Sneezing, wheezing, runny nose, throat clearing, and chronic cough: These are just a few of the symptoms of both allergies and asthma. If you or your children suffer from allergies, asthma, hay fever, sinusitis, rashes, hives, or reactions to foods, insect stings, or drugs, we can help. At Cayuga ENT, you're assured of a complete allergy evaluation by specialists who will listen to you. If something is confusing, we will carefully explain it, in language you can understand. We emphasize patient education because we realize there is a lot of confusion about allergies, and how they can be treated.

Allergy testing has come a long way from the days that the patient received 50 scratches on his or her back.  We primarily use the Multitest II allergy skin testing system.  This is a quick, safe, and reliable method to perform skin testing with minimal discomfort on both children and adults.  As a fellow of the American Academy of Otolaryngic Allergy with the help of a trained allergy staff Dr. Strominger is able to ensure that all Cayuga Ear, Nose, Throat - Head & Neck Surgery patients receive the best and safest immunotherapy.  Most patients notice relief of their symptoms within 6 months of starting therapy.  We offer both subcutaneous injection immunotherapy and sublingual immunotherapy.  The latter can be given in the comfort of your own home.  The doctors and trained staff will help you determine what is best for the treatment of your allergies.

Immunotherapy is a technique in which repeated doses of a substance (known as an allergen) that a patient is allergic to is given to that patient to make him/her no longer allergic to that substance.  Historically, immunotherapy is given with weekly subcutaneous injections of ascending doses until a maintenance dose is reached.  The course of therapy lasts at least three years and often longer.  It takes time for the body to make the conversion from having a high level of IgE antibodies that are responsible for the allergic response to a high level of IgG antibodies that work as blocking antibodies, so that the patient is no longer allergic to that allergen.  Because of the need for injections, this therapy is generally performed in the physician’s office, which can be inconvenient for some patients. 

The technique of sublingual immunotherapy (SLIT) has been around for some time but until recently has not been widely accepted.  In SLIT therapy, the allergen is placed under the tongue and absorbed through the oral mucosa.  Thus, there is no need for weekly injections and the therapy can be performed at home.  Recent scientific studies have shown that this is an effective form of immunotherapy and thus, we offer it to our patients.  If you have any questions or are interested in learning more, please ask one of the physicians, the nurse practitioner, or the allergy nurse.

There are 3 skin testing techniques and one blood test to test a patient for allergies:

1.    Intradermal Dilution Testing (IDT) - IDT is the gold standard for allergy testing for Otolaryngic allergists.  A small amount of an allergen is injected into the skin (intradermal) and a small wheal (bump) is raised.  By injecting both negative and positive controls as well as the allergens, and comparing the skin response of a specific allergen to those controls we are able to determine not only if a patient is allergic to that allergen but also by the size of the reaction how sensitive the patient is to the allergen.  The downside to IDT is that it is time consuming and expensive.  We primarily use this technique when we need to perform confirmatory testing after a person has had either prick testing or RAST testing.  

2.    Prick skin testing - This is the most common form of allergy testing that we perform on patients.  By utilizing the Multitest II (www.lincolndiagnostics.com) allergy skin testing system, we are able to test for many allergens quickly and safely with minimal discomfort on both children and adults.  The Multitest II is an applicator with 8 little prongs.  At the tip of each prong are a number of very fine points.  The prongs are dipped into wells of specific antigens. It is then pressed onto the skin.  The points prick the skin. By using multiple applicators we are able to test for many allergens quickly.  This gives us similar responses as IDT testing but is not quite as accurate.  

3.    RAST testing - This is the only blood test for allergies.  It became very popular during the 1990’s but we have found it is not as sensitive as either IDT or prick testing.  In RAST testing the blood is tested for IgE antibodies to specific allergens.  The number of antibodies are measured and reported on a scale of 0 to 6.  This way we can determine whether a patient is allergic to that allergen and if so how sensitive the patient is.  The problem is that this technique only tests for IgE mediated allergy and not for other types of allergic responses.  What we have found over time is that it misses some allergies and overstates others.  We don’t know how to fully explain this but allergy is much more complex than our current understanding.  It is a useful technique for children who will not tolerate skin testing, in patients with dermatographia whose skin responds more than it should, in patients on medications such as beta blockers on whom we cannot perform allergy testing, for food and bee testing when a patient has already had an anaphylactic reaction and skin testing would be too dangerous, and to compare to a patients skin testing when we are unsure about the skin testing results.  

4.    Scratch Test - Many adults remember this form of testing from their childhood.  In this type of testing scratches are made on the skin.  Then a drop of allergen is dropped on the scratch.  The skin response is observed.  Scratch testing should no longer be used because it is inaccurate.

The important thing to remember about allergy testing, no matter what type is performed, is that it is a guide to a patient’s allergies.  It is not 100% definitive.  We cannot test for every conceivable allergy a patient might have.  We do test for seasonal, perennial and food allergies but we test for one allergen in a group that will have cross reactivity with one another and test only for those trees, grasses, and pollens in the Northeast.  We can customize the testing if we know a patient is getting exposed to a specific allergen, such as horses or cows.  With the results we are able to better determine the best medical management for the patient’s allergies and teach a patient how to avoid the allergens.  This is called establishing environmental controls.  We also use the results to build a patient’s vial for immunotherapy.