Are You Driving Everyone Crazy at Work?

Constant sneezing and throat-clearing, both symptoms of allergies, can irritate co-workers. There is a solution that will make everyone happy — immunotherapy.

Is there someone in your office who always sneezes, coughs and/or continuously clears their throat? That person may be suffering from allergy symptoms that include post-nasal drip. Co-workers offer a “bless you” once or twice, but the well wishes gradually taper off as thoroughly annoyed office mates secretly wish that person would get their allergies under control and put everyone out of their misery. It’s certainly not your fault but if you’ve been noticing dirty looks, you might be that person.

Similarly, is there a student at your child’s school who just looks miserable — suffering daily with watery eyes, runny nose, lack of energy and fleeting attention? The teacher and fellow students undoubtedly feel bad for that child — at least at first. But when symptoms continue day after day, sympathy turns to frustration and friends find excuses to slink away. That child’s grades are likely to suffer as a result of inattention and/or missed days. For this great, smart kid who isn’t achieving their deserved social or intellectual status, top notch performance seems an impossible dream. Is that your child?

Whether it’s you, your child, or someone who shares your air, there IS a solution that can clear symptoms and restore good relations — immunotherapy. Here are three need-to-know points about it … First, it can resolve reactions to multiple allergens like ragweed, mold and cat dander. Second, it lasts for years. Third, it’s entirely natural — it’s not medication. Immunotherapy exposes your immune system to very small quantities of the allergens, effectively teaching it “see, they’re really not so bad.” Since your system stops trying to fight off these harmless particles, your symptoms subside greatly or disappear altogether.

Allergy drops and shots are both forms of immunotherapy and they’re both effective. One of the major benefits of drops is you can take them at home — or on the road — so there’s no need to miss work or school for weekly doctor appointments, which are required with shots. (Missing work or school may be another strain on relationships with co-workers, friends and teachers.) Drops are affordable and are ideal for everyone from children to seniors. The upside of shots is that, currently, more insurance companies pay for them (co-pay and deductible may apply.)  In the long run, both shots and drops will likely be less expensive than medications — and will almost certainly be more effective.

If you or your child are the ones getting on everyone’s nerves, through no fault of your own, it’s time to put your allergies behind you and patch up those strained relationships. Talk to your doctor about immunotherapy. If it’s someone else, don’t bludgeon them to death — point them to https://www.allervision.com/allergies.

Make “Get Rid of My Allergies” Your New Year’s Resolution

Don’t let pollen keep you from enjoying the great outdoors. You can overcome your tree, grass and weed allergies with immunotherapy.

Some people resolve to diet. Others commit to exercise more. Whatever you promised yourself for this year, we suggest the additional new year’s resolution (it’s not too late to make one!) of improving your health and wellness by overcoming your allergies. It’s possible, and we’ll tell you how below. But first, in case you need a little extra motivation, here are a few activities that you should be able to enjoy, but which often provoke allergy symptoms: strolling in the park; playing soccer; watching a little league game; exploring a forest; hugging your dog; rolling in the grass; visiting friends; petting a cat; walking outside in spring; cleaning your home; sleeping; breathing.

When we say “get rid of allergies” we’re not talking about covering up your symptoms with medications or temporary treatments. We’re talking about using immunotherapy to teach your immune system not to react to the harmless allergens that it mistakes for enemies. When you do this with allergy drops or shots, your body stops creating allergy symptoms each time it encounters the allergens; in other words, you become healthier!

The first step is visiting your healthcare provider for a pain-free allergy skin test to determine what allergen(s) causes your symptoms. If your doctor doesn’t offer the skin tests, click here to find one who does. Then talk to your provider about whether immunotherapy is right for you. If you are a good candidate for the treatment, your doctor will recommend either drops or shots. Within two months of starting immunotherapy, you may leave your allergies in the dust – not just for this year, but for many years to come! And next year, your resolution can be based on using your good health to reach new goals!

