Allergy & Asthma Center of Stamford


                                       Paul S. Lindner, MD, FACP   &   Ora Burstein, MD
                             1275 Summer St - Stamford, CT 06905    -    (203) 978-0072
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Sneezing, itchy nose, runny nose, stuffy nose, post nasal drip - caused by allergies. Common triggers include dust mites, pollens (trees, grasses, ragweed), molds, cat, dog and other animal danders.
Typically we will perform skin or blood testing to determine which substances are triggering symptoms and need to be avoided. Environmental avoidance measures are discussed. Medications such as antihistamines and nasal sprays may be provided. Allergy Shots (allergy immunotherapy) are highly effective in providing long term relief from allergy symptoms and minimize the amount of medications needed to control symptoms.
Non-Allergic Rhinitis (Vasomotor Rhinitis)
Sneezing, itchy nose, runny nose, stuffy nose, post nasal drip - not caused by allergies. Allergy testing is negative. Common triggers include cold air, changes in weather, infections, medications, airborne irritants.
Treatment may include antihistamines, decongestants and nasal sprays as well as avoidance of triggers.
Conjunctivitis can be caused by allergies above (allergic conjunctivitis), infections (infectious conjunctivitis or "pink eye"), irritants (irritant conjunctivitis), dry eyes and other ocular conditions. Generally eyes can be itchy, runny, red, irritated and have clear or discolored drainage.
A history and physical will be provided to determine if the cause of the conjunctivitis is allergic or infectious or other. If allergies are suspected, skin or blood allergy tests can be performed. Allergy eyedrops can be prescribed or if any infection is suspected, antibacterial eye drops can be given.
Wheezing, coughing, shortness of breath and atight chest are all symptoms of asthma. Asthma severity can range from mild intermittent symptoms to severe daily symptoms andlife-threatening attacks. Most asthma patients have allergies as a trigger; however, some patients have no allergies at all. Common allergic triggers include dust mites, pollens (trees, grasses, ragweed), molds, cat, dog and other animal danders. Food allergies can also trigger an asthma attack. Asthma may be set off by cold air, exercise, pollution, infections, stress and other nonallergic triggers.
Typically we will perform skin or blood testing to determine which substances are triggering asthma symptoms and need to be avoided. A breathing test will be performed in our office (pulmonary function testing), and we can determine the level of oxygen in the blood stream with a painless, noninvasive device. Environmental avoidance measures are counselled. Medications such as quick acting inhalers and maintenance inhalers or pills may be provided. Allergy shots (allergy immunotherapy)are highly effective in providing long term relief from asthma symptoms and minimize the amount of medications needed to control symptoms.
Wheezing, coughing, shortness of breath, sputum productionand atight chest are all symptoms of COPD as well as asthma. The major difference between the two diseasesis that with COPD, we do not generally find improvement in pulmonary function testing after a bronchodilator is given which is defined as irreversible lung damage. Generally allergies play a much important role in asthma, although some patients may have features of both asthma and COPD. COPD is usually associated with cigarette smoking, however this is not always the case. Some patients may have a rare syndrome known as Alpha-1-antitrypsin deficiency which can cause COPD, and for which we now have a good screening blood test.
Our evaluation generally starts with a breathing test to measure how much lung function can be improved with medications. An oxygen level is obtained. Smoking cessation is counselled. Inhalers and pills are often prescribed which can improvesymptoms so thatdaily activities can be performed without shortness of breath. A chest x-ray may be obtained if indicated. Often patients with COPD experience exacerbations of symptoms when having respiratory infections such as bronchitis and pneumonia and for these we can provide antibiotics.
Typical "cold" symptoms with sore throat, runny nose, nasal congestion, post nasal drip, fever, aches. Most of the time these symptoms are due to a viral infection. A strep screen can be performed in our office to give results within 5 minutes to determine if antibiotics are needed. If symptoms are lasting for more than a week and especially if there is discolored nasal drainage or sputum production, these may be signs of a bacterial infection (sinusitis, bronchitis, pneumonia.)
