FAQ

In the United States physicians who hold certification by the American Board of Allergy and Immunology (ABAI) have successfully completed an accredited educational program and an evaluation process, including a secure, proctored examination to demonstrate the knowledge, skills, and experience to the provision of patient care in allergy and immunology. An allergist-immunologist is a physician specially trained to manage and treat asthma and the other allergic diseases. Becoming an allergist-immunologist requires completion of at least nine years of training. After completing medical school and graduating with a medical degree, a physician will then undergo three years of training in internal medicine (to become an internist) or pediatrics (to become a pediatrician). Once physicians have finished training in one of these specialties, they must pass the exam of either the American Board of Pediatrics (ABP) or the American Board of Internal Medicine (ABIM). Internists or pediatricians who wish to focus on the sub-specialty of allergy-immunology then complete at least an additional two years of study, called a fellowship, in an allergy-immunology training program. Allergist-immunologists who are listed as ABAI-certified have successfully passed the certifying examination of the American Board of Allergy and Immunology (ABAI), following their fellowship.

A NURSE PRACTITIONER also known as physician extender has advanced education and training in a health care specialty.

Nurse practitioners provide health care similar to physicians including:

• Performing advanced physical exams.
• Ordering and interpreting diagnostic tests like blood work and X-rays
• Diagnosing and initiating a plan of care.
• Ordering medications.
• Evaluating response to treatments.
• Working closely with other specialists as needed.
• Working very closely with the attending physician.

Nurse Practitioners are highly trained specialists providing health care in a variety of areas including Allergy and Immunology for Children, Adults, and Geriatric patients. In essence the Nurse Practitioner as a Physician Extender works very closely with the doctor she is working with and helps coordinate care to a higher level with a team approach.

At Allergy and Asthma Care of the Palm Beaches the Nurse Practitioner like the doctor will:

• Complete a detailed medical history.
• Perform comprehensive physical exams.
• Place and interpret allergy skin testing.
• Order and interpret pulmonary function tests (lung capacity tests).
• Order and interpret laboratory work, X-rays, Chloride Sweat test and CT scans.
• Prepare and Administer Xolair injections.
• Perform Oral Drug and Food Challenges.
• Initiate medications and treatments.
• Monitor progress during follow up appointments.

We ask that you arrive 15 minutes before your scheduled time so we may process your information before you see the doctor or nurse practitioner.

Upon arrival to Allergy and Asthma Care, our receptionist will ask for your driver’s license, insurance identification card, and appropriate referrals. Please bring with you any information about your medical/surgical history. Please also bring with you any X-ray written reports, Sinus CT Scan written reports, lab reports, or other relevant medical records for review at the time of your evaluation. You will also be asked for a list of all prescription and/or over-the-counter medications, including dose and frequency.

During your initial visit us you will be asked to turn in or complete the new patient questionnaire with a health history. You will be expected to pay any applicable insurance co-payment and/or deductible at that time.

You will first see the nurse who obtains your blood pressure along with other useful information.

We will then meet with you to obtain a complete medical history and perform a physical examination. Some important questions that will be asked include: allergy symptoms, exposures, the timing of your symptoms, and the effect of past treatments. The physician or nurse practitioner will also look at how your other medical conditions may relate to your allergy symptoms.

We will then summarize your condition and will speak to you about your diagnosis, any necessary evaluations, treatment options, and provide appropriate education. Further testing may be needed to clarify what you are allergic to, how well your lungs are functioning, or if other problems are present. Further testing may include allergy skin testing, Sinus CT Scans, Chest X-rays, blood tests, pulmonary function tests, and challenges. Skin testing may be offered at your initial consultation, so please avoid antihistamines for at least 5 days prior to your office visit.

It is advised to see a board certified allergy specialist when your allergy related symptoms and/or asthma are not getting better and could eventually interfere with your quality of life. At Allergy and Asthma Care we would do specific tests to determine the triggers for your symptoms. We often work closely with your primary care physician to improve the quality of your care. We offer many treatment options and tools tailored to each individual.

