Allergy And Allergy Testing

Allergies are perhaps one of the most underdiagnosed problems in America today, and East Tennessee in particular. If you look at the yearly published lists of the worst allergy cities in the United States, invaribly, two or three of the top ten cities will be in East Tennessee.

However, appropriate diagnosis and treatment of allergies is not the easiest task. In fact, I treat many patients who have been on shots diagnosed using the classical method of allergy testing who continue with problems even after ten to fifteen years of shot therapy. It is for this reason we offer four different methods of testing dependent upon the individual characteristics of each patient.

Allergies are genetic. Thus, if one person in your family has allergies, most usually others will as well. Therefore, testing of other family members may be recommended.

Allergy Symptoms
• Fatigue. Although most people don't think of it, fatigue is one of the most common symptoms of allergies and often results in diminished academic or work performance.
• Itching or Rash.
• Runny Nose. Clear nasal drainage is a common report with allergies.
• Restless sleep patterns. Either from dust or feather allergies related to the exposure to the allergen when you are in bed.
• Itchy, watery eyes.
• Gastro-intestinal distress. Nausea, irritable bowel symptoms, diarrea or peri-anal pruritis(itching).

Types Of Testing
• RAST A simple blood test drawn which allows for complete safety with no risk of exposure to the patient. All the testing is done in a laboratory where the patient's blood is exposed to different allergens (things which cause allergic reactions).
• Prick A common test performed by placing drops of allergen serum on the patient's skin and exposing the patient with a small prick,either by needle or using a multi-stick method. Roughly equal in sensitivity to the RAST
• Intra-Dermal A less common form of testing where a small wheal of antigen is placed just beneath the patient's skin. More sensitive than either RAST or Prick
• SET Or Serial Endpoint Titration, also called intradermal titration, where an actual level of response is obtained, similar to with the RAST, but where the patient is directly tested with a wheal as described in the Intradermal method. This is arguably the most accurate method of diagnosing inhaled allergies, the kind most commonly associated with upper respiratory symptoms.
• Please call if you are unable the keep your scheduled appointment.
• Please pre-admit before your surgery. This avoids timely delays in getting your blood work results before surgery.

Testing
• Depending on the method of testing, be prepard to spend up to two hours for the testing.
• You may experience ithcing or swelling at the site of testing if skin testing is performed.
• Eat a light meal before coming.
• If you are diabetic, bring your medicine and a light snack with you.
• You may need to use a topical steroid cream to reduce itching after testing.
• If you experience shortness of breath or any tightness in the throat or any unusual tingling in the throat or tongue, notify the testing nurse immediately.
• Once allergies are identified, your nurse and doctor will describe options of treatment including shot therapy, avoidance and medication.
• Schedule an appointment with your doctor after testing.

If you experience any symptoms that are not listed that you feel are significant please call immediately.

Possible Complications
Potential complications include, but are not limited to:
• Itching or rash.
• Lack of response to therapy.
• Death, brain damage, temporary or permanent loss of an airway, paresthesias, neuralgias, neuropraxia.
• Need for further or additional treatment, or recurrence of polyps or other disease processes.
• Adverse or unforseen reactions to medications, drugs or or other agents commonly used for evaluation of allergies.

Allergy Treatments
• Avoidance: In some instances avoidance of the offending allergen may be all that is needed. In all cases, avoidance is recommended.
• Allergy Desensitization: Shots, sublingual drops or other methods of gradual exposure of the patient to the allergens to which they react. This allows the body to eventually recognize the offending allergen as a normal part of the environment, rather than as an attacking entity.
• Antihistamines: Histamines are just one of many substances released during an allergic reaction. They are ususally associated with swelling, redness, and itching. Anti-histamines prevent or counter the release and effects of histamines. Most Otolaryngologists currently recommend low sedating or non-sedating antihistamines rather than traditional antihistamines such as diphenhydramine. Some states include sedating antihistamines in DUI laws.
• Steroids: Steroids, either topical such as creams used on the skin to reduce itching,redness, and rashes; nasal,used to decrease irritation and reaction in the nose and possibly eustachian tubes; inhaled, to reduce inflammation and reactions in the lungs and tracheo-bronchial tree; systemic, or given by injection, mouth or intraveneously, usually reserved for recalcitrant or severe reactions.