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.

Pulmonary function tests are a group of tests that measure how well the lungs take in and release air and how well they move gases such as oxygen from the atmosphere into the body’s circulation.

Pulmonary function tests are done to:

• Diagnose certain types of lung disease (most commonly asthma, chronic bronchitis and emphysema)
• Help find the cause of shortness of breath
• Assess the effect of medication to treat your lung disease
• Assess the effect of medication prescribed to treat your lung disease
• Assess the effect of medication that may negatively affect your lung function (for example, amiodarone)
• Measure progress in disease progression
• To assess perioperative pulmonary risk prior to undergoing surgery

The most commonly performed test is called “spirometry.” With this test you will breathe into a mouthpiece that is connected to an instrument called a spirometer. The spirometer records the amount and the rate of air that you breathe in and out over a period of time. For some of the test measurements, you can breathe normally and quietly. Other tests require forced inhalation or exhalation after a deep breath. You will be asked to wear a nose clip so we can collect all the air that comes out of your mouth. “Lung volume” is measured in other ways. In one way you will be asked to sit in a sealed, clear box that looks like a telephone booth (body plethysmograph) while breathing in and out into a mouthpiece. Changes in pressure inside the box help determine the lung volume.

Lung volume can also be measured when you breathe nitrogen or helium gas through a tube for a certain period of time. For one test known as a “methacholine challenge test” you will have to breathe in medication before the test.

Do not eat a heavy meal before the test. Do not smoke for 4 – 6 hours before the test. You’ll get specific instructions if you need to stop using bronchodilators or inhaler medications prior to the test. The tests are usually very well tolerated. Since the test involves some forced and rapid breathing, you may have some temporary shortness of breath or light-headedness.

Cystic fibrosis (CF) is an inherited condition caused by a defective gene (CFTR – Cystic Fibrosis Transmembrane Conductance Regulator) which causes the body to produce abnormally thick and sticky fluid, called mucus. This mucus builds up in the breathing passages of the lungs and in the pancreas, the organ that helps to break down and absorb food. This collection of sticky mucus results in life-threatening lung infections and serious digestion problems. The disease may also affect the sweat glands and a man’s reproductive system. Millions of Americans carry the defective CF gene, but do not have any symptoms. That’s because a person with CF must inherit two defective CF genes – one from each parent. An estimated 1 in 29 Caucasian Americans has the CF gene. The disease is the most common, deadly, inherited disorder affecting Caucasians in the United States. It’s more common among those of Northern or Central European descent. Most children with CF are diagnosed by age 2. A small number, however, are not diagnosed until age 18 or older. Occasionally, relatively mild symptoms may lead to frequent misdiagnosis or no diagnosis at all unless the symptoms become worse. The condition may be misdiagnosed as emphysema, asthma or chronic bronchitis. These patients usually have a milder form of the disease. About 30,000 Americans and 70,000 people worldwide are living with cystic fibrosis. Only a few decades ago, children with CF seldom survived elementary school. Today, thanks to earlier diagnosis and improved treatments, the median survival for those with CF is 47 years of age. With new, novel therapies known as CFTR modifiers this number is likely to climb.

Dr. Schaefer helped to establish the Adult Cystic Fibrosis Program at the UMass-Memorial Medical Center. He sees patients with CF at the CF Center at UMass-Memorial University campus, as well as in MLA’s Worcester office.

UMass-Memorial / UMass Chan Medical School Adult Cystic Fibrosis Program

The UMass-Memorial Adult Cystic Fibrosis Center, accredited by the national Cystic Fibrosis Foundation, specializes in the management of adults with cystic fibrosis. We provide a team approach to care that includes medical, nurse, registered dietician, physical therapy, social worker, and respiratory therapy cystic fibrosis specialists. We collaborate closely with our colleagues in the UMass-Memorial Pediatric Cystic Fibrosis Center to assist adolescents and young adults in the transition from pediatric to adult care.

Our services

• Comprehensive cystic fibrosis diagnosis including sweat testing and blood testing for all known mutations related to cystic fibrosis.
• Full range of treatments for all complications related to cystic fibrosis, including those involving the respiratory, sinus, digestive, endocrine, and reproductive systems.
• Up to date therapeutics including use of the newest CFTR Modulators
• Management of cystic fibrosis lung disease, including mucus clearance techniques, mucolytics, and preventive therapy for patients infected with pseudomonas.
• Comprehensive nutrition counseling and care, including pancreatic enzyme replacement therapy, screening for and repletion of vitamin deficiencies.
• Bronchoscopy is a procedure used to visualize the inside of the airways (bronchial tubes). It is used for both diagnostic and therapeutic purposes. The bronchoscope is a flexible instrument that is inserted into the airways, usually through the nose or mouth. It has both a light source and digital camera at its end. This allows the physician to examine the patient’s airways for abnormalities such as tumors, bleeding, foreign bodies, or inflammation. At the time of the bronchoscopy specimens may be taken from inside the lungs such as biopsies, fluid, or brushings. The procedure can be accomplished as an outpatient with the use of sedation, similar to that used for a colonoscopy.You may be referred to MLA by your physician for abnormalities such as a nodule or mass found on an x-ray or CT scan, or for the evaluation of persistent or recurrent pneumonia. Your MLA physician will review all the specifics of this test if he or she decides this would be the best study for you.
• Close collaboration with Nutrition, Psychology, Respiratory Therapy, Gastroenterology, Endocrinology (diabetes), Transplant Surgery and Palliative Care.

Thoracentesis (also known as a pleural tap) is a procedure to remove fluid or air from the pleural space. The pleural space is an area between the lung and the chest wall that usually contains just a thin layer of fluid. At times, air or more commonly fluid can collect in this space. If there is enough fluid, a patient can become symptomatic, for example develop shortness of breath. If that occurs, removal can provide relief of these symptoms. Additionally, fluid may need to be removed to help aide in the diagnosis of many conditions. The test is performed as follows: You will sit on the edge of a bed or chair. Your head and arms will rest on a table. The skin around the procedure site is cleaned and the area is draped. A local numbing medicine (anesthetic) is injected into the skin. You will feel a stinging sensation when the local anesthetic is injected. The thoracentesis needle is inserted above the rib into the pleural space and a catheter (small plastic tube) if introduced. You may feel pressure when the needle is inserted into the pleural space. Fluid is collected and will be sent to a laboratory for testing. This procedure has been performed by physicians since 1852!