House dust mite allergy is caused by mites living in the house dust and the allergy is actually brought on by the excrement of the mites. The house dust mites are co-inhabitants of our domestic environment and have nothing to do with inadequate hygiene. Neither do they carry any diseases. You will find a spectacular selection of mites in micro-photos. After dessication, the excremental capsules decay into very small particles and join up with the house dust. This allergy-containing dust can then be inhaled by breathing and lead to allergic complaints such as watering or itching of the eyes, coughing, congestion of the nasal mucosa, sneezing attacks, skin reactions and in serious cases to dyspnea and allergic asthma. If these symptoms occur all year round and if they are particularly severe in the evening or the early morning on rising, this would indicate a house dust mite allergy.

The two most common types of dust mite in our everyday environment are dermatophagoides pteronyssinus (Dust mite p) and dermatophagoides farinae (Dust mite f). The dust mites belong to the arachnid (spider) group. They feed mainly on human and animal skin scale and mold. A human being loses about one to two grams of skin scale every day, enough to feed 1.5 million house dust mites for a day. Apart from the availability of nourishment, the house dust mite population is encouraged by high atmospheric humidity.

The main reproductive period for house dust mites is in the months of May until October. At the beginning of the period when the heating is turned on and the consequent reduction in the atmospheric humidity the majority of the dust mites die off. At this time the maximum quantity of excrement has built up so this is also the time when the symptoms of those allergic to house dust mites are at their worst.

At Allergy and Asthma Care we provide extensive education on avoidance measures, by first identifying the allergen or irritant relative to your condition. If implemented regularly, it will help resolve or decrease symptoms, minimize the amount of medications and improve your quality of life. The allergy vaccination treatment is an option for patients that qualify based on skin test results and is the patients or parents ultimate decision.

In order to become a candidate for airborne allergy shots your skin test results should correlate with your symptoms. Allergy shots or vaccines work for a majority of patients that do not respond well to medical treatment and environmental control. In some circumstances, allergy shots or vaccines are the best options. It takes understanding of your condition, dedication, time, and knowing, as well as trusting the treatment method. Allergy vaccines are also given to patients with systemic reactions to insect stings (venoms) with a high cure rate. Currently, allergy shots are not an option for food allergies.

It is a painless measurement of your lung capacity, detects and measures airway obstruction and response to treatment. The Pulmonary Function Test, also known as Spirometry, will help you us determine how severe your asthma is and how much medication you need. Furthermore, the test will help assess if your current therapy program is effective.

Allergy tests are administered by us and can identify what triggers your allergy, asthma and sinus symptoms. Examples of common allergy symptoms are sneezing, watery eyes, runny nose, itching, swelling, hives, stomach cramps, and diarrhea. Allergy testing is the most precise way to find what causes allergic symptoms. Allergy tests can help you know what substances you are allergic to. Substances that trigger allergy symptoms are called allergens. Knowing which allergens cause your symptoms can help you avoid these substances and reduce your symptoms.

Consider having allergy tests if you have allergy symptoms that you are not able to control with environmental control or medicine. We may recommend that you start having allergy shots based on allergy skin tests results. Allergy vaccines (shots) are usually recommended for those suffering from some airborne allergy related symptoms. A mixture that contains the specific airborne allergens identified in your tests are used to make the shots. Your allergies can then be treated by injecting the mixture into your skin in tiny but increasing amounts over the course of many months. Over time, the shots make you less sensitive to the allergens. Allergy shots are not given for food allergies.

How do I prepare for these tests?

You may need to avoid taking certain medicines before the tests because they might affect the test result. For example, you may need to stop taking any antihistamines for at least five days and some antidepressants for two weeks before the skin tests.

Call Allergy and Asthma Care if you have any questions.

How are the tests done?

The 4 main kinds of tests used to identify allergy triggers are:

• skin tests
• blood tests
• food challenges
• elimination diets

Skin tests: A test called the skin puncture test is the most common type of skin test. For this test, a drop of allergen extract is put on the multi-test puncture device and the puncture devise is pressed on your skin. This lets the allergen get under the skin. The test can also be done with a pricking device that has been presoaked in the allergen extract. Only the top layer of skin is pricked. The test is usually done on the back or the arm. The skin test is ready to check in about 15 minutes. If you are allergic to the allergen in any of the extracts, a red bump that looks like a mosquito bite will appear at the spot where the extract was placed. If the puncture/prick test is negative or the test results are not clear, a more sensitive test called an intradermal test may be done. For the intradermal test, a very small amount of allergen is injected under the skin of the upper arm.

