Frequently
Asked Questions about Allergies, Asthma, and Sinus Care
New
Patients
Q:
As a new patient, what happens at the first doctor appointment?
Your
physician will take a complete history and then testing will
begin. (Some appointments are purposefully set up to only
accomplish a consultation and testing will be performed on a
separate date). The testing may include skin testing, lung
function testing or other various forms of testing needed to
evaluate your symptoms.
Once testing is complete, your doctor will review the
results and recommended plan of treatment. Please click the
“AT YOUR FIRST VISIT” tab above for more information.
Q:
At what age can I bring my child in to get skin tested?
Limited
skin testing can be done even on small infants.
The best approach is to have a consultation visit with one
of our physicians to discuss your child’s history and determine
the best course of testing for the child.
Q:
Do I need to have a referral from a primary care physician to
become a patient and be seen?
You
should check with your insurance regarding the need for a referral
to come and see us. All insurance plans are different.
Most of our patients have been referred by friends and
family members.
Q:
If I need a referral will you call my primary care physician
(PCP)?
No.
Your primary care doctor is not obligated to provide us with a
referral.
You will need to contact your primary care doctor for a
referral.
If we have not received the referral by the time of your
visit, you will need to reschedule your appointment.
We will notify you if your previous referral has expired.
Remember that most primary care physicians require 5
business days to provide a referral.
Q:
Is there a charge for no-show appointments? How far in advance can
I cancel Or reschedule with no penalty?
You
may be charged a no-show fee if you fail to arrive for your
appointment.
Please make every effort to be courteous to others and
cancel or reschedule your appointments as soon as possible to
allow other patients to access those available appointment
options.
Q:
How fast can I be seen as a new patient?
Most
often we can accommodate a new patient appointment within 48
hours. However, you must be off antihistamines for 4 days or more
to have allergy skin testing.
Allergy
Testing
Q:
What can I expect during my visit for allergy testing?
If
the patient is a child, he or she will lie on their stomach and
rows of antigen drops are placed on the back. If the patient is an
adult, the tests are usually placed on both arms. Then each drop
is lightly pricked to allow the antigen to enter the skin.
The patient then has a 15 minute wait.
The testing is then measured and recorded. The doctor then
will review all results with the patient/parent.
The most difficult part for a child is usually the need to
lie still and the waiting time in between the testing steps.
We can have children get up after tests are applied.
It is helpful to bring books, handheld games etc., to help
with the waiting time.
Q:
What is the youngest age of a patient that can be seen by an
allergist?
We
manage the care for patients ranging from small infants to elderly
patients. We can work in conjunction with your pediatrician to
provide a continuity of care. Many times your pediatrician will
recommend our involvement in your child's care. Our
physician’s are board certified in pediatric as well as adult
allergy/immunology
Q:
What is the difference between blood testing and skin testing for
allergies?
Blood
testing is generally more expensive, and the results are not
available for about one week after a blood sample is obtained. In
many cases skin testing can identify an allergy that is missed by
blood testing. Allergy skin testing also allows us to obtain
results and to develop a treatment plan at the time of your visit.
However, in a few cases, skin testing cannot be performed. In
those situations, your doctor will help determine whether blood
testing is needed for evaluation.
Q:
For what kind of items can you do testing?
Many
items can be tested for. Allergy to airborne allergens, like
pollens, molds, and dust mites are the most common types of
allergy--so they are the ones most commonly tested for.
We can also test for foods, stinging insects, and a limited
number of medications and vaccines.
There are not reliable allergy tests for most types of
medications, including antibiotics.
There are no reliable tests for food additives or
preservatives.
We can also perform Patch Testing to test for contact
allergy to common substances.
Please call our office to discuss any particular questions
you have regarding available testing options.
Q:
Why do I have bumps after skin testing when I didn’t have my
reactions while in the office?
The
delayed reaction is simply an irritation and can be comforted with
ice and benadryl.
It does not change any diagnostic outcome of the skin
testing.
Allergy
Injections
Q:
How do allergy shots work?
An
allergy is when your immune system mistakes a harmless substance
for a dangerous one and triggers the release of chemicals into
your body, thus creating symptoms like runny nose, sneezing,
watery eyes, itching and in some cases, more serious symptoms like
coughing or wheezing, swelling of the throat and tongue, and in
the worst case anaphylaxis.
