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Cheryl Martin (Host): Are you or someone you know experiencing symptoms you believe are caused by an allergy? Well, coming up next, we'll learn what allergies are, how you can be tested, and the best treatments with Dr. Vincent Devlin, an allergy and immunology specialist at Eisenhower Health.

Intro: You are listening to another episode of Living Well with Eisenhower Health, healthcare as it should be.

Host: This is Living Well with Eisenhower Health. I'm Cheryl Martin. Dr. Devlin, are more people than usual suffering from allergies these days? A person just passed on that question when I said I would be talking to you.

Vincent Devlin, DO: Absolutely. There are certainly more people suffering from allergies these days. While we're not a hundred percent sure why, we do know that the incidence and prevalence of allergies are increasing over the past decades.

Host: So, what are allergies and why do some people have allergies and others don't?

Vincent Devlin, DO: Allergies are actually a dysfunction of your immune system. It's when you react to something that is otherwise benign, such as venom and aeroallergens, such as pollen; foods or medications. Because of your exposure to that, as well as your genetic history, you may be more likely to develop allergies.

Host: So, at what point should someone see an allergist?

Vincent Devlin, DO: Someone should see an allergist if they're concerned that they have an allergy to something in their environment, a food, a medication, or a stinging insect. Or if they have concerns related to rashes that they think may be allergic in etiology.

Host: So, how do you test for allergies?

Vincent Devlin, DO: There's a few different ways to test for allergies actually. The primary way that we do here in this clinic is something called skin testing, commonly called scratch testing. I call it percutaneous testing. And this involves a device that agitates the top layer of skin in order to access the immune system. It presents some protein or antigen to your immune system. And then if you do have an allergy to that protein or product, you actually get a hive in the spot where you have been tested. We also do additional forms of testing called intradermal testing, which involves a small needle under the top layer of skin. It can be more sensitive for certain types of allergies. There's also blood allergy testing, which we will sometimes send in certain patients. And in some cases, we'll even do all three types of testing.

Host: How long does it usually take to get the results?

Vincent Devlin, DO: So, the results are typically demonstrated on the same-day visit, so you'll actually get results that day if we perform a skin test. Blood testing may take anywhere from a few days to a few weeks, depending on the test ordered.

Host: Okay. Now, doctor, what is immunotherapy?

Vincent Devlin, DO: Immunotherapy is a type of treatment that we utilize for aeroallergens, and they've also started using it for foods. It's exposing your body to a little bit of what you're allergic to, a little safe amount of what you're allergic to, in increasing amounts over time. The therapy for environmental allergens is typically something called allergen immunotherapy or allergy shots. These shots are administered in increasing amounts slowly over time until a therapeutic dose is achieved. Once that dose is achieved, the shot is continued for three to five years for completion of treatment and tolerance. This allows patients to decrease symptoms, have fewer symptoms when they're exposed to their allergens, decrease the need for medication, possibly have fewer sinus infections and have overall better health. Here at Eisenhower, we also do accelerated immunotherapy, which is a type of immunotherapy that helps to shorten the initial buildup period. We're also starting to offer oral immunotherapy to peanut protein for patients and children who are peanut allergic.

Host: That's great. Now, are you finding that there is now more immunotherapy for most allergies or just a limited number?

Vincent Devlin, DO: You can have immunotherapy to whatever you're allergic to. Typically, we test to the most common allergens in the environment and you can be desensitized to most of those things. You can also be desensitized to venom, venom immunotherapy, which we offer here in this office. That's for patients who have an allergic reaction to a stinging insect, like a bee or wasp or fire ant. And then, as of right now, the only FDA-approved product for foods is an oral peanut immunotherapy.

Host: Okay. Now, you mentioned venom allergy. Talk about that more, especially, let's say, bee stings. I know I'm allergic to bee stings.

Vincent Devlin, DO: Bees or the flying hymenoptera, which are a class of flying stinging insects, can cause anaphylaxis in some patients and even death. These stinging insects, when they sting you, can cause a systemic reaction, systemic allergic reaction. That's important to identify early and potentially have an EpiPen with those patients in order to reverse the reaction. We're also able to desensitize these patients to that venom so that the patients, when they do get stung, will have some degree of protection and should not go into anaphylaxis or have that serious systemic reaction.

Host: And what is an EpiPen?

Vincent Devlin, DO: An EpiPen is also commonly known as an epinephrine autoinjector. It is a life-saving device that can deliver a life-saving dose of a medication called epinephrine, which is something that's naturally found in your body, but also something when used exogenously can reverse an allergic reaction and prevent that person from having more serious effects.

Host: And so, which allergies would a person typically have an EpiPen?

Vincent Devlin, DO: An EpiPen is utilized when the patient has a venom allergy, and also when the patient has a food allergy. Sometimes patients will also carry an EpiPen when they're on allergy shots.

Host: Now, what is the difference between allergies and asthma?

