Services we offer
Testing
- Environmental Allergy Testing (Skin Testing)
- Breathing Tests in Clinic
- Patch Testing for Contact Dermatitis
- Food Allergy Testing (Skin Testing)
- Food Challenges in Clinic
- Penicillin Testing
- Drug Challenges
- Hymenoptera Testing
- Laboratory Evaluation for Hereditary Conditions and Immune Deficiencies
Treatments
- Subcutaneous Immunotherapy (Allergy Shots/Allergy Injections)
- Sublingual (under the tongue) Immunotherapy with FDA-Approved Products
- Odactra
- Ragwitek
- Grastek
- Peanut Allergy Sublingual Treatment (Palforzia)
- Hymenoptera (venom) Desensitization (Honey Bee, Wasp, Yellow Jacket and Yellow Hornet Allergy Shots)
- Influenza Vaccination (Flu Shots)
- Breathing Treatments for Asthma Flares
- Prescription and Injection of Biologics for Asthma, Eczema and Nasal Polyps
- Dupixent
- Fasenra
- Nucala
- Xolair
- CINQAIR
- Aspirin Desensitization
- Prescription of Immunoglobulin Replacement for Humoral Immune Deficiencies
- Prescription of preventative and emergency treatment of Hereditary Angioedema
Allergy Injections (Subcutaneous Immunotherapy)
What are allergy injections?
Allergy injections are also called immunotherapy or desensitization shots. Allergy injections treat allergic diseases such as hay fever, asthma and bee sting allergy. The goal of immunotherapy is disease modification. As of now, there are no allergy injections for food allergy, poison ivy, hives or eczema. Injections start out weekly and then change to monthly. Injections are customized to include small amounts of sterilized proteins found in dust, mold, pollens, pet dander or venom, depending on the specific needs of each patient. Allergy injections can be received in our office or taken to the office of the patient's primary care physician, whichever is easier for the patient.
How often are allergy shots given?
Shots start out weekly. They progress to every two weeks, then every three weeks and then every four weeks.
What types of allergies are treated with allergy shots?
Allergy injections treat allergic diseases such as hay fever (also called allergic rhinitis), asthma and bee sting allergy.
What are the risks of allergy shots?
Allergy shots may cause redness and swelling at the site of the injections. If the redness or swelling is larger than the size of a mosquito bite then the amount of the next allergy shot can be reduced to avoid a larger reaction. It is necessary to stay in the office for at least 30 minutes following each allergy injection in case you experience a very rare life threatening allergic reaction that may require emergency medicines. These rare reactions may include problems breathing, severe shortness of breath, throat closing, faintness and dizziness.
Can I get a shot if I don't feel well?
You should report any new illness, pregnancy, or change in your health before receiving your allergy injections. If you have a fever you should not receive your allergy injections. You can receive allergy injections even if you are on antibiotics only if you are not having a fever and you feel well.
When will I see a difference from the allergy shots?
It varies from patient to patient but usually it takes about two months to start to see improvement from allergy injections. Some patients see a decrease in their symptoms sooner and some take longer than two months. Once symptoms decrease then the need for allergy medicines would also decrease.
When are allergy shots stopped?
Shots are stopped after 3-5 years of therapy. When shots are stopped, allergy symptoms are under very good control and the need for allergy medicines has decreased significantly.
What is Sublingual Immunotherapy?
Sublingual immunotherapy is another treatment option for disease modification. Currently 3 tablets have been approved for use in by the FDA, and are prescribed by our physicians for appropriate patients.
Biologic Injections
Biologics are strong medicines that are very effective in treating a variety of illnesses including severe asthma, severe eczema, chronic hives and nasal polyps. Examples of biologics include Cinqair, Dupixent, Fasenra, Nucala and Xolair. Biologics are helpful in reducing the need for other therapies with significant side effects such as oral steroids.
Biologics target and inhibit different parts of the immune system such as immunoglobulin E (IgE), eosinophils and interleukins. IgE and interleukins are immune proteins and eosinohils are white blood cells that are crucial in promoting allergy reactions. By inhibiting these proteins or cells biologic medicines can reduce or inhibit allergies.
