Asthma, Allergy & Immunology

Asthma, Allergy & Immunology on Long Island, NY.


WHAT IS AN ALLERGIST?

An allergist / immunologist (commonly referred to as an allergist) is a physician specially trained to diagnose, treat and manage allergies, asthma, sinusitis, otitis media, urticaria (hives), dermatitis (itchy skin), environmental and food allergies from infancy to the elderly. The specialty of allergy / immunology encompasses medical conditions from the very common to the very rare, spanning all age groups and involving numerous organ systems. This breadth of knowledge and experience makes the allergist / immunologist the ideal specialist to make sense of your symptoms and develop a coordinated treatment approach.

In the United States, becoming an allergist / immunologist requires at least an additional nine years of training beyond a bachelor’s degree. Dr. Louis Guida has had 12.5 additional years of training after he received his bachelor’s degree from college and has had 30+ years in specialized allergy / asthma, etc. practice here on Long Island.

SYMPTOMS, DIAGNOSIS, TREATMENT & MANAGEMENT

Allergies are among the most common chronic conditions worldwide. Allergy symptoms range from making you miserable to putting you at risk for life-threatening reactions.

According to the leading experts in allergy, an allergic reaction begins in the immune system. Our immune system protects us from invading organisms that can cause illness. If you have an allergy, your immune system mistakes an otherwise harmless substance as an invader. This substance is called an allergen. The immune system overreacts to the allergen by producing Immunoglobulin E (IgE) antibodies. These antibodies travel to cells that release histamine and other chemicals, causing an allergic reaction.

ALLERGY SYMPTOMS

An allergic reaction typically triggers symptoms in the nose, lungs, throat, sinuses, ears, lining of the stomach or on the skin. For some people, allergies can also trigger symptoms of asthma. In the most serious cases, a life-threatening reaction called anaphylaxis (an-a-fi-LAK-sis) can occur.

A number of different allergens are responsible for allergic reactions. The most common include:
•    Pollen
•    Dust
•    Food
•    Insect stings
•    Animal dander
•    Mold
•    Medications/Drugs
•    Latex

ALLERGY DIAGNOSIS

If you or your child have allergy symptoms, an allergist, can help with a diagnosis. An allergist has advanced training and experience to properly diagnose your condition and prescribe an allergy treatment and management plan to help you feel better and live better.

Asthma is a chronic disease involving the airways in the lungs. These airways, or bronchial tubes, allow air to come in and out of the lungs.

If you have asthma your airways are always inflamed. They become even more swollen and the muscles around the airways can tighten when something triggers your symptoms. This makes it difficult for air to move in and out of the lungs, causing symptoms such as coughing, wheezing, shortness of breath and/or chest tightness.

For many asthma sufferers, timing of these symptoms is closely related to physical activity. And, some otherwise healthy people can develop asthma symptoms only when exercising. This is called exercise-induced asthma (EIA). Staying active is an important way to stay healthy, so asthma shouldn't keep you on the sidelines. Dr. Guida  can develop a management plan to keep your symptoms under control before, during and after physical activity.

People with a family history of allergies or asthma are more prone to developing asthma. Many people with asthma also have allergies called allergic asthma.

Occupational asthma is caused by inhaling fumes, gases, dust or other potentially harmful substances while on the job.  Childhood asthma impacts millions of children and their families. In fact, the majority of children who develop asthma do so before the age of five.

There is no cure for asthma, but once it is properly diagnosed and a treatment plan is in place you will be able to manage your condition, and your quality of life. An allergist is best qualified physician in diagnosing and treating asthma. With the help of your allergist, you can take control of your condition and participate in normal activities.

URTICARIA (HIVES) DEFINITION

Hives (urticaria), involve red, itchy, swollen areas of the skin that range in size and appear anywhere on the body. They can appear suddenly, and may be the result of an allergic reaction.

Some people have chronic urticaria that occurs almost daily for months or, in some cases, years. Treatment with oral antihistamines is frequently successful, but in severe cases, steroids may be needed.

In addition to allergic reactions to medications, foods, or other substances, hives may be triggered by viral infections, temperature extremes, water, sun, and physical exercise.