Blood test (IgE/RAST test): Blood tests are not done as often as skin tests, but they can be useful in some cases. A sample of your blood is sent to a lab for testing. The test measures the amount of IgE antibody in the blood. The body makes this type of antibody when trying to fight off allergy-causing substances and also as a response to some parasites. The test results show whether you are making antibodies to certain allergens and thus whether you are allergic to those allergens.

Food challenges: To check for food allergies, we may want you to do a food challenge test. For this test, you are given gradually increasing amounts of a food while your provider watches for symptoms. This test should be done only by an allergist, a trained professional who is ready to treat you if you have a serious reaction to the food. In cases of allergies that are not caused by IgE antibodies (such as some gastrointestinal allergies), a food challenge test may be the only good way to diagnose a food reaction.

Elimination diet: For another check of possible food allergies, we may want you to avoid eating certain foods for a few weeks to see if allergy symptoms go away. During this time, you will need to keep a record of the foods that you eat and any symptoms you have. The diet is followed until all allergic symptoms are gone. Foods are then added back to the diet one at a time. If symptoms come back, you know which foods are safe to eat and which foods to avoid.

If the skin or blood test is negative for an allergen, then you probably do not have an allergy to that substance. If the skin test is positive for an allergen, it may mean you are allergic to that food. However, sometimes a test can be positive even if you are not allergic to the food.

The positive test result can be wrong sometimes because:

• You can sometimes continue to have a positive test result for many years to an allergy you have outgrown.
• You are allergic to a different substance that has some components similar to the allergen you were tested for. For example, you might have a positive test for soy if you have peanut allergy, or a positive test to wheat if you have a grass pollen allergy.

Test results are only one part of a larger picture that takes into account your medical history and current health. Sometimes a test needs to be repeated to check the first result. Talk to us about your results and feel free to ask questions. As allergy specialists we will interpret the results of the tests and suggest ways your allergy might be treated. Be sure to discuss all your concerns with us and make sure you understand how best to care for your allergy symptoms.

A test called the skin puncture test is the most common type of skin test. For this test, a drop of allergen extract is put on the multi-test puncture device and the puncture device is pressed on your skin. This lets the allergen get slightly under the skin. The test can also be done with a pricking device that has been presoaked in the allergen extract. Only the top layer of skin is pricked. The test is usually done on the back or the forearm. The skin test is ready to read in about 15 minutes. If you are allergic to the allergen in any of the extracts, a red bump that looks like a mosquito bite will appear at the spot where the extract was placed. If the puncture/prick test is negative or the test results are not clear, a more sensitive test called an intradermal test may be done. For the intradermal test, a very small amount of allergen is injected under the skin of the upper arm and you get results within 15-20 minutes.

Intradermal skin test are not done for food allergies.

If the airborne puncture/prick test is negative or the test results are not clear, a more sensitive test called an intradermal test may be done. For the intradermal test, a very small amount of allergen is injected under the skin. This involves the sterile injection of a tiny amount of allergen just under the skin of the upper arm. Because a needle is used, some patients fear that this test will be painful as a shot. It is not. Only a small amount of allergen is injected, and the small needle slips barely under the skin surface. Local reactions are read by us within 15-20 minutes.

A patch test is a skin test used to help determine the cause and nature of your contact dermatitis. A patch test helps to identify any substance(s) causing your dermatitis so that you may avoid exposure to the source of your skin rash.

When should patch testing be done?

Patch tests are done to help determine if your skin rash is contact dermatitis and not another condition such as psoriasis or eczema.

How is patch testing done?

A number of different allergens that may be causing your rash are applied in very small amounts on a small area of skin on your upper back, which is covered so it’s watertight. The patch test is usually left on your back for two days. When you return to the office the patches are removed and the test is read at 48 hours, you will then return two days later for a second reading at 96 hours.

What to avoid prior to patch testing?

