Frequently Asked Questions

What is an Allergic Reaction?

Approximately 50 million Americans suffer from some form of allergic disease, and the incidence is increasing. When most of us think of allergies, we think of sneezing, a runny nose or watery eyes. While those are symptoms of some types of allergic disease, an allergic reaction is actually a product of several events occurring within your immune system.

What types of conditions do you treat?

Major conditions treated include:

Allergic rhinitis/conjunctivitis

Allergic rhinitis, commonly referred to as "hay fever," occurs when allergens touch the lining of the nose - called the mucus membranes - of a person who is sensitive to that particular allergen. Allergic rhinitis is characterized by congestion, itching, sneezing, runny nose, and itchy, watery eyes. If the person continues to have daily, ongoing exposure to the responsible allergen(s), the symptoms will continue. Similar to allergic rhinitis, allergic conjunctivitis occurs when the eyes react to allergens with symptoms of reddening, itching and swelling.

Other types of rhinitis, including nonallergic rhinitis or nasal polyps

Rhinitis is not always allergic, and frequently patients who have nasal or eye symptoms are found not to be allergic. Other triggers for nasal symptoms include recurrent infections, irritants, (such as odors, pollutants, and weather changes) as well as nasal polyps. Determining the underlying cause of a patient's symptoms is critical to developing an effective treatment plan, and our physicians are very experienced at diagnosing the cause of your symptoms.


Asthma is a chronic lung disease that affects more than 17 million Americans and is characterized by coughing, chest tightness, shortness of breath and wheezing. Allergic rhinitis is considered a risk factor in developing asthma: a high percentage of those with asthma also have allergic rhinitis. When an individual experiences asthma symptoms, the inflamed airways become constricted so it becomes more difficult to breathe through the narrowed air passages. For those with allergies, inhaling allergens may produce increased inflammation of the airway lining and further narrowing of the air passages. Asthma may also occur as a result of other stimuli, such as respiratory tract infections, exposure to irritants, or exercise.

Atopic dermatitis

Also called eczema, often result from allergen exposure to the skin. Dermatitis symptoms include intense itching, reddening, and flaking or peeling of the skin. Symptoms begin in early childhood for 80% of those with atopic dermatitis. Dermatitis often precedes other allergic disorders; over 50% of those with atopic dermatitis go on to develop asthma.

Urticaria, (also known as hives), as well as angioedema (swelling)

Urticaria is characterized by itchy red bumps that can occur in clumps and may be either large or small. Hives may be triggered by infection, certain foods, insect stings or medications. Angioedema may occur with hives, or can occur alone. This swelling can occur on any part of the body, but frequently involves the face, eyelids, and lips.

Severe allergic reactions to substances such as food, latex, medications, and insect stings

Individuals who have allergies to specific foods may have severe and possibly life-threatening reactions if they eat them. Common food allergy triggers are the proteins in cow's milk, eggs, peanuts, wheat, soy, fish, shellfish and tree nuts. Food allergy occurs more frequently in children than adults. Many of these children may lose their sensitivity to particular foods over time if strict food allergen avoidance is instituted at an early age.

Foods and other allergens, including antibiotics ,other medications, insect stings and latex, can trigger a severe, systemic allergic reaction called anaphylaxis. Anaphylaxis is caused by swelling throughout the body, and can involve several organ systems. Symptoms of anaphylaxis include a feeling of warmth, flushing, tingling in the mouth or a red, itchy rash. Other symptoms may include feelings of light-headedness, shortness of breath, severe sneezing, anxiety, stomach or uterine cramps, and vomiting and diarrhea. In severe cases, patients may experience a drop in blood pressure that results in a loss of consciousness and shock. Without immediate treatment anaphylaxis may be fatal.

Problems commonly resulting from allergic rhinitis:

Sinusitis and otitis media (ear infections) are other common allergic diseases that may be triggered by allergic rhinitis. Sinusitis is an acute or chronic inflammation of the nasal sinuses, which are hollow cavities within the cheek bones found around the eyes and behind the nose. This condition affects over 15% of the U.S. population. Otitis media - or ear infections - is the most common childhood disease requiring physician care. If not properly treated, it can affect a child's speech and language development. Allergic rhinitis is frequently diagnosed in many children with chronic otitis media.

