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Ohio State Wexner Medical Center's Division of Sinus and Allergy physicians have specialized fellowship training in the medical and surgical treatment of a broad range of diseases and disorders affecting the nose and sinuses. We offer a personalized treatment approach that is centered around you and your overall needs.
Up to 80 percent of asthma patients have allergic triggers, and more than 60 percent of allergy patients have symptoms of asthma or signs of reactive airway disease on breathing tests. Inhaling allergens such as dust mite droppings, mold, pet dander and pollen creates asthmatic symptoms. Airway obstruction, inflammation, coughing, wheezing, shortness of breath and chest tightness are common symptoms.
Allergic reactions cause membranes to swell and become congested. Inflammation, pain, pressure and mucus are the result, culminating in a stuffy, runny nose. If the swelling isn’t controlled, it can obstruct normal sinus drainage, leading to sinus infections. Nasal congestion can also obstruct proper Eustachian tube (ear tube) function, resulting in fluid behind the eardrum.
Inhalant allergies are reactions to things you breathe in like pollens, molds, dust and animal dander. There are two ways to test for inhalant allergies: skin testing and blood testing. Skin testing is more accurate, so blood testing is used only for special situations.
There are some medications that interfere with the results of skin testing or make skin testing less safe. Your doctor may have you stop taking certain medication five to seven days before testing. While it’s usually safe to stop your antihistamine allergy medication on your own, do not stop taking any medications for heart, blood pressure or eye problems without specific approval from the doctor who prescribed you these medications.
There are two methods of performing inhalant allergy skin testing:
The skin prick testing device has small plastic prongs that penetrate the superficial layers of your skin. Children as young as five years old can easily tolerate this type of testing. For most patients, this test provides sufficient information. Occasionally, if these test results are ambiguous, your doctor will proceed with intradermal testing. This test places antigens at a slightly deeper layer of the skin, forming little bleb, similar to a tuberculosis skin test.
For blood testing, the physician decides which allergens to test you for based on your medical history. You’ll have several small tubes of blood drawn in the lab. The blood is then tested against each of these potential allergens.
The advantage of blood testing is that it only takes a few minutes in the lab, and since no allergens are placed on the skin, there’s absolutely no risk of a negative reaction to the test. This type of testing is particularly appropriate for people with asthma that is not well-controlled, those who are pregnant, who have rare skin conditions that do not allow them to stop taking antihistamine medication for five days prior to skin testing, or who are taking a high blood pressure medication, or certain types of eye drops.
Skin contact allergy testing, or patch testing, is a way of diagnosing whether there are substances in your environment that react with your skin to cause allergy symptoms ranging from a rash or hives to chest tightness or difficulty breathing.
Possible allergens include virtually anything your skin comes into contact with:
If your history suggests a possible skin contact sensitivity, you may be advised to have patch testing.
Patch testing is different from allergy skin testing for inhalants. With inhalant testing, the test substances are placed on the skin, and a reaction occurs or doesn’t occur within 20 minutes. The allergens in patch testing can cause a reaction over a 12-to 24-hour period or more, so the test substances have to be in contact with the skin longer. To make this practical, here’s how the test is performed:
Why two readings?
At the time of the first reading, you will have had adhesive paper on your skin for more than 24 hours. The paper alone can irritate the skin, even if there were no allergens present. Sometimes tests that look positive at the first reading calm down and disappear before the second reading. If this occurs, the response was probably inflammation and not true allergy.
Allergy medications are often the first defense against allergic symptoms that cause you problems.
First-generation antihistamines are very effective, but have the use-limiting side effect of making many people very drowsy. Most first-generation antihistamines are available without a prescription. Newer second-generation antihistamines have been formulated to avoid the drowsiness and are available over the counter. Nasal sprays: Sometimes it’s better to use the antihistamine topically, limiting most of its action to the nasal area where symptoms are occurring.
There are two basic types of over-the-counter allergy eye drops. The first is a combination of antihistamine and decongestant. The antihistamine component is effective at managing itching. The decongestant is effective in decreasing redness of the eye, however there’s a rebound effect if used long-term. That is, when drops are stopped, the redness can be worse than before using the medication. Therefore, the drops should only be used for a maximum of three days at a time.
The second type of over-the-counter allergy eye drop contains only one medication, ketotifen. This is an antihistamine and mast cell stabilizer. Both of these actions help minimize allergy eye symptoms.
Leukotrienes are another of the body’s chemical messengers of allergy. Unlike histamine, however, it’s more active in the late response to an allergic stimulus (occurring two to four hours after exposure to allergens). The main leukotriene modifier used in the United States today is Singulair.