The What, Where and When of Allergies

The AllerVision Allergy Map will show you the biggest allergen offenders in your area and when they cause the most damage. Click here to see it.

Maybe you’ve had an allergy test and you have a list of allergens that cause your symptoms. (If not, click here and AllerVision can help you find a provider who will give you the answers you deserve!) But unless you’re a botanist, you probably don’t know what most of those allergens looks like. And even if you do, you may not know when you need to watch out for them. Don’t worry, we have you covered! …

Click on the caption under the image at right to visit the AllerVision allergy map. Once there, click on your region of the country to see the trees, weeds and grasses that cause the worst allergy problems in your area. (AllerVision-affiliated providers test you for sensitivity to those pollens when you visit them for an allergy evaluation.) If you hover over the names of the plants, you’ll see pictures and the season(s) in which each allergen does the most damage. Take the seasons listed with a grain of salt, though — global climate change is, well, changing the environment. Many doctors and allergy specialists blame those shifts for the huge increases in pollen — and, consequently, allergy symptoms — produced each year.

That said, if you’re experiencing allergy symptoms or generally not feeling well right about now, there’s a good chance you can blame pollen from grasses including Rye, Bermuda and Red Top, among many others. As summer fades to fall, weeds become the more primary villain, with Ragweed topping the list as public enemy number one. Pollen tends to take a rest in early winter, but come late winter and early spring, Ash, Alder Cypress and other trees begin spewing pollen like there’s no tomorrow — and allergy patients suffer mightily.

Unfortunately, indoor allergens never go away. Dust, pet dander, cockroaches and mold can cause allergy misery all year long. The allergy symptoms they trigger tend to stand out in the winter because people spend so much time indoors but even in mid-summer any one of them can be the cause of your discomfort.

Given that outdoor allergies are cyclical, you may be able to stuff yourself with medication until your worst season is over — but next year you’ll experience the same problem. Or, you can turn to immunotherapy, which teaches your body to ignore allergens so the disease goes into remission for years. Immunotherapy lets you enjoy many, many seasons without symptoms. To learn more, click here so you can stop worrying about allergies wherever you are, whatever the season.

Do You Have Allergies? Here’s a Quick Test

Allergies cause a wide range of maladies. Have you had an allergy test?

This time of year, allergies can cause all kinds of problems. More than 25% of Americans suffer from allergies to environmental factors from pollen to dust to mold to pet dander. Allergies are to blame for all kinds of symptoms including headaches, sinus infections, rashes, chronic cough, wheezing, eye problems and MANY more.

So how do you know if you have allergies? Discovery starts with this simple score sheet. For each item below, answer 0 for no symptoms to 5 for severe symptoms. If you score a 2 or higher on any question, we recommend you visit your healthcare provider and ask about an allergy evaluation, including a quick, painless skin test. (If your doctor doesn’t offer the skin test, click here. If you’re a doctor and want to offer the test for your patients, click here.) The test will tell you within just 15 minutes if you have allergies, and will reveal the triggers that cause your symptoms.

Nasal Discharge or sneezing         0 1 2 3 4 5

Watery or itchy eyes         0 1 2 3 4 5

Frequent sinus or ear infection         0 1 2 3 4 5

Frequent colds or sore throats         0 1 2 3 4 5

Wheezing or asthma         0 1 2 3 4 5

Cough         0 1 2 3 4 5

Poor memory or concentration         0 1 2 3 4 5

Hyperactivity         0 1 2 3 4 5

Itching, hives, eczema or skin irritations         0 1 2 3 4 5

Abdominal gas or cramping         0 1 2 3 4 5

Arthritis or muscle aching         0 1 2 3 4 5

Headache         0 1 2 3 4 5

The good news is that if you have allergies, there is an excellent treatment option — immunotherapy — because it doesn’t just cover up symptoms, it teaches your body to ignore the allergy triggers so the symptoms stop occurring. And immunotherapy in the form of allergy drops is appropriate for allergy sufferers of all ages, from children to seniors. So contact your provider or allervision.com today.

