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Allergic rhinitis occurs frequently in children and adults. It is estimated to affect approximately 60 million people in the United States and its prevalence is increasing, affecting as many as 30% of adults and 40% of children. Allergic rhinitis, also known as hay fever, occurs when the immune system overreacts to something in the environment that is otherwise harmless (e.g., pollens).

The resulting nasal inflammation manifests as runny nose, sneezing, stuffiness, itchy nose, post-nasal drip and fatigue due to poor sleep quality as a result of nasal obstruction. Once diagnosed, our allergists will discuss treatment options with you including avoidance of triggers, medications and immunotherapy (allergy shots or allergy drops

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Allergic conjunctivitis (eye allergy) occurs when the immune system becomes sensitized and overreacts to something in the environment (e.g., pollens).

Symptoms include watery, red, itchy eyes, eye swelling, grittiness and sensitivity to light. These symptoms can occur alone or together with allergic rhinitis. Eye symptoms can usually be managed with antihistamine eye drops but may require more aggressive treatment including immunotherapy (allergy shots or allergy drops).

Read more about: Eye Allergies Bothering You?

The immune system protects the body from infections, viruses and diseases. An allergic reaction occurs when the immune system overreacts to an otherwise harmless substance.

Allergic reactions can occur to many agents, including pollens, molds, pet dander, dust mites, foods, drugs, chemicals, latex and insect stings.

There are many different types of allergic skin rashes including atopic dermatitis (eczema), contact dermatitis, urticaria (hives), and angioedema. Each of these is discussed separately on this page.

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Anaphylaxis is a serious, life-threatening allergic reaction. The most common anaphylactic reactions are to foods, insect stings, medications and latex. A family history of allergy or asthma increases the risk of anaphylaxis.

A personal history of anaphylaxis also increases the risk of having another anaphylactic reaction. Anaphylaxis requires immediate medical treatment, including epinephrine administration and urgent medical attention. Follow-up with our allergists is recommended to identify the potential cause of anaphylaxis.

Angioedema is swelling in the deep layers of the skin. It is often seen together with urticaria (hives), but can occur on its own.

Angioedema often occurs in soft tissues such as the eyelids, mouth or genitals. Acute angioedema is commonly caused by an allergic reaction to medications or foods and typically lasts minutes to hours.

Chronic angioedema on the other hand will recur intermittently over months or years. Chronic angioedema often does not have an identifiable cause. Hereditary angioedema (HAE) is a rare, but serious genetic condition involving recurrent swelling throughout the body. It does not respond to treatment with antihistamines or epinephrine (adrenaline), so it is important to see our allergists if you have this condition.

Asthma is a chronic lung disease that causes inflammation and narrowing of the airways. Asthma affects 26 million children and adults in the United States.

Asthma symptoms can be caused by inhaled allergens and other irritants, resulting in inflamed, clogged and constricted airways. Symptoms include coughing, wheezing, shortness of breath, chest tightness and trouble breathing due to bronchospasm (tightening of the airways).

People with a family history of allergies and asthma are more prone to develop asthma, and most people with asthma also have allergies. There is no cure for asthma, but it can usually be controlled with preventive treatment strategies.

Read more about: Biologic therapy for asthma

Atopic dermatitis (eczema) is very common, especially in children. It affects one in five infants but only around one in fifty adults. It is thought to be due to “leakiness” of the skin barrier, resulting in dryness and susceptibility to irritation and inflammation by environmental factors. Some people with eczema have food sensitivities which can make eczema symptoms worse.

Atopic dermatitis may be the first step in the “atopic march” as children with eczema have increased risk for food allergy, allergic rhinitis and asthma. Our allergists can help determine whether food or environmental allergies are contributing to your eczema.

Read more about: Eczema

Contact dermatitis occurs when the skin comes in direct contact with a chemical irritant resulting in a rash 24 to 48 hours later.

Metals, nickel, poison ivy, perfumes, dyes, rubber (latex) products, cosmetics and other chemicals can cause contact dermatitis. Some medication ingredients can also cause a reaction when applied to the skin. Contact with even a small amount of the causative agent can cause red, bumpy, scaly, itchy or swollen skin.

Treatment includes wet soaks and compresses as well as corticosteroid creams. Patch testing can help identify the causes of these reactions.

Read more about: Contact Dermatitis

Cough is considered chronic if it is present for eight weeks or more. The most common causes of chronic cough are postnasal drainage from allergic rhinitis or sinusitis, asthma and gastroesophageal reflux disease (GERD or heartburn). While any of these may be the cause of chronic cough, there are a number of other less common causes.

Our allergists can help diagnose the cause of your chronic cough.

While adverse reactions to medications are common, about 5% to 10% of these reactions are due to an underlying allergy to the medication.

Symptoms of a drug allergy can include hives, swelling and difficulty breathing. Common drug allergies include penicillin, sulfa and other antibiotics as well as nonsteroidal anti-inflammatory drugs such as aspirin and ibuprofen.

Drug allergy skin testing and/or drug challenges can help to diagnose or rule out drug allergies.

