If you have an allergy, then you already know how frustrating they can be. Allergies are disruptive to a person’s everyday life and can even be life-threatening. For the millions of people who dread the arrival of spring and pollen or must avoid eating specific foods that cause an allergic reaction, dealing with their allergy can mean discomfort or inconvenience. Although it’s not possible to eliminate an allergy entirely with treatment, there are methods for reducing the severity and frequency of reactions and improving uncomfortable symptoms caused by allergies. Our allergists and immunologists at Penn Medicine Becker ENT & Allergy in Robbinsville and Princeton are dedicated to helping each individual patient find relief. Our asthma and allergy specialists at our clinics provide allergy testing and treatment for patients who want to improve their quality of life and experience fewer allergy symptoms.
What is an Allergy?
For most people, substances like pollen or pet dander are harmless, causing no symptoms. People with an allergy, however, will have a reaction when they are exposed to the substance or food they are allergic to. This is the immune system interpreting the substance as a threat, causing symptoms like a runny nose and watering eyes, skin rashes, lung conditions, and even anaphylaxis, which causes the throat to swell and close up. Some of the most common allergens include:
- Pollens, molds, and dust mites
- Pet dander and hair
- Specific foods, such as peanuts, tree nuts, milk, and shellfish
Allergist and immunologist Kathryn Edwards sees patients at Penn Medicine Becker ENT & Allergy with a wide range of allergies and symptoms. It’s not clear why some patients develop allergies and some do not, but it seems to be partially genetic, as allergic tendencies often run in families.
Allergies often take some time to develop. About 80% of people with seasonal allergies or “hay fever” develop their symptoms before they are twenty. While most food allergies are developed in childhood, at least 15% are diagnosed in adulthood, most commonly shellfish and nut allergies. There are many different types of allergies that can trigger a wide range of symptoms and conditions.
When to See an Allergist?
Before you see an allergist, it’s important to answer the question: what is an allergist? Allergist doctors specialize in allergies, asthma, and primary immunodeficiency disease or PIDD. PIDD refers to conditions that involve a dysfunctional immune system.
It’s a good idea to see an allergist specialist when you notice symptoms of allergy, asthma, or related issues. These might include:
- Hay fever or seasonal allergies longer than a few weeks
- Chronic sinus infections
- Little to no relief from over-the-counter medications, or excessive drowsiness from medications
- Difficulty breathing or catching your breath
- Asthma attacks
Some allergies can be managed at home with avoidance and over-the-counter treatment. But when is an allergy just an annoyance, and when to see an allergist? Basically, if an allergy is disrupting your life or causing severe reactions, you’ll want to seek out expert help.
When to See an Immunologist?
Essentially, an immunologist does the same job as an allergist, meaning that the two terms are typically interchangeable. You should see an allergist/immunologist for yourself or your child whenever you have asthma or allergy symptoms that are interfering with your normal life or compromising your health.
It is especially important to bring children in to see a pediatric allergist if you suspect that they are suffering from allergies or asthma. Early intervention can help reduce symptoms from getting worse, improve long-term management, and may be able to prevent severe reactions. If you’re looking for a pediatric allergist in NJ, our highly-trained staff offers the highest-quality care for both children and adults.
Consulting with an Allergist Specialist
Patients at Penn Medicine Becker ENT & Allergy Center in Princeton and Robbinsville will consult with an allergist doctor at one of our offices prior to testing to create a customized testing and treatment plan. Our board-certified experts will ask questions and consult the patient’s medical history so that they can best diagnose possible allergies. Testing to determine what, if anything, a patient is allergic to may take place the same day or at a subsequent appointment.
Allergy Testing – Pollen, Pet, Mold, Dust, Food, and Drug
At Penn Medicine Becker ENT & Allergy , we offer several types of allergy testing with our asthma and allergy specialists in order to offer patients accurate diagnosis whenever possible. One or more tests may be needed to determine if a patient has an allergy. Each treatment plan is customized according to the patient’s history and needs.
The most common type of allergy test is known as “prick” testing. During this test, a small drop of each allergen is placed on the surface of the skin and a plastic device is used to scratch or slightly puncture the skin to bring the allergen underneath. Within 15-20 minutes, the skin will show signs of reaction if the patient is allergic to a given substance. This test can be used to identify pollen (seasonal allergies), pet hair or dander, dust mites, and food allergies.
Occasionally, a very small needle may be used to deliver a small amount of allergen within the upper layers of the skin. Patients who are interested in allergy testing must avoid antihistamines for 5-7 days before their appointment to avoid false negatives. Over-the-counter allergy medications and cold medications often contain antihistamines. For a more complete list of antihistamines, click here.
