All About Allergies

What are allergies?
Allergies occur when your body’s immune system overreacts to substances that either enter or come into contact with your body. The word allergy covers many topics, but when people are complaining about “allergies” they are probably talking about environmental allergies. Environmental allergies include substances like dust, dander and pollen. These substances cause irritation of the nose and eyes and create symptoms like post-nasal drip, nasal congestion, itchy or watery eyes, sneezing, wheezing, and coughing.

How do I know if I have allergies?
You may already suspect that you have allergies, but your doctor will need to ask questions about your symptoms and your exposures in order to help determine if you are truly allergic. Some people suffer from seasonal allergies and notice that they have a runny or stuffy nose at certain times of the year or after they have been exposed to a cat or dog. Other people may have year-around symptoms without any seasonal variation and many patients will have both types of allergy. After your physician discusses your symptoms and exposures they will usually perform an allergy test.

How is allergy testing done?
Allergy testing is usually done in one of two ways. Typically, your physician will order a “skin-prick” test that checks your body’s reactions to multiple allergic materials such as different pollens, cat dander, dust, etc. The test is well-tolerated by patients and takes about 45 minutes to do in the office. Alternatively, your physician may order a blood test. You doctor will help determine which type of test is best for you.

I was tested for allergies when I was a kid and told I wasn’t allergic.
Just because you may have been tested and shown not to have any allergies as a child doesn’t mean that you can’t develop allergies as an adult. Many patients develop allergies later in life.

What are food allergies?
Food allergies occur when your body reacts to any food such as peanuts, shellfish, milk or eggs. You may experience symptoms such as tingling or itching of the mouth, hives, nausea, wheezing, or even more severe reactions such as anaphylaxis.

There is also a condition called “Oral Allergy Syndrome” where patients with pollen allergies also have reactions to specific related foods. For example, someone with a ragweed allergy may have a reaction to bananas or melons. Symptoms are usually limited to an itchy mouth or throat but they could be more serious.

What do allergies have to do with asthma?
Both allergy and asthma are the result of your body’s overreaction to exposures in the environment. A typical allergy patient reacts by experiencing nasal and/or eye symptoms. An asthma patient reacts with wheezing, cough or difficulty breathing. Many patients will have both conditions to a greater or lesser degree. It is estimated that 70-90% of patients with asthma have nasal allergies and 40-50% of patients with nasal allergies have asthma. Uncontrolled allergies may worsen asthma symptoms. In fact, many asthma patients find that their breathing problems are better controlled when their allergy symptoms are treated. We treat both allergy and asthma together at our practice.

What treatments are available for allergies?
There are three main treatments for allergies. The first treatment is avoidance, and as you would expect, it means trying to keep away from the substances that produce an allergic reaction. Avoidance measures include removing carpets and upholstery (to eliminate dust mites), keeping your windows shut in the warm months, using air filters, and protective covers. The second type of treatment includes the use of special medications such as nasal sprays, oral antihistamines and other medications. The third line of treatment is immunotherapy.   Immunotherapy (also known as “allergy shots”) is a technique where your doctor uses small doses of allergic material to help your body learn not to overreact. At our office we offer the traditional allergy shots as well as a newer technique called allergy drops. Allergy drops have the advantage of allowing you to administer the therapy yourself at home without the need for any injection.

Can allergies cause sinus and ear infections?
Allergies have the potential to lead to many other issues including sinus and ear problems. Your sinuses are connected to your nasal passage through very small openings. Allergies cause these openings to swell, leading to a build up of mucus and infection within the sinuses. Similarly, allergies can cause swelling and blockage of the eustachian tube that connects the nasal passage to the part of the ear. Blockage of this tube can lead to a feeling of pressure in the ear, a build up of fluid, or a middle ear infection.

What can I do if I suspect I have allergies?
The best course of action is to meet with one of our physicians or our physician assistant to have a detailed discussion about your symptoms followed by a thorough examination with possible allergy testing.

