Allergies and Headaches

The importance of allergy as a vital element in clinical medicine has become strongly established in recent years. An informed clinician may consider allergy as possibly playing a significant role, either independently or in combination with other medical problems in almost any patient who has presented for diagnosis. Failure to diagnosis and treat the allergic elements, may easily result in less than optimal results.

We have provided allergy treatment since 2001. We have a yearly average of forty to fifty patients, who receive weekly immunotherapy injections provided at our office.

Prevalence of Allergy

To address this issue properly, we have to ask a few questions. How widespread is this problem, and how much is its effect on the practice? The incidence of allergies is unknown. Overall, the National Institute of Allergy and Infectious Disease suggests that up to seventeen percent of the United States population may have allergy and allergy-like problems. Although, generally allergies are not life threatening, it has a significant economic load on the patient. From figures thirty years ago, the average expansion was around 224 million. Now, it is reaching to billions of dollars at today’s costs.

As ears, nose, and throat physicians, we do more allergy patients than the common population and other specialties of medicine. In order to make a diagnosis of the allergy, we should get a good proper history, full examination, complete testing, and coordination of the findings with the patient’s symptomatology and discomfort. Additionally, allergies are also associated with several different diseases, such as migraine-type headaches, gastrointestinal complaints, difficulty breathing, congestion, sleep disorders, ear problems, some vertigo, and even Meniere’s disease.

Basic Immunology

There are numerous textbooks for immunology. We will not go through all of the details in this short draft. Basically, when we were first born, our own immune cells (which are called T cells) train towards their own configuration of different antigens provided by the garbage cells. The T cells stimulate the B cells and provide allergy antibodies. There are basically known four different types of allergy reactions. Type I is the most common that we are testing for, which includes total IgE production. When IgE attaches to the mast cell, which is a cell that stays in our skin, it causes degranulation of histamine which creates a flare reaction at the target organ. If it is skin, it will have a wheal-and-flare reaction. If it is the respiratory tract, the patient will have hay fever like symptoms, sneezing, runny nose, and itching. If it is a lower target organ, it will be increased sputum and wheezing. If it is the gastrointestinal symptom, there will be a sudden rush to the bathroom with diarrhea. There are other reactions, such as type II, type III, and type IIII reactions, which we will not explain. For the interested reader, there are several different books that they can find about this, and the references have been provided.

As mentioned, allergy diagnosis includes appropriate history, physical examination, and allergy testing. The testing is been done either with prick testing or skin dermal testing. These tests usually take an hour to an hour and a half. It is performed in our office, and we check the patient for common indoor and outdoor allergens, which include common trees, common grass in Illinois, common wild weeds, both airborne and in-house molds, dust mites, and cats and dogs. As we are living a rural area, we check for grass and grain smut, cockroach, etc. The test is performed either by the physician or his qualified assistant. The test results are read immediately. If the patient is not qualified for skin, then we may order blood testing, which will be performed in the hospital.

Another important issue of allergy control is environmental control, which is important especially for indoor allergies. Again, for this section, we do not recommend any specific brands or companies. We do encourage the patient to look at different catalogs to find what works best for their need. Basically, the HEPA-type filtering systems are highly recommended. We do not recommend electrostatic filters. For mold control, we recommend an appropriate check of the house. A mold count can also be ordered. However, the cost varies, depending on the area where the patient is living.

Another important component of allergy therapy is pharmacotherapy. Basically, almost all antihistamines are now available over the counter. They will help certain types of allergy symptoms, such as sneezing or runny nose. It will not have much effect on the breathing, or decreasing nasal stuffiness and congestion. For that part, intranasal steroids are still used effectively. Unfortunately, these medications have to be taken on a regular basis in order to be effective. Additionally, decongestant agents, such as Sudafed, can be used. However, these agents, under long-term use, can cause increase in heart rate, high blood pressure, tachycardia, and gastric irritation. Other agents can also be used for runny nose, such as anticholinergic drugs.

One other therapy that has also been used is anti-IgE treatment, which has been available for the last seven to ten years. We do not specifically recommend this therapy, although there are some patients who definitely may feel benefited. We rarely recommend this therapy to patients, as there are still some questions if this therapy may increase certain diseases.

The benefits of immunotherapy improve the patient’s quality of life, decrease their need for medication, and improve their symptomatology. Currently, our immunotherapy is either recommended as sublingual drops, which the patient will take one drop three times a day, or weekly injections provided at doctor’s office.

Specific contraindications to immunotherapy are in patients who are taking beta-adrenergic blocking agents, which make them more pro-allergic. These patients are not recommended to have immunotherapy. Also, patients who are pregnant are also not advised. Although, if the immunotherapy was started before the pregnancy, it can be continued during the pregnancy.