When allergies become severe or no longer are controlled adequately with reasonable medication use, the key to understanding your symptoms is to learn:
- Which allergens are causing your symptoms?
- How severe is your body’s reaction to each of these allergens?
These answers are only accurately obtained through an allergy test. At Midwest ENT Centre, much care and research goes into choosing the extensive allergen testing panel and the method of treatment. Each test will cover the predominant allergens in the St. Louis region, including representative samples from the following classes:
- Seasonal Allergens
- Tree pollens (primarily springtime)
- Grass pollens (primarily summer)
- Weed pollens (primarily in autumn)
- Perennial (year-round) Allergens
- Dust mite, cockroach
- Weed pollens (primarily in autumn)
While allergy testing can be obtained through a blood sample (called in vitro, or RAST testing), research shows allergy skin testing to be more sensitive and accurate. Skin testing is very easy to complete, even for our pediatric patients. All skin testing is performed by our very qualified and friendly nursing staff under the on-site direction of Midwest ENT physicians.
Allergy skin testing typically takes about 45 minutes to complete, and gives our nursing staff time to educate our patients about the process and about their specific allergies. Standard skin testing is performed in two main steps, and generally follows this sequence:
- Allergy screen of “prick tests” is administered.
- This needle-free step takes about 5 minutes, and is very comfortable.
- This is performed with very quickly using a plastic applicator device that gently introduces allergens to the first layer of the skin.
- For some pediatric patients, this may be the only step necessary during testing.
- Wait 10-15 minutes for skin responses (called “wheals”) to develop, which are then measured and recorded.
- Confirmatory “intradermal tests” of the same allergens are applied.
- Applying the allergen panel in this manner takes about 10 minutes.
- The smallest needle possible is used for this step (it is the same size children use for diabetes). It is typically described much more like a “mosquito bite” than a shot.
- Wait 10-15 minutes.
- Test completion
- Skin responses are quantified and complete results tallied.
- Patient and family are educated about the results, and cream is applied to soothe the itching at the testing site.
- In most cases, patients will immediately see their treating physician to choose a treatment plan based on the results of the test.
Modified testing and pre-testing numbing creams are available for our pediatric and “needle-phobic” patients.
Before Your Allergy Test
Testing will likely take 45-60 minutes to complete, and typically runs right on schedule. Please arrive for your allergy test 10 minutes early wearing comfortable clothing. Tests will be applied to the upper and lower arms, so sleeveless, loose-fitting shirts work best. There will be some down time as we wait for skin responses to develop, so feel free to bring a tablet, book or other personal item to help pass the time. If you would like to have a drink or small snack during your test, you are welcome to bring it.
Allergy skin testing uses your body’s allergic response to each allergen for the most accurate diagnosis. It is very important that you strictly avoid certain medications (especially antihistamines) for 5 days before your test, as they can result in a “false negative” test and a delay in your diagnosis. Please consult the following list for medications to avoid. You may resume them as soon as the test is complete.
Immunotherapy at Midwest ENT Centre
Many patients in the greater St. Louis area have moderate-to-severe allergies, with seasonal or year-round symptoms that cannot be fully controlled with environmental control and medications. For these patients, immunotherapy (allergy shots and drops) can be life-changing treatment. As the name implies, immunotherapy works by re-educating the immune system to tolerate—rather than dramatically overreact to—each patient’s specific allergenic triggers.
Immunotherapy is accomplished by carefully exposing allergic patients to measured, gradually increasing amounts of allergens. Over time, the immune systems of these patients become much less sensitive to these pollens, molds and other allergens—treating the cause of allergy rather than masking the symptoms. In fact allergy medicines all treat symptoms, only immunotherapy actually treats the cause. As the allergens are better tolerated, symptoms and medication use decrease—and both have the potential to be eliminated. In fact, immunotherapy is the only allergy treatment with the potential to cure allergic disease. Immunotherapy has been shown to have the following benefits, which usually begin within the first few months of treatment:
- Significant improvement in allergic symptoms and ear, nose & throat related quality of life
- Decreased allergy medication use
- Improved asthma control in asthmatic patients
- Prevention of progression to more advanced allergic disease (eczema, asthma & allergic rhinitis)—especially in children
With immunotherapy, allergens are introduced to the body either with a small shot under the skin or with drops of extract placed under the tongue. White blood cells then create circulating antibodies directed against these allergens, much like an immunization. For the patient on immunotherapy, allergens in the nose are immediately attacked and neutralized by these protective antibodies—and no longer produce a histamine response. Without histamine constantly being released into the nose, symptoms diminish dramatically.