Read more about: Penicillin Allergy

Eosinophilic esophagitis (EoE) is a recently recognized allergic/immune condition. In EoE increased numbers of white blood cells called eosinophils accumulate in the esophagus resulting in inflammation and swelling. The symptoms of EoE vary with age.

Young children may refuse their food or have growth delay. School-age children often have recurring abdominal pain, trouble swallowing or vomiting. Teenagers and adults most often have difficulty swallowing.

Food skin prick and patch testing, as well as environmental allergy testing can help identify triggers of EoE.

Exercise is a common trigger of asthma symptoms. Symptoms usually occur within 5-20 minutes of strenuous activity and may include wheeze, cough, shortness of breath and chest tightness.

People with EIB are very sensitive to both cold temperatures and dry air. Air is usually warmed and humidified by the nose, but during demanding activity people breathe more through their mouths. This allows cold, dry air to reach the lower airways and lungs without passing through the nose, triggering asthma symptoms. Air pollution, high pollen levels and viral respiratory infections may also be triggers.

Pulmonary function testing and the use of a short-acting beta agonist bronchodilator are helpful in the treatment of exercise induced asthma.

Food allergy occurs when the immune system overreacts to particular proteins in foods. The most common food allergens are milk, egg, peanut, tree nuts, fish, shellfish, soy and wheat. Food allergy reactions can be life-threatening. Oral immunotherapy or desensitization is a new treatment that can help patients and families cope with food allergies.

Other types of food allergy include: oral allergy syndrome, and food protein-induced enterocolitis syndrome or FPIES. Food allergies may be a trigger for, or be associated with other allergic conditions, such as atopic dermatitis (eczema) and eosinophilic gastrointestinal diseases.

Our board-certified allergists can help diagnose and manage your food allergies.

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Gastroesophageal Reflux Disease is a digestive disorder that occurs when acid and other gastric contents back up from the stomach into the esophagus. GERD affects people of all ages, from infants to older adults. Those with asthma are at higher risk of developing GERD, and uncontrolled GERD can make asthma and allergy problems worse.

Symptoms of GERD include heartburn and indigestion. Lifestyle changes and medications can help treat GERD. People with asthma and GERD may see a decrease in asthma symptoms after treating their reflux.

Read more about:  Gastroesophageal Reflux Disease (GERD)

While the majority of headaches are not a sign of a serious or life-threatening illness, they often affect quality of life. Headaches with allergic rhinitis (hay fever) are common and may also be due to acute or chronic sinus disease. An allergist can help to determine if your headaches are due to underlying allergies or sinus problems.

Treatment strategies could include steps to avoid specific allergens, medications or allergy immunotherapy (allergy shots or allergy drops).

Hives (urticaria) are an inflammatory condition of the skin triggered when the immune system releases histamine and other agents. These chemicals cause small blood vessels to leak, which leads to red, itchy raised bumps and swelling of the skin. Hives may appear suddenly and go away just as quickly. Swelling in deep layers of the skin is called angioedema.

There are two kinds of urticaria, acute (6 weeks). Acute urticaria occurs after contact with an allergen, especially foods, insect stings and medications. It can also be triggered occasionally by heat, exercise, infection, or other physical factors.

Chronic urticaria is only diagnosed if hives have lasted longer than 6 weeks and can ultimately be a lifelong condition. Chronic urticaria can sometimes be associated with autoimmune conditions. Although they are annoying and uncomfortable, hives are not contagious.

Testing can help to determine what may be causing your hives. We can help identify an effective treatment for your condition.

Read more about: Hives and Xolair

The immune system protects and defends against attacks by "foreign" invaders including bacteria, viruses and fungi. When a part of the immune system is absent, or is present but does not function properly, an immune deficiency may develop. In most immune deficiencies there is pattern of repeated infections, severe infections and/or infections that are difficult to treat.

Infections may occur in the respiratory tract, ears, gastrointestinal tract, skin or other organ systems, depending on the underlying problem.

Our allergists are board certified in immunology and will evaluate you for immune deficiency conditions if you have trouble with frequent or severe infections.

Read more about: Primary Immune Deficiencies and Immunoglobulin Replacement

Mold is a type of fungus. While plants make seeds, molds make tiny spores that float in the air like pollen. When people with a mold allergy inhale the spores they develop allergy symptoms. There are many different kinds of mold.

The most common allergy-causing molds include Alternaria, Aspergillus, Cladosporium and Penicillium. Outdoor molds can grow on rotting logs and fallen leaves, in compost piles, and on grasses and grains. Unlike pollens, molds do not die with the first frost in late fall or early winter. They just stop growing during this time.

In the spring, they grow on plants killed by the cold. Indoor molds grow in places where there is moisture, such as the kitchen, bathroom, and basement.

Allergy skin testing can help clarify whether you are allergic to molds.

Nasal polyps are soft, non-cancerous growths in the nasal passages and sinuses. They result from chronic inflammation and are often associated with allergic rhinitis, asthma, and specific medications or immune conditions.

Nasal polyps can be large enough to block the nasal passages and may lead to breathing problems, frequent sinus infections or loss of ability to smell.