I have allergies. How can I treat them?

Treating allergies involves four approaches: education, avoidance, medications, and allergy shots.

Our physicians feel that the education of the patient plays a primary role in effectively treating a patient. By educating a patient about their underlying condition, our physicians give the patient the knowledge about their condition that enables the patient to become an active participant in their treatment plan.

Sometimes it will be determined that a patient is allergic to allergens that are found indoors, such as pet dander or dust mite allergens. In that case, our physicians and staff will educate you on measures you can take to minimize your exposure to those allergens.

Most patients with allergies rely on medications for symptom relief. There are allergy pills and syrups, nose sprays, and eye drops now available. Luckily, the medications that are now currently available are much more effective and better tolerated than those medications used in the past. Our physicians are educated on the most current, effective medications available and are able to formulate a treatment regimen that will help you to control your symptoms.

Allergy shots, or immunotherapy (SCIT), can be effective in improving allergy symptoms. It is the only therapy that is currently offered that can potentially treat a patient's underlying allergen susceptibilities, as opposed to just simply treating the symptoms that result from a patient's allergies. By treating these allergy sensitivities, allergy immunotherapy offers the potential of a "cure" of a patient's allergies.

Once our physician makes a diagnosis, they will consult with the patient to determine the treatment best suited to a patient's particular situation. Our physicians realize that every patient is a unique individual, and therefore strive to provide a customized treatment plan tailored to a patient's individual circumstances.

Diagnosing allergic diseases- what tests are done?

A board certified allergist/immunologist is best qualified to treat allergic diseases. To determine if you have an allergy, your allergist/immunologist will take a thorough medical history and perform an exam. If indicated, he or she will then perform allergy skin testing, or sometimes blood testing, to try to determine precisely which substance is causing your allergy.

Allergists generally rely on allergy skin testing to diagnose a patient's particular allergen susceptibilities. This testing is generally performed on the back, utilizing a series of skin pricks to each allergen tested. If you are allergic to a particular item, you will develop a small, itchy bump that resembles a mosquito bite within 15 minutes of that allergen being placed on your skin.

Your physician may go on to perform another form of skin testing known as intradermal skin testing, in which small amounts of individual allergens are injected just below the surface of the skin, and patients who are allergic to a particular allergen will develop a small, itchy bump to that particular allergen. This type of testing is reserved for allergy testing to airborne allergens as well as allergy to various insect venoms and drugs.

Blood allergy testing is sometimes performed as a replacement for skin testing, most commonly in patients who are unable to undergo routine allergy skin testing. This is performed at an off-site laboratory. Blood allergy testing is occasionally performed to supplement the information gained by skin testing.

Once your allergy triggers are identified, your physician can help you establish a treatment program.

The immune system

The immune system serves as the body's defense mechanism against the countless different substances present in the air we breathe, the foods we eat, and the things we touch. The term "allergen" refers to any substance that can trigger an allergic response. Common allergens include pollen, mold, animal dander, and cockroach and house dust mite droppings.

Antibodies circulate in the bloodstream and are present in almost all bodily fluids. They help to capture unwanted invaders. People with allergies have an antibody called Immunoglobulin E, or IgE. When allergens first enter the body of a person predisposed to allergies, a series of reactions occur and allergen-specific IgE antibodies are produced. These antibodies travel to cells called mast cells, which are plentiful in the nose, eyes, lungs and gastrointestinal tract. The IgE antibodies attach themselves to the surface of the mast cells and wait for their particular allergen.

Each type of IgE has specific "radar" for one type of allergen only. That's why some people are only allergic to cat dander (they only have the IgE antibodies specific to cat dander) and others seem to be allergic to everything (they have many more types of IgE antibodies.) The next time an allergic individual comes into contact with the allergens to which he or she is sensitive, the allergens will be captured by the IgE. This initiates the release of chemical "mediators" such as histamine and other chemicals from the mast cells. These mediators produce the symptoms of an allergic reaction, such as swelling of tissues, sneezing, wheezing, coughing and other reactions.