The Top 7 Questions About Allergy Drops

Drops are one of the simplest, most effective allergy treatments. A few drops under the tongue each day teaches your immune system to ignore allergens so symptoms naturally fade away.

If you’ve been following the AllerVision blog and Facebook page, you know we’re enthusiastic about allergy drops (also known as sublingual immunotherapy or SLIT). Why? Lots of reasons, including the facts that they’re very easy to use, extremely effective, and suitable for allergy sufferers of all ages, to name just a few. Many people haven’t heard of allergy drops, though, and here are the top seven questions they ask when their doctor prescribes them.

1) How do they work? Once your doctor performs an allergy test and determines your allergy triggers, s/he prescribes drops based on those allergens that affect you. The drops contain low doses of those allergens (also known as antigens) — essentially, you put drops of pollen, dust, etc. under your tongue. Your immune system gradually begins to recognize that those particles are allies, not enemies, and stops trying to fight them off. As a result, allergy symptoms retreat and disappear.

2) How long does it take to work and how long do they last? Within the first six months of starting treatment — and often much sooner — your allergy symptoms will likely fall away dramatically. You’ll stay on the drops for about four years and probably will enjoy allergy relief for at least 10-15 years after you stop. For some, it will last significantly longer; relief varies from person to person.

3) What allergies do they “fix”? Drops can help resolve your allergies to inhaled allergens such as pollen, pet dander, dust and mold. Exciting new studies have shown success with peanut allergy as well, but that treatment is in its infancy and requires close monitoring by an allergy specialist.

4) Are they better than allergy shots? Drops and shots use the same antigens, so in principle they should work equally well. The clinical studies confirm that when used consistently, drops and shots have basically the same results. Drops seem to work better for some people, though. This may be because they’re much more convenient and you don’t have to stop them when you go on vacation, feel under the weather or can’t make it to the doctor’s office; therefore, patients are more likely to complete the full course of treatment. And kids, especially, prefer drops because there are no needles. For drops, you simply squeeze a little liquid under your tongue and hold it for two minutes each morning. For shots, you visit the doctor each week and stay for at least 30 minutes.

5) Why are the drops considered “off label” by the FDA? The FDA has approved individual antigens for use in injections, and a few some sublingual delivery but whenever antigens are combined for individualized treatment, the mix is considered off label. Both shots and drops are formulated off label to make sure they fit your exact needs. Nonetheless, every ingredient is FDA-approved and manufactured under the highest FDA standards. And drops are proven to be safer than injections.

6) What do they taste like? Because the antigens are suspended in glycerine, which is basically a sugar, the drops taste rather sweet. You place them under your tongue where you won’t taste much, but most patients usually enjoy what they do taste.

7) Will they interfere with medications or treatment of other conditions? It’s important to remember that drops are not medicine but are rather just little bits of tree, grass, weeds etc. that you already encounter in your environment, so they don’t interact with meds. For the same reason, they don’t cause side effects — like drowsiness, weight gain and increased blood pressure, common problems of many allergy medications — and have no effect on the treatment of other conditions. Also, drops are suitable for allergy sufferers of all ages, from young children to seniors.

For answers to other questions about drops, click here or ask your healthcare provider. In this world where allergies are only getting worse, drops are the safe, easy, and definitive solution to the allergy problem!

Top 7 Questions (and Answers) About Allergy Skin Testing

After antigens are applied to a patient’s back, her skin reacts with bumps and/or wheals — and, possibly, itchiness. After about 15 minutes, the provider wipes away the antigens are the reaction(s) fade away.

In our last post, we explained why nearly every doctor should offer allergy skin testing. (If you missed it, click here.) Here are patients’ top seven questions about the test.

1) Should I have an allergy skin test? Allergies cause many more symptoms than the average person realizes, including rashes (dermatitis), sinus infections, migraine headaches, dizziness, conjunctivitis, respiratory problems, fatigue, muscle and joint pain, and the list goes on. If you get any of these symptoms regularly, you should discuss the possibility of allergies with your doctor, who will likely suggest the test and a review of your health history.

