Gregory Carnevale, MD, LLC and Finger Lakes Allergy Clinic
784 Pre-Emption Road, Geneva, NY 14456

Phone: (315) 789-2153
Fax: (315) 789-4781

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Allergy

What is an Otolaryngic allergist?
What is Allergy?
Allergens
Food Allergy
Allergy Testing
Allergy Treatment
Allergy Drops
Frequently Asked Questions

WHAT IS AN OTOLARYNGIC ALLERGIST?

Dr. Gregory Carnevale is a Ear, Nose, Throat (Otolaryngology), board certified specialist, who has a Fellowship in Otolaryngic Allergy.

An Otolaryngic Allergist is able to diagnose and treat disorders of the upper respiratory tract (ear, nose, throat etc.) caused by allergic conditions. Because the Otolaryngic Allergist is an Ear, Nose, and Throat surgeon and specialist, other non-allergic diseases of the upper respiratory tract can also be efficiently diagnosed and treated. To diagnose and treat your allergies, the Otolaryngic Allergist uses methods that have been shown to not only identify specific allergens, but also to achieve effective control of allergies quickly.

When to see a Specialist: Under the following circumstances, the patient should seek consultation with an Otolaryngic Allergist:

• When the diagnosis of an ear, nose, or throat allergy or cause of an ear, nose, or throat symptom is uncertain.
• When allergy or ear, nose or throat symptoms are not adequately controlled.
• When special diagnostic allergy tests are needed.
• When specialized treatment such as immunotherapy is needed.
• When other related ear, nose, and throat medical problems, such as chronic sinusitis, nasal polyps, fluid in the middle ear, chronic ear infections, deviated septum, vocal disturbances, or enlarged adenoids or tonsils may be present.
• When complications associated with treatment or difficulty in controlling allergy symptoms are affecting the patient's quality of life.

WHAT IS ALLERGY?

Allergy is a condition, often inherited, in which the immune system of the affected person reacts to something eaten or something in the environment that doesn't affect most other people. People often think of an allergy as only "hay fever," with sneezing, runny nose, nasal stuffiness and itchy, watery eyes. However, allergies can also cause symptoms such as chronic "sinus" problems, post nasal drip, head congestion, frequent "colds," recurring ear infections, hearing loss, dizziness, chronic cough and asthma.

Even stomach and intestinal problems, many skin rashes, chronic headaches and fatigue can be symptoms of allergy. Any substance that triggers an allergic reaction is called an allergen. Allergens "invade" the body by being inhaled, swallowed or injected, or they may be absorbed through the skin. Common allergens include pollen, molds, dust, animal danders and foods.

ALLERGENS

Allergy symptoms that occur primarily in the spring, summer, or fall are frequently the result of inhaled pollens. Tree pollens in the spring, grass pollens in the early summer, and weed pollens in the late summer and fall provide a predictable pattern of symptoms often helpful in identifying the offending pollens. Pollen counts decrease during rain, increase after rain, and are highest between 5:00 am and 10:00 am. Unfortunately exposure to pollen is not limited to outdoors because they are carried inside on clothing, shoes, on pets, and enter through open doors and windows.

Molds or fungi are organisms that thrive on decaying organic matter. They are present year round, especially during the spring and fall. Most molds produce spores that become airborne and may cause inhalant allergies. They thrive in warm, dark, moist areas. Places such as bathrooms, poorly vented laundry rooms, basements, kitchens, window frames, refrigerator drain pans, old books, plants, poorly ventilated closets, leaking roofs, plumbing leaks and deteriorating carpets provide moisture that allow molds to thrive. Humid, warm air fosters mold growth. Therefore, control of your home's temperature and humidity can have great impact on your allergen exposure in the home.

Dust mites are microscopic insects that feed on tiny particles of skin that humans shed. Like molds, they tend to thrive with heat and humidity. Their favorite habitats include mattresses, couches, carpets, bedding, pillows, and children's stuffed animals. They do poorly when the humidity is less that 50% and thrive at comfortable air temperatures for humans--65 to 84 degrees Fahrenheit.

Animal dander is small particles found on the surface of animals that are deposited on anything the animal touches. Animal dander is light and stays airborne even longer than pollens. Cat dander, in particular, is very sticky and will hang around your house for at lest six months after the cat is removed from the environment. Cat dander is a very powerful trigger for allergic reactions for many individuals. Even if you do not have a cat at home, you will probably be exposed to cat dander through friends, family, and co-workers because the dander is so long lasting and difficult to eradicate. Cat saliva also induces allergy symptoms.

FOOD ALLERGIES

There are two types of food allergies: immediate (fixed) and delayed (cyclic). Fixed food reactions are not very common. Even so, they attract the most attention because they cause rapid and sometimes very dramatic reactions. Breaking out in hives and itching or serious swelling of the tongue and throat soon after eating shellfish, peanuts, or garlic, are typical examples of immediate food reactions. The best treatment for this type of food allergy is complete eliminations of the offending food from the diet.

Delayed-type food reactions are the most common food allergy. However, unlike immediate food reactions, the connection between the causative food and the symptoms is more difficult to pinpoint. This is because the typical symptoms from a delayed food allergy are slow to develop because repeated exposures to the food over a long time are required. Also, the symptoms are not so dramatic: they are usually slow to develop, chronic, and lingering.

