Allergy Shots (Immunotherapy)

Allergy Shots (Immunotherapy)

Immunotherapy, also known as “allergy shots” is a way of making the body less sensitive to specific substances known as allergens. With reduced sensitivity comes a reduction in your allergy symptoms. Allergic sensitivity is determined by allergy skin tests, or blood tests. This information is used to determine which allergens contribute to your reactions. Mixtures of these allergens are then developed for your therapy. The mixtures are given by injections under the skin.

By starting with extremely tiny doses and gradually increasing, the immune system becomes more tolerant, and thus your allergy symptoms are reduced. There are 2 stages of immunotherapy. Build-Up: This is the 1st stage when the amount of each injection is slowly increased. Most patients receive injections once per week, though if your schedule allows, you can come twice weekly. There are about 25 steps to complete this 1st phase. During this phase some but not all of our patients notice any improvement in their symptoms. Maintenance: The 2nd stage. Once you have reached the highest dose of each mixture, that dose is repeated once a month. Benefits from immunotherapy have been shown when a patient reaches this dose. Because of the potential risk of an allergic reaction, shots are only given by medical professionals trained in the proper administration, and in the recognition and management of complications. For this reason shots are given in the MLA Worcester office only.

There is a 20-30 minute observation period after each shot during which you will wait in the office to be sure that you do not have an allergic reaction. At least 80% of patients who receive immunotherapy have a significant improvement in their allergy symptoms, although many do not feel completely “cured.” Not everyone is able to stop taking all of their allergy medications. Allergy shots do not cure you of your allergies, only make you more tolerant upon allergen exposure or during your season. If therapy is stopped some of the symptoms may return, though most individuals have some long-lasting benefit well beyond the time the shots were discontinued. Because of the need to maintain a regular injection schedule, immunotherapy should not be started unless your schedule allows for fairly regular visits.

If your symptoms are troublesome despite avoidance strategies and medications, allergy immunotherapy may be right for you.

Insect Sting Allergy

Insect Sting Allergy

Allergic reactions to flying stinging insects – honeybees, hornets, wasps and yellow jackets – are relatively common. In the southern United States, the red or black imported fire ant now infests more than 260 million acres where it has become a significant health hazard and may be the number one agent of insect stings there. The severity of an insect sting reaction varies from person to person. A normal reaction will result in pain, swelling and redness confined to the sting site. A large local reaction occurs in 10-15% and will result in swelling that extends beyond the sting site. For example, a sting on the forearm could result in the entire arm swelling twice its normal size. Although alarming in appearance, this condition is not dangerous and is often treated the same as a normal reaction. The rarest but most severe sting reaction, called anaphylaxis, occurs in about 0.5% of children and 3% of adults who are stung. At least 90 to 100 deaths per year result from insect sting anaphylaxis.

If you are referred to MLA for evaluation of an insect sting, a careful history will be obtained. Based on this, allergy testing may be performed likely with a skin test, but sometimes through a blood test. As the skin testing for a stinging insect reaction is involved, this will be performed at a separate visit. Based on your history and the results of the testing your physician will be able to recommend the best intervention for you. For those experiencing a severe sting reaction this may include allergy immunotherapy – “desensitization” (see below) as well as self-injectable epinephrine (EpiPen) and MedicAlert® identification.

Avoiding Insect Stings

Knowing how to avoid stings from fire ants, honeybees, wasps, hornets and yellow jackets leads to a more enjoyable summer for everyone. Stinging insects are most active during the late spring, summer, and early fall. Insect repellents do not work against stinging insects. Yellow jackets will nest in the ground and in walls. Hornets and wasps will nest in bushes, trees and on buildings. Use extreme caution when working or playing in these areas. Avoid open garbage cans and exposed food at picnics, which attract yellow jackets. Also, try to reduce the amount of exposed skin when outdoors.

Consider the following additional precautions to avoid insect stings:

  • Avoid wearing sandals or walking barefoot in the grass. Honeybees and bumblebees forage on white clover, a weed that grows in lawns throughout the country.
  • Never swat at a flying insect. If need be, gently brush it aside or patiently wait for it to leave.
  • Do not drink from open beverage cans. Stinging insects will crawl inside a can attracted by the sweet beverage.
  • When eating outdoors, try to keep food covered at all times.
  • Garbage cans stored outside should be covered with tight-fitting lids.
  • Avoid sweet-smelling perfumes, hair sprays, colognes and deodorants.
  • Avoid wearing bright-colored clothing.
  • Yard work and gardening should be done with caution. Wearing shoes and socks and using work gloves will prevent stings on hands and feet.
  • Keep window and door screens in good repair. Drive with car windows closed.

