A person that develops symptoms when exposed to particles in the air is said to be reactive to those particles. This is a person that has “allergies”. An allergic person then, develops symptoms when exposed to dust particles or dander from different animals, one or more of the multiple pollens or molds that are usually present in the immediate environment. The traditional approach to such problems is the administration of allergy medications.
At Associates in ENT & Allergy, a more holistic approach is used for the comprehensive management of environmental allergies. This approach enables us to provide highly successful allergy treatments. Patients that fail medical management or that are dissatisfied with the continued use of allergy medications can be tested and considered for treatment.
The allergy test used at Associates in ENT & Allergy, which is very patient-specific, will provide information about the allergens causing the symptoms. With the information provided by the test, a therapeutic allergy vaccine can be prepared. The administration of such vaccine is called Allergy Immunotherapy. Immunotherapy is a multi-year process but this treatment will decrease the reactivity of the sufferer when exposed to the surrounding environment and will therefore provide long-term relief of patient’s symptoms after treatment discontinuation.
About the allergy test
At our office, the environmental-allergy test determines patient’s reactivity to allergens contained in the air we breathe, including seasonal and perennial allergens present in the indoor and outdoor environment.
The type of test used to diagnose the allergens responsible for the symptoms of each patient makes a difference in the ultimate quality of treatment results. Not all tests “are made equal”. The test used at this office provides the best information about which allergens are responsible for patient’s symptoms. When a vaccine is formulated based on the information from a good quality test, treatment results are much better as treatment is patient-specific. The test includes different the following panels:
a) Indoor allergens: This panel tests for dust-mites, insects, cat and dog dander and feathers.
b) Molds: This test includes multiple molds present in the indoor and outdoor environment
c) Pollens: This test includes the three pollen families, trees, grasses and weeds, present in our geographical region.
The test is done in several separate sessions. The number of sessions is dependent upon health and age of the patient as well as restrictions by certain insurance carriers.
Further Information about Allergy Testing
Allergic symptoms develop as a consequence of an immunological reaction between patient’s immunological system and the allergen in the immediate environment. This type of reactivity is called hypersensitivity. There are 4 types of hypersensitivity reactions described by Gell and Coombs in 1963.
The first type is related to the presence of an antibody called immunoglobulin E (IgE). It is usually assumed (by the majority of doctors) that allergies are reactions mediated exclusively by IgE. In fact, this reactivity corresponds only to the first of the 4 types of hypersensitivity reactions. When evaluating allergies with a holistic approach it is clear that the allergic reaction involves a complex response of the immunological system involving more than one of the 4 types of reactions.
The belief that allergies are mediated only by the IgE antibody led into the description of “non-allergic rhinitis”. More importantly, when using tests designed only to measure the presence of IgE, many patients with clear allergic symptoms but lacking IgE, (and therefore with false negative tests) are told they have no allergies. These patients are not offered a treatment that can help solve their problems as they are considered to have a “non-allergic” condition.
Basically, there are 2 types of tests: Blood Tests and Skin Tests
1) Blood Tests: The usual blood tests measure how much IgE the body produces against each individual allergen. This type of test is generically known a “RAST” test. There are other special blood tests, often not covered by insurance companies, that can measure for other types of hypersensitivity reactions that are not part of everyday medicine.
Because frequently the allergic symptoms are produced with mechanisms other than related to the presence of IgE, patients that have a clear history of allergic disease but a “negative” blood test are often told, as explained above, that they do not have allergies. The end result is that these patients will suffer from their symptoms because no real treatment is offered to them. When these cases are tested with a good quality skin test, reactivity involving the 4 types of hypersensitivity reactions are evidenced therefore the skin test will be positive (reactive) while the blood test was negative. In this case a rational and highly effective treatment can be planned.
2) Skin tests: There are 2 types of skin tests, the Prick Test and the Intradermal Test.
The Prick Test applies the allergen over the skin by an applicator that will press the allergen on the skin without piercing the skin.
The Intradermal Test injects the allergen into (“inside”) the skin, under the superficial layer of the skin.
If the patient is reactive to the tested allergen, a reaction between the allergen and special cells called Mast Cells will ensue. These cells carry specific antibodies in their surface, capable of recognizing different allergens. When this happens, the allergen and those antibodies “lock” together triggering the release by the Mast Cell of many chemicals of which the best known is Histamine. The reactivity of the allergen depends therefore on the allergen being able to reach the Mast Cells.
The superficial layer of the skin is called the epidermis. Under it there is a deeper layer called the dermis. The Mast Cells live in the dermis (under the superficial layer of the skin). The Prick Test deposits the allergen on the epidermis (superficial layer). The Intradermal Test injects the allergen into the dermis (deeper layer where the Mast Cells accumulate). Obviously, the sensitivity of an intradermal test will be much more significant than the sensitivity of the prick test. Doing a Prick Test is simpler and easier to do than the Intradermal Test so, the majority of allergy doctors only use the prick test as the tool to diagnose allergic conditions.
