled and experienced allergy office. Ear, Nose and Throat Consultants are exactly that. We can perform skin testing for 30+ different antigens!

Allergy testing can be accomplished through a few different modalities. We prefer skin testing over blood work testing as it is more sensitive and more accurate. Skin testing is also less expensive than other types of testing. However, depending on your situation, blood work may still be preferred due to certain medical conditions or medications.

Skin Testing
Skin testing for allergies is easy. It takes place over a 90-minute appointment on site at our office. When you first arrive for skin testing, you will compete a breathing test called spirometry. Spirometry will help us get a good picture of your lung health and make sure we move forward in a safe manner. This test measures how much and how quickly you can move air out of your lungs. This portion of testing takes approximately 5-minutes and is painless.

Once you have passed your breathing test, we can move on to the actual skin testing portion. We utilize two different testing methods to form an accurate picture of your allergies. 

  • Prick Testing: This test is performed first. This involves putting liquid allergy formulations on the skin and pressing it firmly into the top layers of the skin with a small plastic device. This is generally performed on the back. When complete, we move on to the second stage of testing called Intradermal Testing. 
  • Intradermal Testing: This requires a minimal amount of allergen extract to be injected under the skin to test for further reaction. If you react to one of the allergens, your skin will respond with minor swelling, redness and itching.

Your allergy skin test may include testing for many different types of allergens, including environmental allergens, such as:  

  • Molds
  • Dust mites 
  • Pet Dander
  • Varieties of Tree, Weed, and Grass Pollen

Safety
Skin testing is extremely safe. Our physicians only recommend skin testing for patients who are good candidates. Contraindications for allergy skin testing include: poorly controlled asthma, poor lung function, significant cardiovascular disease, frail health in an older adult, pregnancy, or those with a history of a severe reaction to only a minute amount of allergen.

All skin testing is performed on site within our allergy office. Trained professionals are available if any problems arise. Although these rarely occur, our staff is highly trained for emergency situations. We carry all the necessary medicines to stop or control systemic reactions.

Medications and Skin Testing
Certain medications can interfere with skin testing. These include: antihistamines, blood pressure medications, psychotropic medications, anti-anxiety medications, nausea medications, and even over-the-counter medications. Ear, Nose and Throat Consultants will discuss with you a comprehensive list of medications that you should stop prior to your testing. You may need approval from your primary care provider before stopping certain medications. As always, contact us with any medication changes prior to testing.

During or after skin testing, you may experience minor and temporary skin reactions. If so, our office may recommend oral antihistamine medications and/or topical creams to alleviate or reduce symptoms of redness or itching.

Allergy Immunotherapy

If patients are not receiving relief of their allergy symptoms by simple way of allergen avoidance and medications, our office strongly recommends Allergy Immunotherapy. Allergy immunotherapy is a desensitization process that rehabilitates the allergy immune system by giving patients increasing doses of identified allergens (pet dander, dust mites, tree and grass pollen, and molds). Over time your body “gets used to” these allergens and will eventually not respond to them in a harmful way. Immunotherapy treats the cause of allergies, not the symptoms. It is effective in over 90% of patients when used appropriately. We regularly see patients who have successfully used immunotherapy to improve symptoms of: sneezing, nasal congestion, watery/itchy eyes, sinus pressure, frequent sinus infections, headaches, fatigue, and others.

Let’s look into the different forms of allergy immunotherapy…

Allergy Injections - Subcutaneous Immunotherapy

Allergy injections, known as Subcutaneous Immunotherapy or allergy shots, have been the staple to allergy immunotherapy for over 100-years since its technology was first discovered by Leonard Noon and John Freeman in 1911.

At our offices, we schedule allergy injections once a week. During these encounters, patients can expect to see an allergy nurse face-to-face, receive one to three injections (depending on how many allergies you have), and to wait 30-minutes afterward to make sure no adverse reactions occur. The process is simple and easy. Allergy injections are usually initiated at a very low dose. This dosage is gradually increased ("escalation phase") until the therapeutic dose (called the "maintenance" dose) is reached. The maintenance dose will differ from person to person. Injections are typically given 1-2 times per week during the escalation phase while the dose is being increased. This frequency reduces the chance of a bad reaction and permits the maintenance dose to be reached within a maintenance dose on allergy shots. The time may be longer if there are vaccine reactions or if the injections are not received on a regular basis. Most patients start to see relief 3-6 months into treatment. Most patients stop immunotherapy after 3-5 year but still get continued relief for up to a decade after completing allergy shots. 