Occasionally, blood testing is preferred by the patient or is necessary due to the skin conditions of the patient. Blood testing is also accurate although not as sensitive as skin testing, the preferred method. Blood testing is also preferred in those patients with a long history of food allergies, in order to follow a specific level to the allergic antibody to determine when a patient may have outgrown his or her allergy, warranting a food challenge in the clinic.
Patch testing can help determine if an allergy to a substance is the culprit for recurrent rashes such as allergic contact dermatitis. This diagnostic method takes several days as allergic contact dermatitis is a delayed reaction. During the first visit for the test, common potential culprit allergens will be placed on the back and adhered using medical tape. The patient will be instructed to avoid activities that may introduce water to the area (showering, swimming) or cause significant sweating (vigorous exercise). In 48 hours, the patient returns to the clinic for removal of the patches and initial read. Then patients are instructed to return in another 24-48 hours for the final read. Rarely, a 3rd reading is required 7 days after removal. Any positive results can be recorded and instructions on avoidance provided.
Pulmonary Function Testing
Testing to determine lung function is used to evaluate possible obstruction caused by allergy-induced asthma in a patient. Pulmonary function tests measure the amount of air the lungs can hold and how quickly air can circulate in and out of the system. People who have had what they suspect to be asthma attacks are good candidates for spirometry, a method of evaluating how much air a person can force out of their lungs. Patients need only blow into a hand-held tube to undergo this test, and can then be treated with albuterol to confirm a diagnosis of allergy-induced asthma. Early detection will help patients to manage an asthma attack in the future.
Common Allergy Symptoms
Because there are so many different types of allergies, patients may experience a range of allergy symptoms. If you have experienced any of the following symptoms when exposed to a specific substance, you may have an allergy.
Nasal, Sinus and Eye Conditions
The term “rhinitis” refers to inflammation of the nasal passages. A patient with rhinitis may experience symptoms like a runny or stuffy nose, postnasal drip, sneezing, and itching. Eye symptoms often accompany rhinitis and may include itching, watering, and redness.
Most patients with rhinitis have an allergy or sensitivity to pollen, pets, mold, dust. Patients who experience rhinitis symptoms don’t always have an allergy–some have what is known as “vasomotor rhinitis,” typically caused by a nerve imbalance. Treatment varies depending on the cause of rhinitis symptoms and may include avoidance techniques, medications, and/or immunotherapy (allergy shots or drops).
Hives or urticaria is an intensely itchy red rash that is characterized by a wheal (raised bump) and flare (redness surrounding). Each lesion should last less than 24 hours although new hives can develop at other sites. Angioedema is self-limited localized swelling which is a deeper form of hives and typically lasts several days to the deeper nature. The causes of hives are sometimes difficult to diagnose, as there is not always a clear trigger. Allergies, stress, or illness can all cause hives to develop. In many cases, management of symptoms is the best option.
Skin allergies are very common and come in many different varieties. Atopic dermatitis (AD) or eczema is a lifelong skin disorder that generally starts in childhood. It is closely related to seasonal or indoor allergies and many children who present with eczema often develop allergies and asthma as they grow–a phenomenon known as “atopic march.” Another skin condition known as contact dermatitis is caused by an irritant or a substance the person is allergic to (such as nickel or poison ivy). These skin conditions can typically be diagnosed with patient history and allergy testing.
Asthma is a lung condition that often develops during childhood. It is a reversible airway obstruction with symptoms that include coughing, wheezing, shortness of breath, and chest tightness. When a person has an “asthma attack” an inhaler can often relieve symptoms. Some patients need steroids to control their symptoms. Asthma can vary in its severity and frequency.
Some people only develop symptoms when exposed to allergens, illness, or after exercise, while others need medications every day. Testing and patient history can be used to diagnose this lung condition. Sometimes, asthma can be prevented in children with allergies with early treatment using allergy drops or shots.
Anaphylaxis is the most severe allergic reaction to a trigger and almost never occurs without a specific cause. It is systemic, and often life-threatening. Symptoms include throat swelling, nausea, vomiting, cramping, low blood pressure, hives, and more. People with allergies that cause these severe reactions will require testing and avoidance to help prevent future attacks.
Most food allergies involve a reaction that takes place within 30-60 minutes. Someone with a food allergy will react every time the food is ingested in any form. Symptoms vary but may involve hives, gastrointestinal distress, swelling, respiratory problems, or dizziness/lightheadedness. Oral allergy syndrome, typically less serious than a traditional reaction, causes mouth and throat itching, tingling, and swelling when certain raw fruits and vegetables are eaten. This is due to the cross-reactivity of pollens, and can often be minimized by cooking the food.