Venom Immunotherapy

The long-term treatment of insect sting allergy is called venom immunotherapy. It is a highly effective program administered by an allergist, which can prevent future allergic reactions to insect stings.

Venom immunotherapy involves administering gradually increasing doses of venom to decrease a patient’s sensitivity to the venom. This can reduce the risk of a future allergic reaction to that of the general population. In a matter of weeks to months, people who previously lived under the constant threat of severe reactions to insect stings can return to leading normal lives.

Allergic Rhinitis

Allergic Rhinitis

Allergic rhinitis, commonly known as a runny nose, or when due to pollen exposure, “Hay Fever” is the medical term describing irritation and inflammation of the nose. This results in a variety of symptoms including runny nose, sneezing, stuffy nose, sore throat, itching of the nose, mouth and eyes, as well as tearing of the eyes. An allergen is something that triggers an allergy. When a person with allergic rhinitis breathes in an allergen such as pollen or dust, the body releases chemicals, including histamine. This causes allergy symptoms. Hay fever involves an allergic reaction to pollen. A similar reaction occurs with allergy to mold, animal dander, dust, and similar inhaled allergens. The pollens that cause hay fever vary from person to person and from region to region. Large, visible pollens such as those from colorful, showy flowers are seldom responsible for hay fever. Tiny, hard to see pollens more often cause hay fever. Examples of plants commonly responsible for hay fever include trees, grasses, and weeds, in particular, ragweed. Though allergies (and allergic rhinitis) are common, many people who suffer from the symptoms above actually do not have allergy! When consulting your MLA physician it is likely that allergy testing will be performed. This will tell you if in fact your symptoms are due to an environmental allergy and if so, which particular ones. Skin testing (“scratch test”) is the most common method of allergy testing. If your doctor determines you cannot undergo skin testing, special blood tests may help with the diagnosis. These tests can measure the levels of specific allergy-related substances (antibodies), especially one called immunoglobulin E (IgE). Based on the results of the allergy testing, your physician will be better able to recommend various treatments, including avoidance strategies, medications and allergy shots (immunotherapy) to help control your symptoms.

Allergy Testing

Allergy Testing

When suspicion is raised about a possible allergy, your allergist will first get more details from your history. Do the symptoms suggest an environmental allergy such as sneezing, nasal congestion and itchy eyes? Perhaps symptoms developed after ingestion of food or after an insect sting. He or she will want to know about any symptoms of asthma as well as family history. The medical history serves as a basis for the allergy diagnosis and may then lead to confirmatory testing. There are 2 primary forms of testing, the skin test – which gives the fastest and most accurate results – and the allergy blood test.

A skin prick test, also called a puncture or scratch test, checks for immediate allergic reactions to as many as 50 different substances at once. This test is usually done to identify allergies to pollen, mold, pet dander, dust mites and foods. In adults, the test is usually done on the forearm. Children may be tested on the upper back. Skin prick testing provides results in about 20 minutes. A liquid containing a tiny amount of the food allergen is placed on the skin. Your skin is pricked with a small, sterile probe, allowing the liquid to seep under the skin. Multitest devices now allow for 8 or 10 tests to be applied simultaneously, making the process even easier. To see if your skin is reacting normally, two additional substances are scratched into your skin’s surface. Histamine (positive control) – in most people, this substance causes a skin response. If you don’t react to histamine, your allergy skin test may not reveal an allergy even if you have one. Glycerin or saline (negative control – in most people, these substances don’t cause any reaction. If you do react to the negative control, you may have sensitive skin. Test results will need to be interpreted cautiously to avoid a false allergy diagnosis. The test isn’t painful.  You won’t bleed or feel more than mild, momentary discomfort. The test is considered positive if you develop a raised, red, itchy bump (wheal) that may look like a mosquito bite. The nurse will then measure the bump’s size and record the results. Next, he or she will clean your skin with alcohol and may apply a topical steroid. When the test is over, the doctor or nurse will clean your skin and put some cream on it to help with any itching.  Any swelling from a reaction usually goes away within 30 minutes to a few hours. Some medicines can get in the way of the tests. Check with your doctor to see if you need to stop taking any medication before the test.