Allergy
shots increase your tolerance to the harmful allergen. By
injecting gradually increasing doses of the offending allergen
extract, the immune system builds up a tolerance to that allergen
so that it is no longer seen as a threat to your body. Allergy
shots slow down and reduce the production of the IgE antibody. You
can think of each shot as adding a brick to the "wall of
protection" against things that trigger your allergies.
Q:
Who are the best candidates for allergy shots?
If
you are able to avoid the trigger of your allergies or if usual
doses of medications control your symptoms, then immunotherapy
might not be needed. While allergy shots have been proven
effective against inhalant allergies and stinging insect
allergies, they are not used for food allergies. If any of the
following applies to you, then you may be a candidate for allergy
shots:
●
If the
medications to control your symptoms (i.e., antihistamines,
decongestants) do not work.
●
If the
medication used to control your symptoms produces too many side
effects.
●
If
complications (i.e., sinus infections, ear infections) develop.
●
If you have
asthma triggered by allergies.
●
If you are at
risk of developing anaphylaxis (a severe reaction that, in some
cases, may be fatal) when exposed to an allergen, such as a
stinging insect.
(As noted above - allergy shots are not used for food
allergy.)
●
If
medications control your symptoms, but your symptoms flare back up
every time you try to reduce your medications.
●
If you can't
effectively avoid things that trigger your allergies.
●
If you would
rather take a series of allergy shots than daily medications.
●
If you would
rather treat the actual problem rather than just use medications
to control symptoms. Allergy shots are the only potential cure
that is FDA approved.
●
If cost of
the medications is a burden, allergy shots are very cost effective
compared to the use of daily prescription medications over several
years.
Q:
How often do I need shots?
Allergy
shots are typically started on a weekly schedule during the
build-up phase. This can be accelerated under certain
circumstances and this may be discussed with your allergist.
Symptomatic improvement may occur within the first 3-6 months with
full benefit usually seen with the first 12-18 months.
After
a maintenance dose is reached, your allergist will determine when
to decrease the interval between shots (for example, every 2
weeks, every 3 weeks, every 4 weeks). This usually occurs at 6 to
12 month intervals but is also affected by how your allergy
symptoms are responding to treatment. Most people will be able to
stop their injections after about 3 to 5 years.
Board-certified
allergists are specially trained to safely utilize potent allergy
extracts which are more complicated to use, but which provide
significantly greater benefit than the low-dose allergy extracts
used by physicians not specifically trained in the sub-specialty
of Allergy/Immunology. You should always consult with a Board
Certified Allergist before beginning a program of allergy shots.
Q:
Are allergy shots expensive?
Studies
have shown that allergy shots are a very cost-effective way to
treat allergies. They have been shown to reduce medication
requirements and improve the quality of life in those patients who
take them. They are the only long-term way to bring symptoms under
control in those patients who have significant allergic disease.
Q:
What is in the allergy injections?
After
skin testing has been done, your physician will write specific
orders regarding what should be included in your allergy
injections. Your allergy extract (which is prepared and tailored
specifically for you) contains many or all of the things to which
you tested positive.
Allergy injections are used to reduce your sensitivity to
specific allergens by producing certain immunological changes.
By injecting increasing amounts of allergens to which you
are sensitive, the degree of sensitivity is progressively
decreased to those specific allergens.
This occurs in part because one of the protective
antibodies, IgG, is increased during allergy injections, and
serves to protect the individual by blocking the IgE response
which causes the release of the mediators leading to the allergic
symptoms. Studies have shown that other safe, but complex,
immunologic changes also occur in the development of tolerance to
an allergen.
In order to insure that these changes take place and
maintain protection, it is important to receive allergy injections
on a regular basis at an interval directed by the physician.
Treatment with allergy injections takes place over a three
to five year period of time to maximize the effectiveness of the
therapy.
Q:
I have heard of other types of allergy treatments different from
allergy injections.
Do you offer them and why not?
Allergy
injections are the standard of care from The American Academy of
Allergy and Immunology.
Other treatment modalities, such as sublingual
immunotherapy are being researched but are not FDA approved.
The sublingual drops used by some doctors are not approved
by the FDA for immunotherapy and have been found to be less
effective than allergy injections in studies.
Q:
Why do I have a large bump on my arm where my allergy injection
was given?
A
large local reaction does not mean a patient is having a systemic
reaction.
It can be comforted with ice, ibuprofen, acetaminophen or
Benadryl and should be reported to the nurse the next time you are
in for an injection.