While many people believe that they have food allergies, some intolerances are actually not considered to be allergies. These are known as “non-immunologic reactions” that do not involve the immune system and cannot be diagnosed with allergy testing. Lactose intolerance is an example of this type of response. Other mixed-reaction conditions like eosinophilic esophagitis (EoE) and food protein-induced enterocolitis (FPIES) are best diagnosed by an allergist, but the celiac disease should be evaluated by a gastroenterologist.
Many patients are mislabeled as being allergic to drugs, namely penicillin. Around 90% of patients who have been told they are allergic to this drug are able to tolerate it. Some outgrow the allergy while others never had it to begin with. High sensitivity allergy testing can be used to determine if a patient is allergic to specific drugs, which can help to reduce the use of strong antibiotics that encourage drug-resistant bacteria to develop.
A latex allergy causes reactions when a person is exposed to products containing latex, such as rubber gloves, balloons, rubber bands, condoms, and even envelope adhesive. Individuals at the highest risk are those who work in healthcare or patients using devices containing latex. Patients are typically instructed to simply avoid products containing latex, as there are many alternatives available. While patients may only develop a rash when exposed to the substance, this can evolve into anaphylaxis unpredictably.
Stinging Insect or Venom Allergies
Venom or stinging insect allergy is a potentially life-threatening condition. Bees, hornets, yellow jackets, and wasps are the most common insects to cause this allergy. Some patients may only have minor skin reactions, while others can experience anaphylaxis, affecting the whole body. Testing to determine the type of insect causing the reaction, followed by allergy shots, can be exceptionally effective in reducing the risk for anaphylaxis in case of future exposure.
Allergy Treatments and Therapies
Once a diagnosis has been made, our skilled allergy and immunology specialists will turn to a range of treatment options for everything from symptoms of allergic rhinitis (stuffy nose, runny nose, watery eyes, etc.) to contact dermatitis or an asthma attack.
Allergy Shots or Immunotherapy
Since an allergic reaction is caused by the body’s immune system, treatment for allergies involves long term intervention to decrease symptoms over time. Allergy shots are a common treatment option for patients with allergic rhinitis, stinging, insect allergy, or eye allergies. These shots are given long-term to decrease sensitivity to a given allergy. Over time, they can create lasting improvement even after the treatments have stopped. Patients with an eligible allergy over the age of five who have no serious medical conditions are typically good candidates for this cost-effective approach. Food allergies, however, cannot be improved with allergy shots.
Good candidates for allergy shots will need to be willing to come into the office one to two times a week for about 3-6 months. After this time, injections will decrease to once every 2-4 weeks. This is known as the “maintenance phase.” Most patients will continue on this schedule for up to 3-5 years. Essentially, the shots work like a vaccine, gradually increasing the body’s tolerance for the allergen.
Patients will discuss the pros and cons of starting an allergy shot regimen with their allergist at Penn Medicine Becker ENT & Allergy Center following diagnosis. For some patients, avoidance and medication is more practical. For others, the benefits of the treatment outweigh the time commitment and cost of ongoing allergy shots. Children who have developed eczema may be good candidates for this treatment to help prevent allergy asthma from developing. Older patients may be able to find relief from severe allergic rhinitis and allergic conjunctivitis.
Because shots involve introducing the substance a patient is allergic to, there are minor side effects and potential risks to allergy shot treatments. Redness, swelling, itching are common at the injection site, and allergy symptoms like a runny nose or eyes, stuffy nose, sneezing, congestion, and hives. Occasionally, anaphylaxis (systemic reaction) can occur, which is why allergy shot patients must wait for 30 minutes after their appointments, to ensure that no serious reactions occur. All allergy shots are given in the clinic under the direct supervision of properly trained staff, with ready access to life-saving equipment.
Many patients are concerned about the regular visits to the clinic and the time commitment involved, but many of these concerns fade away once patients get used to the regimen. The allergy staff often becomes like a second family. Most patients tell our staff that we “changed their lives” for the better with allergy shots.
Sublingual Immunotherapy (SLIT) or “Allergy Drops”
An alternative treatment to ongoing allergy shots, allergy drops (or sublingual immunotherapy) (SLIT) are used to fight symptoms caused by allergies to ragweed, northern grasses, and dust mites. According to some promising studies, there is a possibility that food allergies may be treated with allergy drops in the future, but they are currently not approved for this purpose. Since this is a new treatment that is still being studied, the FDA has approved this method only for a small number of allergy types.
