Our physicians are Board Certified in Pediatrics, Internal Medicine, Allergy and Immunology. We treat children and adults of all ages who experience allergic and other immune conditions, including:
- Allergic rhinitis
- Sinus disease
- Asthma, chronic cough and related respiratory complaints
- Aeroallergen, food, drug and stinging insect sensitivities
- Skin sensitivities
- Recurrent infections
We feel it imperative that every patient receive the time and attention required for the best possible patient experience. Our goal is to satisfy patient and referring physician needs diligently, expediently, and expertly.
Allergy Associates FAQ
How are childhood allergies diagnosed?
The earlier allergies show themselves in childhood, the worse they will tend to be. The earliest expression of allergy in childhood is a food allergy. This allergy typically takes the form of eczema but can also cause rhinitis, sinusitis, otitis media (recurrent ear infections), and childhood asthma. Most food allergies that do not cause severe life threatening allergic reactions resolve by school age or puberty. This is particularly true for milk allergy which is very common in early childhood. Others such as peanuts, tree nuts, fish, and shellfish tend to last a lifetime.
Allergies to environmental allergens such as pollens, dust mites, molds and animal danders do not appear until two or three years of age, at the earliest. However, once they do appear they tend to gradually worsen and become more and more complicated. For example, a child with grass or dust mite allergy at three to five years of age will typically have multiple allergies by puberty and eventually suffer from complications of the allergies over time.
For children under the age of five, allergies are typically diagnosed using a blood test. Skin testing (prick only) can be used, but minimally, since false negative (NOT false positive) results occur. After the age of five, the skin test is the most accurate method for diagnosing most allergies.
Skin test prick technique involves introducing a small amount of allergen into the skin by making a small scratch through a drop of the allergen extract. If you have an allergy, the specific allergens that you are allergic to will cause a chain reaction to begin on your skin and you will get a small itchy welt at the site of the scratch. This will develop over about 15 minutes and then slowly resolve over another 30 minutes, so you don't have to wait long to know the results. There is a negligible risk of the reaction affecting other areas of your body. People with allergies have an allergic antibody called IgE (immunoglobulin E) in their body. This chemical, which is only found in people with allergies, activates special cells called mast cells. These mast cells release chemicals called mediators such as histamine, the chemical that causes redness and swelling. With testing, this swelling occurs only in the spots where the tiny amount of allergen to which you are allergic has been introduced. So, if you are allergic to grass pollen but not to cats, the spot where the ragweed allergen touched your skin will swell and itch a bit, forming a small dime-sized hive. The spot where the cat allergen scratched your skin will remain normal. This reaction occurs and tends to resolve within your body quickly.
How can childhood allergies by prevented?
Children in families where one or both parents have allergies and related conditions (e.g. eczema, asthma) are more likely to develop allergies. That is why many prevention efforts have been targeted to children of allergic parents. We cannot change the genes we inherit from our parents. However, it has been known for some time that how our genes express themselves can be influenced by our environment.
Food allergies in children can cause a variety of problems that range from eczema to life-threatening allergic reactions. The major strategy for preventing food allergies is to delay exposure to potentially allergenic foods and liquids, since newborn infants may be more likely to become allergic to foods than older infants. Mothers should exclusively breast feed their infants for at least four to six months, if possible, since breast milk is much less likely to produce an allergic reaction than formula and can strengthen the child's immune system. Any supplements should be limited to either water or pumped breast milk, if possible. Infants that are not breast fed or are fed with breast milk and in need of a supplement, should be fed partially pre-digested, protein hydrolysate formulas such as Alimentum or Nutramigen rather than milk or soy-based formulas.
Infants should not be fed solid foods until they are six months old. When infants are six to 12 months old, vegetables, rice, meat, and fruit can be introduced to their diets. Each food should be introduced individually (one at a time for several days before another is introduced) so parents or caregivers can identify and eliminate any foods that cause a reaction. After the child is one year old, milk, wheat, corn, citrus and soy may be added. At two years of age, the child may have egg. Finally, at age three, fish and peanuts may be introduced.
It makes good common sense that since some airborne substances may trigger allergy symptoms, including eczema, rhinitis and asthma, that reducing contact with these substances early in life may delay or prevent the onset of allergy conditions. The evidence for this relationship is clearest in the case of dust mites, which are found in large quantities inside the home. Taking steps to aggressively control dust mites in the homes of high-risk children may reduce the occurrence of dust mite allergy in these children. Refer to Dust Mite Avoidance for specific avoidance steps.
