“Allergy is a four-season disease inflicting high morbidity and underappreciated by patients and providers alike,” says Philip Halverson, MD, Allergy and Asthma Specialists. Ragweed, the fiercest culprit, joins a host of other offenders including tree and grass pollen, mold spores, dust mites and pets.
“This disease doesn’t get the respect it deserves.”
Halverson says specialists can help manage chronic conditions where allergy is not always identified, such as rhinosinusitis, conjunctivitis, asthma, cough, urticaria/ angioedema, eczema and anaphylaxis.
Primary care physicians have referred to specialists for years, often using their own guidelines, according to David Brockway, MD, Richfield Medical Group.
“If someone has allergic issues or allergy symptoms more than three months out of the year and doesn’t respond to antihistamines, steroid nasal sprays or a non-steroid leukotriene inhibitor like Singulair®, I will refer to a specialist,” Brockway says.
Cherie Zachary, MD, Midwest ENT Specialists, recommends that primary care providers refer when the patient experiences one or more urgent care or emergency visits for asthma or is hospitalized. She also wants to see patients who take moderate to high doses of inhaled steroids or oral prednisone more than once a year.
“They are candidates for evaluation,” Zachary says, “especially pediatric patients because prednisone and inhaled corticosteroids can cause adverse growth effects.”
“Medical literature is clear when it comes to the treatment of patients with asthma,” she adds. “Allergists are more cost-effective because patients end up in the hospital less frequently.”
The time to refer an asthma patient is when he or she has moderate to severe or persistent asthma requiring ongoing therapy with a controller, says Halverson. “We can determine whether a chronic cough is actually asthma or perhaps post-nasal drainage or reflux, each of which is treated differently,” he says.Mee Lee Nelson, MD, an allergy and asthma specialist with Southdale Pediatric Associates, encourages primary care physicians to seek a board-certified allergist for patients with difficult-to-treat allergies or asthma.
“Food-related allergies should always be treated by a specialist,” says Nelson. “We know how to interpret blood test results, which can sometimes produce false positives. We also know that patients sometimes outgrow food allergies and can resume eating troublesome foods after a period of time.”
Halverson adds: “Patients who have had chronic hives, with or without angioedema, for six weeks or more should also probably see an allergy specialist.”Allergists offer services including:
- Allergy evaluation of aeroallergens, foods, drugs, venom –skin testing, oral challenge, ImmunoCap blood testing
- Contact dermatitis evaluation –patch testing
- Pulmonary function (spirometry, exhaled nitric oxide measurement)
- Bronchoprovocation testing
- Inhalant immunotherapy
- Omalizumab (Xolair) immunomodulator therapy –indicated for moderate-severe asthma
- Venom immunotherapy
- Evaluation of immune competence