Conditions and Treatment

Conditions we investigate and treat:

Anaphylaxis 

Anaphylaxis (an-a-fi-LAK-sis) is a serious allergic response that often involves swelling, hives, lowered blood pressure and in severe cases, shock. If anaphylactic shock isn't treated immediately, it can be fatal.

A major difference between anaphylaxis and other allergic reactions is that anaphylaxis typically involves more than one system of the body. 

Symptoms usually start within 5 to 30 minutes of coming into contact with an allergen to which an individual is allergic. In some cases, however, it may take more than an hour to notice anaphylactic symptoms. Warning signs may include:

• Red rash (usually itchy and may have welts/hives)

• Swollen throat or swollen areas of the body

• Wheezing

• Passing out

• Chest tightness

• Trouble breathing

• Hoarse voice

• Trouble swallowing

• Vomiting

• Diarrhea

• Stomach cramping

• Pale or red color to the face and body

Anaphylaxis may occur in people with allergies to foods, insect stings, medications or latex. If you are at risk for anaphylaxis, be prepared with an anyphylaxis action plan and by carrying autoinjectible epinephrine.

Allergic and Non-Allergic Rhinitis

Allergic rhinitis is caused by allergens, which are usually harmless substances but trigger an allergic reaction in some people.

People with rhinitis are prone to symptoms such as runny nose, sneezing, congestion and sinus pressure. Rhinitis can contribute to other problems such as asthma, sinus or ear conditions or trouble sleeping.

Seasonal allergic rhinitis, often referred to as hay fever, is typically caused by outdoor allergens such as pollen from trees, grasses and weeds.

Perennial allergic rhinitis occurs year-round. It is usually triggered by allergens such as pets or dust mites.

Some people with rhinitis symptoms don’t suffer from allergies. The symptoms may be similar, but the causes are different. Strong odors, pollution, smoke and other irritants may cause symptoms of non-allergic rhinitis. Medications and other chronic health conditions can also contribute to non-allergic rhinitis symptoms.

Nasal Polyps

Nasal polyps are growths on the lining of the sinuses and nasal passages. Nasal polyps can develop when the mucous membrane of your nasal passages and sinuses are inflamed, typically for 12 weeks or more. Some of these growths can be large enough to block the nasal passages. When this occurs, it can lead to breathing problems, frequent sinus infections or loss of ability to smell.

Nasal polyps are often associated with respiratory diseases such as allergic rhinitis, rhinosinusitis (chronic sinusitis), asthma or cystic fibrosis. Sensitivity to aspirin can also lead to the development of nasal polyps.

Common symptoms of nasal polyps include:
• Runny nose with clear or colored mucus
• Stuffy nose
• Postnasal drip
• Loss or decreased sense of smell and taste
• Headache, sinus pressure
• Itching around the eyes

Asthma

Asthma is a chronic disease involving the airways (tubes) that carry air in and out of the lungs. These airways are inflamed in people with asthma. The inflammation makes the airways very sensitive, and the tubes often react to allergens or irritations. There is no cure for asthma. But with the proper diagnosis, medication and an asthma management plan, symptoms can be controlled.

Asthma symptoms may include wheezing, coughing, chest tightness and trouble breathing–especially early in the morning or at night. In a severe asthma attack, the airways close so much that other vital organs in the body do not get enough oxygen. 

Asthma is treated with two kinds of medicines. Long-term controller medications are typically taken daily to prevent symptoms. Quick-relief medicines stop asthma symptoms when they occur.

Many people have "allergic asthma," which means that allergens–like dust mites, mold, animal dander, pollen and cockroaches - make asthma symptoms worse. Others have asthma symptoms only when exercising or playing a sport. This is called exercise-induced bronchoconstriction.

Vocal Cord Dysfunction

Vocal Cord Dysfunction (VCD) is a condition that causes the vocal cords to function incorrectly. It is also sometimes called paradoxical vocal fold movement (PVFM).

The vocal cords are located at the top of the airway called a windpipe. Typically, the vocal cords open as we breathe air into the lungs. With VCD, the vocal cords sometimes close or constrict during inhalation when they should open. This leaves only a small opening for air to pass through, which can make breathing difficult

The symptoms of VCD can be similar to asthma symptoms. Some of the triggers for VCD and asthma are also the same. These include exercise, stress, Gastroesophageal Reflux Disease (GERD), Laryngopharyngeal Reflux Disease (LRD), exposure to irritants or allergens, changes in temperature, respiratory infections and phychosocial stress.

