American College of Allergy, Asthma, and Immunology
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The American Lung Association is works to save lives by improving lung health and preventing lung disease through Education, Advocacy and Research. For more than 100 years, the American Lung Association has been leading the fight for healthy lungs and healthy air. The American Lung Association was among the first to tackle smoking as the nation’s greatest preventable health risk, and to make the connection between air pollution and lung disease.
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| Peanut Allergy Treatment | Avoidance |
|---|---|
| The child is less likely to react to accidental peanut exposure. | Current standard of care. |
| May help the child feel more comfortable in social situations. | No need to take daily treatment and no risk of reaction from that treatment. |
| No need to adjust activities based on peanut dosing. |
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Allergic rhinitis can make sufferers miserable. Most people manage it on their own or with your help using over-the-counter or prescription medications. When those don’t work, it may be time to refer your patients to a board-certified allergist/immunologist, who can work with you to guide their treatment.
Diagnosis:
The allergist/immunologist will take a detailed history to help reveal what might be causing the nasal and eye symptoms, including potential triggers in home and work environments. Other conditions, such as a deviated septum, can make allergic rhinitis more severe. In some cases, the allergist/immunologist may conduct an inhalant allergy test to determine the offending allergen.
Treatment:
Once the allergen is identified, it’s best to avoid it if possible or use methods to reduce it (e.g. closing windows when pollen counts are high). Depending on the allergen and patient, the allergist/immunologist might recommend:
- Intranasal corticosteroids
- Intranasal and oral antihistamines
- Oral and topical decongestants
- Leukotriene pathway inhibitors (which also are used to treat asthma)
- Eye allergy drops
- Subcutaneous or sublingual immunotherapy
Learn more about the diagnosis and treatment of allergic rhinitis.
Allergic rhinitis can make sufferers miserable. Most people manage it on their own or with your help using over-the-counter or prescription medications. When those don’t work, it may be time to refer your patients to a board-certified allergist/immunologist, who can work with you to guide their treatment.
The allergist/immunologist will take a detailed history to help reveal what might be causing the nasal and eye symptoms, including potential triggers in home and work environments. Other conditions, such as a deviated septum, can make allergic rhinitis more severe. In some cases, the allergist/immunologist may conduct an inhalant allergy test to determine the offending allergen.
Treatment:
Once the allergen is identified, it’s best to avoid it if possible or use methods to reduce it (e.g. closing windows when pollen counts are high). Depending on the allergen and patient, the allergist/immunologist might recommend:
- Intranasal corticosteroids
- Intranasal and oral antihistamines
- Oral and topical decongestants
- Leukotriene pathway inhibitors (which also are used to treat asthma)
- Eye allergy drops
- Subcutaneous or sublingual immunotherapy
Learn more about the diagnosis and treatment of allergic rhinitis.
There are many types of asthma including: allergic, non-allergic, adult-onset, occupational and exercise-induced bronchoconstriction. Each has its own triggers causing a variety of symptoms your patients need to manage. It’s time to refer them to a board-certified allergist/immunologist who can help you get their condition under control if their symptoms:
- interfere with normal activities,
- cause frequent coughing or wheezing – especially if it’s nocturnal or exercise-induced,
- require more than two corticosteroid bursts in a year,
- require use of quick-relief medication two or more times a week or
- result in an emergency department visit or hospitalization.
Diagnosis:
The allergist/immunologist can review the patient’s symptoms and family history, conduct lung function testing and screen for underlying type 2 airway inflammation. An allergy test and an in vitro blood test for allergens may also be part of the asthma workup to develop an individualized asthma action and treatment plan. Allergists/immunologists are trained to care for both adult and pediatric patients.
Treatment:
Effective treatment of asthma may include identifying and avoiding allergens that trigger symptoms of allergic asthma using drug therapies, minimizing the use of systemic corticosteroids and developing an emergency action plan for symptoms. Many of your patients with asthma will require one medication for quick-relief and another for long-term control; however, some medications can be used for both quick-relief and long-term control.
