Allergy/Immunology

Allergic conjunctivitis is the inflammation of the usually clear, thin membrane that covers part of the front surface of the eye and the inner surface of the eyelids (conjunctiva) caused by an allergic reaction.

Allergic reactions caused by allergens may inflame the conjunctiva, causing redness, itching, swelling, tearing and/or stringy discharge.

Allergic rhinitis is an allergic reaction that causes sneezing, congestion, itchy nose and sore throat.

Allergens that may lead to allergic rhinits may include pollen, pet dander, mold or insects.

Allergic rhinitis is also referred to as hay fever.

Asthma is considered difficult to control if someone is experiencing poor symptom control or frequent exacerbations.

This means they have difficulty breathing almost all of the time and often have what could be life-threatening asthma attacks.

In difficult-to-treat asthma, the asthma is:

• uncontrolled despite adherence treatment recommendations
• an oral corticosteroid is needed to achieve control
• uncontrolled despite oral corticosteroid therapy.

Severe asthma is at the extreme end of difficult-to-treat asthma in which the disease is uncontrolled despite maintaining optimal management or it worsens when high-intensity therapy is decreased. 

Our physicians see patients at our specialized Severe Asthma Clinic. See more infomration about our clinic here. 

Note to Parents: If your child is being seen for asthma or allergies, please bring all prescription medications and have child avoid antihistamines for seven days prior to new patient appointments.

Atopic dermatitis (eczema) is a condition that makes your skin red and itchy. It's common in children but can occur at any age. It's a chronic that tends to flare up periodically. It may be accompanied by asthma or hay fever.

Signs and symptoms vary from person to person but may include:

• Dry skin
• Itching
• Red to brownish-gray skin patches
• Small, raised bumps; may leak fluid and crust over when scratched
• Thickened, cracked or scaly skin

An allergic reaction to a drug, medication or a vaccine occurs when your immune system has an abnormal reaction to the medication or vaccine.

Any medication (prescription, over-the-counter, herbal or vaccine) can cause a drug allergy, but are more common with certain medications. The most common signs and symptoms of drug allergies are hives, rash or fever. Symptoms can occur shortly after first dose, or after multiple doses.

Food allergies, also known as food hypersensitivity, is an immune system reaction that occurs soon after eating a certain food. A reaction can occur from even the smallest amount of the allergy-causing food. It can trigger signs and symptoms such as digestive problems, hives or swollen airways. 

Reactions can range from mildly uncomfortable to life-threatening. 

Our team treats food allergies, including from food-protein induced enterocolitis and eosinophilic esophagitis.

Hereditary angioedema is a genetic disorder passed down through families. It is characterized by severe swelling (angioedema) that can be recurrent.

The most common areas of the body to develop swelling are the limbs, face, intestinal tract, and airway. Minor trauma or stress may trigger an attack, but swelling often occurs without a known trigger.

Chronic hives (urticaria) are red, itchy welts that come from a skin reaction.

The welts can vary in size and appear and fade repeatedly as the reaction runs its course. Hives are considered to be chronic if the welts appear for more than six weeks and recur frequently over months or years.

A latex allergy is an allergic reaction to natural latex rubber products, specifically to certain proteins found in natural rubber latex.

Natural rubber latex is made from rubber tree fluids.

Symptoms range from minor skin irritation to life-threatening shock.

Primary immune deficiencies, also known as primary immune deficiency diseases (PIDDs) are rare, genetic disorders that impair the immune system.

Without a functional immune response, people with PIDDs may be subject to chronic, debilitating infections, such as Epstein-Barr virus (EBV), which can increase the risk of developing cancer. Some PIDDs can be fatal.

Some examples of PIDDs include:

• Autoimmune Lymphoproliferative Syndrome (ALPS)
• BENTA Disease
• Caspase Eight Deficiency State (CEDS)
• Chronic Granulomatous Disease (CGD)
• Common Variable Immunodeficiency (CVID)
• Congenital Neutropenia Syndromes
• Epstein-Barr virus (EBV)
  
• Hyper-Immunoglobulin Syndromes

Allergy shots are regular injections over a period of time to stop or reduce allergy attacks.

Allergy shots are provided as a series, usually over the course of three-to-five years.

Allergy shots are a form of immunotheraphy treatment in which each allergy shot contains a tiny amount of the specific substance or substances that trigger the allergic reactions.

Pulmonary function tests (PFTs) are noninvasive tests that are used to measure how well the lungs are working.

The tests measure lung volume, capacity, rates of flow and gas exchange. This information can help your healthcare provider diagnose and determine the treatment of certain lung disorders.

Information from allergy tests help your doctor develop an allergy treatment plan that includes allergen avoidance, medications or allergy shots.

During an allergy skin test, skin is exposed to suspected allergy-causing substances (allergens) and is then observed for signs of an allergic reaction.

Along with medical history, allergy tests may be able to confirm whether a particular substance touched, breathed or eaten is causing symptoms.

