Dr. Kali Gerace

The human body is sensitive to its surroundings. It is prone to harm, but also performs many functions to protect itself. Allergies are a great example of this.

An allergic reaction is a way that the body communicates. Swelling and redness, also known as histamine responses, are a signal that a substance isn’t welcome and potentially harmful. Those symptoms are also defense mechanisms to try to keep that substance out.

Building immunity to an allergy is another example of the body’s defense mechanisms. It’s a demonstration of adaptability, and with the right care, you can give your body a boost in this area. That’s where allergy specialists come in!

We believe it’s important to be aware of your health, and you don’t have to go to medical school to do that. As professionals with your care in mind, we created this page to provide an overview of allergies and allergy treatment that may help you, especially if you’ve developed new allergies or are seeking treatment for the first time.

What to Expect with Allergy Testing

The first step to allergy treatment is testing so you and your doctor know exactly what you’re allergic to. If you decide on immunotherapy, this test also tells us what to put into your shots or drops.

The first step to an allergy test is getting scheduled with a doctor who specializes in this like we do. You can schedule an allergy test with us here.

The most common type of test allergy specialists recommend is a skin prick test. We’ll expose your skin to liquid droplets of common allergy triggers, or allergens, and lightly puncture the skin with small needles to see if any of the liquids make the allergy cells in your skin react. There are also other test types, specifically patch tests and intradermal tests which we will also mention.

A skin prick test is like it sounds. You will be pricked several times at once into the top layer of skin on your arm or your back. We use a multitest which we can poke you with up to eight things at one time and up to 80 different allergens in total. The amount we test for depends on the symptoms you are having as well as your age.

It is quick and easy. These tests have been depicted on television in a humorous way because the result may look worse than they really are! The test area on your skin may look red afterward or show bumps – that’s what we need to see to verify an allergy – but it does NOT hurt, and you shouldn’t bleed.

Most people describe it like having the tip of a paper clip pressed lightly into your skin. Occasionally, we hear toothpick, plastic fork, or a hairbrush used to describe the feeling.

Allergy Testing for Children & Adults

With children, we may not do as many pricks at once. One reason is because it actually takes exposure to become allergic to certain things like pollen. A younger child is less likely to have as many allergies. Also, their back and arms are small so there’s only so much room for us to administer the pricks.

But as an adult, you’ve had plenty of time to develop multiple allergies. Just another hard truth about growing up! A doctor will test you for a bigger panel of allergens.

When you come in for this appointment, rest assured it is a very common procedure, no matter your age. You probably won’t be in our office for long. Before releasing you to go home, though, we like to wait around 20 minutes after the test. If you were to have an abnormal reaction from the substances you were exposed to, you’re right where you need to be for us to help you.

What Do You Test for During Allergy Tests?

Some of the most common allergens we’ll test with include but are not limited to:

  • Mold
  • Various pollens
  • Various grasses
  • Pet dander
  • Latex
  • Bee stings
  • Food, such as peanuts

There is a spectrum for how people react to the same allergens. This test does not determine how you will react to an allergen. It is useful for telling you and your doctor whether you are allergic to something or not. Some people may get bigger welts on their skin after the test. Sections of skin may feel a little itchy for some people while others don’t feel that at all. This could correlate with the severity of allergy symptoms you’d experience in daily life, but it doesn’t always.

The Role of Histamine

Histamine is a biologically active substance in the human body and in other living organisms.

Histamine is behind the stinging feature that many plants and insects have. It’s found within almost all of our tissue as humans and is stored primarily in mast cells. This chemical helps stimulate gastric acid in our digestion. It’s extremely important for dilating our blood vessels for healthy blood pressure and to move fluid to parts of the body that need protection and healing from physical injury, irritants, or infection. That’s why on the outside, histamine looks to us like body swelling and fluid movement, making skin red, eyes water, and, at its worst, tightening air passages.

Primarily, Histamine is helpful and crucial to our immune systems, but many people develop hypersensitivities that lead to what you could call overreactions in the body. That’s one way to describe allergies. They would not exist without histamine.

It’s easy to confuse a histamine response to allergies with symptoms of a cold. Think about it! Red, runny nose. Respiratory troubles. So we created a helpful resource for you to tell the difference. You can view that by clicking below.