If you take medicine that could affect allergy test results, have sensitive skin, or have had a bad reaction to a skin test, your doctor might do a blood test instead. A sample of your blood is sent to a lab, and your doctor will typically get the results in about a week. Allergy blood tests, which are a bit less exact than skin tests, measure the amount of IgE antibody (“allergic antibody”) to the specific allergen being tested and are reported as a numerical value. This is typically more expensive than a skin test.

Your allergist will use the results of these tests in making a diagnosis. If an allergy test is negative, you aren’t allergic to that substance. It’s rare to get a false (incorrect) negative allergy test result (meaning the test says you don’t have an allergy when you actually do). A positive test however does not mean you have an allergy – or at least react to that allergen. A false positive test result is possible, especially from a blood (IgE) test. A false positive means the results show you have an allergy when in fact you don’t.

In some cases, a skin or blood test is not available, or the results are not conclusive. In those cases, an allergist may recommend an oral challenge. This is considered the most accurate way to make a food allergy diagnosis. During an oral food challenge, which is conducted under strict medical supervision, the patient is fed tiny amounts of the suspected trigger food in increasing doses over a period of time, followed by a few hours of observation to see if a reaction occurs. Because of the possibility of a severe reaction, an oral food challenge should be conducted only by experienced allergists in a doctor’s office or at a food challenge center, with emergency medication and equipment on hand.

Preparing for Allergy Skin Testing

There are certain medications that can interfere with the performance of an allergy sin test and therefore limit its value. For that reason, it is important to review the list below.

Medications MUST be stopped for at least 7 to 10 days prior to allergy testing

Antihistamines – “Allergy medications”  (Brand name / Generic name)

  • Allegra (fexofenadine)
  • Chlor-Trimeton (chlorpheniramine)
  • Zyrtec (cetirizine)
  • Xyzal (levocetirizine)
  • Claritin (loratadine)
  • Clarinex (desloratadine)
  • Benadryl (diphenhydramine)
  • Atarax (hydroxyzine)
  • Astelin/Astepro (azelastine) allergy nasal spray needs to be stopped
  • All allergy eyedrops need to be stopped

Medications used for Heartburn may be an antihistamine and must be stopped

  • Pepcid (famotidine)
  • Zantac (ranitidine)
  • Tagamet (cimetidine)

Please contact the office if you are taking any of the following medications:

  • Oral steroids (prednisone, methylprednisolone, dexamethasone)
  • Tylenol PM (And all other “PM” medications) – these contain Benadryl
  • Antidepressants (amitriptyline, nortriptyline)

If you have ANY questions about your medications, please call the office 774-420-2611

Drug Allergy

Drug Allergy

A drug allergy is the abnormal reaction of your immune system to a medication.  A drug allergy occurs when your immune system mistakenly identifies a drug as a harmful substance, such as a virus or bacterium. Once your immune system detects a drug as a harmful substance, it will develop an antibody specific to that drug. This can happen the first time you take a drug, but sometimes an allergy doesn’t develop until there have been repeated exposures. The next time you take the drug, these specific antibodies flag the drug and direct immune system attacks on the substance. Chemicals released by this activity cause the signs and symptoms associated with an allergic reaction.  You may not be aware of your first exposure to a drug, however. Some evidence suggests that trace amounts of a drug in the food supply, such as an antibiotic, may be sufficient for the immune system to create an antibody to it.  Any medication – over-the-counter, prescription or herbal – is capable of inducing a drug allergy. However, a drug allergy is more likely with certain medications. A drug allergy is not the same as a drug side effect, a known possible reaction listed on a drug label. A drug allergy is also different from drug toxicity caused by an overdose of medication.

Drugs commonly linked to allergies

Although any drug can cause an allergic reaction, some drugs are more commonly associated with allergies. These include:

  • Antibiotics, such as penicillin
  • Pain-relievers, such as aspirin, ibuprofen (Advil, Motrin) and naproxen sodium (Aleve)
  • Chemotherapy drugs for treating cancer
  • Medications for autoimmune diseases, such as rheumatoid arthritis

Nonallergic drug reactions

Sometimes a reaction to a drug can produce signs and symptoms virtually the same as those of a drug allergy, but a drug reaction isn’t triggered by immune system activity. This condition is called a nonallergic hypersensitivity reaction or pseudoallergic drug reaction. Drugs that are more commonly associated with this condition include:

  • Aspirin
  • Dyes used in imaging tests (radiocontrast media)
  • Opiates for treating pain
  • Local anesthetics

Symptoms of Drug Allergy

The most common signs and symptoms of drug allergy are hives, rash or fever. A drug allergy may cause serious reactions, including a life-threatening condition that affects multiple body systems (anaphylaxis). Signs and symptoms of a serious drug allergy often occur within an hour after taking a drug. Other reactions, particularly rashes, can occur hours, days or weeks later.