Allergy injections are very safe overall, but do carry some inherent risks. It is not uncommon for patients to experience local site reactions such as redness, itching, and swelling. Our allergy nurses carefully monitor these reactions and sometimes an antihistamine is recommended before and/or after injections. More serious reactions are called systemic reactions. These range from a mild runny nose to, very rarely, heart and lung complications. All patents are prescribed an Epinephrine Auto-Injector to be used in settings of emergencies. We review this with you. However, given our expertise in allergy care, our reactions are few and far between. We have well-trained staff who perform allergy functions regularly.

See these links for more detailed information on subcutaneous immunotherapy

Interested in a shot-free way of receiving immunotherapy? Check out our Allergy Drop section.

Allergy Drops – Sublingual Immunotherapy

Allergy immunotherapy without needle injections is called Sublingual Immunotherapy or Allergy Drops.  In recent years, sublingual immunotherapy has gained popularity in the treatment of allergies. This treatment is widely utilized in Europe and the World Health Organization has endorsed sublingual immunotherapy as a viable alternative to allergy injection immunotherapy. Many of our patients receive the same significant benefit using allergy drops.  There have been numerous medical studies on sublingual immunotherapy and this treatment is now a "headliner" at major allergy conferences. 

What is Sublingual Immunotherapy or Allergy Drops?
In sublingual immunotherapy, the route of exposing and desensitizing the body to allergens is accomplished through placing allergy drops underneath the tongue. Patient-specific allergy drop solution is created based on individualized skin testing results. The solution is the same allergy extract that is FDA-approved for allergy shots.

Once testing is complete and the solution is made, patients are ready to begin their treatment. We ask patients to return to our office for their initial allergy drops. Here we review the details, timing, and methods for proper allergy drop administration. Patients are watched for 30-minutes and if no reactions occur, patients will begin AT HOME treatment with allergy drops.

A build-up phase occurs over the first 10-days where anywhere from one to three drops from each vial are administered underneath the tongue. After 10-days, a maintenance-phase is reached where patients simply apply four drops from each of their allergy vials underneath their tongue once daily. A major advantage of allergy drops is that it is administered in the convenience of your home, instead of at the doctor’s office. No wait times!

How Effective are Allergy Drops?
Although allergy shots are considered the "gold standard" for allergy treatment in the United States, allergy drops are used as a first line treatment in a number of European countries. They are very effective in relieving allergy and asthma symptoms, making them worth considering as an alternative to allergy injections for many patients, particularly children or those with busy schedules. There have been many studies showing that allergy drops have resulted in a significant reduction in the need for allergy and asthma medications.

Are the Allergy Drops Safe?
The incidence of significant adverse reactions to allergy drops is very low and the most common reaction reported is mild itching or tingling of the mouth or tongue which goes away with continued treatment. It is extremely rare to have a serious systemic reaction to allergy drops, even more rare than with allergy shots. As noted above, the extracts used in sublingual immunotherapy are the same FDA-approved, standardized extracts used in injection immunotherapy.

However, because the FDA has not yet approved these allergy extracts for sublingual administration, they are classified as “off-label”. Off-label use of an FDA-approved product is common in the United States. The classic example is the off-label use of aspirin to help prevent heart attacks, which occurred for years when the FDA had not yet approved this use, even though it was widely known that aspirin treatment was safe and effective. Other examples include the use of seizure medications which were proven and widely used off-label to prevent migraine headaches and chemotherapy agents, approved by the FDA to treat one form of cancer, which were then proven to be very effective and commonly used to treat other forms of cancer. There is frequently a very long lag time between when a medical treatment is proven to be effective and when the FDA approves it to treat a specific medical condition.

Given that allergy drops are not FDA-approved, insurances do not cover the cost of allergy drops. There are inherent costs to purchasing allergy extract and making your patient-specific formula -- this is built into the cost charged for allergy drops. We offer competitive pricing. If you have a high-deductible insurance plan, you may find that allergy drops are a more affordable option than injection therapy.

How do I Start this Treatment for Me?
The first step is to identify your underlying allergies with skin testing or blood work testing. From there, we will formulate your drops based on the results of your allergy testing and medical evaluation. The allergy drops are individualized to treat your allergies and will contain the allergens only to which you are allergic.

See these links for more detailed information on sublingual immunotherapy

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