Allergy skin tests are widely used to help diagnose allergic conditions, including:

• Allergic asthma
• Bee venom allergy
• Dermatitis (eczema)
  
• Food allergies
• Hay fever (allergic rhinitis)
• Penicillin allergy

Skin tests are generally safe for adults and children of all ages, including infants.

With a skin test, the allergist or nurse administers a small amount of the suspect penicillin to a small portion of skin with a tiny needle.

A positive reaction to a test will cause a red, itchy, raised bump. A positive result indicates a high likelihood of penicillin allergy.

An oral food challenge (OFC), or feeding test, is a medical procedure in which a food is eaten slowly, in gradually increasing amounts, under medical supervision. This is done to accurately diagnose or rule out a true food allergy.

A single serving size of the food allergen is divided into gradually increasing portion sizes over approximately one hour. Team members will then observe the patient for an additional one to three hours to monitor for a reaction.

OFCs are usually done when a careful medical history and allergy tests, such as skin and blood tests, are inconclusive. The OFC is a more definitive test because it will show whether the food ingested produces no symptoms or triggers a reaction.

Oral Immunotherapy is a treatment process that involves eating the food allergen, starting with a very small amount, and increasing the amount over time. This is done in an effort to retrain the immune system and raise the threshold amount of food protein that results in an allergic reaction.

Successful OIT can result in desensitization, in which the patient can eat a significant amount of food allergen without causing a reaction.

Using OIT to develop desensitization to food allergens may significantly reduce food allergy reactions and the need for emergency medications and treatment.

Drug desensitization is meant to help patients with a drug allergy, providing the person with the opportunity to develop a stronger immune resistance to an allergen. This is done under direct medical supervision in an inpatient, hospital setting.

Drug desensitization can be used for a range of medications, including antibiotics, chemotherapy, monoclonal antibodies, iron products, small molecules, progesterone and others.

IVIG is a treatment therapy used to reduce the effects of inflammatory conditions that involve the immune system, also known as autoimmune diseases.

The therapy is also used to increase levels of immunoglobulins if these are low, or have been lowered by treatment as a result of other medications. Immunoglobulin replacement therapy is treatment that can boosts antibody levels when they are low. 

Additional Physician
Aasha Harish, MD

Division Manager
Julie Lopian

Clinical Secretary
Alisa Schwabel 

Physician Assistant
Tabrina Schreier, PA-C

Registered Nurse & Asthma Educator
Kristel McGuire, RN, AE-C

Registered Nurses
Meghan Musilli, RN

Rachel Rainey, RN

Research Coordinator
Helena McClenahan

The Severe Asthma Clinic is a multidisciplinary program with specialists in Pulmonology, Allergy/Immunology, Respiratory Therapy, and Nursing, who collaborate to help children with severe asthma. A severe asthma patient is one who experiences pediatric intensive care unit admission, frequent hospitalizations or ER visits, frequent/high doses of systemic steroids and/or one who is symptomatic despite receiving high-dose controller asthma medications.

The mission of this clinic is to provide optimal care to our patients and educate parents and families about asthma to help them improve asthma control and quality of life for themselves and their loved ones.

Children with severe asthma tend to fall into two categories: difficult-to-treat asthma or severe therapy-resistant asthma.

Difficult-to-treat asthma is poor control due to an incorrect diagnosis or comorbidities and poor adherence due to adverse psychological or environmental factors. Evaluating the patient from a 360-degree view, which involves factoring in other medical conditions, addressing home exposures (mold, dust), assessing access to medication and health services, looking at tobacco exposure, and dealing with school issues, are all important and can all contribute to the clinical picture.

Severe therapy-resistant asthmatics are children whose asthma remains uncontrolled despite resolution of any reversible factors. Incorporating a multidisciplinary model that addresses the medical and social needs of children with asthma has shown demonstrable improvement in quality of life and symptom-free days, as well as decreased hospitalizations and ER visits.

We offer a full range of clinical services including:

• Comprehensive evaluation with dedicated physician time from both Pulmonology and Allergy to confirm the diagnosis of asthma
• Identifying and addressing co-existing problems that may be making the asthma worse (i.e. vocal cord dysfunction, sinusitis, GERD, rhinitis, sinusitis)
• Pulmonary function testing with bronchodilator and other tests as deemed appropriate
• Testing for environmental allergen triggers
• Utilizing community resources to perform in-home assessment of potential asthma triggers and providing free products and resources to help reduce the triggers
• Individualized asthma action plan
• Comprehensive patient education with dedicated asthma educators

For patients with refractory asthma, the Severe Asthma Clinic offers innovative diagnostic and treatment services that are at the forefront of asthma care including:

• Measurement of inflammatory biomarkers in exhaled breath for patients not responding to therapies, and requiring high doses of corticosteroids
• Bronchoscopic evaluation to identify potential chronic causes of asthma