The allergic reaction typically continues: these newly released mediators recruit other inflammatory cells to that site, resulting in additional inflammation. Many symptoms of chronic allergic disease - such as swelling, excessive mucus and hyper-responsiveness to irritating stimuli-are the result of tissue inflammation due to on-going exposure to allergens. It is not yet fully understood why some substances trigger allergies and others do not, nor why not every person develops an allergic reaction after exposure to allergens. A family history of allergies is one of the most important factors that predispose a person to develop allergic disease. If one parent has allergic disease, the estimated risk for the child to develop allergies is 35-50%; the child's risk grows to over 50% if both parents have allergies.

What are allergy shots?

Allergy shots, or immunotherapy, are a way that our physicians can potentially treat your allergies. The purpose of allergy immunotherapy is to decrease your sensitivity to allergens that you are allergic to, so future exposures to those substances will result in fewer and less severe symptoms. The best treatment of an allergy is to avoid known allergenic triggers, and allergy shots do not substitute for avoidance. Allergy shots are used for treatment of allergies, along with allergen avoidance and allergy medications.

Allergy shots have been shown to result in the formation of "blocking" (or protective) antibodies, and lead to a gradual decrease in allergic antibody levels. These and other favorable changes in your immune system may allow you to tolerate exposure to the allergen with fewer symptoms. The end result of this change in your immune system is that you become more "tolerant" of the offending allergen(s). This effect is different in each person and is therefore unpredictable.

It must first be determined that you are a candidate for allergy shots. To qualify, you must have documented allergy to a substance (an "allergen"). This documentation may be through allergy skin testing or allergy blood tests. In addition, you should have symptoms, whether they are nasal, eye, respiratory, or a reaction to an insect sting, upon exposure to the substance you are allergic to. Due to the risks and time commitment involved in immunotherapy, avoidance measures and medicines are usually attempted first.

The allergy shot is a mixture of the allergens you are allergic to. When you first begin receiving your allergy shot, this mixture is diluted so that your body will be less likely to react to the shot. Your allergens may be divided into one or two shots. The dose is increased on a regular basis, usually once or twice a week, until your full strength allergy shot ("maintenance dose") is achieved. The maintenance dose will differ from person to person. Once you achieve your maintenance dose, you will receive this dose every 2-6 weeks, depending on your individual circumstance.

Improvement in your allergy symptoms is not immediate, and your allergies may in fact worsen initially while starting your allergy injections. Patients may not begin to see improvement in symptoms for 3-6 months, and full benefits may not be evident for 12-24 months. A majority of patients improve while on allergy shots, which means that symptoms are reduced, but not necessarily eliminated. Occasionally, allergy shots can lead to a complex resolution of symptoms.

The time it takes you to achieve a maintenance dose will vary, but may take 6-12 months. Things that influence the time it takes you to reach your maintenance dose include missed shots or reactions to your shots. For this reason, it is recommended that the immunotherapy schedule be followed. If you anticipate that it will be difficult for you to get your allergy shot on a routine basis, immunotherapy should not be considered. Immunotherapy may be discontinued at the discretion of your doctor if injections are frequently missed, as there is an increased risk of reactions under these circumstances. It is currently recommended that immunotherapy be continued for a period of 3-5 years, at which point the need for further allergy shots is reassessed. It is very important to have at least an annual follow-up visit with your allergy healthcare provider while on allergy shots.

What is rush immunotherapy and do you offer it?

