Allergy Evaluation and Treatments
Allergy Evaluation
Allergist & Immunologist | Clinical & Laboratory Immunology
Getting to know you and your story is an essential part of developing an allergy treatment plan that works to improve your health and quality of life, but also fits into your life and lifestyle.
Your allergy evaluation will include a combination of a thorough history taking, review of medications you have used, allergy testing, and development of an allergy treatment plan. We will discuss factors such as your home environment, pets, exposures, travel, and medical history. Some patients choose to bring in the medications they use, which is very helpful as medication names can be confusing.
There are two ways to conduct an allergy test: skin prick testing and blood testing. Skin prick testing is preferable as it is more extensive and accurate than blood testing.
Skin testing also provides results within minutes, right in the office. The test involves using a multi-pronged plastic device which has been dipped in allergen extract, then is gently and quickly pressed against the skin of your back or forearm. After the test is applied, we wait 15 minutes for a reaction to develop. Your skin is then examined for positive and negative tests before being wiped off. A positive test is when a small bump (“hive”) forms at the location of a particular extract; a negative test is flat and normal appearing.
The combination of your story and allergy testing will guide our next conversation about allergy treatment options.
Allergies develop when cells of your immune system (T cells and B cells, primarily) bind a foreign protein (ie dog dander, tree pollen), determine that specific protein is “foreign,” and mount an attack against the foreign offender. The body attempts to expel the protein with inflammation, drainage, and itch.
Immunotherapy is the medicinal process of slowly exposing your body to that particular protein trigger (allergen) in increasing amounts in order to desensitize your body to that allergen. Over the past century, several techniques have been developed to achieve this desensitization. The oldest and most widely used methods include “allergy shots” (subcutaneous immunotherapy/SCIT) and “allergy drops” (sublingual immunotherapy/SLIT).
Both of these immunotherapies require 3-5 years of treatment in order to solidify your body’s immune change into its new state, where your immune cells no longer recognize the protein as a foreign.
Newer techniques such as oral mucosal immunotherapy (OMIT), use allergy drops mixed into a specialized toothpaste, thereby administering the immunotherapy while brushing your teeth, daily. An even newer technique, intralymphatic immunotherapy (QUICK-Li), was developed about 15 years ago and involves a series of 3 ultrasound-guided injections directly into one of your body’s lymph nodes (each injection spaced 4 weeks apart). Research shows this short therapy has as much immune impact as 5 years of allergy shots or drops!
Immunotherapy Options Pros & Cons
Dr. Brynn Everist Can Help Determine the Right Allergy Treatment for You and Your Allergy Symptoms
Dr. Brynn Everist started Prairie Allergy with patient convenience in mind to use not only conventional allergy shots (subcutaneous immunotherapy or SCIT), but also include equally-effective and safer immunotherapy allergy treatments that are infinitely more convenient for busier lives. The current gold standard in the allergy community is allergy shots (SCIT). Nearly every allergist in the country uses SCIT because it works well and is FDA approved (therefore insurance/Medicare reimbursed, depending on your insurance and deductible).
Allergy shots (SCIT) require a buildup period of 2-3 injections per week for 3-6 months before weaning down to monthly injections. As you can imagine, it can be incredibly taxing on patients, parents, and children given the discomfort, frequency, and limitations of allergist office hours. Too many patients struggle to make this time commitment and over 75% quit by year 3 due to inconsistent injection visits, pain, needle phobia, or allergic reactions to the injections.
Allergy drops (SLIT) have been used for over a hundred years, and have proven to be safe, convenient, and equally effective. Insurance reimbursement has created a market incentive for the FDA-approved SCIT therapies, and SLIT has consequently become less widely available. Both SLIT and SCIT use the same FDA-approved purified allergenic extracts, but the method of administration (drops under the tongue) is not currently FDA-approved, meaning insurance won’t cover SLIT. Allergy drops have been used in Europe for many years, and by ENTs here in the US as an “off-label” therapy for over 20 years.
Allergy drops are preferable to the shots because patients can administer them at home and they are exceptionally safe; additionally, there are no uncomfortable side effects like pain and swelling around the injection site. Some patients report brief itching, tingling, or numbness inside the mouth, which improves over time.
Several years ago, the FDA approved 3 oral allergy tablets: Odactra, Grasstek, and Ragwitek (for dust mite, grass pollen, and ragweed pollen allergies, respectively). The studies conducted for these tablets yet again proved that the mouth holds great potential for immunotherapy administration. Over the past decade, additional studies have highlighted both the safety and efficacy of allergy drops, which has led to their use with increasing frequency among allergists again.
For more information, a great overview on SLIT is available on the Johns Hopkins website.
QUICK-Li is one of the most exciting advancements in allergy immunotherapy. Finally, a “quick fix” for allergies has arrived. This requires a fraction of the allergen extract of typical allergy shots or drops injected into a lymph node under ultrasound guidance. The procedure is very well tolerated (very few patients report swelling or redness at the injection site) and has minimal risk of a more severe reaction. The 3 injections are spaced 4 weeks apart, and patients typically notice improvement within a month of the last injection (or sooner!).
Our Immunotherapy Options
Immunotherapy Treatments Designed to Suppress your Allergic Response System
