We provide effective allergy treatment for the whole family. An Ear, Nose and Throat Allergist is a specialist who can diagnose and treat allergies that affect the ear, nose, throat and sinuses. The overall specialty of ear, nose and throat is called Otolaryngology, and the subspecialty of allergy in Otolaryngology often is referred to as Otolaryngic Allergy.
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The common way to test for allergies is on the skin. At Flagstaff Surgical – Allergy, this is usually done on the back and upper arms. During a typical skin test, a trained specialist will place a slight amount of allergen using the prick puncture method on the back and an intradermal injection on the upper arms. The entire appointment will take approximately 2 hours from start to finish
If you or your child reacts to one of the allergens, your skin will respond with minor swelling in that area within about 15 minutes but usually diminishes within 30 minutes. Anti-itch cream will be applied if necessary.
With a skin test, your specialist can check for these kinds of allergies:
Some medications (such as antihistamines) can interfere with skin testing, check with the specialist to see if you or your child’s medications need to be stopped prior to the testing date. While skin testing is useful, additional tests ( like blood tests of oral challenges) may be an additional necessary step in helping to determine allergy sensitivity.
While skin tests are usually well tolerated, in rare instances they can cause a more serious allergic reaction. Skin testing must always be done in an allergist’s office, where the doctor is appropriately prepared to handle a reaction. We only do testing on days a doctor is available in the office.
Allergen immunotherapy rehabilitates the immune system by administering increasing doses of identified allergens to accustom the body to substances that are generally harmless (pollen, house dust mites) and thereby induce specific long-term tolerance. Immunotherapy can be administered under the tongue (sublingually with drops or tablets) or by injections under the skin (subcutaneous). Allergen immunotherapy represents the only relative treatment for respiratory allergies. It is the only medicine known to tackle not only the symptoms but also the causes of respiratory allergies. A detailed diagnosis is necessary to identify the allergens involved. The medicine must be prescribed and initiated by an otolaryngic allergy specialist or general allergist.
Allergy Injections (Subcutaneous Immunotherapy)
Subcutaneous immunotherapy is the historical route of administration and consists of allergen extract injections. Subcutaneous immunotherapy can only be performed with medical observation. Subcutaneous immunotherapy protocols generally involve weekly injections during a build-up phase, followed by monthly maintenance injections for a period of 3 years. Although the value of subcutaneous immunotherapy has been demonstrated by several studies, subcutaneous immunotherapy brings a risk of systemic anaphylactic reactions necessitating the need for subcutaneous immunotherapy to be performed by clinicians trained in allergy.
Sublingual Immunotherpy (Oral Drops)
Immunotherapy, as opposed to allergy medication, “treats” the underlying allergies and builds immunity, rather than just blocking the symptoms. In SLIT, drops are administered orally, under the tongue, rather than by injection. During the “build-up” phase, the doses are gradually increased but once “maintenance” dose is reached, you or your child will typically take the same dose for the duration of the treatment. The same allergy extract that is FDA approved for allergy shots is used in SLIT. A major advantage of allergy drops is that it is administered in the convenience of your home, instead of at the doctor’s office.
In recent years, sublingual immunotherapy/allergy drops (SLIT) has gained popularity in the treatment of allergies. This treatment is widely utilized in Europe and the World Health Organization has endorsed sublingual immunotherapy as a viable alternative to injection immunotherapy or allergy shots. Many of our patients, both adults and children, have noticed a significant improvement in their allergy symptoms with this treatment. There have been numerous medical studies on SLIT and this treatment is now a “headliner” at the major allergy conferences. In the upcoming years, allergy drops are sure to become a standard in the treatment of many allergic conditions, including hay fever, asthma, eczema and even food allergies.
Although allergy shots are still considered the “gold standard” for allergy treatment in the United States, allergy drops are considered first line treatment in a number of European countries. They are very effective in relieving allergy and asthma symptoms, making them worth considering as an alternative to allergy injections for many patients, particularly children. As with allergy injections, numerous medical studies have proven that allergy drops can help prevent the onset of asthma in children with allergic rhinitis (hay fever). There have also been many studies showing that allergy drops have resulted in a significant reduction in the need for allergy and asthma medications.
The incidence of significant adverse reactions to allergy drops is very low and the most common reaction reported is mild itching or tingling of the mouth or tongue. It is extremely rare to have a serious systemic reaction to allergy drops, even more rare than with allergy shots. With dosing adjustments, treatment usually proceeds as scheduled, without further incident. As noted above, the extracts used in SLIT are the same FDA approved, standardized, extracts used in injection immunotherapy. However, because the FDA has not yet approved these allergy extracts for sublingual administration, they are classified as “off-label”. Off-label use of an FDA approved product is extremely common in the United States, and is often utilized by physicians. The classic example is the off-label use of aspirin to help prevent heart attacks, which occurred for years when the FDA had not yet approved this use, even though it was widely known that aspirin treatment was safe and effective.
Other examples include the use of seizure medications which were proven and widely used off- label to prevent migraine headaches and chemotherapy agents, approved by the FDA to treat one form of cancer, which were then proven to be very effective and commonly used to treat other forms of cancer. There is frequently a very long lag time between when a medical treatment is proven to be effective and when the FDA approves it to treat a specific medical condition.
The first step is to identify the underlying allergy and from there, we will formulate your drops based on the results of your allergy testing and medical evaluation. The allergy drops are individualized to treat your allergies and will contain the allergens to which you are allergic.
We offer the Modified Quantitative testing. This is a two-step process that takes approximately 2 hours. The first part is a skin prick test on the back. The second part is intradermal injections on the upper arms.
We offer two immunotherapy options. A build-up process is started to reach a maintenance dose that is adequate to build immunity to your allergies. Injections begin with a weekly injection that lasts up to 1 year; when maintenance is reached the goal is a monthly injection. Sublingual is a daily drop under the tongue and has a 3 month build-up; when maintenance is reached the daily dose continues. Both are recommended to continue for 3-5 years.
We test for environmental allergies; weeds, grasses, trees, dust mite, molds, and epidermals (this includes cat, dog, horse, feather, cockroach). We do not test for food allergies.
Once maintenance is reached, we expect you to notice changes. The amount of time this takes depends on the immunotherapy option you choose and the severity of your allergies.
To decrease or eliminate the need for allergy and/or asthma medications. The “unified airway” is affected by allergies and asthma. We hope to see an improvement in asthma as well. Commonly, allergies are asthma triggers. If we can identify triggers through your symptom history and testing, it is likely we can treat those allergies.
You must be off antihistamines for 7 days. This will allow the skin to react to something you are allergic to. Beta blockers and tricyclic antidepressants are drug classes that are contraindicated for testing and immunotherapy. Consult with your prescribing provider regarding this.