Pharmacotherapy

Safe and effective medications remain the cornerstone of treatment for most allergic conditions. Non-sedating antihistamines, topical (inhaled, intranasal, or cutaneous) corticosteroid preparations, bronchodilators (asthma rescue inhalers), and various other medical therapies can be safely and effectively used to control most allergy and asthma symptoms.

Early, appropriate and regular use of appropriate controller or anti-inflammatory medications for asthma, allergic rhinitis, and atopic dermatitis have been shown to dramatically reduce symptoms, improve quality of life, and decrease long-term complications from these common and often life-long conditions

Your Snö allergy team shares your goal: the least amount of medication required to adequately and appropriately control your condition. It is important to understand that as much as we would all love to eliminate your need for treatment, there is no “cure” for most allergic conditions, and it is possible you or your child will require medication for a long time. Your allergist will work with you to ensure a safe and effective treatment plan, which will be continually reassessed and adjusted over time

Immunotherapy

Also known as Allergen “immunotherapy” (IT) is the oldest treatment for allergic conditions, first described more than 100 years ago.

There are 3”, primary forms of allergen immunotherapy, subcutaneous (injection) IT, sublingual (under the tongue) IT, and oral (swallowed) IT.

Subcutaneous (injection) immunotherapy, also known as SCIT or “allergy shots”,s the oldest and most familiar approach. SCIT is often used for environmental allergies such as tree, grass or weed pollen, dust mites, or furred animals. SCIT is the only appropriate treatment to prevent stinging insect or venomallergies, and can be considered a life-saving treatment for this very serious condition.

SCIT involves injecting small and gradually increases amounts of the allergen into the fatty tissue in the upper arm, usually every week until eventually achieving a target monthly “maintenance” dose, which has been proven to result in protection against the allergic exposure and long-term benefit in decreasing the allergic response. SCIT has the potential to “cure” an allergy in some cases, with 3-5 years of treatment usually resulting in long-term immunologic benefit

SCIT has a long record of safety and efficacy, however this treatment does carry a risk of anaphylaxis, with as many as 1/6 patients receiving high-dose IT suffering a systemic reaction along the way. Your Snö allergy team has extensive training and experience in determining your need for SCIT, and in the safe administration of such therapy.

Sublingual immunotherapy (SLIT) is a newer approach, common in Europe for the past 20 years, with either drops or dissolvable tablets of allergen placed under the tongue on a daily basis. This has been most commonly used for environmental allergies, including tree, grass & weed pollen, dust mites, and furred animals, and there are currently approved SLIT tablets for grasspollen, ragweed pollen, and dust mites, with even more on the way. SLIT offers the convenience of home dosing, with a very low risk of reaction, and may also have similar long-term immunologic benefits like SCIT.

Oral immunotherapy (OIT) is a newer and evolving approach to food allergies. Studies have shown that OIT can be very effective for children with milk, egg, and peanut allergies, and may be able to “cure” a food allergy over time, allowing the child to enjoy a normal diet. While a promising approach for some children, OIT carries a risk for anaphylaxis, and your allergist will help determine if this is an appropriate option for your child.

Education and avoidance

Your Snö allergy team places a premium on patient education, and will spend a great deal of time explaining your diagnosis, management plan, therapeutic options, and prognosis.We will always take the time to answer your questions and make sure that you are comfortable with your treatment plan.

Whenever possible, your allergy team will help you determine strategies to avoid your allergic triggers. Although it is usually fairly easy to avoid allergenic foodsor medications, it may be a lot harder to effectively avoid environmental allergens. Your allergist will work with you to determine if changes to your environment will be worthwhile.

Biological therapies

There have been tremendous advances in targeted biological therapies for asthma and allergies over the past 20 years, and your Snö team has experience and expertise in determining if any of these may be appropriate for you or your child.

Anti-IgE therapy (omalizumab)

Omalizumab is a monoclonal antibody therapy proven effective for moderate-to-severe asthma in patients > 6 years of age, or for patients with chronic urticaria (hives) > 12 years of age. It has also shown promising results in patients undergoing OIT for food allergies. This biological agent has been in wide use for nearly 20 years, and your allergist will be able to determine if this is a good option for you.

Anti-IL5 therapies (mepolizumab, reslizumab, benralizumab)

These newer biological anti-IL5 or anti-eosinophil agents have been shown to be particularly effective in severe difficult-to-control allergic or eosinophilic asthma. They each have their own potential advantages, and your allergist will be able to help decide if one of these agents is right for you.

Anti-IL4 therapy (dupilumab)

Dupilumab is a novel anti-IL4 antibody which has been proven effective for severe persistent atopic dermatitis (eczema), and has also shown promising results for severe asthma, both allergic/eosinophilic and not. The Snö Asthma & Allergy team will help determine if you are a candidate for this newer treatment option.

Skin prick test

Skin prick Testing(SPT) is one of the most commonly used diagnostic procedures in allergy, as it is simple, safe,cost effective, and delivers quick results. All skin prick tests must be based on a careful and detailed clinical history, as screening or random SPT may be highly inaccurate and misleading.

SPTs take about 15-20 minutes, and can be safely performed on children of any age, as long as they have not taken antihistamines for a few days prior.

A skin prick test involves introducing a very small amount of a suspected allergen into the surface layer of the skin, usually on the forearm. The skin is then observed for 15-20 minutes, and any resulting local reactions(lumps or wheals) are marked as potential allergic responses.

Pulmonary Function Tests

Pulmonary Function Tests, also called lung function tests or spirometry, are simple and non-invasive tests that measure how well your lungs are working. The tests determine whether or not you have any airflow obstruction or restriction, and whether or not your lung function improves following asthma therapy. Like measuring blood pressure in a person with hypertension, or blood sugars in someone with diabetes, PFTs are essential to diagnose and monitor conditions like asthma and chronic obstructive pulmonary disorder (COPD).

Your allergist will determine if you require spirometry, and your results will be immediately available to review with the team.

 

Oral Food Challenges (OFC)

If your history suggests a possible food allergy, your allergist may wish to perform an oral food challenge (OFC) to confirm or refute this.

OFC involve eating small and then increasing amounts of a food you may be allergic to under observation in a safe, controlled setting. Experts agree that OFC are essential for the accurate diagnosis of food allergy, as both skin and blood testing have an unacceptably high rate of false or clinically-irrelevant positive results.

OFC carry a risk of reaction, including anaphylaxis, however the Snö team of allergists and nurses have extensive training and experience with food challenges, and will only recommend this procedure when appropriate or necessary for your care.

Intradermal allergy test

Intradermal (ID) testing is less commonly needed, but can behelpful in the diagnosis of suspected drug, venom, or vaccine allergies. With ID testing, which is approximately 1000x stronger than skin prick testing, very small amounts (0.02ml or 1/1500 of an ounce) of the potential allergen are injected with an extremely tiny needle into the surface layer of the skin, much like a screening test for tuberculosis. The injection site is then monitored for a local reaction for 20 minutes, which may suggest an allergic response.

ID testing is not generally used for suspected food or environmental allergies.

Drug challenges

Like oral food challenges, there are some situations where the best and most accurate way to confirm or rule out a suspected drug allergy is by performing a drug challenge. This may involve oral administration of a suspected drug allergen, such as penicillin, or a low-dose injection of a medication such as lidocaine or another local anesthetic used in dental work.

Following a drug challenge, the patient is monitored for a possible allergic reaction, usually for an hour, and of course would be treated appropriately should any concerning symptoms develop.