Allergy and Asthma

Specialized Adult & Pediatric ENT Care In San Antonio

At Everyone’s ENT & Sinus Center we provide leading ENT care for both adult and pediatric patients in the San Antonio area. In the Southwest, there are many allergens and irritants in the air that can cause and/or worsen allergy and asthma problems. We provide a variety of treatment options that will vastly improve the quality of life for children, teens and adults suffering from allergies and asthma.

What is Causing My Allergies?

There are hundreds of allergens that trigger allergic reactions, including the most common:

  • Trees
  • Weeds
  • Food
  • Medicine
  • Pollen
  • Household dust
  • Animal dander
  • Mold
  • Insect stings

The skin, nose, sinuses, eyes, throat and lungs are most often affected by an allergic reaction, however, they can occur anywhere on or in the body. Allergies can affect anyone of any age, but most often start in childhood. Allergies can affect anyone of any age. While most often, start in childhood, adults can experience allergies for the first time later in life or have a recurrence of a pre-existing allergy. Many patients tell me their allergies were not that bad until moving to the hill country/central Texas. For most people it takes about 6-12 months to get sensitized to an area.

Some of the most common allergies include:Children playing outside

  • Food Allergies, which are most common among children and affect up to 50 million Americans
  • Pollen Allergies, which include polled from trees, grassed and weeds
  • Animal dander, dust mites and mold
  • Stinging Insect Allergies are less common than others, but roughly 5% of Americans suffer from severe allergic reactions due to insect stings

After reviewing a complete medical history and discussion of your symptoms, a treatment plan will be discussed including possible allergy testing by either skin, blood, or a combination of both. Our comprehensive approach to allergy testing will allow us to identify what you are allergic to, and how allergic you are to each allergen. Once we have all the results, several options well be discussed. Information obtained with testing is invaluable even if a patient is not interested in allergy therapy.

Allergy Treatment Options

Here at Everyone's ENT & Sinus Center we have several treatment options available. Treatment for allergies include avoiding contact with the allergen, medications to alleviate the allergy symptoms and/or immunotherapy. Immunotherapy comes in two forms, allergy shots or allergy drops (SLIT). Depending on what type of allergy you have, you can avoid allergens by taking special precautions such as wearing a pollen mask when doing yard work or cleaning, being aware of the ingredients in foods by reading the labels, closing windows and doors during heavy pollination, keeping pets outdoors, washing your bedding in hot water every 7-10 days or taking other precautions to reduce contact with dust and pollen. Once we have what your allergens are we can determine what medicines are needed and when they are to be taken. Additionally, based on how many allergens you have and how sensitive you are to them, we can determine if immunotherapy would be appropriate for you.

For more information on Immunotherapy please read through the information below. You may also contact us at our office to schedule your allergy test appointment.

Sub Lingual-Immuno Therapy (SLIT)
 

Introduction
Allergies affect millions of patients. Medicines do not cure the problem, and it is not always possible to avoid the cause (such as grass pollen). Desensitization (immunotherapy) is currently the only way of “teaching” the immune system to tolerate allergic triggers.

How the treatment works
Our immune system responds to substances in our environment that we eat, drink or inhale. By giving small but increasing amounts of those allergens at regular intervals, tolerance increases. On re-exposure to the allergens, symptoms may be milder or not occur at all.

How can this be done?
Immunotherapy has been given by injection for more than 60 years and many studies prove that it is effective. A number of studies published have shown that sublingual immunotherapy (SLIT), where drops of the allergen extract are retained under the tongue for a few minutes, then swallowed, can also be effective. This form of treatment has a longer history of use in Europe than in the United States, where it is used more commonly than injected immunotherapy.

Who should have immunotherapy?
Immunotherapy is indicated in people when:

  • Allergy is severe
  • The cause is hard to avoid
  • Reducing exposure to allergenic triggers is only partially effective
  • Medication does not work
  • Medications cause side-effects, or a person would prefer to avoid medication.

Why chose sublingual (SLIT) instead of injected immunotherapy?
The potential advantages of sublingual treatment are those of no injections, fewer regular doctor visits, no waiting periods after the injections, and a more natural way to intake the allergen. The main disadvantage of this form of treatment is cost; currently SLIT is not covered by insurance. If you have a high deductible your out of pocket expense may be the same or less than with shots. Some people also dislike the taste. On the other hand, this needs to be balanced with time, cost, and convenience of drops over shots.

