Allergy – Three Atlanta Specialists Provide Insights

By Helen Kelley

From itchy eyes, stuffy noses and sore throats to breathing problems, digestive issues and more severe symptoms, allergies affect the lives of millions of American every day. Atlanta Medicine recently spoke with three Atlanta area allergy specialists to learn more about which types of allergies affect people living in Georgia and the treatments available to treat those allergies successfully.

Trending allergies, ongoing research

Stanley M. Fineman, M.D., M.B.A., a partner in Atlanta Allergy & Asthma and adjunct faculty member at Emory University, says that one interesting trend in the Atlanta area is a spike in tree pollen allergies in the fall.  Technicians at Atlanta Allergy & Asthma, which provides the official daily Atlanta Allergy Pollen Count on its website (www.atlantaallergy.com), recently traced the source of the spike to one particular tree.

“In Atlanta, there are two pollen seasons, spring and fall. Spring is the season for tree and grass pollens and fall is the time for weed pollen such as ragweed. So it was unusual that we were starting to see more people with tree pollen allergy in the fall,” said Fineman. “We were able to trace the source of their allergy to the Chinese Elm, which had not been a tree that we typically saw here in Georgia. However, it has become very popular with landscapers and homeowners in recent years as an ornamental tree because it’s pretty, hardy and grows fast. And it pollenates in the fall instead of the spring.”

Fineman also has noticed an increase in food allergies in the past 10 years.

“There are a number of theories about why we’re seeing an increased prevalence in food allergies, but we’re still not certain of the reason,” he said. “Each person is different, but we’re definitely seeing more people with allergies to nuts, milk, eggs and fish.”

Atlanta Allergy & Asthma is conducting ongoing research to help develop therapies for allergic diseases. The practice is actively recruiting participants for various clinical trials, including asthma patients who have difficulty controlling their symptoms, people who have a dust allergy and those who have an allergy to peanuts.

“The clinical trials are carefully regulated by the FDA and involve treatment methods like targeted therapy for asthma, sublingual medications for dust mite allergy or oral desensitization for peanut allergy,” Fineman said. “We hope that the data we gather will lead to the development of improved treatments for different types of allergies and asthma.”

Advances in treatments for allergies, asthma

Some of the best testing and treatment options are tried-and-true methods, according to Alan R. Redding, M.D., of Redding Allergy & Asthma Center. But he also cites a new treatment as an improvement in treating certain allergies.

“Skin testing remains the mainstay of allergy testing because it doesn’t require a blood draw from the patient and it allows us to see results immediately. And subcutaneous immunotherapy is still the most widely used treatment for allergic rhinitis and asthma,” he noted. “However, there is a new FDA-approved sublingual immunotherapy (SLIT) treatment on the market for people with grass and ragweed allergies. This may signal additional SLIT treatments in the future for other allergies.”

Redding says that patients who suffer with severe uncontrolled asthma are finding relief from a new treatment, Omalizumab.  Omalizumab is currently the only biologic treatment for asthma that is FDA-approved for use in the U.S.

“Omalizumab, given to the patient as an injection every four weeks, targets one of the main interleukins that causes chronic spontaneous urticarial (hives),” he explained. “This drug has multiple benefits. In addition to helping control the patient’s chronic hives, it can also reduce their dependence on oral steroids.”

Redding encourages his fellow physicians to refer patients they suspect of having allergies or who have uncontrolled asthma to a board certified allergist for treatment.

“I think it’s important to understand that a board certified allergist has very specific training in identifying and treating allergies and asthma,” he said. “Physicians who are certified by the American Board of Allergy and Immunology have completed either an internal medicine or pediatric residency and an allergy/immunology fellowship, and have passed a board exam. The American Board of Allergy and Immunology is the only allergy organization that is recognized by the American College of Graduate Medical Education.”

Adult-onset allergies, recognizing symptoms

Faria Khan, M.D., a physician with Georgia’s Allergy and Asthma Institute and current Communications Chairman for the Medical Association of Atlanta, says she has noticed a rise in the number of adults presenting with allergies later in life.

“At least one-fourth of all people in America have allergies, but we’ve seen a noticeable trend emerge over at least the last 10 years but probably more,” she said. “While the proportions and types of allergies — to pollen, environment and food — are the same, we’re now seeing people in their 40s and 50s who are experiencing their first allergies.”

Khan says there are many theories as to why this is happening, but that no clear reason has emerged.

“Some theories suggest we are ‘too sanitary’ and are not allowing our immune systems to develop by being exposed to germs. Other ideas involve dietary factors or aspects of living in an industrialized society that we haven’t yet identified,” she explained. “But we really don’t know why we are seeing this increase in adult allergies.”

Khan says the symptoms for allergies may often mimic other illnesses, so it’s important for physicians to be aware of this and know when to refer a patient to an allergist.

“There are so many aspects of allergy. Allergies often affect the upper respiratory tract, so if a patient has chronic sinusitis or frequent colds, it may actually be allergy. Sometimes, gastrointestinal problems turn out to be an undiagnosed food allergy. A rash could be caused by an allergy. And breathing problems could actually be asthma,” she noted. “I would advise other physicians to consider allergies as a root cause of symptoms of many kinds that they can’t get to the bottom of and solve.”