Though immunotherapy is usually remarkably effective shortly after beginning the treatment, the primary goal is excellent long-term symptom control. While your specific treatment goals and plan will be formulated by your Midwest ENT physician, ideal long-term improvement usually requires treatment with allergy shots or drops over time. Research indicates that with 3-5 years of treatment (most of which can be done at home), the immune systems of most patients can be permanently trained to tolerate allergens that once made these patients miserable. Immunotherapy, properly done, should give excellent symptom control with less reliance on medications now and indefinitely in the future.
There is some inherent risk of causing an allergic reaction anytime an allergic patient is exposed to something to which they are sensitive. Rest assured that your safety is our primary concern. Through education, close monitoring and training, our staff will assure you receive the most up-to-date and effective allergic treatments in the safest possible setting.
Choosing Your Immunotherapy Treatment: Subcutaneous (“Allergy Shots”) vs. Sublingual (“Allergy Drops”) Immunotherapy
Your Midwest ENT physician will determine if you are likely to benefit from allergy immunotherapy based on your history, examination and allergy test. If you are a candidate, you may then choose which method of immunotherapy (allergy shots or drops) is best for you. Regardless of which option you choose, remember immunotherapy is a commitment—one that more than 90% of patients are very happy they’ve made. Consider allergy treatment a worthy (and cost-effective) investment into your long-term health. Most will be on home shots or drops for 3-5 years (and many will not need any other allergy medicines during this time), but recent research indicates most will enjoy many years of symptom-free relief after completing the program.
Allergy Shots (Subcutaneous Immunotherapy, or SCIT)
Allergy shots (SCIT) have proven very effective for most patients with severe allergies or those who do not receive appropriate relief from allergy medicines. Shots are formulated based on the “recipe” gathered from that specific patient’s allergy test—so each person’s shot vial is as unique to them as their fingerprint. For safety reasons, weekly allergy injections start at low concentrations and “escalate” to more concentrated doses as tolerated. During this escalation process, patients must receive injections here at Midwest ENT Centre to be briefly monitored for swelling or other reactions to the shot. Once this escalation process is complete, patients then receive weekly “maintenance shots” consisting of the same amount of allergen each time. Most patients will be given the option of self-administering maintenance injections at home from allergy vials kept in their own refrigerators. The process of training the immune system to be “less allergic” takes time, but is well worth the effort.
Allergy Drops (Sublingual Immunotherapy, or SLIT)
In past decades, allergy shots were the only option for patients requiring immunotherapy. At Midwest ENT Centre, we understand that some of our very allergic patients (especially children) may be “needle-phobic,” and some may have schedules that prevent them from coming into the office for 10-20 consecutive weeks for allergy shot escalation, or “build-up.” To give these patients an option for effective treatment, Midwest ENT Centre offers sublingual immunotherapy (SLIT). SLIT has been proven to deliver the benefits of allergy shots in a pain-free, convenient manner. With SLIT, drops containing allergens are placed under the tongue, held in place for 2 minutes and swallowed. Similar to allergy shots, SLIT gradually desensitizes the immune system to the allergens that had been provoking it, significantly improving symptoms and decreasing the need for allergy medicines over time.
Some patients well-suited for SLIT include the following:
- Those with work/school conflicts that prevent them from in-office escalation of shot therapy in the office
- Patients at higher risk for adverse events during the course of SCIT escalation/therapy:
- Moderate-severe asthmatics
- Patients with unacceptably large local shot reactions
- Out-of-town college students
- Needle-phobic patients
- Pediatric patients
SLIT is exceedingly safe. In fact, documented cases of anaphylaxis with sublingual treatment are exceedingly rare. Since it is so safe, all treatment—both escalation and maintenance—can be done fully at home. Patients need only come to the office for periodic allergy reviews. For select patients, SLIT offers symptom improvement with minimal inconvenience or imposition—and without needles.
Please consult the following table to learn more:
For more information about the SLIT program, please see our SLIT frequently asked questions.