SLIT involves drops or tablets taken orally to help improve tolerance to allergens and decrease symptoms. Currently, these treatments are not covered by insurance, because their efficacy is not yet well-established. Past studies have shown that the effects of drops are typically not as powerful as allergy shots, but they are a good option for patients with needle phobia or simply want a less invasive, more convenient option. As with allergy shots, there is a small risk for severe allergic reactions, so the first drops of a new vial are given in the clinic environment. After each vial has been deemed safe, patients may take the treatment at home.
- Dr. Samuel Becker invited Faculty at PENN International Rhinology and Skull Base Course.
- Dr. Daniel Becker invited speaker at the American Rhinologic Society’s 2014 Summer Symposium
- ENT department at PENN has once again received a NATIONAL TOP 10 rating
- Dr. Samuel Becker appointed to editorial board of 2 journals
- Dr. Oz recently decided to have a show on Epistaxis
Frequently Asked Questions
Colds and other minor illnesses can cause many of the same symptoms as allergies but tend to last only a few days or weeks. Allergies tend to start at the beginning of the season and last weeks to months and correlate with the pollinating seasons. They recur every year at approximately the same time, and they may worsen with each subsequent year. Fever is generally NOT associated with allergies.
Some people do outgrow their allergies and naturally find relief as they get older. About 90% of children, for instance, outgrow allergies like milk and eggs. Allergies to peanuts, tree nuts, and shellfish are more likely to last. In contrast to outgrowing allergies, some adults develop them later in life. Seasonal allergies tend to taper off as people leave mid-adulthood.
Pollen allergens are seasonal and include tree pollen, grass pollen, and weed pollen. Trees tend to pollinate in the spring months. Grasses tend to pollinate in the summer months. Weeds tend to pollinate in the fall months. In warmer climates, there can be some plants that pollinate over the winter. Perennial or year-round allergens include molds and dust mites, which are more plentiful in humid climates.). Cockroach and pet allergens are based on exposure.
Briefly, the allergist definition: a doctor specializing in the diagnosis and treatment of allergies, asthma, and related disorders. This specialty is also known as immunology, and the terms allergists and immunologists are almost interchangeable. Within the field of allergy and immunology, an allergist specialist may further specialize and become a pediatric allergist or focus on researching new treatments for people with allergies.
Asthma and allergy specialists help people manage their conditions to lead safer, more comfortable lives. They may conduct allergy testing, prescribe medications, provide long-term care including allergy shots, and suggest lifestyle changes to help patients manage their allergies and improve their quality of life.
Does allergy testing hurt?
Typically, an allergist doctor performs a skin test using a large stamper, which delivers multiple tiny pricks at once. Most patients, even children, find that this process is not painful or uncomfortable. There will be some itching as allergens cause a reaction, but this is fairly short-lived. Other forms of allergy testing may involve slightly more discomfort.
Are allergies and asthma-related?
Allergies, asthma, and atopic dermatitis or eczema are related. For this reason, identifying allergens early can help prevent problems from developing or worsening. Asthma is a lung condition in which the airways become inflamed and swollen resulting in narrowing of the airways. This narrowing combined with an increase in mucus production makes it hard to breathe. About 80-90% of asthmatic patients have allergic rhinitis (allergies affecting their nose).
Asthma tends to be genetic and run in families, but no one fully understands what causes it. Environmental triggers like allergens or smoke and exercise can cause an asthma attack in someone with allergy asthma. Symptoms include rapid breathing, chest tightness, coughing that won’t stop, and wheezing. More serious attacks can cause tightening of the neck and chest muscles, panic, sweating, and blue lips or fingernails. During a severe asthma attack, patients should seek medical attention immediately. There is no cure for asthma, but the condition can typically be managed with medication.
If you think your child may have asthma, it’s important to reach out to a pediatric allergist as soon as possible. Our skilled staff at Penn Medicine Becker ENT & Allergy includes asthma and allergy specialists, including pediatric allergists in NJ at our various locations.
- Princeton, NJ
- Robbinsville, NJ
- Sewell, NJ
- Voorhees, NJ
- Yardley, PA
Can you test for food allergies?
We can test for food allergies with prick skin testing or blood testing. However, allergy testing cannot diagnose food intolerances, only allergies involving the immune system. Once a food allergy has been identified, avoidance and epinephrine are the main courses of management. Oral immunotherapy for food allergies, known as food OIT, is currently being studied to one day hopefully help patients reduce sensitivity to food allergens over time.
What are the most common food allergens?
About 90% of all food allergies are due to a few food groups: milk, egg, soy, wheat, peanuts, tree nuts, shellfish, and fish. The most common food allergies in children are milk and egg, which are often outgrown. The most common food allergies in adults are peanuts, tree nuts, shellfish, and fish. Allergic reactions to food vary and may involve a range of symptoms.
