An allergist is a physician who, on completing medical school, trained at least three years and passed an examination to become a fully qualified specialist in either internal medicine or in pediatrics. After that, he or she must undergo at least two years of highly specialized training in allergy and immunology. Mere completion of this training does not qualify one as a specialist. To be recognized as a specialist in allergy, a physician must next become certified by the American Board of Allergy and Immunology, a conjoint board of the American Board of Internal Medicine and the American Board of Pediatrics. This requires the passing of a comprehensive examination that assesses the doctor’s basic knowledge as well as diagnostic and treatment skills with a variety of allergy and immunology problems. All told, specialists in allergy and immunology are required to complete five years of training and pass two difficult specialty examinations before they can be recognized as allergy specialists. Your county/parish medical society should be able to provide you with a list of board-certified specialists in allergy and immunology.
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Archive for the ‘Allergies’ Category
Just because you have nose symptoms that act like allergy doesn’t mean that you are allergic. The first step in determining whether or not your nasal symptoms would benefit from immunotherapy is to be certain that you have allergic rhinitis. That requires your doctor to ensure that you actually make IgE antibodies (allergic antibodies) to the common airborne allergens and that it is these allergens that are causing your symptoms. To do this your doctor must take a very detailed medical history, perform a physical examination, and then do skin or serological (blood) tests to confirm the presence of IgE antibodies to common airborne allergens. Once these allergy tests are obtained, they are correlated with the history and physical examination findings and a treatment program is planned.
The steps that should be taken prior to your beginning any immunotherapy program are summarized below:
Before Beginning Immunotherapy
Be sure that your nose problem is allergic and not some other problem that causes similar symptoms.
Be sure that you have IgE antibodies to airborne allergens (pollens, dust mites, animals, etc.).
Your symptoms should be uncomfortable and poorly controlled by avoidance measures and medications.
Be sure that you are willing to take the time to participate in the treatments.
Be sure that the physician giving your immunotherapy is experienced in the diagnosis and treatment of allergic rhinitis.
Anyone who embarks on a course of immunotherapy should make a commitment to complete the entire course of therapy. Taking a course of immunotherapy for a few months, stopping it, and then starting it again is a waste of your time and money. If immunotherapy is to be effective, a high dose of allergen extract must be given regularly over a prolonged period of time. If you stop and start on the program, you will never achieve the dose needed, nor will you take it long enough for it to help.
Immunotherapy is time consuming and expensive. If you are going to make such a commitment to time and funds, then for goodness’ sake seek out a specialist in allergic diseases. Ask for references from your regular physician or friends who have undergone immunotherapy.
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Allergy shots, desensitization, hyposensitization, and immunotherapy are different terms for the same thing. Immunotherapy is the term allergists use when referring to allergy shots.
Immunotherapy is the process by which a series of injections of gradually increasing doses of extracts of airborne allergens is taken. Only the allergens to which you are allergic are used in immunotherapy. These may include dust mites, mold spores, and grass, tree, or ragweed pollens. Each injection received is just a little stronger than the preceding one until you reach the highest dose that will be given. This dose is frequently called the maintenance dose, because it is the dose that will be repeated, weekly or every other week, throughout your course of immunotherapy. Ordinarily, it will take about three months of regularly administered injections to reach your maintenance dose. This maintenance dose is then continued at regular intervals until you have obtained your maximum relief. An immunotherapy program for airborne allergens generally requires a minimum of three years of injections.
Immunotherapy works by producing very specific immune changes in your body. Allergic conditions responding to immunotherapy include the following:
- Seasonal Allergic Rhinitis
- Perennial Allergic Rhinitis
- Insect Sting Allergy
- Allergic Asthma
Most people with perennial allergic rhinitis have non-allergic triggers of their nasal symptoms as well. For example, you might have PAR and be using nasal decongestant sprays too often as well as suffering nasal congestion whenever you are around cigarette smoke, perfumes, or the smell of cleaning chemicals. Your chronic nasal symptoms are in fact caused by the interaction of three different types of rhinitis: allergen triggered rhinitis (PAR), nose-spray triggered rhinitis (chemical rhinitis) and irritant triggered rhinitis (irritant rhinitis). Immunotherapy will help protect you against the allergens causing your perennial allergic rhinitis. It won’t help you break the nose- spray habit or keep cigarette smoke from twitching your nose. Other measures will have to be used to help you break the nose-spray habit and reduce your response to irritating odors.
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Which Nasal Symptoms Respond Best To Cromolyn Sodium?
The nasal symptoms best helped by cromolyn sodium are watery, runny nose and sneezing. Nasal congestion and postnasal drainage do not respond as well.
Indications for Cromolyn Sodium
The manufacturer’s package insert accompanying a bottle of Nasalcrom lists only one indication: “allergic rhinitis.” Clinical experience shows that its use should be considered in the following conditions:
- Seasonal allergic rhinitis
- Perennial allergic rhinitis
- Occupational allergic rhinitis
- Possibly effective in most forms of non-allergic, non-anatomic rhinitis
It has not been shown to be helpful in treating either vasomotor rhinitis or chemical rhinitis.
What To Expect When Using Cromolyn Sodium
If you have seasonal allergic rhinitis, you should expect a significant reduction or even clearing of your symptoms during your allergy season. Here are some tips for the effective use of Nasalcrom Nasal Solution:
• For best results, cromolyn sodium should be begun two weeks before the pollen season begins, used regularly throughout the season, and not discontinued until the pollen is no longer in the air.
• If you have perennial allergic rhinitis, you should expect a gradual reduction in your symptoms with regular use.
• If you have some other form of rhinitis in which the actions of cromolyn sodium might warrant your giving it a try, look for gradual improvement with prolonged use.
If, like some of my patients, you have an isolated problem, such as an allergy to your brother-in-law’s cat and you experience a flare-up of your nasal symptoms every time you go to his home, you may find that two sprays of cromolyn sodium on each side of the nose about 15 minutes before going into his home, followed by two more sprays on each side of the nose every four hours while there, will offer protection. This doesn’t always work, but it works often enough that it’s worth a try. If you have an allergy to an agent at work to which you are exposed only occasionally, cromolyn sodium could be used in a similar manner to prevent symptoms.
Side Effects Of Cromolyn Sodium
Sneezing is the most common side effect of cromolyn sodium. This is followed by burning and stinging, bad taste in the mouth, nasal bleeding, and increased postnasal drip. A rash is the least common side effect.
Warnings Regarding Cromolyn Sodium Nasal Solution
Like so many products, the safety and efficacy of cromolyn sodium nasal solution has not been established regarding use during pregnancy, lactation, and in children younger than six years.
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