Vincent Devlin, DO: Allergies are a reaction when you are exposed to your allergen in the environment. You have certain types of symptoms such as itchy nose, runny nose, sometimes congestion, sometimes hives or rash, and that's related to the release of histamine and other mediators from inside your body. Asthma is a disorder of your lungs specifically. And allergies can affect asthma. Many asthmatics have allergies as one of their triggers, but asthma is a specific disorder where the lungs actually, become inflamed and you're not able to breathe as easily or pass air as easily. Commonly, patients that have asthma will notice that they are wheezing or causing sounds or coughing after they are active or after they are exposed to one of their allergens.

Host: You have been talking about drug allergies and you also mentioned food allergies. How common are these?

Vincent Devlin, DO: Food allergies are fairly common in different populations. In children, you know, up to one in seven or one in eight patients or children can have a food allergy, less so in adults. Typically, patients that have allergies to other things can have allergies to foods as well as medications. So, they're lot more common than you might think.

Host: And children, do they typically outgrow their food allergies?

Vincent Devlin, DO: It depends on the allergy. And typically, it also depends on if the patient is re-exposed to that allergen. Oftentimes, if the patient is able to remove that allergen from their diet, their immune system tends to forget it, so they may be more likely to grow out of their allergy. But it is all dependent on which food and the patient and kind of what their exposure is to that allergen. But some do outgrow their allergies.

Host: Any successful treatments for food allergies?

Vincent Devlin, DO: There's a treatment called oral immunotherapy, which similar to the subcutaneous shots that are administered. You ingest a small amount of what you're allergic to in increasing amounts over time until you get to a maintenance or therapeutic treatment dose. That treatment dose is continued to desensitize the patient to their allergen, increasing their tolerance and decreasing their allergy over time. The only FDA-approved product as of right now is called Palforzia. It is an oral peanut immunotherapy product.

Host: Anything you wanted to share about drug allergies and possible treatment?

Vincent Devlin, DO: Medication allergies are very common, particularly as people get older and are exposed to more medications. Medication allergies can potentially be life-threatening or severe, or they also can be more mild in nature. It's important to have your allergist look at your medication allergies and decide if they still may be clinically relevant. The reason we like to do this is we know that 90-95% of people that have allergies to medications, particularly penicillin, they're no longer clinically relevant. We're able to skin test you and potentially challenge you in our office to this medication in order to de-label you from that allergy.

The importance of de-labeling is because penicillin and amoxicillin and other medications that are similar are very safe medications for common maladies, such as sinus infections or ear infections or simple pneumonias. So, it's nice to have those in your antibiotic arsenal should you need them. We know that patients with a penicillin allergy, like I said, are less likely to have it be clinically significant over time. And we know that patients that are admitted to the hospital with a penicillin allergy will oftentimes have to receive second or third-line antibiotics. So, it's good to address that at a time when you're healthy, so that if you are admitted to the hospital or if you do need more significant antibiotics, that they're able to give you the best optimal antibiotic for the best chance at treating your malady.

Host: So, you're saying if, at some point you tested you were allergic to penicillin, it's best to get that rechecked because it could have changed.

Vincent Devlin, DO: Absolutely, absolutely. In most people, it changes. So I think if you were told that you had penicillin allergy as a child or you had a reaction to penicillin allergy as a child or an adult, it's a good idea to see an allergist to have that reevaluated and potentially de-label you from that allergy because likely it's no longer clinically relevant.

Host: Great advice. Now, are eczema and dermatitis considered allergies?

Vincent Devlin, DO: Atopic dermatitis is a form of eczema or irritation or inflammation of the skin. We know that there's overlap between allergies and eczema because sometimes allergies can lead to or worsen or cause eczema. The allergic inflammation that's underlying some forms of eczema can be exacerbated by things in the environment such as household pets, cats and dogs, dust in the home, feathers and feather bedding or different types of molds and pollens. So, it's nice to not only see a dermatologist if you do have these problems, but you may also want to see an allergist in order to be tested to ensure there's not anything in your environment exacerbating what's going on on your skin.

Host: Dr. Devlin, anything else you want to share about either new approaches or treatments or anything else as it relates to allergies and immunology?

Vincent Devlin, DO: I think the world of allergy is rapidly changing and it's an exciting field. I think we can get people in quickly and we're able to get them relief faster with the accelerated types of immunotherapy. And I think, keep your eye on this field because there's going to be a lot of changes in the future and a lot of new treatments coming out in the coming decade.

Host: Dr. Vincent Devlin, thanks so much for sharing your expertise with us on allergies and immunology. For more information, you can go to eisenhowerhealth.org/allergyrelief. That's eisenhowerhealth.org/allergyrelief. If you found this podcast helpful, please share it on your social channels. You can also check out our full podcast library for other topics of interest to you.

Thanks for listening to Living Well with Eisenhower Health, healthcare as it should be.