Management of allergic conditions
The management of allergic conditions is based upon 3 approaches
- Medical management (allergy medications)
- Modifications of the environment (Air filters, dehumidifiers, masks, etc.)
- Administration of Allergy Immunotherapy (allergy vaccines)
Only allergy immunotherapy can lead into a cure of the problem as immunotherapy can modify the dysfunctional immunological system of the allergy sufferer.
Allergy vaccines refers to the treatment by which the patient is slowly and progressively desensitized against the allergens that trigger symptoms upon exposure. The treatment consists in the administration of an allergy vaccine that contains all the allergens that were reactive in the allergy test. The vaccine is given in progressively larger doses over a long period of time. As the dose increases, the symptoms start to decrease.
When the treatment is maintained for a long period of time, the results upon discontinuation are long lasting. In Dr. Saporta’s experience, when a treatment is continued for 5-6 years the results are evident for many decades, even for life. Shorter treatments of 2-3 years often give symptom-relief for 5-7 years following discontinuation.
Different types of allergy immunotherapy
Allergy immunotherapy is traditionally administered through weekly shots. The injectable version of the vaccine (properly called Subcutaneous Injection Immunotherapy) is given weekly at the doctor’s office. At our office, there are two alternative treatment options to weekly allergy shots:
- Administration of oral vaccines. These are allergy drops that are administered under the tongue therefore this treatment is known as Sublingual Immunotherapy or SLIT. Oral vaccines are in use probably for a longer period of time than allergy injections. The first paper published about oral vaccines is from 1900. SLIT, is a home-based therapy that requires daily administration of oral drops for the same number of years.
- Administration of ultralow dose allergens known as Low dose Allergen immunotherapy or LDA
Why it is important to consider treatment with allergy vaccines (allergy immunotherapy)
When a person suffers from allergies, the person develops generalized inflammation. In other words: When a person has allergies his/her body is inflamed. Think of inflammation as a fire. The example of the fire is not to be taken literally as a flame, rather as a chemical injury of the tissues inside the body.
Many factors can cause inflammation, for example a bad diet, exposure to pesticides, herbicides or chemical smells all of which are so prevalent in modern society. The more inflamed the body is, the more the problems that are generated, like high cholesterol, heart disease, brain dysfunction, allergies and others.
Allergies affect the whole organism but some body-systems, like the lungs or the nose, are clearly and frequently more involved. It is a common occurrence that allergy sufferers develop respiratory symptoms including asthma or asthma-like symptoms. There is a chronic lung condition called Emphysema (or COPD) where the patient develops severe shortness of breath with impairment of physical performance. This is usually related to exposure to smoke (usually from cigarettes) or some occupational exposure. But there is a sub-group of people that develop emphysema that never smoked or that do not have occupational exposures. These are individuals that have allergies, have minor respiratory symptoms, perhaps use an inhaler during one of the pollen seasons or when performing exercise “but nothing more than that”. The lungs in these cases are inflamed and even though there may not be clinical symptoms, the persistent inflammation in lung-tissue injures the lung producing permanent changes that lead into Emphysema.
Patients with allergies can also develop chronic sinusitis. In this condition, the internal lining of the sinuses (mucosa) swells and grows (hypertrophic changes). Persistent inflammation can lead into irreversible mucosal changes. The patient can develop one or more of nasal obstruction, sinus headaches and nasal discharge. Symptoms may be so severe they require surgery.
Timely administration of immunotherapy can prevent development of such sinus mucosal changes. When patient requires surgery, immunotherapy administration can prevent recurrence of sinus problems after the surgery. This is an example of how, by decreasing patient’s inflammation, immunotherapy leads into resolution of allergic conditions and overall health improvement.
The example given at our office, for patients with allergies, is the example of the house with a hole in the roof: Having a hole in the roof, each time it rains, water will enter into the house and the floor will be wet. Certainly, having this house in Arizona implies a less severe problem than a house in Florida, but the problem is the same: there is a hole in the roof and each time that it rains, water comes through.
Think of the hole in the roof as the allergic condition, the rain as the allergic reaction and the wet floor as the symptoms. Putting a bucket to collect the water certainly helps to control the how wet the floor is (symptoms) but will never solve this problem. Medications are “buckets” that prevent chemicals produced during the allergic reaction from reaching the cells and producing symptoms but will never cure the condition.
Only immunotherapy can alter the immunological abnormalities correcting the immunological imbalance that led to the allergic condition.
Immunotherapy implies allergy vaccines that are usually known as “allergy shots” but injectable vaccines are not the only way to administer allergy immunotherapy.
- Address 470 North Ave. Elizabeth, NJ 07208
- Email EntAllergyNJ@gmail.com
- Phone (908) 352-6700