Update 9/01/2020 Hi Everyone, it's Dr Feigenbaum. We're not accepting new patients right now. You could try my colleagues at Scripps Clinic Allergy Carmel Valley. If you're a current patient and need me for something, my cell phone is 858 215 2201.
San Diego Allergy Asthma & Immunology Consultants, Inc.
Bernard A. Feigenbaum, M.D. FACP, FAAAAI
Non-Surgical Nasal Treatment
(Allergic Rhinitis, Hayfever, Pollen Allergy, Nasal Congestion, Runny Nose)
Environmental/Airborne Testing to cat, dog, dust mite; tree, grass and weed pollens; molds and other aero-allergens (Results in 15 minutes)
Rhinitis basically means inflammation of the nasal lining. Typical symptoms include runny nose, sneezing, nasal congestion, sinus headache, postnasal drip.
IS ALL RHINITIS THE SAME?
No. There are several categories of rhinitis; allergic rhinitis; “local” allergic rhinitis; non-allergic rhinitis. Allergy testing can be very helpful in making this distinction.
WHAT IS ALLERGIC RHINITIS?
Approximately 20% of the US population has this condition. Allergic rhinitis is caused by antibodies called Immunoglobulin E (IgE) interacting with typical allergens/triggers—tree, grass or weed pollens; cats, dogs and other animals, dust mite, cockroach; molds. This interaction between IgE and allergens results in the release of histamine and other inflammatory chemicals from special white blood cells called mast cells. Histamine causes itching, sneezing, runny nose, nasal congestion, etc. (Antihistamines work by blocking these effects of histamine. Histamine is used as a “positive control” during skin testing, because it quickly causes visible redness and swelling.) Response to prescription medication is usually good with this condition.
WHAT IS LOCAL ALLERGIC RHINITIS?
Less than 1% of the US population has this condition. “Local” allergic rhinitis can be a little confusing. Patients’ symptoms are caused the same allergic antibodies (IgE) but skin testing is negative because the antibodies are only present locally in the nose, not in the skin. In other words, skin testing is “false” negative. Response to prescription medication is usually good with this condition.
WHAT IS NON-ALLERGIC RHINITIS?
Approximately 10% of the US population has this condition. Response to prescription medication is variable with this condition and it is harder to treat than allergic rhinitis. Non-allergic rhinitis is not caused by Immunoglobulin-E antibodies. The cause of the symptoms depends on the subtype:
Atrophic—Associated with elderly patients usually in frail health
Infectious—For example, from a viral upper respiratory infection (URI)
Hormonal—Pregnancy, birth control pills, thyroid disease
Systemic inflammatory—Uncommon diseases such as Wegeners or Sarcoidosis
Anatomic and foreign body --More common in young children
Medication—Blood pressure and cardiac medications or hormones may cause this
Occupational—Due to exposures with work or hobbies
Gustatory—Worse after eating
Rhinitis Medicamentosa—Due to prolonged use of nasal decongestants—Afrin, Vicks, cocaine
Idiopathic/Vasomotor—The most common subtype of non-allergic rhinitis and thought to be due to a malfunction of nerves in the nasal lining.
SKIN TEST INTERPRETATION
Testing involves being “pricked” with several Multitest devices. Each white Multitest device has 8 skin testing prongs. Each prong is dipped in a well and each well contains a different aero-allergen or food allergen. 15 minutes later, the results are written down and interpreted.
Your testing sheet will indicate the size of the wheal and the size of the flare, both of which are used in interpreting the reaction. The wheal is the raised area of skin. The flare is the red area of skin surrounding the wheal. For example, a result of 5/15 for alder tree doesn’t mean 5 out of 25.
Both numbers are measurements, so it indicates that there was a 5 mm wheal and a 15 mm flare.
Usually (but not always), the larger the wheal and flare response, the worse the allergy. There is no standard for grading severity, but here are some rough guidelines:
Mild allergy—3/5 to 5/10
Moderate allergy—5/10 to 8/20
Strong allergy—Larger than 8/20
Also, with airborne allergen testing, 1st round reactions are more significant than 2nd or 3rd round reactions.
One of the testing site contains histamine, which is used as a positive control. An itchy, red, raised histamine site is normal and shows that your skin is reacting as expected to the testing. (It doesn’t mean an allergy to histamine.)