Nasal steroids are one of the cornerstones of allergy treatment. The nice thing about the sprays is that since they’re used in the nose, there is minimal absorption by or effect on the rest of the body. The most common side effect of nasal steroids is irritation or mild bleeding of the septum (dividing wall between the two halves of the nose). Other common side effects of using steroid nasal sprays are dryness inside the nose or headache. Two more serious, but rare, side effects of nasal steroid use are a thrush (yeast) infection in the back of the nose or a septal perforation (hole between the two sides of the nose). There is some evidence that nasal steroid sprays may increase pressure in the eye. If you have glaucoma and are using a nasal steroid spray, it’s important to have your intraocular pressure checked regularly.
Decongestants, available as oral or topical medications, help with a stuffy nose. They’re highly effective, but have some major side effects and disadvantages. Always read labels carefully, and understand what medicines you are taking. Decongestants may not be right for you if you have high blood pressure, prostate enlargement, glaucoma, rapid heart beat or sleep problems. Be sure to ask your physician if decongestants are safe for you to take.
A mild food allergy reaction can be treated with an over-the-counter oral antihistamine. Liquid antihistamines get into the bloodstream faster than pills or capsules.
The only treatment of immediate-type food allergies is lifelong avoidance. Avoiding obvious forms of the food is pretty easy. But hidden forms of the allergic substances are often hard to avoid. For example, if you’re allergic to milk you won’t drink it, or eat ice cream or cheese. But whey is a milk protein, and is found in many prepared foods such as bread.
Another concern is the risk of accidental exposure: the restaurant waiter who doesn't take seriously your request for “nothing containing shrimp,” or the classmate who brings cookies to your child's classroom, forgetting the treats contain peanuts.
In some cases, difficulty swallowing could be a sign of a condition known as eosinophilic esophagitis. This allergic reaction is triggered by food and environmental allergens and causes white blood cells in the throat to become inflamed. Treatment of eosinophilic esophagitis varies depending on the source of the allergic reaction. Your doctor may eliminate specific foods from your diet or prescribe glucocorticosteroids to control inflammation.
For more serious food allergy reactions, such as chest tightness or trouble breathing, feeling like your throat is closing, lip and tongue swelling, or severe generalized hives, you should carry self-injectable epinephrine that you or a friend or family member can inject into your thigh.
Keep in mind that using self-injectable epinephrine is just a temporary measure and the symptoms will return. Always call 911 or head to the nearest emergency room immediately for complete treatment.
The theory behind allergy immunotherapy is helping the body’s immune system build a tolerance to the allergens it currently reacts to. This is done by starting with very small amounts of these allergens taken as shots or drops, and gradually building up to a target dose we know is effective. This takes between one to five months to get to the target dose, depending on the form of immunotherapy you are using, and how your body tolerates it.
Once you reach the target dose, you continue at that dose for three to five years, with important changes taking place in your immune system over that entire time. When you finish with immunotherapy, most people have a three or more years of sustained relief.
The other mainstays of allergy treatment – avoiding allergens or using medicines to control symptoms – only make temporary changes. Immunotherapy makes permanent changes in your immune system, helping you develop tolerance to the allergens that cause reactions. Additionally, immunotherapy can decrease the rate at which you develop future allergic sensitivities, and can improve or prevent asthma in allergic children.
Immunotherapy can be delivered as weekly allergy shorts (injection or subcutaneous immunotherapy, also called SCIT) or daily under-the-tongue treatments (sublingual immunotherapy, or SLIT).
Allergy Shots
Allergy Shots (Subcutaneous immunotherapy or SCIT) Your allergy injections are specifically formulated for your allergies. No one else has an allergy vaccine exactly the same as yours.
Allergy shots are given once a week. While climbing to the target dose, these shots must be delivered in the physician’s office, or the office of another physician with the expertise and equipment to treat an allergic reaction. This is because there’s a greater, though still small, chance of an allergic reaction occurring when the dose is being increased.
After you reach your target dose, you or a family member can administer the shots at home. You must agree to stringent safety measures if you choose this option: you must always have auto-injectable epinephrine and liquid antihistamine with you, always have another adult with you for 20 minutes after the shot, and always have a land line or cell phone capable of reaching emergency responders.
Most reactions are just small red areas on the arm. If the redness is any greater than the size of a dime after an injection, or if you have any general symptoms like hives, chest tightness or shortness of breath, call your physician or 911 immediately.
Allergy Drops
Allergy Drops (Sublingual immunotherapy, or SLIT) Sublingual (under-the-tongue) immunotherapy (SLIT) can be used instead of shots. SLIT has been used extensively in Europe, Asia and Australia for the last 30 years, but only recently in the United States. It’s been shown to be highly effective in treating allergies.
