Many seemingly ordinary substances can trigger allergic reactions causing nasal allergies, eye allergies, asthma, sinus disease or food allergies. These substances are referred to as allergens. The common allergens in St Louis, MO are pollens (trees, grasses, weeds), mold spores, house dust mites, animals, foods, medications and insect stings. In some people the immune system produces an antibody to these allergens; this is the difference between someone who is allergic and someone who is not – a person that is not allergic does not produce the antibodies after exposure to these substances/allergens. When we test for allergies, we are testing for the presence of these antibodies.
Children are afflicted with allergies more than adults though you can develop allergies at any age. The CDC estimates that 10% of children have nasal allergies and/or eye allergies with around 8% of adults affected. The CDC also estimates that almost 6% of children have a food allergy.
Typical symptoms are runny nose, stuffy nose, post nasal drip, sneezing, itching of the nose/back of throat/ear canal, headaches, sinus pressure, ear fullness, or ear popping. It is common in young children to have a history of recurrent nosebleeds. Nasal allergies can contribute to sinus disease and ear problems. Eye allergies involve itching of the eye, tearing, redness of the eye and eyelid puffiness. When eye allergies are severe, the white of the eye can swell. In St Louis, MO this is more commonly seen in the spring due to tree allergy.
In children, cow’s milk and peanuts are the most common food allergies. Egg, soy, wheat, shellfish, fish and tree nuts are also problematic. In adults the most common food allergies are to shellfish, fish, peanuts and tree nuts.
The first step in the diagnosis and evaluation of allergies is a thorough health history and physical examination. Diagnostic tests are of two types – skin tests and blood tests.
Skin tests, in most situations, are preferable because the results are available immediately, they are less expensive and are more sensitive (more likely to detect the presence of an allergy).
A blood test is appropriate in certain situations, particularly when you cannot stop your antihistamines which can inhibit skin tests, if you have widespread skin disease, or if you had a severe allergic reaction to an allergen.
Immunotherapy or allergy shots are the most common way a person can reduce the severity of nasal allergies and eye allergies. There are no allergy injections currently approved for treating food allergy. Another recently approved treatment involves taking treatment under the tongue (sublingual immunotherapy).
Unlike the medications used to treat nasal allergies and eye allergies, allergy shots will make a patient less allergic. The shot actually contains what a person is allergic to. Allergy shots can be considered a vaccination; by giving a patient injections of what they are allergic to they become increasingly tolerant to the substances that cause allergic reactions.
Allergy shots can be used in all age groups though it is generally not recommended for children less than 5 years old. Since allergy shots reduce your allergic reaction, good candidates for allergy shots are patients who find their medications do not adequately control their symptoms, those who do not want to continue taking as much medication, or those who have undesirable side effects from their medications.
Allergy shots are given in the arm, after which a patient must wait in the office for a 30 minute observation period. There are 2 phases of treatment with allergy shots – the buildup phase where weekly increasing amounts of allergen are given with each shot which is followed by the maintenance phase whereby a fixed amount of allergen is given every 2-4 weeks. In the past, the buildup phase used to take 4-6 months in order to reach the maintenance phase but with the use of accelerated schedules, the maintenance phase can now be reached within a month!
It is not unusual for some patients to note some relief during the buildup phase but most relief will occur during the maintenance phase. It is recommended that once a patient reaches the maintenance phase that the allergy shots are continued for 3 to 5 years. On rare occasions some patients may continue on monthly injections for ongoing relief past 5 years.
These are treatments put under the tongue that are similar to allergy injections in that they can reduce how severe a patient’s nasal allergies and eye allergies are. At this time there are only 2 approved sublingual treatments, one for grass and the other for ragweed. Advantages of this treatment is that it can be done at home and there are no shots. Disadvantages are that it cannot be used to treat allergy to trees, mold, dust mite, animals or insects. Additionally it does not appear to induce long lasting remission like the allergy shots can nor does it appear to be as effective.
A detailed history of your health and symptoms will be taken. A physical exam will be performed and appropriate diagnostic testing will be done. Lastly a detailed discussion of the results as well as the various treatment options will be reviewed. The typical first office visit takes 45-90 minutes. Testing will not prevent a patient from returning to work or to school that day.
In the St Louis, MO area, tree pollen is seen first each year. It may start as early as February and is generally gone by late May. Oak pollen is especially troublesome in this area, it is the pollen that turns cars yellow-green in the spring! Grass pollen closely follows tree pollen and is seen from late April until early July. Weed pollen is seen in the fall with Ragweed the dominant species. It is typically seen from mid August till early October. Mold spores are found year round in the St Louis, MO area with peak counts in the fall; lowest counts typically occur in the winter especially after we have snow cover.