- Quick-relief rescue:
- Short-acting inhaled beta2-agonists
- Short-acting inhaled beta2-agonist with budesonide
- Short-acting anticholinergics
- Long-term control:
- Inhaled corticosteroids
- Long-acting inhaled beta2-agonists (LABA) with an inhaled corticosteroid
- Antileukotriene agents
- Long-acting anticholinergics
- Biologics
- Quick-relief rescue and long-term control:
- Formoterol (LABA) with an inhaled corticosteroid
For your patients whose asthma is triggered by an allergy, immunotherapy – either as subcutaneous injection or sublingual tablet – may be appropriate.
If your patient’s asthma is moderate to severe and uncontrolled, biologic therapies may be used to manage the condition and improve quality of life.
Learn more about the diagnosis and treatment of asthma.
You likely see and treat many patients with AD, but if a patient is developing severe pruritis, moderate-to-severe erythema, lichenification, excoriations or secondary infections, you should refer them to a board-certified allergist/immunologist who can work with you to treat them.
Diagnosis:
Since AD can be related to allergies, an allergist/immunologist can help your patients determine what exposure exacerbates the condition. They may conduct allergy testing to identify allergens and ask what soap, detergent or skin care products the patient uses that might make AD worse. An estimated one-third to two-thirds of young children who have moderate-to-severe AD have food allergies that an allergist/immunologist can also help manage.
Treatment:
Depending on the severity of the AD, an allergist/immunologist may recommend different treatments.
They may start by prescribing topical treatments, including:
- Corticosteroids
- Calcineurin inhibitor
- Phosphodiesterase inhibitor
- Topical JAK inhibitor
If those treatments don’t control the patient’s symptoms, the allergist/immunologist may prescribe a biologic, oral JAK inhibitor or other treatments
Learn more about the diagnosis and treatment of AD.
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Please submit your allergy and/or asthma-related question. Submitted questions are reviewed by our editorial staff. Responses of interest to the general population will be anonymously published online.
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If a patient with CRSwNP has sleep disturbances and mouth breathing leading to poor work and school performance or decreased or loss of smell, a board-certified allergist/immunologist can help you evaluate their condition. Although CRSwNP is not cancerous, it can cause significant and frustrating symptomology. Anyone is at risk for CRSwNP, but it is more common in people with asthma and those who are 40 to 60 years old.
Diagnosis:
Nasal endoscopy is used to diagnose CRSwNP, and a CT scan may be necessary to confirm the diagnosis. If your patient’s CRSwNP is associated with type 2 inflammation, it may influence the treatment plan. The allergist/immunologist can help determine the underlying causes and may also work with an otolaryngologist during diagnosis and treatment.
Treatment:
Initial treatment to reduce nasal edema includes avoiding common triggers, such as tobacco smoke, aspirin or non-steroidal anti-inflammatory drugs (NSAIDs), chemical fumes, dust or debris, and incense. Home remedies include saline spray and rinsing out nasal passages with a Neti pot. If they don’t provide relief, the allergist/immunologist may prescribe a corticosteroid nasal spray or fluticasone breath-powered corticosteroid device. If the polyps are large and these medications aren’t beneficial, the otolaryngologist may recommend surgery to remove them and enlarge the sinus passages. Polyps often recur despite surgery and long-term treatment with nasal steroids may be necessary. Alternatively, the allergist/immunologist may recommend a biologic. Biologics have been shown to reduce the need for surgery and treatment with oral steroids.
Learn more about the diagnosis and treatment of CRSwNP.
Poor feeding, failure to thrive, food regurgitation, emesis or stomach pain in children, and dysphagia, food impactions or severe reflux in adult patients should prompt a referral to a board-certified allergist/immunologist who can collaborate with you and a gastroenterologist for testing and treatment.
Diagnosis:
An upper endoscopy will be performed by a gastroenterologist to confirm the diagnosis by conducting a biopsy of the tissue and checking for eosinophils. Once EoE is confirmed, the allergist/immunologist will assess your patient for potential food (the most common trigger of EoE) and environmental allergies.