How to Get Started on Immunotherapy at Midwest ENT Centre
If you and your Midwest ENT Centre physician decide that allergy shots are right for you, here are a few tips to help you get started:
- If you agreed to start allergy shots during your post-test appointment with your doctor, the allergy department has already been notified and will start processing your vial shortly. If you decide at a later time to start shots recommended to you at your appointment, simply call the allergy department at 636.441.6012 to order the vial and start the program.
- Call the allergy department 7-10 days after the order is placed to make sure your custom-mixed allergy serum vial is ready for your first injection.
- You may come in anytime during our allergy shot hours for your first (or any subsequent) shot. Shots are given on a walk-in basis and usually there is little to no wait. No appointments for shots are necessary. Allergy shot hours are as follows:
- Monday: 10:00 – 5:30
- Tuesday: 9:00 – 3:00
- Wednesday: 8:30 – 3:00
- Thursday: 10:00 – 5:30
- Friday: 9:00 – 3:00
- Most shots will be given in the upper arms, so remember to wear clothes that will allow the nurses easy access to your arms.
- It is normal for the injection site to swell some after each shot. Taking an antihistamine 30 minutes prior to the injection or icing the site after the shot can help.
- For quickest improvement and maximum benefit and safety, you need to get your shots every 5-11 days. You may choose which day of the week to come in, and it need not be the same day each week.
- Shots given sooner than 5 days from the date of the last shot can lead to higher risk of adverse reactions to your shots.
- If too much time (≥12 days) elapses since your last shot, you may need to repeat the same dose as the previous shot—prolonging the shot dose escalation process.
- Home injections may be available for some patients once the dose has been safely escalated to the appropriate level in the office. See the nursing staff for details.
- Remember that you will need to see your doctor at least once yearly while on the allergy shot program.
If you have settled on treatment with allergy sublingual drops, contact the allergy department at 636.441.6012 to arrange for payment, mixing and delivery. Drop vials can be mailed directly to your door and can be done entirely at home.
What are Allergies?
In the St. Louis area, seemingly everyone knows someone with a significant allergy problem—or suffers from one themselves. Allergy is a chronic condition characterized by oversensitivity to otherwise harmless particles called allergens. In an allergic state, a person’s immune system mistakenly recognizes these allergens as potentially harmful foreign invaders (like bacteria or viruses). The response results in histamine being released from mast cells, causing the characteristic symptoms associated with allergy.
Over 80% of all allergic disease primarily affects the nose, ears and throat. Most often, the primary complaints are the expected congestion, itching and sneezing. At Midwest ENT Centre, our physicians pride themselves on diagnosing and treating moderate-to-severe allergies and those that affect patients in ways that may not be so obvious, like the following:
- Nasal obstruction
- Recurrent and chronic sinus infections
- Decreased smell
- Nasal polyps
- Eustachian tube problems and ear popping
- Recurrent ear infections
- Ear canal dermatitis, ear itching
- Throat & Lung
- Trouble swallowing, globus sensation (the feeling that something is stuck in the throat)
- Chronic cough
- Worsened asthma and reactive airway disease
- Recurrent bronchitis and pneumonia
What is Allergic Rhinitis?
Allergic rhinitis is immune-mediated inflammation of the nasal passages. It is by far the most common manifestation of allergic disease, affecting 30% of Americans and accounting for over 11 million physician visits in the U.S. each year. Allergic rhinitis is said to cost the U.S. healthcare system over $4 billion annually.
Care of the allergic patient usually centers on controlling the nose. Most patients complain most about their nasal symptoms, and the nose is the starting point for many allergies elsewhere in the body. As we often say, “The nose rules the ears—and often the throat.” Luckily, there are many effective treatments available.
Which Allergy Treatment is Best?
It’s always best to remember that for allergies, the simplest treatment that controls symptoms is usually the best. Unlike high blood pressure, allergic rhinitis doesn’t put patients at risk for serious future harm. We usually treat when symptoms require it. Great quality of life through symptom control is the main goal.
For those with mild seasonal allergies, environmental control and intermittent antihistamine use can be enough. Many patients have more severe allergies, or year-round symptoms that cannot be controlled with OTC (over-the-counter) medications. There are now wonderful prescription options available that can give much better control—much more conveniently—than what is available over the counter. Finally, if medications no longer help or have become too cumbersome, an allergy test can be the key to much better control over your allergies. Talk to one of the board-certified otolaryngologists at Midwest ENT Centre to learn more.