Patients with allergies tend to have sinusitis much more than the average population. The swelling of the nasal and sinus linings from allergic triggers increase the chances of a minor coldbecoming a full fledged bacterial sinus infection. Symptoms include nasal and sinus congestion, pain, sinus pressure, headache, post nasal drip anddiscolored nasal secretions. Sinusitis can become chronic.
For sinus sufferers we employ a comprehensive approach looking at the three most important factors leading to recurrent sinusitis - allergies, immune deficiency and structural issues. Depending on the history and physical examination, our evaluation can include skin or blood testing for allergies, blood testing of the immune system and CT scanning of the sinuses looking for structural problems. Our goal is to treat sinusitis medically without surgery,addressing allergies if they are present, decreasing sinus inflammation, eradicating bacteria with antibiotics andlooking for fungal sinusitis. If medical therapy is insufficient, especially in cases with structural deformities of the sinuses, we work closely with the top otolaryngologists in Stamford to see if a surgical remedy is warranted.
Generally patients with allergies, asthma and COPD are much more prone to these infections. The symptoms are similar, and may include cough, sputum production, fever, chills, shortness of breath and wheezing. The major difference between bronchitis and pneumonia is that with bronchitis a chest xray will be normal.
Treatment generally includes appropriate antibiotics but may also include asthma/COPD medications if there are additional breathing issues. After dealing with the acute event, our focus is on prevention, especially if there is underlying asthma or COPD or other pulmonary disease. A pneumonia vaccine given once every 5-10 years can help prevent further infections. Yearly influenza vaccines may also be recommended.
We treat ear infections aggressively with antibiotics. If ear infections are recurrent, especially in children, there may be an underlying allergy trigger which can be tested for. Immunodeficiencies are rare; however if suspected, we can perform a complete immune evaluation. We work closely with the top otolaryngologistsin case a surgical opinion is needed.
Nasal polyps are growths inside the nose and sinuses. Unlike other forms of polyps in the body, nasal polyps are generally not a risk for cancer. The big problem with nasal polyps is that they block the nasal and sinus passageways, and nasal congestion can be quite severe. They are often associated with chronic sinusitis. Often patients may be allergic to aspirin and other antiinflammatory medications such as motrin and advil. In children, polyps may be a sign of cystic fibrosis.
We generally test patients for allergies as this may be a contributing factor. In addition to providing allergy therapy, medication therapy can shrink and prevent regrowth of polyps. Sometimes only surgery to remove the polyps may be effective, however even after surgical removal, polyps can regrow. We work closely with the top otolaryngologists in case a surgical opinion is needed.
Food allergies can be as mild as a little stomach irritation after eating a particular food, to the most severe of allergic reactions, anaphylactic shock. Food allergies have been implicated in causing nausea, abdominal discomfort, vomiting, diarrhea, malabsorption, eczema, hives and other rashes, headache, nasal symptoms, itchy eyes, asthma symptoms, throat and facial swelling, decreased blood pressure and cardiovascular collapse.
If a food allergy is suspected, we perform skin or blood testing for evaluation. If the tests are negative, we may do an oral challenge to confirm. Any food can cause an allergy; however, the most common foods would include milk, eggs, soy, peanut, tree nuts, shellfish and some fruit. We can test for more than 90 different foods in the office.
The treatment for food allergy at this point in time is avoidance. An allergy shot is being researched currently for food allergy patients. There are no FDA approved allergy treatments for food allergy at this point in time (sublingual drops are not proven to be safe or effectiveand are not an approved therapy by the government and are generally not covered by insurance for this reason.)
The most deadly of allergies. Reactions range from local self limited swelling which can get quite large, to generalized reactions. Patients may have hives, generalized itching, swelling of the lips, tongue, throat, eyes and dfficulty breathing. Cardiopulmonary collapse (anaphylactic shock) can occur suddenly.