While the symptoms and triggers of VCD and asthma are often similar, the treatment is very different. This makes an accurate diagnosis essential.

Unlike asthma, medications are not a long term solution to managing VCD. While medications may help treat underlying causes of VCD (such as GERD), speech therapy is the standard treatment approach to gaining more control of vocal cord movements.

Food Allergy

People with food allergies have an allergic reaction when they come in contact with certain foods. This happens because their immune system overreacts to the proteins in that food. 

Eight kinds of food cause most food allergies: 
• Cow's milk
• Eggs
• Peanuts
• Wheat
• Soy
• Fish
• Shellfish
• Tree nuts

Signs of a food allergy include:
• A rash, or red, itchy skin
• Stuffy or itchy nose, sneezing, or itchy and teary eyes
• Vomiting, stomach cramps or diarrhea
• Angioedema or swelling
• Hoarseness, throat tightness or a lump in the throat
• Wheezing, chest tightness or trouble breathing

Some people with food allergies can have a serious reaction called anaphylaxis. 

It is common for people and even some healthcare providers to misdiagnose the difference between food allergy and food intolerance. Food allergy can result in a life-threatening allergic reaction. On the other hand, a misdiagnosis could mean that you are unnecessarily limiting what you eat.

Drug Allergy

Adverse reactions to medications are common, yet everyone responds differently. One person may develop a rash or other reactions when taking a certain medication, while another person on the same drug may have no adverse reaction at all.

Only about 5% to 10% of these reactions are due to an allergy to the medication.

An allergic reaction occurs when the immune system overreacts to a harmless substance, in this case a medication, which triggers an allergic reaction. Sensitivities to drugs may produce similar symptoms, but do not involve the immune system.

Certain medications are more likely to produce allergic reactions than others. The most common are:

•    Antibiotics, such as penicillin

•    Aspirin and non-steroidal anti-inflammatory medications, such as ibuprofen

•    Anticonvulsants

•    Monoclonal antibody therapy

•    Chemotherapy

Contact Dermatitis

Contact dermatitis refers to an inflammation of the skin resulting from direct contact of a substance with the surface of the skin. Unlike atopic dermatitis, there is not necessarily a pre-disposition to allergic disease.

Symptoms of contact dermatitis include: 
• Red rash, bumps or a burn-like rash on the skin
• Itchy, painful or burning skin
• Blisters and draining fluid

There are two types of contact dermatitis:

Irritant contact dermatitis is the most common form and is caused when substances such as solvents or other chemicals irritate the skin. The exposure produces red, often more painful than itchy, patches on the involved skin areas.

Allergic contact dermatitis occurs when a substance triggers an immune response. Nickel, perfumes, dyes, rubber (latex) products, topical medications and cosmetics frequently cause allergic contact dermatitis. 

Atopic Dermatitis

Atopic dermatitis (eczema) is a chronic or recurrent inflammatory skin disease. "Atopic" means that there is typically a genetic tendency toward allergic disease. Atopic dermatitis usually begins in the first few years of life and is often the initial indication that a child may later develop asthma and/or allergic rhinitis (hay fever).

In infants, eczema usually appears as tiny bumps on the cheeks. Older children and adults often experience rashes on the knees or elbows (often in the folds of the joints), on the backs of hands or on the scalp.

Symptoms of atopic dermatitis (eczema) include: 

• Patches of skin that are red or brownish

• Itchy skin, especially at night

• Dry cracked or scaly skin

Latex Allergy

Latex allergy occurs when the body's immune system overreacts to proteins found in natural rubber latex.

Natural rubber latex is used to make some gloves, condoms, balloons, rubber bands, erasers and toys. Latex can also be in bottle nipples and pacifiers. Synthetic products, including latex house paints, have not been shown to pose any hazard to latex-sensitive individuals. Certain fruits and vegetables (such as bananas, chestnuts, kiwi, avocado and tomato) can cause allergic symptoms in some latex-sensitive individuals.

Exposure to latex often results in contact dermatitis symptoms. However, in some individuals, latex allergy can trigger a life-threatening reaction called anaphylaxis. 

Learn more about latex allergy symptoms, diagnosis, treatment and management.

Atopic conjunctivitis

Allergic conjunctivitis (eye allergy) is the most common allergy affecting the eyes. 