2) Can my child have the test? The test is safe for children as well as seniors. In fact, it is appropriate for virtually everyone, with the exception of pregnant women, patients with unexplained episodes of anaphylaxis, patients with active hives or active severe asthma symptoms, and people with significantly suppressed immune systems.

3) What does it test for? AllerVision-affiliated providers test for a wide variety of airborne antigens common to your region of the country — such as pollen from local trees, grasses and molds — as well as molds, dust, animal dander, cockroaches and certain foods. If you suspect allergies to specific foods, your provider may test you separately for those individual items.

4) What happens during the test?  Your provider presses several plastic applicators coated with antigens onto your back. As your skin reacts to certain antigens, you may feel itchiness. After 15 minutes, the provider measures any bumps (or “wheals”) that develop — indicating positive results — and record them. Then he or she cleans your back to relieve any discomfort.

5) Does it hurt? No. You’ll temporarily feel minor pressure from the tines of the testing devices as they’re applied, but they don’t penetrate your skin and they’re specially-designed to prevent pain. Even young children rarely complain. Itching caused by positive results begins to resolve as soon as the antigens are wiped away.

6) Is there anything I need to do to prepare? The most important thing to remember is that you shouldn’t take antihistamines for three days before testing because they can prevent the very reactions your provider needs to see. Also, be sure to inform your provider if you’re pregnant, have asthma, are suffering from severe illness, or have experienced a strong allergic reaction.

7) How long does it take to get results? In just 15 minutes, your doctor will have a clear picture of your allergic reactions so you can plan and begin a treatment program immediately.

 

Allergy Testing, Immunotherapy Boost Medical Practice and its Patients

Allergy immunotherapy has helped the patients and the practice of Dr. Stephen Sisselman, of Sisselman Medical Group in New York.

This post, from guest blogger Dr. Stephen Sisselman, looks at allergy testing and treatment from the general practitioner’s point of view. 

Sara V is a patient I’ve known for a long time. She comes in every few months with assorted respiratory complaints including runny nose, cough, congestion and excessive mucus production. I typically tell her she has rhinitis and that antibiotics are ineffective. Nevertheless, she usually requests an antibiotic. Recently, we began offering allergy testing at my office so I told Sara that I wanted to test her to see if allergies might be the cause for her respiratory complaints.

I started allergy testing as a way to offer more services to my patients and enhance the ancillary testing in my practice. It takes just five minutes to prep a patient and about five more to complete the test. In another 15 minutes the test results are ready to read. About half the patients we test each week show significant allergies to trees, weeds, molds, grasses or other environmental allergens. Patients love the idea of in-office testing where they get immediate results and don’t have to schlep to an allergist.

Getting back to Sara V… I thought that maybe seasonal allergies play a role in her frequent respiratory complaints. I performed an allergy test and we were both surprised by her results; she was positive for trees, weeds, grasses and indoor perennials such as dust mites. After a discussion of appropriate therapy, she decided that allergy shots — subcutaneous immunotherapy (SCIT) —were the best choice for her. Now, three months into the program, she already has fewer symptoms and respiratory complaints. And Sara is just one of many of my patients now experiencing a greater quality of life.

Sara chose allergy shots but those aren’t the only treatment option. I help patients with positive test results choose the treatment that’s right for them. Some prefer oral antihistamines and steroid nasal sprays. Others, like Sara, choose immunotherapy because it doesn’t just cover up symptoms, it trains the body to ignore the allergens that trigger the symptoms.

I administer allergy shots in my office. Based on insurance coverage, patients may have just a small copay, or none at all. Some patients prefer the freedom of treating themselves with immunotherapy at home. For them, we offer sublingual immunotherapy (SLIT), also known as allergy drops. SLIT drops from AllerVision are customized to the patient based on the results of their allergy test. The patients simply place three drops under their tongue and hold them there for three minutes each day. Drops usually cost about $70/month. They’re not covered by insurance but for those who choose them, the convenience easily outweighs the cost. Both shots and drops start working within a few weeks to a few months and treatment is complete in four years.