Skin testing for thefive most common insects in the region is performed. These include yellow jackets, wasps, bees, yellow hornets and white hornets. We can also test for fire ants that are found in southern regions. If a patient has experienced a generalized reaction to an insect sting, the risk of anaphylaxis on a future sting is 60%. For this reason, any person with a history of a generalized reaction after an insect sting who is proven to be allergic by skin testing should be desensitized with allergy shots which have a 99% effective rate of cure.
Contact Dermatitis is a very common problem. Generally this is an allergic response to any substance in contact with the skin. Very common forms in New England are due to contact with poison plants (ivy, sumac, oak). Jewelry with a high nickel contact often causes problems. Cosmetics, shampoos, hair dyes, soaps, lotions, creams, sunscreens and latex also commonly cause problems.
The treatment consists of using medication to stop the acute reaction and then identifying which substances need to be avoided. There is no reason to suffer with a case of poison ivy; we have medications which can act quickly to relieve symptoms and prevent spread of lesions. We have a special patch test panel where we can test for a variety of chemicals and other substances which commonly cause contact dermatitis, so these can be avoided.
There are many triggers of urticaria. Urticaria typically looks like mosquito bites and are usually very itchy. They may be very small or very large but usually last less than 24 hours in any particular spot. Urticaria can be daily and chronic and last for months or years. Angioedema often accompanies urticaria and is generally described as a deeper swelling which can involve the facial structures to include lip, tongue, eyelid swelling and even throat swelling.
Our goal is to identify the cause of hives which may not be easily apparent. Common causes of hives include drug allergy, food allergy, environmental allergy, infections, stress, insect allergy and more rarely autoimmune disease and cancer. Our evaluation may include allergy skin testing and general laboratory testing to screen for systemic ailments associated with development of urticaria. We will prescribe medications to alleviate the symptoms of urticaria and angioedema.
Eczema is best described as dry, itchy, scaly skin. Eczema can occur on any area of the skin, but typically occurs inside the elbows, on the wrists, hands, behind the knees, behind the ears, under the arms and sometimes on the face and around the neck. Eczema can start in early childhood, and although most children will improve with time, some adults will constantly have eczema.
Most patients with eczema, especially children, will have allergic triggers. Food allergies in particular, tend to be the most important culprit. We test for a variety of foods to find the cause and can give dietary guidance to improve eczema. In young children especially, eczema can be totally cleared by avoidance of the offending allergenic foods such as milk, eggs, soy, nuts, peanut, shellfish and other foods. Eczema control also involves hydrating the skin with moisturizering creams and controlling itching with antihistamines.
Our office has specialized expertise in evaluating drug allergy reactions. Any acute reactions will be treated immediately with appropriate therapy. Once the reaction has cleared, discussions regarding future avoidance of particular medication groups will be discussed. Most of the time, alternative medications can be used for future therapy and a list of alternative medications will be provided to patients and their referring physicians. Sometimes there may be no alternative medications available for a certain medical condition (such as for patients with a history of penicillin allergy who need a penicillin related drug for lyme disease or other infection) and in these cases we can test for penicillin allergy or other antibiotics to see if the patient is truly allergic. We have worked closely with the Oncology department in cases where essential chemotherapy drugs have caused reactions, to test and desensitize these patients for future chemotherapy infusions.
Immunodeficiency (decrease in the immune system)
In addtion to allergies as a component inrecurrent respiratory infections (sinusitis, otitis, bronchitis and pneumonia), an often overlooked reason behind recurrent infections is immunodeficiency. The most common immunodeficiencies are lack of antibody production or white blood cell counts.
We specialize in examination of the immune system and use a routine blood sample to evaluate immune status. We look at white blood cell counts including B and T lymphocyes as well as levels of antibodies including IgG, IgA, IgM, IgE and IgG subclasses. We will also look at how well the antibodies are functioning. If a significant immune system problem is found, we will discuss appropriate treatment measures. IVIG (intravenous immunoglobulin replacement therapy) can be prescribed in appropriate situations.