Many people with allergies get allergic conjunctivitis when their eyes come in contact with an allergen. The allergen triggers the release of histamine. This typically results in itching, redness, burning or tearing of the conjunctivae. These are the thin membranes lining the eyelids and the exposed surface of the eyes.

Allergic conjunctivitis can be seasonal or perennial. The seasonal version is much more common. It is related to exposure to airborne allergens such as grass, tree and weed pollen or molds. The perennial form persists throughout the year and is usually triggered by dust mites, animal dander or molds.

Irritants such as cigarette smoke, strong odors or fumes are not necessarily allergens, but they can make symptoms worse. 

Learn more about allergic conjunctivitis symptoms, diagnosis, treatment and management.

Angioedema

Angioedema is swelling in the deep layers of the skin, often seen with urticaria (hives). Angioedema most often occurs in soft tissues such as the eyelids, mouth or genitals.

Angioedema is called "acute" if the condition lasts only a short time (minutes to days). This is commonly caused by an allergic reaction to medications or foods.

Chronic recurrent angioedema is when the condition returns over a long period of time. It most often does not have an identifiable cause.

Hereditary angiodema (HAE) is a rare, but serious genetic condition involving swelling in various body parts including the hands, feet, face, intestinal wall and airways.

Pet Allergy

Allergies to pets are caused by protein found in the animal's dander (dead skin cells), saliva or urine. For birds, many people are allergic to the excreta.

The proteins from pets are carried on microscopic particles through the air. When inhaled, they trigger reactions in allergic people. As all dogs and cats possess these proteins, none of them is allergy-free. Though some breeds are considered more allergy-friendly, it is likely because they are groomed more frequently, a process that removes much of the dander. It is a common misconception that people are allergic to a dog or cat's hair, and it is falsely believed that an animal that sheds less will not cause a reaction.

Learn more about pet allergy symptoms, diagnosis, treatment and management.

Insect Allergy

Most of us develop redness and swelling at the site of an insect bite. Yet people who are allergic to stinging insect venom are at risk for a much more serious reaction. This life-threatening reaction is called anaphylaxis (an-a-fi-LAK-sis).

An allergic reaction occurs when the immune system overreacts to an allergen. In stinging insect allergy, the allergen is venom from a sting. Most serious reactions are caused by five types of insects:

•    Yellow jackets are black with yellow markings, found in various climates. Their nests are usually located underground, but sometimes found in the walls of buildings, cracks in masonry or in woodpiles.

•    Honeybees have round, fuzzy bodies with dark brown and yellow markings. They can be found in honeycombs in trees, old tires or other partially protected sites.

•    Paper wasps are slender with black, brown, red and yellow markings. They live in a circular comb under eaves, behind shutters or in shrubs and woodpiles.

•    Hornets are black or brown with white, orange or yellow markings. Their nests are gray or brown and are usually found in trees.

•    Fire ants are reddish-brown ants living in large mounds, mostly in warmer climates. They attack with little warning, inserting highly concentrated toxins that cause burning and pain.

Eosinopjilic Esophagitis

Eosinophilic (ee-uh-sin-uh-fil-ik) esophagitis (EoE) is an allergic condition caused by inflammation of the esophagus. The esophagus is the tube that sends food from the throat to the stomach. The most common symptom of EoE in adults is difficulty swallowing solid, particularly dry or dense foods. Symptoms in children vary and may include abdominal pain, vomiting, regurgitation, difficulty swallowing, insufficient weight gain, and failure to thrive. Inflammation in individuals with EoE is often caused by an allergic reaction to specific food proteins. Most of the time, the allergic reactions to specific foods are delayed and develop over days, which is different than other food allergic reactions that occur immediately. Most adults and children with EoE do not have rashes, swelling or difficulty breathing immediately after eating specific foods. However, eating the foods may contribute to the symptoms of EoE. Many people with EoE have a family history of allergic disorders such as asthma, rhinitis, atopic dermatitis (eczema) or food allergy.

In order to diagnose EoE, a doctor will perform an endoscopy and a biopsy of the esophagus. This is usually done after medications to control acid reflux have failed to improve symptoms. At the current time, treatments include food elimination diets and the use of anti-inflammatory medications that are swallowed, with the goal of coating the esophagus with the medication to reduce inflammation.