The allergy program has been a great addition to my practice. I enjoy the increased reimbursements for allergy testing and shots administration while my patients love the convenience of getting needed testing and treatment in my office. My staff also loves the program because it’s easy and we can better diagnose and treat patients with frequent or chronic upper respiratory complaints. It’s a win-win for everybody.

Stephen G. Sisselman, D.O., F.A.C.P.

Dr. Stephen Sisselman is Board Certified in Internal Medicine. His practice, Sisselman Medical Group, in Massapequa NY and Commack, NY cares for patients ages 12 and up.

Chart Your Patients’ Asthma Visits Like an Expert

Asthma is often triggered by allergies. Determining the allergy source, with a skin test, can help patients avoid extensive treatment.

This time of year brings changing weather and an uptick of respiratory viruses. For most physician offices, asthma visits rise with these trends. The diagnosis of asthma is often not the hard part; patients short of breath with coughing and wheezing make for a simple diagnosis. Other patients come in with the elusive and often undiagnosed cough, and a quick run of the spirometry can provide the answer. But navigating the art of managing and charting your asthmatic patients requires some skill.

The experts agree on the need to document two key points: severity and control. The components of severity are: intermittent, mild, moderate and severe. Begin the differentiation by stratifying the patient by the Rule of Twos using the key asthma indicators: nocturnal awakenings, use of short-acting beta-agonists inhalers, and interference in daily activities. If these indicators occur less than twice a week, then the patient is considered to have intermittent asthma; if the patient has these symptoms more than twice a week but not daily, then he/she falls into the mild persistent category. Moderate persistent is used for patients who experience the indicator symptoms daily, and severe persistent asthmatics suffer with symptoms throughout the day. It is critically important to follow and document pulmonary function tests and home peak flow levels in your moderate and severe patients. The moderate persistent asthmatic will demonstrate FEV1 values between 60-80% predicted, while more severe persistent patient values fall consistently under 60%.

The ACT (Asthma Control Test) is a standardized validated questionnaire that serves as another key component to the management process. The questionnaire provides a quick assessment of both severity and control. This form should be downloaded and printed from the back end of the AllerVision website — you will use it often! A score of less than 20 on the ACT signifies poor control, indicating that intervention or change in therapy is in order.

Always keep in mind that asthma is multi-factorial and heterogenetic; meaning there are lots of components at play. The detective work of good medicine means finding that trigger of your patient’s asthma, so the plan can center on avoiding those triggers whenever possible. Respiratory infections, especially viral, are common culprits that prove difficult to avoid. Stress and emotions also affect asthma, leading to exacerbations. However, a main trigger in most asthmatic exacerbations is allergic response. This fact is the impetus behind the NIH guideline stating that all persistent asthmatics be tested to identify their allergic triggers. The AllerVision testing program offers a comprehensive and regionally appropriate assessment. Perform the test, carefully document positive results along with correlation to the careful and detailed history, and take action to help the patient learn how to remove the offending allergen(s) from his or her environment. Because avoidance can be near-impossible, give serious consideration to allergen immunotherapy for your asthmatic patients. SLIT (sublingual immunotherapy) is a fantastic option in this case because it offers the benefits with significantly less risk than SCIT (subcutaneous immunotherapy, aka allergy shots).

Our next blog post will comment on making adjustments to asthma control through medications.

Dr. Dean Mitchell

The Important Difference Between Clinical Allergy and Allergy Sensitization

A doctor’s review of patients’ medical history is as important as skin test results in diagnosing clinical allergies.

I’m sure you have patients come into your office and say: “I was once tested by an allergist and told I was allergic to everything green!” I’m  always dismayed when I hear that patients were given results in this manner. Almost no one is allergic to “everything green.” Patients may be sensitized to multiple allergens but most likely they’re not allergic to them all. Making the distinction between clinical allergy and allergy sensitization requires the doctor to study each patient’s health history in conjunction with allergy test results.