When Should I Have an Allergy Test?

Anyone can benefit from an allergy test. Especially if you notice allergy symptoms, you may not only want to confirm what they are, but you may also desire treatment so you don’t have to suffer with symptoms regularly.

As we mentioned, your body changes over time. So it may be advised to be tested again later in life. You can decide that together with a doctor based on any returning or newly developed symptoms.


Other Types of Allergy Tests

Intradermal Testing

There is an intradermal test option that can make sure there weren’t additional signs that didn’t show up in the prick test. Intradermal tests look kind of like TB Tests and involve a smaller panel of allergens. This type of testing does involve injecting into the top layer of skin. It is a little more sensitive. Like the old saying goes, this test is like taking a “fine-tooth comb” to your system to make sure we didn’t miss anything.

Patch Testing

Some doctors will recommend patch testing. This allows us to look for allergies to chemicals and other products you use on the outside of the body like fragrances, cosmetics, and detergents. The test will usually cause a reaction like a rash. If you’re familiar with contact dermatitis, that looks similar to the rash caused by patch testing. It may also remind you of a poison ivy reaction.

Unlike other histamine responses and allergy tests, where the process or signs are quick, patch testing is a delayed test. It can take 2 days to confirm the outcome. During the patch testing process, we’ll place stickers on your back that have all different kinds of chemicals on them.

It takes us around 20 minutes to prepare the patches and then a few additional minutes to place them on you. We’ll release you, but you must leave the patches on at home for the 2-day process. This is why our offices often schedule this test on a Monday or Tuesday so you can come back in for us to assess the results toward the end of the week.

While you wait those 2 days, you can’t sweat or shower because the stickers may come off. The only medication you can be on during that time is your prescribed allergy medicine. Some medications may affect the results. For example, if you have been on steroids, you must be off of them for a full month before your test because they cause a false negative.

When done successfully, a patch test should provide you clear answers on the triggers that may be causing dermatitis or other skin reactions so you can avoid them. Contact dermatitis can take up to 4 weeks to clear up which is quite a long time to bear the irritation or frustration associated with it. That’s why patch tests can help patients find relief and prevent future reactions.

Reach out to one of our doctors near you about how a patch test may benefit you.

The Purpose and Process of Allergy Immunotherapy

Allergy immunotherapy is a great option for many allergy sufferers. Its purpose is to retrain your immune system to build up your tolerance to certain environmental triggers. In simple terms, your body can get “used to” what’s around it, like dust and pollen. It learns to ignore it rather than cause an unpleasant reaction.

But how do allergy shots accomplish this? The idea is simple. The vials we use in your injections contain a specific dosage of what you are allergic to. We start with tiny doses – with gradual increases in the dosage – to expose your body to the allergen. This helps your body become more familiar and, consequently, adjust to it.

As doctors, we don’t want you to have an adverse reaction to this process. We have your best interest in mind! That’s why we will go slow at the beginning. Initially, most patients come in once a week for about a year. Eventually, the goal is to space your injections to monthly.

Immunotherapy induces something called “sustained tolerance.” It flips a switch in your immune system so that it learns a new behavior. Even after you stop the shots, the benefits should stick with you into the future.

Allergy Immunotherapy Time Frame

The course of allergy shots typically lasts three to five years. As we’ve already alluded, we need this period of time because we’re trying to retrain your system which requires a slow and deliberate process. However, people usually start to feel better about halfway through the time frame, which is what we refer to as the “build up”- approximately 4-6 months after starting.

You can take heart knowing you may start to see significant improvement in your allergy symptoms soon, probably within your first year of injections. We advise patients to complete the full course so that the benefit sticks with them long term.

There are times where health changes impact needing a longer timeline or a return to injections later on. For example, if people are having trouble with injections like an abnormal reaction, a doctor may need to go even slower with the timeframe and dosages. If you’re on immune suppression for another illness like Lupus, that can affect the way injections work too. These circumstances should be discussed with your doctor and handled on a case-by-case basis.