How long does it take to work?
Improvement does not occur immediately. You are training your immune system which takes time. Any immunotherapy is a 3-5 year commitment. Your first allergy season after starting immunotherapy may only be slightly less than normal, but with each season you will notice the benefits. Symptoms are better controlled, and less medication is needed.
Can you still use medicines as well?
Yes. You can still use your usual allergy medicines. Symptoms will still need to be controlled with medications as your immunity is improved.

Common methods for taking the allergen extracts include:

  • Take in the morning on an empty stomach.
  • Keep them under the tongue for at least 2 minutes, then swallow.
  • Do NOT eat anything for 15 minutes.
  • Avoid crunchy cereals, as these may cut the tongue and increase the likelihood of mouth irritation from the extracts.
  • If you forget to take them in the morning, take them before bedtime instead.

Risks and side-effects of SLIT:

  • Salty or unpleasant taste - to make it more acceptable, children can suck on a sweet at the same time.
  • Irritation or itching inside the mouth - this can be controlled by temporarily reducing the dose or taking an antihistamine beforehand.
  • Upset stomach- allowing the drops to absorb in your mouth prior to swallowing decreases this risk.

Patient Information On Immunotherapy - Allergy Shots

Allergy shots (Immunotherapy injections) are administered to allergic patients who have symptoms that affect their quality of life. Many allergic patients do not need allergy shots for treatment of their symptoms. If however, medications and/or environmental changes are not sufficient to minimize symptoms, allergy shots may then be the only effective option available. In persons who require multiple medications to control their symptoms, allergy shots may actually be a cost saving option when considering the pharmacy "co-pays" and the out-of-pocket expense of "over-the-counter" drugs such as "Claritin" and "Allegra."

Immunotherapy is usually very effective for the treatment of nasal allergies and approximately 95% of patients will improve on shots. Immunotherapy "turns off" the allergic reaction to pollens, molds, dust mites, and animal dander over time. This is accomplished by the frequent administration of the material to which the patient is allergic. During the "build-up" phase of immunotherapy (the initial 6 to 12 months on the allergy injections), there is a gradual decrease in sensitivity to allergens. Allergy shots can "cure" allergies in many people but some must continue shots long-term to maintain good results. Unfortunately, up to 50% of patients with true "Allergies" (Allergic Rhinitis) also suffer from "Non-Allergic" rhinitis. Allergy shots do not treat the symptoms of "Non-Allergic" Rhinitis caused by sensitivity to environmental irritants. Nasal symptoms triggered by weather changes, tobacco smoke, perfumes, strong odors, exercise, diesel fumes, spicy food, dust, dirt and other irritants, may require medical treatment while on allergy shots.

"Conventional" Immunotherapy shots are usually administered in the upper arm. During the "build-up" phase, these shots are given once a week using a schedule of progressive dosage increases until the "maintenance" dose is reached. Once you are on the maintenance dose, the time between injections can be increased, attempting to make the shot administration once or twice per month. Maintaining your shots at the proper time interval is very important, however, missing shots for a short vacation or because of some other problem is usually acceptable. Missing shots may require temporary dosage reductions. Allergy shots are generally continued for a period of three to five years; after which your doctor may consider discontinuing the allergy shots for an observation period. Symptom control along with repeat testing, helps determine when immunotherapy can be discontinued.

Immunotherapy injections may be associated with various types of side effects. Side effects are usually more common in the most severely allergic patients and in those with asthma. The most common side effect is swelling or inflammation at the injection site. These "local" reactions almost always improve over time. Allergy shots may occasionally be associated with more serious generalized "systemic" reaction(s). 
Symptoms or signs of these reactions may consist of hives, body tissue swelling distant from the injection site, increasing asthma symptoms, abdominal pain, diarrhea, dizziness and even loss of consciousness. Life-threatening reactions are extremely rare. Our office is prepared to treat any serious reaction that may develop, but if the allergic symptoms do not respond quickly to our treatment, it may be necessary to transport you to the nearest Emergency room for further monitoring.

For more information on allergies and allergy treatment options, call Everyone's ENT & Sinus Center at 210-647-3838.