Diagnosing the condition is often a coordinated effort between a gastroenterologist and an an allergist / immunologist. An allergist will determine the role that allergies may play in EoE. Your allergist may perform allergy testing to diagnose which specific allergens may be involved with your EoE, although these tests often have limited value in identifying the foods involved in the eosinophilic esophagitis.

Learn more about eosinophilic esophagitis symptoms, diagnosis, treatment and management.

Primary Immunodeficiency

Primary Immunodeficiency Diseases (PIDD) are a group of more than 300 diseases. These conditions are due to defects in the body's defenses (immune system).

In most cases, PIDD are associated with acute or recurrent infections, depending on the portion of the immune system affected. Most PIDD are inherited in our genes, so they are present at birth, but they often do not become apparent or diagnosed until late in childhood--or even in adult life. It often takes time for a pattern of recurrent infections or other symptoms to develop before a PIDD is suspected. There are more than 200 different genetic causes of PIDD.

Signs that you or your child might have a PIDD include:

• Recurrent, unusual, or difficult to treat infections

• Poor growth or loss of weight

• Recurrent pneumonia, ear infections or sinusitis

• Multiple courses of antibiotics or IV antibiotics necessary to clear infections

• Recurrent deep abscesses of the organs or skin

• A family history of PIDD

• Swollen lymph glands or an enlarged spleen

Some PIDD can mimic other conditions including allergy, asthma, or eczema and vice versa, so evaluation by an allergist / immunologist is extremely helpful for reaching a diagnosis and developing an effective treatment plan.

Learn more about PIDD symptoms, diagnosis, treatment and management.

Mastocytosis

Mastocytosis is a condition that occurs when mast cells accumulate in skin and/or internal organs such as the liver, spleen, bone marrow, and small intestines. The signs and symptoms vary based on which part(s) of the body are affected.

Hyper-Eosinophilic Syndrome

Hypereosinophilic syndrome (HES) is a rare blood disorder. It occurs when a person's blood has very high numbers of eosinophils. This is a type of white blood cell that plays an important role in the immune system. These eosinophils get into various tissues, causing inflammation and eventually organ dysfunction. The most commonly involved organs in HES include the skin, lungs, heart and the nervous system.

Most people have less than 500 eosinophils/microliter in their blood. People with HES usually have more than 1500 eosinophils/microliter in their blood for 6 months or more, and the cause cannot be identified.

Learn more about Hypereosinophilic syndrome (HES) symptoms, diagnosis, treatment and management.

Protein Induced Enterocolitis

Food Protein-Induced Enterocolitis Syndrome (FPIES), sometimes referred to as a delayed food allergy, is a severe condition causing vomiting and diarrhea. In some cases, symptoms can progress to dehydration and shock brought on by low blood pressure and poor blood circulation.

Much like other food allergies, FPIES allergic reactions are triggered by ingesting a food allergen. Unlike a typical food allergy, FPIES allergic reactions are delayed, occurring within hours after eating the trigger allergen. Most children with FPIES have only one or two food triggers, but it is possible to have FPIES reactions to multiple foods. FPIES often develops in infancy, usually when a baby is introduced to solid food or formula.

Gastro-Esophageal Reflux Disease

Gastroesophageal Reflux Disease (GERD) is a digestive disorder that occurs when acidic stomach juices, or food and fluids back up from the stomach into the esophagus. GERD affects people of all ages—from infants to older adults.

People with asthma are at higher risk of developing GERD. Asthma flare-ups can cause the lower esophageal sphincter to relax, allowing stomach contents to flow back, or reflux, into the esophagus. Some asthma medications (especially theophylline) may worsen reflux symptoms.

On the other hand, acid reflux can make asthma symptoms worse by irritating the airways and lungs. This, in turn, can lead to progressively more serious asthma. Also, this irritation can trigger allergic reactions and make the airways more sensitive to environmental conditions such as smoke or cold air.

Allergic Bronchopulmonary Aspergillosis

Allergic Bronchopulmonary Aspergillosis (ABPA) is an allergic or hypersensitive reaction to a fungus known as Aspergillus fumigatus. This is a fungi found in the soil.

Although most of us are frequently exposed to Aspergillus, a reaction to it is rare in people with normal immune systems.

However, in certain people the immune system overreacts to the antigens of Aspergillus fumigatus in the lungs. This may damage the airways and result in permanent lung damage such as fibrosis.

ABPA most commonly affects people with asthma or cystic fibrosis. Many people with ABPA also suffer from allergic conditions such as allergic rhinitis (hay fever) and sinusitis.