You’re required to have at least one day in between injections, so you can choose to come in a few times a week when you first begin. However, in our experience, many people choose to come in only once a week because it can be hard to fit multiple visits into your schedule. If that’s the case, it will take around a year to get to the top dose. If you come in more than once a week, you’re likely to build up your immunity faster. Once we reach your highest dose, we begin maintenance where we’ll space out your appointments.

We also offer a cluster build-up where we can get to maintenance in 8 visits. You doctor can discuss if this is a good option for you.

Side Effects of Allergy Injections

The most common side effect during allergy injections is an itchy welt at the injection site, which is a local reaction. If the welt appears to be getting larger than normal, we can adjust the dosage so you can tolerate it which slows down the build up process.

There is also a risk of having an allergic reaction throughout the body rather than just a change to that section of your skin but that is uncommon. It’s reported that it could happen with 1 in every 2000 people. In our history as a practice, it’s even less than that.

As with any medical procedure, there’s technically a risk of fatality, however it is extremely rare. Reports show one in several million may experience a critical outcome such as death. Having additional serious health issues play a role in that risk factor. This is why it is important to seek treatment with a board certified physician.

It’s important to consult a medical professional about your medical history before deciding on any kind of treatment. Because the experience of immunotherapy is easy for most people and its success rate is so high, it has proven to be an effective treatment for allergies for decades.

The Success Rate of Allergy Injections

About 80% of the time, allergy immunotherapy works. Allergy sufferers report having less trouble and needing less medicine after their series of injections.

What about the other 20%? For people who fall into that smaller category, either allergy shots don’t work at all for their system, or its effectiveness did not last long after the round of shots were completed. Doctors don’t know exactly why this happens. If it’s the latter, some patients may choose to resume injections for different periods of time because they were able to manage their allergies well while receiving them. Others may choose medicine as their primary way of coping with allergies.

Common Allergens

We test for many of the same triggers with patients because there are common allergies across the globe. You can probably think of several of them.

Dust mites, molds, pollen, and pet dander can cause rhinitis for many people. These same triggers often cause eye allergies too.

Trees typically bloom in the spring, grass in the summer, and weeds in the fall. Some triggers like dust, animal dander, and mold are year-round.  More than 24 million people in the U.S. were diagnosed with seasonal allergies in recent years. Here’s a blog post we created about common allergies in the Fall.

Ingredients cleaning and cosmetic products commonly cause a skin reaction called dermatitis. It could be:

Both forms can provide insights about your body such as the type of clothing, jewelry, or chemicals you should avoid as well as worsening allergies you may develop in the future.

Food allergies can vary in the types of reaction they cause, from skin, to GI involvement, to even the more severe forms of anaphylaxis such as chest tightness, trouble breathing or swallowing, and passing out.

Because allergies and their severity vary from person to person, you should not rely only on stats or personal experience. Testing is important to confirm and manage your allergies.


Allergies in Kentuckiana

This region has a long pollen season. Often, the trees will bloom around Valentine’s Day, and we may not have our first freeze until the end of the year. This means pollen could be present for the majority of the year! And that means trouble for people allergic to pollen.

Ragweed season begins in August and lasts through the Fall. A rainier summer season correlates with a harsher ragweed season. In 2014, Louisville was ranked the worst city for allergies by the AAFA and ragweed was a big reason why.

There are several reasons our area is harder on allergy sufferers. Because we are in the Ohio River Valley rather than on a mountain or in a flat, arid desert, the pollen tends to stay in our air and stick to surfaces. It gets trapped by the humid valley terrain rather than blowing away.

Also, in Kentuckiana, the weather can change quickly, unlike moderate climates or places that don’t have the typical four seasons. Rapid swings in temperature and changes in environmental pressure are hard for our immune systems to adapt to, and it causes the fluid in the body to shift. That might look like a runny nose or swelling in body tissue. Ever get a headache around a rainstorm? Or have you had a grandparent tell you they can predict the weather with their injured leg? Weather affects our body’s functions and that includes our sinus passages.

Besides pollen, Kentuckiana is known for allergies to grasses, especially in the summer. We’re also known for oak trees and timothy grass.

