Allergy Testing and Treatment
by James Biddle, MD

WHAT IS AN ALLERGY?

An allergy is an immune reaction in which small amounts of a substance (an allergen) cause an exaggerated immune response, with unpleasant symptoms. If you display hay fever, chronic sinusitis, chronic bronchitis, itching, headaches, bloating, muscle and joint pains, fatigue, sneezing, and/or coughing, you have a pretty good chance of having allergies to inhaled allergens, such as pollen, dust mites, mold, or pet dander.

HOW DID IT HAPPEN TO ME?

Some people inherit a tendency to form allergies. When you are repeatedly exposed to an allergen, you then form antibodies (IgE) against that substance. Once they are formed, IgE antibodies attach to certain cells in the lining of the nose and sinuses and wait for re-exposure. When re-exposure occurs, the antibodies bind with the offending allergen, causing the release of chemicals such as histamine. Histamine causes swelling and itching along the linings of the nose, eyes, sinuses, and airways.

WHAT DOES THE IMMUNE SYSTEM DO?

Your immune system protects you from bacteria, viruses, and other foreign substances (allergens). People with allergies have immune systems that are overly reactive, and thus attack substances which are actually not otherwise dangerous to us, such as pollen. They see these allergens as harmful and produce antibodies against them inappropriately. When the antibodies later see the offending allergen again, they cause the release of histamine to try and "wash" the bad guys away. This histamine production is usually the main culprit in making us feel so horrible. Your immune system has a very good memory and will quickly attack allergens that are "repeat offenders", even years later. This is why many allergy sufferers tend to get their symptoms at the same time each year. We can make our lives much more comfortable with appropriate treatment.

WHAT IS THE CONVENTIONAL APPROACH TO "DESENSITIZING" ALLERGIES?

The conventional approach to desensitization is to give the client a weekly injection of a mixture of small amounts ("serum") of their allergens. The induces the body to make IgG antibodies against the allergen, which bind onto the offending substance during any future exposures, thereby blocking the activation of IgE antibodies. Recall that it is the IgE which causes histamine release and therefore allergy symptoms. Thus, the body builds up an immunity to the allergens and no longer sees them as foreign. In other words, you have been "desensitized". This allows your immune system to calm down and stop its over-reactivity. This system works well, but has several drawbacks. The most serious is that the concentrations of allergens in the injection serum is periodically increased. The first injection after this increase is known as a "boosting dose", and patients will occasionally have a dangerous anaphylactic allergic response after a boosting dose injection. Another drawback is that it's inconvenient and expensive to go to the physician's office once or twice a week for injections.

WHAT IS ORAL DESENSITIZATION?

Research has shown that similar results can be accomplished by desensitizing with oral drops of serum under the tongue (i.e. sublingually) rather than using shots (see page 4). This decreases costs and increases convenience for the client. In addition, it's much safer because there is virtually no risk of an anaphylactic reaction. After an initial visit with the doctor, skin testing is performed to establish what you are allergic to. Routine allergy testing stops there, but never tells how allergic you are to each particular allergen. In other words, how strongly do you react to each different pollen? Our method of testing is much more revealing than the conventional approach of just a positive or negative result. By having a measure of the degree of your allergic response to each antigen (known as "end-point titration"), we're able to choose an appropriate concentration of each allergen to mix into the serum. This is what allows us to use the oral drops effectively. Our testing takes a little more time, but provides us with a high degree of confidence in treating our patients safely.

BUT I'VE TRIED SHOTS!

Many of our patients have also tried shots, and they are very excited that AIM is giving them the opportunity to administer their own serum at home instead of going to the doctor's office once or twice a week. Waiting at the office for an anaphylactic response to the boosting doses can be time-consuming and worrisome. Our patients go directly onto the maintenance dose that their own body prescribes during testing. Patients feel better faster, it's safer, and it's great for their immune system! We feel sublingual serum is one of the best-kept secrets for allergy patients. You pay just for the serum, not for office personnel to administer it. When you lead a busy life-style as many of us do, it's much more convenient to do this safely in the privacy of your own home, and at your own leisure.

HOW IS THIS DIFFERENT FROM SHOTS?

First we titrate you. This means we find out just how allergic you are on a scale of 1 to 8. This tells us more than just a "yes" or "no" answer about your allergy to something. It tells us exactly what dose you need. Your treatment regimen is designed specifically for your particular degree of sensitivity. With shots, it often takes years to get regulated. With drops, you can often feel better in a couple of weeks. We also check your skin's delayed reaction in 24 hours, which is very important. Some people only have delayed allergies and these are the hardest to pinpoint. We do this via phone and a map of your arm, or you can drop by the clinic and let us read your delayed reactions for you.

IS THERE ANY REASON I CAN'T DO THIS?

There are no absolute contraindications. However, for your own safety, we cannot test you against substances for which you've had a prior anaphylactic reaction. In addition, we are unable to test you if you have recently taken prednisone within a number of weeks, or antihistamines within a number of days, because your immune system will not react appropriately.

HOW IS TESTING DONE?

To assess exactly what you are allergic to, and to what degree, minute amounts of allergen are put just under the skin of the upper arm with a tiny needle. Even children tolerate this testing. During testing, please wear clothes that allow easy access to your upper arm and are not restrictive to blood flow. The initial session may take an hour, or at most two hours.

To learn more about the treatment options available for Allergic Rhinitis (hay fever), click here.