It does not require further treatment and it is not
necessary to call the on call Doctor after hours to be reported.
Asthma
Questions
Q:
Can asthma be controlled ?
Yes,
asthma is a very treatable disease. With appropriate treatment
plans and consistent physician monitoring and evaluation, you can
control your asthma and not have your asthma control you.
Q:
What are the signs and symptoms that I may have asthma?
Coughing,
wheezing, shortness of breath, tightness in chest, frequent or
lingering bronchitis, and exercise intolerance are just a few of
the potential signs and symptoms that may indicate a reason to
investigate a possible asthma problem.
Q:
Can acid reflux make my asthma worse?
Yes,
acid reflux can contribute to cough, SOB and tightness in chest.
It has been reported that 45-70% of adults with asthma also have
Gastroesophageal Reflux Disease (GERD).
Sinus
Questions
Q:
I chronically get sinus infections. Is there any help?
Allergies
and sinus issues often co-exist and managing the allergy component
may in fact prove helpful in deceasing the frequency and severity
of sinus infections.
Q:
I have chronic headaches.
Is this because I have sinus infection?
There
are many potential causes of headaches.
Sinusitis is one of them.
In order to determine if your headaches are due to sinus
infection, it is often necessary to do a CT scan of your sinuses.
We can order a CT scan for you and will review the findings
with you.
If you do not have sinus infection, we can help you to
identify and manage the cause of your headaches.
Medication
refills
Q:
What to do if I need a medication refill?
Call
your pharmacy.
They will then contact us if they need more information or
refill authorization.
You can also sign up for our Patient Portal and request a
refill electronically at your convenience.
Q:
My pharmacy/insurance told me I need a Prior Authorization.
What is this?
Many
insurances require a patient to have tried other less expensive
medications in a certain drug class before they will consider
paying for a particular drug.
If this is the case, the process requires the doctor’s
office to call the insurance and answer questions or complete
paperwork regarding the patient’s medical and medication
history.
This process requires several days to accomplish.
We will notify you and your pharmacy when we get a
determination from the insurance.
Please bear in mind, that the rules of your insurance might
prevent us from getting your medication approved.
Q:
Do I have to make an appointment just to get a refill?
Part
of helping to manage your condition involves seeing you regularly
to ensure that your symptoms are controlled, and that you are not
on too much or too little medication.
For many stable conditions, we will only need to see you
once a year.
Other conditions will require you to be seen more often.
We will not refill any medications if you have not been
seen in our office in the past year.
Q:
Can you send in an antibiotic for me when I am sick?
It
is our policy to not send in antibiotics over the phone.
If you are ill, you should contact our office for an
appointment.
In some cases, you might need an antibiotic.
In some circumstances, you might need more than an
antibiotic.
The best way for us to provide you with the best care is to
see you
in the office.
We have openings daily for same-day visits.
About
Billing
Q:
Will my insurance pay for allergy testing and or allergy shots?
All
plans have different benefits.
Our staff can assist you in investigating your benefits,
but in most cases we cannot be certain of what your insurer will
cover until after we have submitted the charges for our services.
We encourage you to check with your company for your exact
covered benefits.
Q:
What if I do not have my insurance information at my time of
service?
You
will be identified as a "self-pay" patient and will need
to pay at your time of service.
Q:
If I disagree with what my insurance has paid, will you call them
for a better explanation?
No,
if you disagree with the payment, you need to call the customer
service department at the number on the back of your insurance
card.
Q:
Do you participate in Medicaid?
No.
Q:
Do you participate in Medicare?
Yes.
Q:
Do you charge for an office visit every time we get an allergy
shot?
No,
allergy shots are given by a nurse and the only time you are
charged for an office visit is when you see a doctor.
Q:
Do you know if a co-pay applies to my allergy shots?
With
some insurance companies, there is a co-pay for allergy shots.
It is always best to check the specific coverage for your
plan.
Q:
Is there a code I can give my insurance provider to see what they
will pay on allergy testing?
If
you are planning to be tested to airborne allergens like pollens,
dust and animal danders, or to foods, please use these codes:
95004 and 95024.
If you plan to be tested for stinging insect venom or drug
allergy, different codes are used.
Please contact our office for further information for these
codes.
Q:
Is there a code I can give my insurance provider to check and see
if the allergy shots are covered? Yes,
please use the following: Single Injection = 95115, Multiple
injections = 95117
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