Let’s demonstrate with a food allergy example… A patient visited my office and told me that he attended a party and ate a piece of cake. Within 15 minutes, he developed hives (urticarial) all over his body. He wasn’t sure what was in the cake but was worried about what he should avoid in the future. I tested him and the results showed a positive for tree nuts — walnuts, cashews and pistachios. The skin tests also showed positive for milk and eggs, but he told me that he eats eggs and drinks milk all the time without a problem. We found out that the cake contained walnuts, so I diagnosed him with walnut and tree nut allergy. I explained that his positive allergy tests to egg and milk demonstrated that he has allergic sensitization to the raw pure proteins in those foods, but, with no clinical complaints, he can still continue to eat them.

Here is another example of a potentially confusing situation that you may encounter using the AllerVision skin testing panels: you test a patient and find she is allergic to several tree pollens, grass pollens and ragweed pollen. The patient’s history says she only has symptoms in the spring — from March until June. She has no symptoms in the fall. My assessment would be that she has clinical allergy to the spring pollens, trees and grasses, and allergic sensitization to ragweed. This distinction becomes important not just in educating the patient, but in determining the patient’s course of immunotherapy. In this case, you might decide to treat the patient for the trees and grasses but leave the weeds out of the equation.

The allergy world is buzzing with research on diagnostic techniques to delineate clinical allergies more clearly. One company is working on a blood test that involves Resolve Component Testing. That measures a protein called Ara h2 — highly specific for peanut allergy. Preliminary studies indicate 95% accuracy. In the meantime, don’t forget the importance of clinical history in conducting the “detective work” required to distinguish clinical allergy from allergy sensitization. And remember that, as always, the AllerVision clinical team is available to work with you and discuss your cases any time you have questions.

Dr. Dean Mitchell

When Allergy Season Peaks, Do You Have a Plan? My Tips for Your Worst Patients

With pollen counts skyrocketing, this could be the worst allergy season in years. Be prepared to help your patients.

It’s happening already: TV stations, newspapers and radio are hyping the severe spring pollen season ahead. As we know, long winters with lots of snow are springboards for high pollen counts. Every year when spring arrives my office phone starts ringing and patients can’t wait one day to be seen. My new patients, that is. I’ll explain the difference below. These new patients’ developing allergy “emergency” can be handled effectively with proper management, but more importantly, the crisis can turn into an opportunity to make sure these patients can enjoy spring without interruption next year. Here’s what I’ve learned about allergy peaks over the past 20 years…

They bring a lot of allergic inflammation! Patients come in with their eyes and noses red and swollen. They’ll tell you they feel miserable – like they have a terrible cold. They’ll also tell you they’re tired but can’t sleep at night. Many will complain that their head feels so heavy and their sinuses so painful. These are the ones with the self-diagnosis of “sinusitis.” And they’re right —their sinus passages ARE definitely inflamed. While we know from our training that the inflammatory process is often the result of allergic response, many patients equate sinusitis with infection. And all of them want solutions. So what should you do?

You reach for your prescription pad to put out the fire. But before you do that, it’s critically important that you make a definitive diagnosis. Allergy skin testing is the gold standard for diagnosing IgE mediated allergic disease. When skin test is contraindicated, IgE blood test is an acceptable alternative. Once you know what you’re dealing with, you can begin the management process. Of course, a positive skin or blood test doesn’t rule out infection but if you know there’s an underlying allergic process, you can’t go wrong by attacking it from that angle. Only a sinus tap confirms infection but if you clear up the inflammation, you can bet that this will rarely be necessary.