As with allergy shots, your SLIT vaccine is mixed specifically for you, with only the allergens to which you are sensitive. You would receive your very first dose at the office, and thereafter take your daily drops (even during your escalation) at home. This is because SLIT is even safer than allergy shots. When you are at your target dose, you’ll be using your allergy drop vial to deliver three squirts under the tongue. You’ll hold these there for two minutes then swallow the dose.
Some people experience mild tingling or itching in the mouth with SLIT. The chances of a serious reaction are very small.
Dust mites are microscopic arthropods (bugs) that live on shed human skin flakes. Anywhere humans are, they are. Allergy to dust mites is fairly common. Removing as many of these allergy-triggering dust mites as possible from your environment will make your symptoms better. The first focus should be on making your bedroom and any other area you spend significant amounts of time in as dust mite-free as possible.
Fortunately, there are many inexpensive strategies that will minimize your exposure to dust mites. Those include:
Food allergies generally come in two forms. Some allergies show symptoms immediately, such as an allergy to peanuts or shrimp. Other allergies take longer for symptoms to develop, or may only develop if a certain food is heavily consumed.
Other types of food reactions include oral-allergy syndrome, celiac disease and food intolerance:
There are some foods that contain a naturally occurring chemical similar to the body's main chemical messenger of allergy – histamine – or chemicals that can cause the body to release histamine directly without any participation by the immune system. These can cause symptoms in very sensitive individuals. Foods that may do this include strawberries and tomatoes.
Most insect bites are harmless, though they may cause temporary discomfort. Bee, wasp and hornet stings, and fire ant bites usually hurt. Mosquito, flea, and mite bites usually itch. Insects can also spread diseases. For some people however, bites and stings can cause big problems.
If you’re allergic to insect stings and bites you have what’s called a venom allergy. A bite or sting can often result in a very large local reaction, or even reactions involving other parts of the body such as hives or difficulty breathing. Death can occur from blockage of the airway from swelling in the throat.
In the United States, some mosquitoes spread West Nile Virus. Travelers outside the United States may be at risk for malaria and other infections.
Diagnosis is easier if the stinging was observed and the type of insect identified. If there’s question about whether an allergy exists, your physician will usually begin with blood tests, looking for a reaction to honey bees, yellow jackets, paper wasps, yellow hornets and white-faced hornets. If these are negative, yet there’s a strong chance that a reaction to a sting will cause problems, you doctor may proceed with skin testing, similar to that done for inhalant antigens.
For most people, the best treatment for venom allergy is immunotherapy, or allergy shots. Once the specific insect venom you’re allergic to is identified a customized vaccine is mixed for you. Starting with a very small dose, the amount in each weekly shot is gradually increased until it’s at a known effective dose. When this is reached, the shots are given once a month for an indefinite period of time, at least three to five years.
Molds are found everywhere, indoors and out. There is no way to completely avoid them, but if you are allergic to molds, your symptoms will be better if you minimize your exposure. Mold grows well in damp conditions, so the places indoors that may be harboring mold include kitchens, bathrooms, basements and laundry areas. Clean these areas with a bleach-containing cleaner. It is also advised to monitor the humidity inside your house, ideally keeping it at or below 40 percent. Dehumidifier units can help reduce mold count in areas that tend to be damp. When outside, avoid gardening and lawn mowing. In addition, when conditions are rainy, damp or foggy, mold counts tend to increase.
People who are allergic to animals react to saliva, skin flakes (dander), urine or feathers. Avoiding the animal(s) causing the problem is the simplest solution, but isn't always possible. If your work requires being around animals, or if an animal is a beloved family member, there are some actions you can take to minimize the symptoms you develop around them. Ohio State is a pet-friendly allergy practice and will work with patients to find a solution to your reactions to enable you to keep your pets.
The most important step is making at least one area in your home a dedicated animal-free zone. The bedroom is a great choice for this area, which will permit you to rest undisturbed by allergy symptoms. Brushing and washing your pet regularly can help reduce the amount of dander exposure. In addition, immunotherapy is available to help your body build a tolerance to the allergens it reacts to.
Most plants pollinate in the early morning, so allergy symptoms may be more prevalent then. Plan outdoor activities for later in the day to avoid peak pollen times. Pollen counts may also be lower during rainy days, as pollen is washed from the air. In contrast, windy days may increase your symptoms. After spending time outdoors, showering and changing clothes can help you prevent symptoms. In addition, wiping your pet with a damp cloth when they return from outside can help remove the pollen from their fur.
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