During the initial consultation at Central Coast Otolaryngology one of our physicians will review your symptoms and history and determine if allergy testing is of value. Generally skin testing is the initial diagnostic study as this is the fastest, most specific, and most cost-effective way to identify allergy. It also tests for the exact substances which would be used for immunotherapy if this is recommended. The forms below outline what is expected during your allergy test as well as the medications which you must stop in order to accurately skin test for allergies. Please note that many over the counter sleep aids and cold remedies contain anti-histamines which interfere with testing. If there are questions regarding these medications please ask one of the office staff.
In some cases, blood testing may be recommended if you cannot be skin tested. Results should be available within one week. A provider will discuss the results of the testing with you at a return appointment.
After specific allergens have been identified with skin or blood testing, one way of reducing symptoms is avoiding those allergens. Avoidance of allergens can be somewhat effective in certain situations but almost impossible in others. The following are suggestions to reduce levels for specific allergens:
Cat: Dander from cats is a well-known cause of allergies is some people. Although cat lovers will likely not every get rid of cats, keeping them outside of the bedroom can improve symptoms. Even if you decide to remove the cat from the house, it will take 4-6 months to reduce the dander levels inside the house. Even if you don’t own a cat 70% of homes have measurable cat dander and up to 75% of cat-allergic children have never lived in a house with a cat.
Dust mite: Dust mites feed on shed skin cells and are one of the most common indoor allergens. There are a number of avoidance measures which can reduce dust mite counts significantly. Unfortunately even with the most involved avoidance measures there is only minimal long-term clinical benefit in reducing symptoms and medication use. The following are the most cost effective options:
- Install dust mite impermeable mattress and pillow covers
- Wash bedding weekly > 131˚F
- Acaricides – a number of products kill dust mites and can be used on sofas and carpets including benzyl benzonate, pyrethoids, natamycin, and pirimiphos methyl.
General tips to reduce indoor allergens include:
- Install a HEPA filter
- Keep interior décor with fabric to a minimum. Less carpet, upholstered fabric, fabric curtains etc.
- Use a high efficiency vacuum
- liminate sources of mold or mildew
Reducing exposure to outdoor allergens may be more difficult. Some tips include
- Close or seal windows and doors
- Keep shoes and close in entryway outside of house
- Keep pets completely inside or outside
Irritants: Although not technically an allergen there are many airborne substances which are known irritants of the nose and lungs which can exacerbate symptoms alone or in addition to allergies. These include tobacco smoke, perfumes, pesticides, pollution and occupational fumes. Tobacco smoke exposure is the easiest to control. If you choose to smoke the following are tips to reduce exposure to others particularly children.
- Smoke outside
- Don’t smoke in the car
- Do not bring clothes which have smoke exposure into the house
Many over-the-counter medications are available. Most people have tried the majority of these without much improvement by the time they reach an allergy office. Our providers will discuss which medications are best to control your allergy symptoms. Allergy immunotherapy is the only treatment option which improves the disease itself by changing your immune response to environmental allergens.
Commonly known as “allergy shots”, subcutaneous immunotherapy gives increasing amount of allergens to you as a very small injection. For most people this fundamentally changes your immune system to develop tolerance to those allergens. Treatment consists of a shot in the back of the arm weekly for the first year or two and then is frequently spaced out to every 2-4 weeks depending on symptoms. A course of 3-5 years total is recommended to get the most long-lasting benefit. There is a small risk of a systemic reaction after the shot, therefore you will need to be observed for 30 minutes afterwards. This service is covered by almost insurances. Typically there is no co-pay necessary for each injection although you will need to see your physician about every 3-6 months to monitor symptoms and progress.
There are two methods of sublingual immunotherapy. The first of known also as “allergy drops” where a custom preparation is made depending on what you are allergic to. This is applied under the tongue for a couple of minutes each day. Treatment results are similar to SCIT. Although this has been commonly used in Europe for decades, currently it is not FDA approved and therefore does not have insurance coverage. Because this can be done at home though, the costs can be offset by less travel and time spent in the office.
The other method is by sublingual tablets. There are currently tablets which are FDA approved for grass and ragweed. If you are predominantly allergic to grass this may be a good alternative which is covered by most insurances. It is taken similarly to the custom preparation made in the office by resting under the tongue.
Custom sublingual immunotherapy is provided by the office in 1-3 month increments. Typically higher doses are slightly more effective in controlling symptoms. We try make this a reasonably affordable service by limits the number of antigens while still having effective symptom relief. Treatment costs start around $40/month depending on your testing results.