Is My Sore Throat From Acid Reflux: Understanding LPR

What is laryngopharyngeal reflux, or LPR?

This is a common disorder where acidic contents from the stomach go up beyond the esophagus and into the area around your voice box creating irritation and inflammation. Small amounts of acid can damage this area of your throat since it is not equipped like the esophagus to handle acid exposure. As few as 3 reflux episodes can cause severe laryngeal inflammation and injury.

What is “silent reflux”?

This is the name given to LPR since many patients do not experience classic heartburn or indigestion, and in fact, may be completely unaware it is occurring. Some common symptoms of LPR include hoarseness, a feeling of mucus in the throat, or throat clearing. It may occur when you are upright or lying down.

How is LPR diagnosed?

Swelling and irritation around the voice box can be indicative of acid reflux. Your ENT provider has special scopes to visualize this area in the office.

A 24 hour pH probe monitor is a great test to objectively measure and confirm acid reflux. This test detects acid that occurs above your esophagus. A small probe is placed into one nostril and sits above the back of the throat. It does not interfere with eating, drinking or sleeping. This test is more sensitive in diagnosing LPR than traditional pH testing. Additionally, this test is easy to administer, is more comfortable and less expensive than standard pH manometry.

What is the best treatment for LPR?

Your doctor may prescribe a Proton-Pump Inhibitor (PPI) or a different class of antacid medication. It is important to take the medication every day as prescribed. It can take 4-6 weeks for the inflammation to appear improved on exam.

Besides medication, lifestyle changes are very important. Elevation of the head of the bed (using wooden blocks or a wedge pillow) is a great way to decrease acid reflux at night. Some studies show this to be more effective than medication. Avoidance of caffeine, chocolate, acidic juices (OJ, Grapefruit), peppermints, and spicy food help. It is beneficial to stop eating 2-3 hours before lying down, and to eat smaller, more frequent meals rather than large meals.

Why is it important to treat LPR?

Laryngopharyngeal reflux has serious potential consequences. Barrett’s esophagus is a precancerous condition of the esophagus that happens in a small percentage of people who have acid reflux. Chronic acid exposure creates changes in the esophagus which can potentially become cancer of the esophagus. It is important to have routine checkups with your ENT provider.

Understanding Your Allergies and Sinuses

Please join Dr. Michael Ondik on May 20th at 7pm for a patient seminar at the MossRehab Einstein Elkins Park at 60 Township Line Road, Elkins Park, PA 19027.  The seminar will discuss treatment of allergies and sinus disease and offers patients an opportunity to learn more about their condition.  The seminar will be in the G1 Conference Room.  Please call our office at 215-887-7380 with any additional questions about the upcoming seminar.

New Treatment for Nasal Polyps – PolypVac on “The Doctors”

Recently aired on the TV show, The Doctors, is a device for the removal of nasal polyps called the PolypVac which we have in our office. This device vacuums and removes the polyps in the nasal and sinus cavities that cause nasal blockage and in some patients, affect the sense of smell and taste. The procedure can be done under local anesthesia in the office.
Check out this link and call us for a consultation if you think you may be a candidate.

New Allergy Tablets for Grass and Ragweed Sufferers

An effective way to treat seasonal grass or ragweed allergy. This is a convenient option for patients who are not able to commit to weekly allergy shots, patients who have a needle phobia, or patients who suffer from seasonal allergies due to grass or ragweed. A rapidly dissolving tablet is placed under the tongue every day in order to reduce allergic symptoms. Therapy should start around January for grass, and May for ragweed, and should be continued throughout the season. The first tablet is given in the office and the patient is observed for 30 minutes. A prescription is given for the grass tablets to be taken at home. Grastek is approved to treat children 5 years and older; Oralair is approved for ages 10-65 years old; Ragwitek is approved for adults 18-65 years old.