Our clinic is pleased to offer rush immunotherapy as an alternative to conventional allergy immunotherapy, or allergy shots. There are several potential benefits of rush over conventional immunotherapy. Rush usually allows you to achieve your maintenance dose more rapidly. This may allow you to begin experiencing the benefits of allergen immunotherapy sooner. Your time commitment may be decreased, as rush requires fewer visits to our office. Additionally, you may receive fewer injections than you would receive with conventional immunotherapy. This may make immunotherapy more convenient for you and may reduce your costs.There is no evidence that one form of immunotherapy works better than another, and choosing which form of immunotherapy is best for your circumstance is based on numerous factors which your physician can discuss with you.

Do you offer sublingual immunotherapy?

Sublingual immunotherapy (SLIT) offers a way to treat allergies without shots, by administering a small dose of allergens in tablet form under the tongue. It is widely accepted and used in Europe, South America, Australia, and Asia and is gaining increased interest among allergists in the United States. At this time however, SLIT is not yet approved by the FDA and usage of it is off-label. We do not currently offer SLIT at our office, but there are ongoing clinical trials throughout the United States. If interested, you may contact our clinical research facility (PRC) at (214) 361-5555 to see if there are any currently enrolling studies that you may qualify to participate in.

What is asthma? How will you determine if I have asthma?

  • Asthma is a chronic lung disease in which airflow in and out of the lungs may be blocked by muscle squeezing, tissue swelling and excess mucus.
  • Patients with asthma may respond to factors in the environment, called triggers, which do not affect non-asthmatics. In response to a trigger, an asthmatic's airways become narrowed and inflamed, resulting in shortness of breath, chest tightness, wheezing and/or coughing.
  • Triggers that can bring on asthma include: allergens, irritants such as tobacco, pollutants, and strong odors, changes in weather, viral or sinus infections, exercise, medications, food, emotional anxiety and reflux disease.
  • Even "mild" asthma can be life-threatening. However, by working with your physician, you can learn to manage your asthma. The goal of asthma treatment is to manage symptoms so that you can do what you want instead of changing your activities to suit your asthma.

Our doctors are experienced in diagnosing and treating patients with asthma. Generally, this diagnosis is made by evaluating a patient's symptoms, performing a physical exam, and by obtaining a pulmonary function test (spirometry).

A pulmonary function test is a simple test that measures the volume of air in the chest and the flow of air through a patient's airways. These results are then compared to normal values, and the testing is frequently repeated after therapy has been instituted in order to judge a patient's response to therapy.

There is not one simple test to determine whether or not you have asthma, but usually, by performing a thorough patient history, doing a physical exam as well as pulmonary function test, our physicians are able to determine whether or not a patient has asthma.

Helpful Websites?

This website is geared towards raising public awareness on food allergies through media, education, and research efforts. It is a great communication link among patients and families of patients with food allergy. This website also addresses food allergy and children. There are many activities and project ideas on ways kids can get involved with educating others on food allergies.

This website has up to date information regarding allergies and asthma for adults and kids. You can find topics such as- Camping with allergies and asthma, back to school tips, growing up with allergies addressed on this website. If you need information regarding a topic in particular you can submit the "Info Request Form." Don't forget to visit the Asthma Wizard while checking out this website: an interactive tool that allows kids to learn more about asthma.

Allergy and Asthma Network/Mothers of Asthmatics (AANMA) is an organization dedicated to helping people affected by allergies and asthma through education, advocacy , community outreach and research. This website offers educational materials, monthly award-winning publications, and a toll free helpline.

The American Lung Association is one of the oldest voluntary health organizations in the US. The ALA today addresses lung disease in many forms including asthma, tobacco control, and environmental health. To get the most up to date information on current research and treatment guidelines check out this website.

This website represents the American College of Allergy, Asthma, and Immunology, a professional association of close to 5000 allergist and immunologist. The ACAAI is dedicated to improving quality of patient care in allergy and immunology through education and research. This website can help you locate an allergist as well as get more educational information regarding allergies, asthma, and immunology

National Jewish Health is a non-profit clinical, research, and educational facility which specializes in lung, heart, and immune disorders. Their dedication to heal, discover, and educate patients is one of their primary focuses. On their website, you can find educational tools such as health information on various conditions, wellness tools, a medical glossay, among other helpful resoursces.