Drug allergy signs and symptoms may include:

  • Skin rash
  • Hives
  • Itching
  • Fever
  • Swelling
  • Shortness of breath
  • Wheezing
  • Runny nose
  • Itchy, watery eyes

Anaphylaxis is a rare, life-threatening reaction to a drug allergy that causes the widespread dysfunction of body systems. Signs and symptoms of anaphylaxis include:

  • Tightening of the airways and throat, causing trouble breathing
  • Nausea or abdominal cramps
  • Vomiting or diarrhea
  • Dizziness or lightheadedness
  • Weak, rapid pulse
  • Drop in blood pressure
  • Seizure
  • Loss of consciousness

Other conditions resulting from drug allergy

Less common drug allergy reactions occur days or weeks after exposure to a drug and may persist for some time after you stop taking the drug. These conditions include:

  • Serum sickness – which may cause fever, joint pain, rash, swelling and nausea
  • Drug-induced anemia – a reduction in red blood cells, which can cause fatigue, irregular heartbeats, shortness of breath and other symptoms
  • Drug rash with eosinophilia and systemic symptoms (DRESS) – which results in rash, high white blood cell count, general swelling, swollen lymph nodes and recurrence of dormant hepatitis infection
  • Inflammation in the kidneys (nephritis) – which can cause fever, blood in the urine, general swelling, confusion and other symptoms

The most severe form of delayed drug reactions not only cause rashes but may also involve other organs including the liver, kidneys, lungs, and heart. Blisters may be a sign of serious drug reactions called Stevens-Johnson Syndrome and Toxic epidermal necrolysis (TEN), where the surfaces of your eye, lips, mouth and genital region may be eroded.

Risk factors

While anyone can have an allergic reaction to a drug, a few factors can increase your risk. These include:

  • A history of other allergies, such as food allergy or hay fever
  • A personal history of drug allergy
  • Increased exposure to a drug, because of high doses, repetitive use or prolonged use
  • Certain illnesses commonly associated with allergic drug reactions, such as infection with HIV or the Epstein-Barr virus
  • Contrary to popular myth, a family history of a reaction to a specific drug typically does not increase your chance of reacting to the same drug.

Diagnosis of Drug Allergy

Drug allergies can be hard to diagnose.

Your allergist will want to know the answers to these questions:

  • What drug do you suspect caused your reaction?
  • When did you start taking it, and have you stopped taking it?
  • How long after you took the drug did you notice symptoms, and what did you experience?
  • How long did your symptoms last, and what did you do to relieve them?
  • What other medications, both prescription and over-the-counter, do you take?
  • Do you consume herbal medications or take vitamin or mineral supplements?

Depending on the drug suspected of causing the reaction, your allergist may suggest a skin test or, in very limited instances, a blood test. An allergy to penicillin-type drugs is the only one that can be definitively diagnosed through a skin test. If a drug allergy is suspected, your allergist may also recommend an oral drug challenge, in which you will be supervised by medical staff as you take the drug suspected of triggering a reaction. (If your reaction was severe, a drug challenge may be considered too dangerous.)


If you have a drug allergy, the best prevention is to avoid the problem drug. Steps you can take to protect yourself include the following:

  • Be sure that your drug allergy is clearly identified in your medical records.
  • Inform your health care providers including other providers, such as your dentist or any medical specialist.
  • Ask about related drugs that you should avoid.
  • Ask about alternatives to the drug that caused your allergic reaction.
  • Wear a medical alert bracelet that identifies your drug allergy. This information can ensure proper treatment in an emergency.
  • If a severe life-threatening reaction (anaphylaxis) occurs, use your epinephrine auto injector and call 911.

A Few Words About Penicillin Allergy

Penicillin, discovered by Alexander Fleming in 1928, is prescribed today to treat a variety of conditions, such as strep throat. Despite its effectiveness, some people steer clear of penicillin for fear of experiencing an allergic reaction to the medication. Nearly everyone knows someone who says they are allergic to penicillin. Up to 10% of people report being allergic to this widely used class of antibiotic, making it the most commonly reported drug allergy. With that said, studies have shown that more than 90% of those who think they are allergic to penicillin, actually are not. In other words, 9 out of 10 people who think they have penicillin allergy are avoiding it for no reason. Even in people with documented allergy to penicillin, only about 20% are still allergic ten years after their initial allergic reaction!