Will antihistamines stop anaphylaxis?
Anaphylaxis can only be treated with epinephrine. However, antihistamines can help treat symptoms, such as hives. Patients experiencing anaphylaxis should be treated with epinephrine as soon as possible, as the reaction can occasionally be fatal.
How long does it take for a reaction to start after food allergies are triggered?
In most cases, symptoms will appear in a few minutes or up to 60 minutes after ingestion. Occasionally, symptoms will appear in 1-2 hours.
Who is at most risk for a severe allergic reaction to food?
Having asthma, particularly uncontrolled asthma, is a risk factor for having a severe reaction to food. Teenagers and young adults are also at particular risk due to risky eating behaviors and delays in the administration of epinephrine. Getting a pediatric allergist involved early in a child’s life if they show signs of food allergies or asthma can be beneficial in preventing severe reactions.
Can the severity of allergic reaction be predicted by previous reactions?
No. Someone may have a mild reaction one time and subsequently have a very severe reaction upon another exposure.
Is there a cure for food allergies?
Currently, there is no cure or effective therapy available for food allergies, and avoidance is typically the best course of action. Some children outgrow their food allergies over time, typically to eggs and milk. Many research studies are being conducted, however, with the goal of developing treatments for these allergies. One promising therapy is known as food OIT (oral immunotherapy), which uses small amounts of a known allergen to safely and gradually reduces a patient’s sensitivity to it.
Can my skin rash be caused by an allergy?
There are many types of rashes that can be caused by allergies. The most common is contact dermatitis, which is a delayed reaction to certain substances. We can perform patch testing to determine if a patient is allergic to common allergens found in skin products, clothes, and topical medications.
Atopic dermatitis or eczema is also related to allergies and can be flared by exposures to pollen, pets, and dust mites.
How are allergies treated?
In most cases, an allergist doctor will suggest avoidance as a primary method for managing allergies. This is really NOT possible for pollen allergies since you can’t stay inside all the time. Sometimes you can avoid pets and animals. Environmental modifications such as keeping the humidity low in the house and vacuuming and dusting weekly can help with some of the dust mite and mold allergies. Usually, avoidance is not enough and patients are often started on allergy medications. Oral antihistamines such as Zyrtec, Allegra, and Claritin are often combined with nasal sprays such as Flonase. For those with allergy eye symptoms, special antihistamine eye drops can help. If these methods are ineffective, an allergist may suggest allergy drops or an allergy shot regimen at Penn Medicine Becker ENT & Allergy.
Learn More About Allergies
If you suffer from allergies or suspect that you might have developed an allergy, meeting with an allergist or a pediatric allergist in NJ at Penn Medicine Becker ENT & Allergy in Princeton or Robbinsville can help you get the answers you’re looking for and get you on a path toward improving your long term quality of life. We offer expert diagnosis and treatment for patients with a range of allergies. To schedule an appointment, contact our telemedicine doctor today.
Schedule an Allergist Consultation in Princeton or Robbinsville, NJ
Prior to joining the Penn Medicine Becker ENT & Allergy family, Dr. Kathryn Edwards completed a 16-year career with the United States Army, serving military families as an Allergist specialist. Specializing in the diagnosis and treatment of seasonal and environmental allergies, skin conditions, asthma, and food allergies; Dr. Edwards brings her extensive Allergist knowledge to our Princeton and Robbinsville offices.
Dr. Edwards performed her undergraduate studies at the University of Delaware and then proceeded onto these next accomplishments:
- Joined the United States Army
- Attended the Uniformed Services University of the Health Sciences
- Completed a Pediatric residency at Walter Reed Army Medical Center where she a Board Certified Pediatrician
- Used her specialties while being deployed to Iraq to care for those in harm’s way
- Was selected into the highly competitive Allergy and Immunology fellowship program at Walter Reed National Military Medical Center
- Included training at the National Institutes of Health (NIH)
- Served as assistant chief for several years
- Served as chief of Allergy/Immunology for her final 3 years in the military
- Received a B.S from Widener University where she conducted research in diabetes.
- Received her medical degree from Drexel University College of Medicine and completed her residency in Internal Medicine at Penn State Hershey Medical Center.
- She has conducted quality improvement research in asthma, awarding her state honors and acquired a grant for an educational initiative on hereditary angioedema, a rare swelling disorder.
- Member of the American Academy of Allergy, Asthma, and Immunology, the American College of Allergy, Asthma, and Immunology, the American College of Physicians, and the American Medical Association.
- Published author, having presented at both national and world allergy conferences.