• Avoid oral steroids for two weeks prior to testing. Avoid steroid injections for one month prior to testing.
• Avoid all antihistamines for five days prior to testing. These include: prescription and over-the-counter medications used for colds, allergies, and reflux symptoms. Ex: Benadryl, Atarax or Hydroxyzine, Claritin, Alavert, Clarinex, Allegra, Zyrtec, Zantac, Tagamet or Cimetidine or any antihistamine containing medications.
• Avoid topical corticosteroid on the back area ex: Hydrocortisone cream, Elocon, Diprolene etc.. .for two weeks prior to testing.
• Avoid topical immunosuppressive on back area ex: Protopic or Elidel for two weeks prior to testing.
• Avoid systemic (oral, injected) steroids for two weeks prior to the patch test.
• Avoid sun exposure and sunburn on back area for one week prior to testing.
• Avoid lotions, creams on back area for 24 hrs prior to testing.
• Avoid shaving back area prior to testing.
• After the patches are on your back, you should strictly avoid swimming, bathing, showering, and any physical activity that causes sweating, (sponge bath is OK but not over the patch test) until after the second reading.

The sensation is like a light pin prick with some degree of stinging and burning, followed by mild to moderate itching if there is an allergy. Most patients categorize the feeling as a discomfort.

Skin tests usually take between 1-1 ½ hours.

You need to avoid antihistamines at least 5 days prior to skin testing. These include Benadryl, Atarax, Dimetapp, Actifed, Novahistine, Polyhistine, Chlor-Trimeton, Naldecon, Marax, Chlorpheniramine; different Tylenol, Motrin and Advil preparations; Contac, Extendryl, Optimine, Phenergan, Tavist, Triaminic, Trinalin, Clarinex, Allegra, Zyrtec, Xyzal, Claritin, Zantac, Tagamet, Pepcid, Axid and many others. This can also include some nasal sprays (Astelin, Astepro, Patanase) or allergy care eye drops. Also some anti-depressants need to be avoided at least two weeks prior to skin testing. Call our office if you have questions about which medications to avoid.

You should not have any other symptoms besides the slight local swelling or small hives and local itchiness (if you are allergic), where the test was done. This will usually start resolving within 30 minutes.

This involves testing for allergies through drawing blood. Blood tests are not done as often as skin tests, but they can be useful in some cases. A sample of your blood is sent to a lab for testing. The test measures the amount of IgE antibody in the blood. The body makes this type of antibody when trying to fight off allergy-causing substances as well as parasites. The test results show whether you are making antibodies to certain allergens and thus whether you are allergic to those allergens. These tests are done for airborne as well as food allergens.

Most of IgE/RAST tests (blood test) are not as accurate as skin tests. They also cost more and the results are not available as rapidly as skin tests. Blood testing for allergies are generally used only in cases in which skin tests cannot be performed, such as on patients taking certain medications that block the results of the skin test, or those patients with skin conditions that may interfere with skin testing.

Besides testing for allergies, blood work is also requested for patients with recurrent, persistent or severe infections. In such patients, we will request a comprehensive evaluation of the immune system pertinent to each patients condition.

Also in patients that present with Urticaria (hives) or Angioedema (swelling) that last over six weeks, if no obvious trigger by history, we may request lab work.

Allergy and Asthma Care accepts the following insurances:

• Aetna HMO, PPO, POS
• Aftra and Vitra
• American Medical Security
• Amerigroup
• AmeriHealth
• APA Partners
• APWU Health Plans
• Avalon HNA
• AvMed HMO and PPO
• Bankers Life and Casualty Ins.
• Blue Cross Blue Shield HMO, PPO, PPC, POS, Health Options
• Care Plus Health Plans, Inc.
• Celtic
• Cigna HMO, PPO , POS
• CMS Networks (not to be confused with children’s medical services)
• Comprehensive Benefits
• Coventry
• Dimension Network
• Evolutions
• First Health Network CCN, Coventry, SouthCare PPO
• Fleet Reserve Assoc.
• Great West Health Care
• Harvard Pilgrim
• Health Care
• Health Net
• Health Smart Beech Street
• Humana PPO, Choice Care, HMO, Gold Plus
• Iron Workers
• Medicare
• Mega Life Ins.
• Midwest national Life Ins.
• Multiplan
• Paragon Benefits
• PHCS – Multi Plan
• Pomco Group
• Samba Federal Health
• Secure Horizons (UHC)
• The JP Farley Corporation
• Time Insurance Company
• United Health Care
• Vista Health Plan of Florida
• Web TPA

If the insurance you are looking for is not on this list, call us for up to date information.

We accept the following credit cards:

• American Express
• Discover
• MasterCard
• Visa