Anyone who has been told they are penicillin allergic, but who hasn’t been tested by an allergist, should be evaluated. An allergist will work with you to find out if you are truly allergic to penicillin, and to determine what your options are for treatment if you are. If you’re not allergic to penicillin you will be able to use medications that are safer, often more effective and less expensive.



Hives, the common term for urticaria, may appear as blotches or raised red bumps (wheals), caused by irritation in the upper layers of the skin. They can be pale or red in color and are very itchy. The bumps are often oval or round, but also can be other shapes. They are usually 1 to 2 cm in size (about the size of a quarter) but can be larger. They may combine with nearby hives as they grow to form larger hives. The individual lesions usually disappear within minutes to hours but may return elsewhere. Once faded, they leave no marks other than scratches from itching. They may come and go for days or weeks, sometimes longer. In most cases hives are not due to a specific allergy. When hives occur most days for more than six weeks this is defined as chronic urticaria.

Hives are common. Up to 1 in 5 people (20%) of people will develop hives at some time during their life. However, in only 1 in 100 (1%) will they last for over 6 weeks. In most cases, hives are not due to allergy. Underneath the lining of the skin and other body organs are blood cells known as Mast cells. Mast cells contain natural chemicals including histamine. When these are released into the skin, they irritate nerve endings to cause local itch and irritation and make local blood vessels expand and leak fluid, triggering redness and swelling.

Hives can also cause deeper swellings in the skin, and this is called angioedema. These swellings are often bigger, last longer, may itch less, sometimes hurt or burn and respond less well to antihistamines. Large swellings over joints, for example, can cause pain that feels like arthritis, even if the joint is not involved. Angioedema most frequently affects the face and lips. Although hives and facial swelling can be uncomfortable and cosmetically embarrassing, they are not usually dangerous. Rarely, angioedema (swelling) occurs without hives. This may suggest a special situation requiring additional evaluation.

Hives are rarely due to a serious underlying disease. Often the cause of hives in not obvious. Infection from a virus is the most common cause of hives in children. Contact allergy to plants or animals may cause localized hives. Allergic reactions to food, medicines or insect stings can appear as hives. They usually occur within one to two hours of exposure and disappear in most cases within six to eight hours. An allergic cause may be suspected if episodes are rare, short-lived and occur under specific circumstances (e.g., Only when exercising, always within two hours of a meal or when symptoms involving other organs occur around the same time, such as stomach pain, vomiting, difficulty breathing or dizziness).

Chronic urticaria is defined when hives occur most days for more than six weeks. Symptoms of chronic urticaria usually resolve, although this can take months or several years. Chronic hives can last for many years but will often go away. In these individuals, hives will resolve in half of patients within 1-2 years and 80-90% of patients will improve within 5 years. Even if a patient’s hives improve, it is not unusual to see the hives recur months to years later. Ongoing hives lasting days at a time are almost never allergic in origin. Usually, the cause of chronic urticaria cannot be identified. The absence of an identifiable trigger can be frustrating for patients. Stress is a very rarely the cause of hives but may make the symptoms worse. In some people hives are caused by physical triggers, including cold, heat, sunlight, vibration, rubbing or scratching of the skin (called dermatographism), and delayed pressure (such as after carrying heavy bags).

Most people with hives do not need allergy tests. Tests are sometimes done when hives go on for long periods of time, or when unusual symptoms are occurring around the same time. This is to exclude other diseases, which may appear as hives first. If hives are associated with high fever, bruising, bleeding into the skin, purple lumps that last for several days, or sore joints, a doctor’s appointment should be scheduled. Allergy testing is performed when the history suggests an allergic cause.

