By Rolando Núñez, M.D.
Dr. Rolando A. Núñez joined Asthma and Allergy Associates of Florida in 2011, after completing his Pediatric Allergy/Immunology and Adult Allergy/Immunology Fellowship at National Jewish Health. National Jewish Health is widely regarded as the #1 respiratory hospital in the United States. He obtained his undergraduate degree in Biochemistry at California State University, Long Beach, prior to attending medical school at the University of Illinois, Chicago. He is specialized in pediatric care completing his internship and residency in pediatrics at UCSF-Fresno. During his fellowship Dr. Nuñez focused his research on Obesity and its effects on Asthma, an area where extensive research still continues. Dr. Nuñez is a fellow of both the American Academy of Allergy, Asthma and Immunology (AAAAI) and the American College of Asthma and Immunology (ACAAI). He is certified by the American Board of Allergy/Immunology. He was born in Puerto Rico and is fluent in both Spanish and English.
If this is allergy season, why am I sick all year round?
The simple answer is because you live in South Florida. In other parts of the country, allergy sufferers get a break during the winter and then start to suffer suddenly in the springtime or in the fall. This is why you see so many allergy medication commercials starting in April every year. Other than our delightful winter, we really don’t have seasons here. Consequently, many types of pollens, grass pollen for instance, are in the air the year round. Also, in South Florida, indoor allergens such as mold spores, dust mites, and animal dander are major causes of allergic symptoms.
How do I know I am having allergies as opposed to just having constant cold symptoms?
This is what makes it hard to diagnose and treat allergies in South Florida. Since most important allergens are present year round, it often takes a good history from the patient to help determine the cause of the symptoms. “Do you have a dog? Do you have carpeting in your bedroom (dust mites thrive in carpets)? Do you have any mold growth in your apartment?” Questions like these help determine the course of therapy for a patient.
How is allergy testing done?
Testing can be done in two ways, skin testing and blood (serum) testing. Allergy specialists typically perform allergy skin testing, as this is considered the most sensitive and cost-effective method. Also, skin testing has the advantage of giving immediate results. Patients must be off all antihistamine medications prior to testing, as this will affect the results. Most general practitioners do serum testing.
What symptoms are typical of allergies?
A runny nose, nasal congestion, post-nasal drip, nasal/eye itching, sneezing, and coughing are common symptoms of upper respiratory allergies (allergic rhinitis). Asthma symptoms can also be caused by allergy. As you can see, these are similar symptoms to what you would get with a viral upper respiratory infection (common cold). The main difference would be that common cold symptoms usually go away within a week.
What medications are used to treat allergies?
Many over-the-counter medications are available to treat allergy symptoms. These include nasal steroid sprays and antihistamines. Available non-sedating antihistamines, which are usually taken once per day, are preferred over other antihistamines which have many more side effects including sleepiness and dry mouth. Nasal steroids are very effective for many patients. Most people do very well on them; however, about 10 or 20% of patients will get side effects such as headaches and nosebleeds. There are prescription medications, such as nasal antihistamines and leukotriene modifiers, which are safe and effective for many patients.
What if the medications don’t work, or if I just don’t like taking medications on a long-term basis?
As mentioned above, allergy testing is important in this regard. Avoidance of allergens can help alleviate many of these symptoms. Allergy specialists are specifically trained to teach patients avoidance techniques for allergens such as dust mite. The physician and patient have to work together to limit exposure to the offending substances. In addition to this, specific allergen immunotherapy (allergy shots) can be an effective tool to decrease symptoms and limit the need for medications.
How do allergy shots work and how are they given?
Put simply, specific allergen immunotherapy works by gradually exposing the body to increasing dosages of allergens so that the immune system learns to ignore them. Typically, the shots are given once or twice a week for a few months, and then eventually spread out to once per month. The once per month therapy usually goes on for three or four years, since a full course of therapy may potentially lead to a permanent cure. Interestingly, allergy shot therapy began in the early 1900s. Over the years, allergen extracts have been refined to become more effective and safer.
I have heard of other forms of immunotherapy like sublingual drops. Are they effective?
Sublingual immunotherapy can be effective, but a very high dose of allergen extract is needed. This leads to increased cost. Also, it is not clear that sublingual therapy can be effective for those allergic to multiple allergens. Lastly, sublingual drops are not FDA approved, and thus are not covered by the great majority of insurance plans. Sublingual tablets are available and are FDA approved, so they could be covered by insurance plans. However, at the present time there are only tablets available for certain limited pollens. Sublingual therapy does have one advantage in that the therapy can be given at home. The great majority of physicians will only allow allergy shots to be given under direct supervision in their offices so that the patient can be observed after each dose.
Do allergy shots work for asthma?
Multiple scientific studies over the years have proven that allergy shots can be effective for asthma. However, because of the small possibility of allergic reactions to the shots, asthma patients must be well controlled on medications prior to starting the allergy shots. After the allergen extract starts to take effect, medication use can then be slowly reduced (in consultation with the doctor) in many cases.
Can allergen immunotherapy also be effective for insect sting allergy, food allergy, or medication allergy?
Yes, no, and no in that order. I’ll explain below. Insect venom immunotherapy has a long track record of being an extremely effective and safe treatment to prevent serious allergic reactions to stings. They work similarly to conventional allergy shots. The food allergy question is more complicated. There are some studies going on with transdermal and oral immunotherapy that have promise. However, the great majority of allergy specialists are not doing these therapies unless the patient is part of a clinical trial. As far as medication allergy, immunotherapy is typically not used, as equally effective other medications can be used. However, in extreme cases, oral or intravenous desensitization to a drug such as penicillin can be performed. This type of therapy would only be done in a hospital setting.