- Topical steroids, e.g. budesonide oral suspension
- Proton pump inhibitors (PPIs)
- Diet elimination therapy of one or more of the most common foods known to trigger EoE (milk, eggs, wheat, soy, peanuts, tree nuts, and fish, including shellfish)
- Esophageal dilatation, which may be performed by the gastroenterologist if esophageal stricture is advanced
- Biologic therapy to reduce inflammation and improve symptoms
Learn more about the diagnosis and treatment of EoE.
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Manage allergy and asthma symptoms and ease the suffering.
Any patient who has had an immediate, severe allergic reaction to a food should be prescribed an epinephrine autoinjector and referred to a board-certified allergist/immunologist who can work with you in managing their condition. Food allergy symptoms are most common in babies and children but can appear at any age. Your patients may even develop an allergy to foods they have eaten for years with no problem. The most common food allergens are eggs, dairy, peanuts, tree nuts, fish, shellfish, wheat, soy and sesame. Symptoms can range from mild with just a few hives to anaphylaxis, which can be life-threatening.
Diagnosis:
An allergist/immunologist will obtain a detailed dietary history, including what food caused the reaction, how much they ate, how long it took for symptoms to develop, what symptoms they experienced and how long they lasted. The allergist/immunologist may conduct an allergy skin test and, in some cases, a blood test to measure the IgE antibody to the specific food tested. An oral food challenge may be conducted in the allergist/immunologist’s office if necessary to confirm the diagnosis and guide treatment.
Treatment:
Once a food or foods are identified as the culprit, the most important step is for your patient to avoid consuming that food. That includes closely reading labels for their food allergen. Patients with food allergens should also share information about their food allergy with servers when eating out at restaurants.
The allergist/immunologist will determine if the patient needs an epinephrine autoinjector and knows how and when to use it. While not a cure, some medications can reduce the risk of a severe allergic reaction by accidental ingestion. Biologics may address type 2 inflammation in adults and children one year of age and older with food allergy to help reduce allergic reactions and anaphylaxis that may occur with an accidental exposure to one or more foods. The allergist/immunologist may also discuss oral immunotherapy (OIT), a daily oral therapy that modifies the immune system.
Learn more about the diagnosis and treatment of food allergies.
This page was reviewed for accuracy 1/29/2018.
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The Foundation
From helping the public find local allergists to publicizing nationwide asthma screenings, see how the College’s strategic initiatives connect patients — and physicians — to success.
Find Certified Allergists
An allergist is trained to find the source of your symptoms, treat it and help you feel healthy. After earning a medical degree, the doctor must complete a three-year residency-training program in either internal medicine or pediatrics.
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Find Certified Allergists
An allergist is trained to find the source of your symptoms, treat it and help you feel healthy. After earning a medical degree, the doctor must complete a three-year residency-training program in either internal medicine or pediatrics.
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Allergic rhinitis can make sufferers miserable. Most people manage it on their own or with your help using over-the-counter or prescription medications. When those don’t work, it may be time to refer your patients to a board-certified allergist/immunologist, who can work with you to guide their treatment.
The allergist/immunologist will take a detailed history to help reveal what might be causing the nasal and eye symptoms, including potential triggers in home and work environments. Other conditions, such as a deviated septum, can make allergic rhinitis more severe. In some cases, the allergist/immunologist may conduct an inhalant allergy test to determine the offending allergen.
Once the allergen is identified, it’s best to avoid it if possible or use methods to reduce it (e.g. closing windows when pollen counts are high). Depending on the allergen and patient, the allergist/immunologist might recommend:
- Intranasal corticosteroids
- Intranasal and oral antihistamines
- Oral and topical decongestants
- Leukotriene pathway inhibitors (which also are used to treat asthma)
- Eye allergy drops
- Subcutaneous or sublingual immunotherapy
Learn more about the diagnosis and treatment of allergic rhinitis.
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If your child has no factors to be at high risk, the best way to introduce peanuts is to make sure first of all your child is healthy – they don’t have a cold, fever, or anything else. Make sure it’s not the first food you’ve introduced to them.
Ruchi Gupta, MD, ACAAI member
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