Treatment may not be needed if the hives are mild. They may disappear on their own. To reduce itching and swelling consider the following: Do not take hot baths or showers; Do not wear tight-fitting clothing, which can irritate the area;). Aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) should be avoided as they can make symptoms worse.  Non-sedating antihistamines such as Allegra (fexofenadine), Zyrtec (cetirizine) or Claritin (loratadine) are often used to reduce the severity of the itch and reduce hives. Medications will not “cure” hives but may help to completely resolve them. Antihistamines are the best initial medication to treat your hives. Sometimes, a combination of several antihistamines or an increased dose of one antihistamine may be recommended. Corticosteroids, such as prednisone may help hives. These are not an ideal treatment for long-term use but may have a role to relieve severe symptoms for a few days.  Other oral prescription medicines may be needed, especially if the hives are chronic (long-lasting).  For those with chronic hives that do not respond to these therapies injection therapy with Xolair (omalizumab) may be an option that is recommended.

Chronic Sinusitis

Chronic Sinusitis

The sinuses are hollow air pockets (cavities, spaces) in the bones of the face and head that probably exist to cushion the brain during trauma. There are four paired sinus cavities in the head. These spaces are connected by narrow channels. The four spaces are named for the bones they are near: ethmoidal, sphenoidal, frontal and maxillary. The sinuses are lined with a thin layer of tissue that normally makes a small amount of mucus to keep the sinuses healthy and lubricated. This drainage works as a filtration system, keeping the nose clean and free of bacteria. Rhinosinusitis occurs when the lining of the sinuses gets infected or irritated, become swollen, and create extra mucus. The swollen lining may also interfere with drainage of mucus.

Chronic sinusitis refers to a condition that lasts at least 12 weeks, despite attempts to treat it, and causes at least two of the following symptoms:

  • Nasal congestion
  • Mucus discharge from the nose or mucus that drips down the back of the throat
  • Facial pain, pressure, or “fullness”
  • A decreased sense of smell

Common signs and symptoms of chronic sinusitis include:

Nasal inflammation, Thick, discolored discharge from the nose (runny nose), Drainage down the back of the throat (postnasal drainage), Blocked or stuffy nose causing difficulty breathing through your nose; Pain, tenderness and swelling around your eyes, cheeks, nose or forehead; Reduced sense of smell and taste, Ear pain, Headache, Aching in your upper jaw and teeth, Cough or throat clearing, Sore throat, bad breath, Fatigue

Chronic sinusitis can be caused by several factors. These include:

  • Blocked airways from asthma or allergies or from conditions such as cystic fibrosis.
  • Infections, which can be bacterial, viral or rarely fungal.
  • Exposure to tobacco smoke or airborne irritants (e.g., environmental toxins, such as formaldehyde).
  • Abnormal nose structures, such as a deviated septum (actually a rare cause of chronic sinusitis) or nasal polyps.
  • Immune system disorders – e.g., antibody deficiency (hypogammaglobulinemia).


Chronic rhinosinusitis is likely if a person has had two or more of the symptoms listed above for a period of at least three months. In addition, there should be evidence of sinus disease that can be seen on a sinus CT scan or with a procedure called sinus endoscopy. A sinus CT scan is a procedure that takes about 15 minutes and involves a series of radiographs of the head and face. The radiographs give a detailed picture of the sinus linings and any mucus or polyps within the sinus spaces. A CT scan could also be used to look for structural issues. Structural problems usually include a deviated nasal septum, bony spurs or nasal polyps. Sinus endoscopy is an office procedure performed by an ENT specialist in which a clinician uses a thin tube attached to a camera to see inside the sinuses.


Unfortunately, chronic sinusitis cannot be cured in most cases, but the symptoms can be managed so that they are not so burdensome. People with chronic sinusitis usually need life-long treatment to keep the symptoms in check. Several treatment options are available, but not all treatments are appropriate for all people. Health care providers usually recommend starting with aggressive treatment to get symptoms and inflammation under control and then changing to a less aggressive approach over time.

Potential treatments for chronic rhinosinusitis include:

Lifestyle modifications – People with chronic sinusitis who smoke cigarettes should stop. People who have environmental allergies should maximize avoidance strategies.

Daily nasal saline washing – Most people with chronic sinusitis find that washing their nasal passages daily with saline (salt water) helps reduce symptoms. Washing the nose before applying medications also clears away mucus and allows nasal medications to be absorbed better. A variety of devices, including squeeze bottles and Neti pots may be used to perform nasal irrigation. These are available without a prescription.

Steroid nasal sprays – Because all forms of chronic rhinosinusitis involve some degree of inflammation most people will need medications to reduce inflammation. Sprays do not reach deep into the sinus cavities, but they reduce swelling in the nasal passages and open the areas through which the sinuses drain.