The medicine that works best in acute inflammatory situations isn’t the antibiotic that the patient often desires. And once your patient sees and feels the results of an allergy test, he/she will understand this concept. Many of us go straight to oral cortisone because it’s effective! However, there’s an art to prescribing oral cortisone so that it works while minimizing side effects and patient concerns. I’ve found Prednisone at a low dose is the key to quick relief. The dosage is weight-dependent but, as a general rule, 20mg is an effective therapeutic dose for adults and children over 60 lbs. You could increase that for patients over 170 kg, but higher doses usually aren’t necessary. Prednisone, like all oral cortisone, should be taken in the morning to synchronize with the patient’s circadian rhythm. It should always be taken with some food to minimize gastrointestinal upset.

One week of Prednisone is usually enough to quell the acute allergic inflammation caused by the eosinophils in the tissue. This gets the ball rolling to reverse patients’ most severe symptoms but you should complement it with topical sustainable medications as well. For nasal congestion, sneezing and rhinorrhea, there is nothing better than topical cortisone nasal spray. Nasacort is the first one of these sprays available over-the-counter. Your patient can use the 24 hour preparation once each morning.

What the patient may not capture from their over-the-counter purchase is the understanding that correct administration technique is vital for effectiveness and safety. It is important that you and your staff demonstrate and educate on the cross-hand technique; show patients how to spray one pump at a time into the lateral aspect of the nostril using the opposite hand.Using opposite hand makes it easier to avoid accidentally spraying medially towards the septum, which diminishes effectiveness, potentially inspires a bloody nose, and ultimately puts the patient at risk for long term septal damage. Nasal steroids are proven superior to antihistamines in terms of both symptom relief and side-effect profile in head-to-head comparison studies.

Many patients don’t like nasal sprays or worry that they’ll “get hooked” on them. My answer: They work. And, no, you don’t get addicted to cortisone nasal sprays as you might after weeks of consecutive use of decongestant sprays like Afrin. That said, decongestant sprays can be incredibly useful for short term treatment of acute inflammation and can sometimes forestall the need for Prednisone.

Eye symptoms such as redness, itching and tearing can be very debilitating. The best short term treatment for acute allergic conjunctivitis is topical antihistamines. I have several favorites in this area, but you need to check with your patient’s insurance coverage. I’ve had patients call up in a panic that the antihistamine eye drop I prescribed cost over $100 for a tiny bottle. I call them “liquid gold” because they’re very effective but the cost is sometimes precious-metal caliber. A nice trick for enhancing relief is storing the eye drops in the refrigerator to ease the burning sensation. Most eye drops should be administered twice each day. Instruct your patients not to use the typical red-out over the counter eye drops. They contain decongestants which may indeed get the red out but also prove quite addicting. Finally, even while using the Prednisone and topical treatments, I recommend my patients take an antihistamine at night. I prefer Allegra(fenofexidine) or Zyrtec (cetirizine) equivalents because they last for 24 hours and are generally more effective and often less sedating than Benedryl (diphenhydramine).

Now that we’ve successfully weathered the initial storm, it’s time for education. This reminds me of an age old saying: “Never waste a good crisis.” In medicine, I take this to mean that when the patient is really suffering, you have an opportunity to explain that they can avoid this same scenario next year with proper diagnosis and treatment! Sometimes it’s necessary to wait for the crisis to pass before definitively diagnosing. This happens when a patient is too symptomatic and miserable to undergo the test. Either way, once we obtain positive results, I explain that allergen immunotherapy — shots or drops — is the only way to minimize or eliminate their regular allergy crises.

No other tools in our bag can actually change the course of the disease. Keep in mind that symptom treatment must continue and even increase in the early weeks of immunotherapy ramp-up, but at the first quarterly visit you’ll discuss tapering meds -for good! For most patients, the choice is simple: a lifetime of meds with side effects and potential interactions vs four years of using elements from the environment to teach the immune system not to overreact to nature. Imagine if we had such a solution for diabetes or hypertension!

In the end, patients relate well to successful results. It brings a smile to my face when I tell the acute patient: “my waiting room used to be filled with sniffles and watery eyes just like yours. Now I have a waiting room mostly full of patients feeling great and just stopping by to pick up their allergy drops.”

– Dr. Dean Mitchell