Most biologic medicines can be administered by subcutaneous injections either biweekly or once a month. Some can even be administered in the patient's home. Patients receiving biologic medicines need to be monitored periodically to make sure their treatments are working, to check for side effects and also to see if some of their other allergy medicines can be reduced.
Breathing Tests
Breathing tests help diagnose lung problems such as asthma by measuring the function or strength of the lung. A breathing test is performed by blowing very long and hard into a tube connected to a flow meter. Children as young as four years of age can perform these tests which are done in our office. They are that easy and only take a few minutes. It is important to monitor breathing tests if a patient has asthma just like it is important for other doctors to monitor the blood pressure of someone with hypertension or the blood sugar of someone with diabetes.
What is a peak flow meter?
A peak flow meter is a handy device that can measure the peak flow of the lungs, a rough measure of lung function. A peak flow meter does not give as much information as a full breathing test but it is still very helpful and used primarily in patient's homes.
When would a patient use a peak flow meter at home?
Peak flow meters are helpful to determine if a patient's asthma is getting worse, better, or staying the same. For example, if a patient is not sure they are experiencing asthma when exercising they can use a peak flow meter before and after the exercise. If the peak flow drops significantly with exercise then asthma may be the problem. If the peak flow does not change with exercise but the patient feels short of breath then poor conditioning may be the problem.
Peak flow meters can also be used when a patient comes down with a cold and fever. If the peak flow measurement starts dropping then certain asthma medicines may need to be started to prevent asthma from getting worse. Peak flow meters are especially helpful at home when monitoring children who may not be able to tell their parents how they feel.
Breathing Treatments
Breathing treatments rapidly reduce symptoms of asthma by bronchodilating, or "opening up" the air passages of the lungs. They are available in our office and may be used if a patient experiences an asthma attack. Breathing treatments use a nebulizer which is a machine that forms a mist of medicine that can be breathed in very easily. Breathing treatments are also used in emergency rooms and can be prescribed for home use with prescription medicines.
Breathing treatments are usually helpful when hand held inhalers fail to work. They are also important in the treatment of childhood asthma when young patients can't use hand held inhalers.
What kinds of medicines are used in breathing treatments?
There are two types of medicines that are used in breathing treatments: bronchodilators, also know as quick relievers, and steroid medicines which provide long term control. Bronchodilators may be used four times daily and steroid treatments usually are used once or twice daily.
Food and Drug Challenges
Skin tests and blood tests can usually be performed to determine if a patient has an allergy to a food. Skin tests are also available for a small number of drugs. On rare occasions a skin test or blood test may appear negative but an allergy may still exist. A more reliable test called a challenge test may then be recommended to provide a more accurate answer. During a challenge test a patient would eat small portions of food or take a drug in our office while under very close medical supervision. An allergic reaction may occur and can be treated with oral or injectable medicines.
What is a "Blind" Challenge?
A challenge with a food or drug may be performed in two different ways. One way is for the patient to know exactly what they are being challenged with. For example, if someone is concerned that they are allergic to wheat then they may be challenged in the office by eating small pieces of wheat bread. This type of challenge is called an "open challenge" and the patient is aware of what they are eating.
Another type of challenge is called a "blind" challenge and takes place on two separate office visits. For example, if someone is concerned that they are allergic to wheat then on one visit they may receive capsules with wheat flour in it and on the second visit they may receive capsules that contains a harmless filler which is also called a placebo. The patient is not sure on each visit if they are being challenged with capsules containing wheat or with capsules containing a placebo. The patient is told what is in each capsule after the challenge is finished and after the patient's response to each capsule is noted. The purpose of a blind challenge is to make sure that a reaction is truly due to an allergy and not due to something else like anxiety for example.
Flu Shots
The flu shot is an inactivated vaccine containing a killed virus. The flu shot helps prevent getting the flu bug and the complications from the flu infection. Complications of the flu infection include worsening asthma, pneumonia, and bronchitis, not to mention severe aches and pains, very high fever, being bedridden and loss of work or school. The flu shot is recommended for the following individuals:
- People with chronic medical conditions such as asthma
- People 50 years of age or older
- Children aged 6 months until their 5th birthday
- Pregnant women or women who will be pregnant during the flu season
- People who live in nursing homes or long term care facilities
- Health care workers
- Family members of those who are at risk from complications of the flu
The risk of receiving the flu vaccine is very small. Some minor side effects include a low grade fever and soreness at the site of the injections.