SINUSES | SINUSITIS | RHINOSINUSITIS DEFINITION

The sinuses are located in the front of the face in the forehead (frontal sinuses), between the eyes (ethmoid and sphenoid sinuses) and in the cheekbones (maxillary sinuses). They  are cavities in your skull located around the eyes and behind the nose. Sinus pockets are also referred to as paranasal sinuses. These cavities lighten the weight of the skull. They also filter and moisten the air you breathe and give resonance to your voice. The sinuses are lined with very fine hair-like cells called cilia. The cilia help drain mucus through the sinus passages into the nose.

Rhinosinusitis, commonly referred to as sinusitis, occurs when the sinus openings become blocked or too much mucus builds up causing one or more of the cavities to become inflamed or swollen, allergic rhinitis and allergic asthma can be associated with chronic sinusitis.

ALLERGY SHOTS (IMMUNOTHERAPY)

Allergen immunotherapy, also known as allergy shots, is a form of long-term treatment that decreases symptoms for many

people with allergic rhinitis, allergic asthma, conjunctivitis (eye allergy) or stinging insect allergy.

Allergy shots decrease sensitivity to allergens and often leads to lasting relief of allergy symptoms even after treatment is stopped. This makes it a cost-effective, beneficial treatment approach for many people.

WHO CAN BENEFIT FROM ALLERGY SHOTS?
Both children and adults can receive allergy shots, although it is not typically recommended for children under age five. This is because of the difficulties younger children may have in cooperating with the program and in articulating any adverse symptoms they may be experiencing. When considering allergy shots for an older adult, medical conditions such as cardiac disease should be taken into consideration and discussed with your allergist / immunologist first.

You and your allergist / immunologist should base your decision regarding allergy shots on:
•    Length of allergy season and severity of your symptoms
•    How well medications and/or environmental controls are helping your allergy symptoms
•    Your desire to avoid long-term medication use
•    Time available for treatment (allergy shots requires a significant commitment)
•    Cost, which may vary depending on region and insurance coverage

Allergy shots are not used to treat food allergies. The best option for people with food allergies is to strictly avoid that food.

HOW DO ALLERGY SHOTS WORK?
Allergy shots work like a vaccine. Your body responds to injected amounts of a particular allergen, given in gradually increasing doses, by developing immunity or tolerance to the allergen.

There are two phases:
•    Build-up phase. This involves receiving injections with increasing amounts of the allergens about one to two times per week. The length of this phase depends upon how often the injections are received, but generally ranges from three to six months.
•    Maintenance phase. This begins once the effective dose is reached. The effective maintenance dose depends on your level of allergen sensitivity and your response to the build-up phase. During the maintenance phase, there will be longer periods of time between treatments, ranging from two to four weeks. Your allergist / immunologist will decide what range is best for you.

You may notice a decrease in symptoms during the build-up phase, but it may take as long as 12 months on the maintenance dose to notice an improvement. If allergy shots are successful, maintenance treatment is generally continued for three to five years. Any decision to stop allergy shots should be discussed with your allergist / immunologist. 

HOW EFFECTIVE ARE ALLERGY SHOTS?
Allergy shots have shown to decrease symptoms of many allergies. It can prevent the development of new allergies, and in children it can prevent the progression of allergic disease from allergic rhinitis to asthma. The effectiveness of allergy shots appears to be related to the length of the treatment program as well as the dose of the allergen. Some people experience lasting relief from allergy symptoms, while others may relapse after discontinuing allergy shots. If you have not seen improvement after a year of maintenance therapy, your allergist / immunologist will work with you to discuss treatment options.

Failure to respond to allergy shots may be due to several factors:
•    Inadequate dose of allergen in the allergy vaccine
•    Missing allergens not identified during the allergy evaluation
•    High levels of allergen in the environment
•    Significant exposure to non-allergic triggers, such as tobacco smoke

WHERE SHOULD ALLERGY SHOTS BE GIVEN?
This type of treatment should be supervised by a specialized physician in a facility equipped with proper staff and equipment to identify and treat adverse reactions to allergy injections. Ideally, immunotherapy should be given in your allergist / immunologist's office. If this is not possible, your allergist / immunologist should provide the supervising physician with comprehensive instructions about your allergy shot treatments.

Information obtained from American Academy of Allergy Asthma Immunology website (https://www.aaaai.org)

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