Steroid pills – Are very effective anti-inflammatory drugs. They also decrease mucus production and help shrink nasal polyps. Oral steroids get into the circulation and deliver higher doses of drug compared with nasal sprays. This can result in better treatment of the inflammation and more dramatic improvement in symptoms. However, oral steroids can be associated with a variety of unwanted side effects and their use should be minimized.

Antibiotics – Although chronic sinusitis is often caused by inflammation rather than infection, sinus infections can develop and aggravate symptoms. As a result, you may need to take antibiotics. It is sometimes recommended to take a long course of antibiotics, lasting several weeks, to fully treat a sinus infection in a person with chronic sinusitis.

Surgery – Although health care providers usually attempt to get the symptoms of chronic sinusitis under control with medication first, some people need surgery to reopen the sinus passages and remove trapped mucus or polyps. Situations in which surgery is helpful include the following:

  • When chronic rhinosinusitis symptoms do not improve enough with the medical treatments mentioned above and there is evidence of persistent sinus disease on sinus CT scan, such as complete blockage of one or more sinuses.
  • When nasal polyps are present that do not sufficiently shrink with medical treatment.
  • When there is severe deviation of the septum or other sinus anatomic problems causing nasal blockage or difficulty with sinus drainage.

Though surgery can be very useful in the treatment of chronic sinusitis by itself it is rarely enough to control symptoms long-term. The factors that caused the sinus linings to become irritated and swollen and produce extra mucus in the first place must still be addressed.

Can you prevent chronic sinusitis?

You may be able to prevent infections and chronic sinusitis if you:

  • Treat the underlying conditions behind chronic sinusitis, like asthma and allergies.
  • Avoid allergens (and irritants) such as animal dander, dust, pollen, smoke and mold that may trigger swelling in the sinuses.
  • Quit smoking if you do smoke and avoid any secondhand smoke.
  • Wash your hands thoroughly with soap and water.
  • Rinse your nasal passages with saline solution
  • Eat healthy foods, stay hydrated and exercise regularly to stay healthy overall.
  • Use a humidifier to keep nasal tissues moist. Be sure to keep the humidifier clean and free of mold with regular, thorough cleaning.

See a doctor immediately if you have the following signs or symptoms, which could indicate a serious infection:

  • Fever
  • Swelling or redness around your eyes
  • Severe headache
  • Forehead swelling
  • Confusion
  • Double vision or other vision changes
  • Stiff neck

Pollen Allergy

Pollen Allergy

Hay fever (Allergic Rhinitis) is the most common of the allergic diseases and refers to seasonal nasal symptoms that are due to pollens. One of the most obvious features of pollen allergy is its seasonal nature; people experience symptoms only when the pollen grains to which they are allergic are in the air. Each plant has a pollinating period that is more or less the same from year to year. Plants produce microscopic pollen grains to reproduce. In some species, the plant uses the pollen from its own flowers to fertilize itself. Other types must be cross-pollinated; that is, in order for fertilization to take place and seeds to form, pollen must be transferred from the flower of one plant to that of another plant of the same species. In-sects do this job for certain flowering plants, while other plants rely on wind transport. The types of pollen that most commonly cause allergic reactions are produced by the plain-looking plants that do not have showy flowers. These plants manufacture small, light, dry pollen grains that are ideal wind transport. Because airborne pollen is carried for long distances, it does little good to rid an area of an offending plant as the pollen can drift in from many miles away. Among North American plants, weeds are the most prolific producers of allergenic pollen. Rag-weed is the major culprit; a single ragweed plant can generate a million grains of pollen a day. Colorful or scented flowers have large, heavy, waxy pollen grains. This type of pollen is not carried by wind but by insects such as butterflies and bees, and is not typically a cause of seasonal allergy. Similarly, the heavy, very visible pine pollen, is usually not a significant cause of symptoms.

Avoiding Pollen

  • Keep windows and outside doors shut during pollen season.
  • Use central or room A/C, so you can keep windows and outside doors shut
  • Consider pollen counts when planning outdoor activities. It may help to limit your out-door activities during the times of highest pollen counts. Outdoor activities may be better tolerated after a gentle, sustained rain.
  • Encourage hand washing after outdoor play to avoid transferring pollen from the hands to the eyes and nose.
  • If you are outdoors during pollen season, take a shower and wash your hair, change your clothes (not in your bed-room), and leave these clothes in the laundry room.
  • Dry laundry in a dryer only; avoid hanging clothes out-side to dry.
  • Drive with your windows closed. If it is hot, use your air conditioner.
  • Keep pets that spend time outdoors out of the bedroom. In addition to animal dander, they may carry and deposit pollen stuck to their fur.

