How is Allergy Diagnosed?
The most important diagnostic tool is
the history of the illness. The patient’s description of the problem
leads to a diagnosis 90% of the time. Skin tests are used to confirm
this impression and to define exactly which allergens are involved. For
over 75 years skin testing has been the standard method of identifying
allergens.
Since 1960 a blood test has been
developed which identifies Immunoglobulin E, IgE, in the blood.
Experience has shown this method to be less sensitive and less accurate
than skin testing.
Moreover, skin tests can be performed
at the cost of $6 to $8 per allergen. Blood testing usually costs $20 to
$25 per allergen. Because of less accuracy and higher costs, medical
insurance plans are currently limiting coverage for the blood test of
allergies. This office uses blood tests for patients whose skin reacts
to everything and for those who have a strong fear of skin testing.
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Immunotherapy is reserved for patients
who have significant hay fever lasting longer than 6 to 8 weeks each
year. It is also helpful for asthma, insect allergy and frequent
sinusitis. Immunotherapy is not recommended for mild allergies or for
food allergies. It is also not useful for less well-defined areas such
as intestinal and emotional problems, arthritis, headaches unrelated to
sinus problems or hives.
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How Long Should
Someone Receive Immunotherapy?
A two (2) year period is adequate to
assess the success of treatment. If high doses of treatment have been
achieved, one should notice a significant improvement in symptoms. Most
patients notice significant improvement after the first 6 months.
At year 4 or 5, a trial of
discontinuing treatment should be attempted. After immunotherapy is
stopped symptoms may return at a rate of 5% in the first (1st) year, 10%
in the second (2nd) year and up to 35% in the third (3rd) to fifth (5th)
years.
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Allergy shots are usually not started
for a woman during pregnancy, though there is no medical reason not to
do so. The beginning of immunotherapy has the most allergic reactions to
the shots (see reactions to shots). If a woman has been receiving
immunotherapy and becomes pregnant, she may safely continue the shots
during the pregnancy. Immunotherapy has been used for over 75 years and
does not harm the baby.
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Reactions to Immunotherapy
There are two (2) kinds of
reactions to the allergy shot : Local and Generalized (Systemic).
One should return to the
office during office hours or go directly to the emergency room for
evaluation and treatment of this reaction. If someone else can
drive you, this would be best.
Patients are requested to have an
antihistamine (available from the nurse or at the desk) with them in the
glove compartment of their car. They should be replaced every 6 months.
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Drugs not to be taken while on Immunotherapy
If any other physician wants you to
take any of the following medications which all contain a family of
drugs called Beta Blockers, it is important to notify him/her
that you are on immunotherapy and have been told you are not
supposed to take them.
** If you are currently taking a
Beta-Blocker, please notify your doctor or a nurse.
There is some evidence that patients
who are taking these medications are more likely to
experience reactions from immunotherapy injections or more severe
allergy symptoms. Also, Beta-Blocker drugs can interfere with
epinephrine (adrenalin) which is the most important drug used to treat
severe reactions to immunotherapy.