Headaches, runny nose, ear pressure, cough, and eczema are some examples of these symptoms. Delayed food allergies often contribute to symptom production in persons with longstanding ear, nose, and throat complaints, such as ear or sinus infections, chronic voice or throat problems, eczema, hives, migraine, and asthma. These symptoms may also occur in people who do not have allergies, thus making it important to obtain a precise diagnosis.

To further complicate things, the types of food that cause delayed allergies are commonly included in just about everyone's diet--milk, wheat, corn, egg, soy to name a few. In order to develop symptoms from delayed allergies, the allergic food must be in your diet on a fairly regular and repeating schedule. The actual pattern of exposure to the food will critically affect the presence, absence, and severity of symptoms. If enough food is kept in the system all the time, symptoms can actually be temporarily minimized or "masked." Therefore some people will exhibit a dependence on the allergic food in order to keep symptoms in check, referred to as "craving" or "food addiction."

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ALLERGY TESTING

The initial or presumptive diagnosis of allergy is made through a patient's history and physical examination. To be certain of the diagnosis and prescribe effective treatment, findings must be confirmed by tests that identify the specific offending allergens. There are several methods to test for allergies which can be divided into two groups: those on the skin and those performed on the patient's blood. The testing methods on the skin involve either prick or intradermal injections using very fine needles which result in being able to measure the skin reactivity compared to non-reactive substances (controls). The test performed on your blood measures specific antibodies to specific allergens. Our office specializes in providing an environment to accurately skin test you with allergy nurses who are trained to quickly and efficiently assess your allergic sensitivity.

ALLERGY TREATMENT

There are three basic, accepted approaches to allergy care.

1. Avoidance of the offending allergens and environmental controls. Unfortunately, avoiding some allergens (such as dust, molds, and animals) is often difficult and thus allergen avoidance alone may not be effective. Additional measures including HEPA air cleaner, air conditioning, dust mite covers, humidity control and food cross-reactivity might provide additional benefit.
2. Pharmacotherapy (medications). These may include antihistamines, decongestants, prescription nasal sprays and other types of products. These, however, only control the symptoms and never really help address the underlying problem of your immune system.
3. Immunotherapy: allergy injections (shots), sublingual drops, anti-IgE injections. Immunotherapy can alter the body's overactive response by carefully challenging the patient’s immune system through regular administration of the actual allergens to which a patient is sensitive. Over time it is possible to alter a person's excessive response to these environmental allergens, and both improve symptoms, as well as, decrease the need for medications and allergen avoidance for many years.

ALLERGY DROPS

Allergy Drops are a 'no shot' method of delivering antigen to the body. Recently re-introduced to this country, it is available through our office. Up to 75% of allergy sufferers in Europe use antigen drops under the tongue for their allergy treatment. Allergy Drops allow patients who are not candidates for injection immunotherapy, including infants and young children, highly reactive patients, severe asthmatics, patients with chronic conditions including sinusitis, patients with food and mold allergies, and patients with multiple allergies to receive the benefits of immunotherapy. Broader applications, increased safety, ease of use, higher compliance and comparable costs are all advantages of sublingual immunotherapy.

FREQUENTLY ASKED QUESTIONS

1. Is allergy testing covered by my insurance?
   Other than your deductible, allergy testing is most always covered. Our office with inform you of the costs, if any, prior to testing being performed.
2. What is the length of treatment for immunotherapy?
   Whether you are on allergy shots or drops, the treatment is generally 3-5 years.
3. How safe are allergy drops?
   Very safe. There have been no reported anaphylactic reactions to this mode of therapy. The most common side-effect is local oral discomfort which usually resolves with conservative treatment.
4. Can Food allergies be treated using immunotherapy?
   Yes, sublingual drops which have been formulated with your specific allergens can be administered to neutralize the allergic reaction, and thus decreasing symptoms.
5. Are sublingual drops covered by insurance?
   Currently, no, despite overwhelming evidence supporting sublingual treatment. However, the cost of therapy is often less than a year’s treatment costs associated with injection immunotherapy. Flex-spending health accounts can be used to pay for sublingual drop therapy.
6. How frequently am I re-evaluated?
   Generally, our office schedules visits every 6 months while on immunotherapy. Our office is always available to handle questions over the phone and our clinics have regular scheduled hours. In addition, our allergy nurses are very experienced in answering your questions or concerns.
7. Can I receive allergy shots at home or at another physician’s office?
   Yes. After achieving a maintenance dose you can either transfer your serums to another physician’s office or learn to do the injections yourself. If you are a minor, an adult family member or friend can learn to administer the injections. Our office will spend considerable time in teaching the proper techniques in giving the shots as well as learning all the paperwork in order to re-order the serums.
8. How long does it take to be tested for allergies?
   A comprehensive allergy test (airborne and food allergens) generally takes up to two hours. The food testing portion takes approximately 30 minutes to perform. You will know what you're allergic to immediately after the testing.
9. Can I be skin tested for peanut allergies?
   No. If your history indicates a possible fixed (immediate) food allergy you can have a simple blood test to determine your allergic sensitivity.
10. Can my child be tested for allergies?
    Yes. We are able to test children 4 years of age and older. If testing is required in younger children we can either order a blood test or perform testing under general anesthesia.
11. How frequently do I need to get shots/drops?
    The frequency for injections (shots) is usually once per week for the first year. In subsequent years the frequency is tapered to control and relieve symptoms. With sublingual drops the treatment frequency is usually every day, done in the convenience of your home.