Although blowing dust off furniture in the attic might cause many people to cough or sneeze as a way to clear out our respiratory system, there are plenty of people who are not allergic to even the most common irritants. Long time allergy sufferers may be surprised to hear this!

Results of an allergy test don’t change based on the season because even in the dead of winter when the pollen count is low, we can expose your body to pollen with a prick test. If you’re allergic to it at that moment, that’s true for you ongoingly until you can build an immunity.

Tips to Minimize Allergies

Here are steps you can take to help with your allergies. Many of them can be done at home.

  • Get tested to confirm what you’re allergic to
  • Try to keep the count low in your home for common allergens like dust, pollen, and animal dander. Here are a few recommendations for that:
    • Dust your home and change your bedding regularly. Once a week is recommended.
    • Too much clutter in the home makes it easy to collect and hide allergens.
    • Keeping your home low in humidity keeps dust mites at bay.
    • Certain bath and bedding brands can be hypo-allergenic.
    • Consider using air purifiers and/or HEPA filters.
    • You can monitor the air quality in your home with tools like this.
    • Put your car in recirculation, especially during pollen season, so you’re not pulling new irritants into your car the whole time you’re driving.
    • If you’re allergic to animal dander, consider keeping pets out of your bedroom.
    • There is now a cat food by Purina that claims to decrease the dander in a cat’s saliva by almost 50%. This may vary how it helps with reactions.

Feel free to check out our blog post on other great ways to treat and prevent allergy symptoms. Just click below to view it now.

Allergy Medications and More

Immunotherapy is obviously a more proactive approach to allergies. So if you are having a reaction and it doesn’t appear to be critical, you might use these to help in the meantime for immediate relief:

  • Antihistamines: Examples are Levocetirizine, Cetirizine, Loratadine, Fexofenadine. This kind of allergy medication is over the counter now and great for allergy symptoms. They typically have very few side effects.
  • Nasal Steroids. You can find these over the counter too. They are a little bit slower to work but they are also typically well tolerated. However, if you have glaucoma you should avoid them.
  • Saline Solutions. This can help with itchiness and irritation in the eyes and nose.
  • Cold Compress. This may help with swelling, redness, and itchiness.

If you have food allergies, or if you’ve ever experienced a life-threatening allergic reaction, a doctor may prescribe epinephrine to keep on you. This is an auto-injector or pen. If you were to go into anaphylaxis, you or someone with you can administer the epinephrine usually into the muscle of the outer thigh. It releases adrenaline that can reverse life-threatening symptoms like swelling of the throat. A delay in using epinephrine could be fatal, so it’s important for your doctor to walk you through your treatment plan and for you to carry it out as prescribed.

Many people ask about local honey as a defense against allergies. This has been studied in recent years, and there is no empirical evidence of a difference in allergies compared to the placebo. When they added birch tree pollen to the honey, however, it helped with that specific allergy. With that example, you are using a homeopathic version of allergy drops which we mention below. Of course, if you notice a benefit to your overall health from local honey, by all means, incorporate it. But its claim to allergy treatment is a myth.

Allergy Drops

This treatment is an alternative to injections. Allergen extracts are placed in the form of tablets or droplets so you can administer them at home under the tongue. That’s why they are also known as sublingual immunotherapy which incorporates the Latin word for “tongue.”

This option allows patients to avoid needles as well as weekly in-office appointments. However, insurance does not cover allergy drops. It is not FDA approved, but it is legal and has been used for over 100 years with excellent results. It is safe, clinically-proven, and we recommend it to many patients.

Allergies and You

No matter how often you clean, dust will show up on the shelf again. New flowers will bloom every spring and produce pollen. Allergens are a part of life, but the pain of allergic reactions doesn’t have to be.

There have been great advancements in medicine allowing you to identify, treat, and build immunity to allergies. It’s a wonderful thing and something we’re passionate about! We hope you have a greater understanding now of the science behind allergies and allergy treatment.

If you have struggled with allergies or are unsure what you’re allergic to, please don’t put it off any longer. We treat adults and children and have 8 convenient office locations so we can help you quickly. Call us or click below to schedule an appointment with an allergist. Let’s get you on a better path to life with allergies in Kentuckiana.


About the author : Advanced ENT

About the author : Advanced ENT