Pollen Counts

A pollen count is a measure of how much pollen is in the air. This count represents the concentration of all the pollen (or of one particular type, like ragweed) in the air in a certain area at a specific time. It is expressed in grains of pollen per square meter of air collected over 24 hours. Pollen counts tend to be highest early in the morning on warm, dry, breezy days and lowest during chilly, wet periods.

Check the pollen count

Important Pollens


  • Maple
  • Birch
  • Hickory
  • Oak
  • Elm
  • Cottonwood


  • Timothy
  • Kentucky bluegrass
  • Orchard


  • Ragweed
  • Pigweed
  • Lamb’s Quarter
  • Plantain
  • Cocklebur
  • Dock

Controllers – Leukotriene Antagonist

  • Singulair®
  • Accolate®

Mold Allergy

Mold Allergy

What it is . . . and isn’t

If you have a respiratory mold allergy, your immune system overreacts when you breathe in mold spores. This reaction triggers a cascade of reactions that lead to allergy symptoms. Like other respiratory allergies, mold allergy can make you cough, make your eyes itch and cause other symptoms that make you miserable. In some people, mold allergy is linked to asthma and exposure causes shortness of breath and other symptoms. Molds are very common both inside and outside. Mold, also known as fungus, is a family of organisms that are found throughout nature. They differ from plants or animals in how they reproduce and grow. The “seeds,” called spores, are spread by the wind outdoors and by air indoors. Some spores are released in dry, windy weather. Others are re-leased with the fog or dew when humidity is high. There are many different types, but only certain kinds of mold cause allergies. Being allergic to one type of mold doesn’t necessarily mean you’ll be allergic to an-other. Allergic symptoms from mold spores are most common from July to late summer. But with molds growing in so many places, allergic reactions can occur year round.

The term “toxic mold” is a misnomer and has no scientific basis. Some molds, called “toxigenic molds” produce byproducts called mycotoxins, which in high enough doses, can be beneficial or detrimental to human health. A common mycotoxin is penicillin – a useful antibiotic. Extreme exposure to very high levels of mycoto-ins may lead to health problems; fortunately such exposures rarely to never occur in normal exposure, even in residences with serious mold problems. Toxic effects may be the result of chronic activation of the immune system, leading to chronic inflammation. Allergy testing does not evaluate patients who feel they suffer from mold toxicity.

How To Reduce Indoor Mold Levels

  • Prevent outdoor molds from entering the home by keeping doors and windows closed and using air conditioning equipped with allergen-grade air filters.
  • Control indoor moisture with the use of dehumidifiers.
  • Fix water leaks in bathrooms, kitchens and basements.
  • Ensure adequate ventilation of moist areas
  • Limit indoor houseplants; ensure those present are free of mold on leaves and in potting soil
  • Stay indoors during periods when the published mold count is high.
  • Remove bathroom carpeting where moisture is a concern.
  • Clean refrigerator door gaskets and garbage pails frequently.
  • Throw away or recycle old books, newspapers, clothing or bedding.
  • Promote ground water drain-age away from a house.

Important Molds

  • Alternaria – A common outdoor mold; allergy to this mold can be associated with severe asthma
  • Cladosporium – The most common airborne outdoor mold
  • Aspergillus – A common indoor and outdoor mold
  • Penicillium – A common indoor mold; allergy to which is not associated with antibiotic allergy
  • Helminthosporum – More commonly found in warmer climates.
  • Epicoccum – Found in grassland and agricultural areas.
  • Fusarium – Commonly found on rotting plants.
  • Rhizopus and Mucor – Commonly found on decaying leaves and damp indoor areas. Airborne forms of these molds are less common.
  • Yeasts – Commonly found in the air during wet periods in agricultural areas. Allergic disease to Candida albicans is controversial, despite some people having positive allergy testing to this type of mold.

What Times of the Year Does Mold Allergy Occur?

In colder climates, molds can be found in the outdoor air starting in the late winter, and peaking in the late summer to early fall months (July to October). In warmer climates, mold spores may be found throughout the year, with the highest levels found in the late summer to early fall months. While indoor molds can occur year round and are dependent on moisture levels in the home, indoor mold levels are higher when out-door mold levels are higher. Therefore, a common source of indoor mold is from the outside environment, although can also be from indoor mold contamination.