Direct visualization on a physical exam or a CT of the sinuses can help determine the presence or absence of nasal polyps.

Nonallergic rhinitis (vasomotor rhinitis) is a condition that causes chronic sneezing, congestion, and runny nose. About 19 million people have nonallergic rhinitis in the United States. While these symptoms are similar to those of allergic rhinitis (hay fever), nonallergic rhinitis is different because, unlike an allergy, it does not involve the immune system.

Triggers of nonallergic rhinitis include smoke, airborne pollutants, perfumes, cleaning solutions, hormonal changes, foods, beverages, changes in weather and some medications.

Symptoms are similar to allergic rhinitis and can be intermittent or constant but rarely includes itchy nose, throat or eyes. Our allergists can help distinguish between nonallergic and allergic rhinitis.

Almost 62% of U.S. households have pets, and more than 161 million of these pets are cats and dogs. Unfortunately, millions of pet owners have allergies to their animals. The proteins found in a pet's dander, skin flakes and saliva can cause an allergic reaction or aggravate asthma symptoms. Also, pet hair or fur can collect pollen, mold spores and other outdoor allergens.

Despite popular opinion, there are no truly “hypoallergenic breeds” of dogs or cats. Allergenicity of the danger in cats and dogs is not affected by length of hair or fur, nor by the amount of shedding. Giving up a pet in order to prevent allergy symptoms is not typically necessary, however.

Our allergists can accurately diagnose a pet allergy and help manage allergy symptoms to help keep the family pet part of the family.

Sinusitis is inflammation or swelling of the tissue lining the sinuses. It occurs commonly and affects 37 million people in the United States annually. The sinuses are normally filled with air, but in sinusitis the sinuses become blocked and filled with fluid allowing germs to grow, often leading to infection.

Symptoms include nasal congestion, facial pressure, thick nasal discharge and cough. Sinusitis can be due to poorly controlled allergies, recent respiratory viral infection, nasal polyps or other structural problems in the nose or sinuses. There are different types of sinusitis including:

• Acute sinusitis: A sudden onset of cold-like symptoms such as runny, stuffy nose and facial pain that does not go away after 10 to 14 days. Acute sinusitis typically lasts 4 weeks or less.
• Chronic sinusitis: A condition characterized by sinus symptoms lasting 12 weeks or longer. Chronic sinusitis may linger for years if not completely treated.
• Recurrent sinusitis: Several episodes within a year. A complete history and physical exam can often identify patients with sinusitis. A CT of the sinuses can also help identify chronic sinus disease and other structural problems that may lead to recurrent sinus infections.

Our on-site state-of-the-art Xoran MiniCAT CT scanner allows us to safely and painlessly image your sinuses and identify signs of sinusitis, nasal polyposis, and other structural abnormalities in less than 1 minute. There is no need for our patients to make an extra trip or be exposed to higher radiation levels typical of full-size CT scanners in hospitals and other imaging facilities.

All CT scans are overread by a Board-Certified Neuroradiologist. IAC (Intersocietal Accreditation Commission) requirements ensure that a imaging facility is providing high quality care and held to industry standards. Our center is a fully IAC accredited facility.

Our physicians are certified to perform and review the CT results with you immediately and direct appropriate treatment.

Read more about: Sinusitis

Most people have pain, redness and localized swelling at the site of an insect bite. People who are allergic to stinging insect venom are at risk for a more serious reactions including symptoms such as hives, shortness of breath, wheezing and anaphylaxis.

Allergic reactions to stings can occur even after many normal reactions to stings and at any age. Potentially life-threatening allergic reactions to insect venom occur in up to 0.8% of children and 3% of adults. Insect sting reactions account for at least 40 deaths each year in the United States.

Stinging insect allergy can be seen due to stings from fire ants, bees, wasps, yellow jackets, and hornets. Insect venom allergy skin testing can help determine the presence of a stinging insect allergy and immunotherapy (allergy shots) can be life-saving.

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Vaccines save lives and most vaccines used now are extremely safe. Allergic reactions to vaccines do occur, and when they happen, episodes can be serious, even life-threatening. In such cases, our board-certified allergists can do skin prick testing and intradermal skin testing with a small dose of vaccine and other vaccine components to help identify the suspected allergen in the vaccine.

For the most part, even those with known allergies can be safely vaccinated using alternative forms of a vaccine that are free of the allergen.

Even if allergen-free formulations are unavailable, many patients can still be vaccinated in our office and remain under physician supervision for several hours after vaccination.

Vocal Cord Dysfunction (VCD) occurs when the vocal cords (voice box) do not open correctly during inhalation, leading to asthma-like breathing symptoms. VCD is a recently recognized disorder and has also been referred to as paradoxical vocal fold movement (PVFM). VCD can exist alone, but many people with asthma also have VCD and reflux.

Symptoms of VCD can overlap with symptoms of asthma and include difficulty breathing, coughing, wheezing, throat tightness and hoarseness. Unlike asthma, VCD causes more difficulty breathing in than breathing out. The reverse is true for asthma.

Our allergists can perform pulmonary function testing and help determine whether you have VCD and recommend treatment options.