However, there is scientific evidence that avoidance of other allergens early in life is not particularly helpful and, in some circumstances, even harmful. Recently published data has made the relationship between early life exposure to animals and the eventual development of allergies and asthma much more confusing. For example, some evidence seems to show that early life exposure to animals may make children more likely to develop allergies and asthma whereas more recent evidence seems to show that early life exposure to animals (dogs and cats, in particular) may protect children from developing these diseases later in life. Your allergist/immunologist can address this issue with you to give you the most current information and can match this current information with the needs of your family. In general, it appears that living on a farm or having a dog seems to have a favorable influence on reducing allergy and asthma development in at-risk children.
What is childhood asthma?
Asthma is the most common serious chronic disease of childhood, affecting nearly six million children in the United States. Asthma in children is the cause of almost four million physician visits and 200,000 hospitalizations each year and is a major cause of school absenteeism.
Children with asthma will cough, wheeze, experience chest tightness and shortness of breath. Many parents do not realize that a chronic cough may be the only symptom of asthma and conversely, that a child does not have to wheeze to have asthma. Children with reactive airway disease, recurrent bronchitis or wheezy bronchitis probably have asthma in different forms. Some children with chronic cough do not have asthma and will never develop it. Your allergist/immunologist can help decide if your child really has asthma and what the future holds for your child.
How is childhood asthma diagnosed?
Up to 80% of children with asthma develop symptoms before age five. A child's physician must rely heavily on parents' observations to make a proper diagnosis in this young age group. Often the diagnosis is made by a combination of family history, presence of wheezing, and response to asthma medications. It is important to remember that many children who wheeze before the age of five do not end up with asthma. It is up to your allergist/immunologist to help define who really has asthma and who will outgrow their tendency to wheeze.
To make a diagnosis of asthma, your child's physician will want to know about the following:
- Does your child cough, wheeze (a whistling sound when breathing), have chest tightness or shortness of breath?
- Do colds go right to your child's chest and last much longer than other siblings?
- Does your child cough or wheeze with exercise, play and laughter or during temper tantrums? Can the wheeze occur any time without there being an infection?
- Is there a family history of asthma or allergies, particularly in the parents or any siblings?
- What triggers your child's symptoms - colds, allergens (like the family pet) or exercise?
- How often are the symptoms and how bad?
- Is your child missing school?
Is coughing or wheezing keeping you and your child up at night? If your child is old enough (usually older than five or six), he or she may do a pulmonary function test. The results will tell the physician about how the child's lungs actually work. This test helps not only in the diagnosis but will help the doctor follow the response to medication.
For children, asthma symptoms can interfere with many school and extracurricular activities. Parents may notice their child has less stamina during play than his or her peers, or they may notice the child trying to limit or avoid physical activities to prevent coughing or wheezing. More subtle signs of asthma, such as chest tightness, are often not identified as such by children. Sometimes they will complain that their "chest hurts" or that they cannot "catch their breath." Often, recurrent or constant coughing spells may be the only observable symptom.
The two most common triggers of asthma in children are common colds and allergens (substances that trigger allergies). In fact, most kids with asthma are allergic and should have an allergy evaluation as part of their evaluation and care. Common allergens include dust mite, animal dander, cockroach, pollen and molds. We cannot do a lot about viral illnesses but there are ways to limit allergen exposure in the home environment if you know what you need to avoid.
How can childhood asthma be prevented?
Mothers who smoke during pregnancy put their newborn at increased risk of wheezing during infancy. Exposing children to second hand smoke in the home has also been shown to increase the development of asthma and other chronic respiratory illnesses. Therefore, it is extremely important that infants not be exposed to tobacco smoke before or after they are born.
Respiratory infections are also a common trigger of asthma. Breast feeding for the recommended time period of at least six months strengthens a child's immune system, which can be helpful in avoiding respiratory infections, and consequently, asthma. Early exposures to viral infections in some circumstances appears to have a beneficial effect on the long-term development of asthma, but not necessarily allergies. However, once asthma has been established in a child, it may be best to avoid early exposures to infectious disease until around school age. This also is a very controversial subject and should be discussed with your allergist/immunologist.