Egg Allergy and the Flu Vaccine
Individuals with a severe egg allergy may still receive a flu shot because the flu vaccine contains only a very insignificant amount of egg protein. Comprehensive medical studies have shown that egg allergic individuals who tolerate a skin test with a tiny drop of the flu vaccine can receive the vaccine. It may be necessary to inject a small fraction of the flu vaccine, wait 20 minutes to make sure it is tolerated, and then inject the remainder of the vaccine under close observation.
When to Get the Flu Shot
September or October is the best time to get the flu shot, but it still can be given in December and later. The flu season can begin as early as October and last as late as May.
Immunoglobulin Therapy
Intravenous immunoglobulin (IVIG) and subcutaneous immunoglobulin (SCIG) infusions are useful to treat patients with certain types of immune deficiencies. Immunoglobulins are antibodies or proteins that are part of the immune system. Both IVIG and SCIG boost blood levels of a specific immunoglobulin called immunoglobulin G (IgG). IgG helps fight infections. Serious infections such as pneumonia, bronchitis and recurrent sinusitis occur more frequently in patients who have low levels of IgG.
IVIG generally is administered on a once per month schedule and SCIG is usually administered more often. Both IVIG and SCIG can usually be administered in the comfort of the patient's own home or in a short procedure unit in a hospital.
Patients receiving immunoglobulin therapy need to be monitored periodically by their allergist/immunologist to make sure their treatments are working and also to determine if their infusions need to be adjusted. Antibiotics may still be necessary even if immunoglobulin therapy is prescribed.
Oral Immunotherapy
Oral immunotherapy is a form of allergy desensitization or hypo-sensitization used to treat asthma and allergic rhinitis. Oral immunotherapy is also called sub-lingual immunotherapy (SLIT) because the treatment involves pills that are placed under the tongue. The pills dissolve and are absorbed through the lining of the mouth.
SLIT is effective but medical studies have shown allergy shots to be more effective. SLIT can treat dust allergy and seasonal allergies. Treatment for seasonal allergies must be given weeks before the onset of the allergy season.
Side effects of sublingual immunotherapy are usually local and mild and can often be avoided by adjusting the dose. Possible side effects include swelling of the mouth, tongue or lips and throat irritation. The first dose of sublingual immunotherapy should be administered in a doctor's office because anaphylaxis, a severe form of an allergic reaction, may occur, although this is rare.
Before oral immunotherapy can be started it is necessary to undergo allergy skin tests to identify the specific type of pill that would be most helpful.
Skin Testing
Skin testing is an easy, quick and reliable way to diagnose allergies. It is more accurate than a blood test. Results from a skin test are obtained within minutes. A positive test shows up like a mosquito bite and fades within hours. Skin testing can be performed on patients of all ages but we prefer to limit the number of tests on very young children. Skin tests use purified, sterile allergy extracts. Skin testing can be used to check for allergies to dust mites, molds, pollens, pet dander, food and insect venom if needed. When performing a prick skin test a drop of allergy extract is placed on the skin and then a scratch is made to gently introduce the drop into the skin.
Patch testing is another form of skin testing. Patch testing involves applying a drop onto the skin and then covering it with a patch. The patch is then removed after 48 hours to check for abnormal signs of redness and swelling.
How do you know the skin test is reliable?
Skin testing with histamine and diluting fluid provide reassurance that the test is reliable. A histamine skin test causes a positive, red raised small reaction in allergic and non allergic individuals. If the histamine skin test is negative then the skin test may not be reliable.
Skin testing with diluting fluid, which is very similar to water, should cause no reaction at all. If the diluting fluid skin test causes redness or swelling then the reliability of the other skin tests can be questioned.
Should any medicines be avoided before skin tests?
Yes. Antihistamines should be avoided for 3-5 days before skin testing. Antihistamines interfere with skin tests and can mask reactions, creating a falsely negative test result. A list of antihistamines appears below.
Disclaimer
The information presented on this web site is intended to be general and not specific to any individual patient. Please consult with the doctors at Delaware Valley Allergy or your health care provider for specific medical advice before following any recommendations presented on this web site. Please do not attempt to self-diagnose or self-treat your allergies or asthma.