Frequently Asked Questions
Frequently Asked Questions
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HOW LONG IS THE FIRST APPOINTMENT, AND WHY DOES IT TAKE SO LONG? Usually, the first appointment will last 1-3 hours, depending upon the nature of your specific problem. During this time we will take a thorough medical history, perform an examination, and (if needed) do allergy testing and a breathing test (called spirometry). After the allergy testing is done, we must wait 20 minutes before we can check the results of the tests. Then, Dr. Accetta will review all the test results with you and together you and he will determine the best treatment for you. DOES EVERYONE GET ALLERGY TESTED? No. Because your history alone is not sufficient to determine if you are an allergic person, allergy testing is necessary to answer this question. However, for some medical problems, allergy testing is unnecessary. For other medical problems, allergy testing will need to be postponed. Prior to the testing, Dr. Accetta will discuss with you any testing he feels is necessary. Of course, you can always decide not to be allergy tested (and if you know before your appointment that you do not want the allergy testing, please let the staff know this at the time you make your appointment). DOES EVERYONE GET ALLERGY TESTED? No. Because your history alone is not sufficient to determine if you are an allergic person, skin testing is necessary to answer this question. However, for some medical problems, skin testing is unnecessary. For other medical problems, skin testing will need to be postponed. Prior to the testing, Dr. Accetta will discuss with you any testing he feels is necessary. Of course, you can always decide not to be skin tested. WHAT IS ALLERGY TESTING? During allergy testing, commonly called "skin testing", drops of naturally occurring chemicals (called allergens), such as grass, ragweed, and various foods are placed on the skin by pricking the skin or by injection. After waiting 15-20 minutes, the tests will look like mosquito bites if you are allergic. Occasionally, a person can have a more serious reaction to the testing, but the doctor will discuss this with you at the time of your visit. DOES ALLERGY TESTING HURT? Allergy testing is a mildly uncomfortable procedure. After being tested, most people realize that the fear of the test was far worse than actually going through the test! CAN I EAT OR DRINK BEFORE THE TEST? Yes. You can continue your normal diet. ARE THERE ANY MEDICATIONS I SHOULD NOT TAKE BEFORE THE TEST? Yes. If you take any antihistamine, this medication should generally be stopped two to seven days (depending on the particular antihistamine) before the testing. If you have any doubt that you are taking an antihistamine, call our office or check with your pharmacist. YOU SHOULD CONTINUE TAKING ALL OF YOUR OTHER MEDICATIONS, INCLUDING ALL OF YOUR ASTHMA MEDICATIONS. CAN I DRIVE AFTER THE TEST? Yes CAN I GO TO WORK OR SCHOOL AFTER THE TESTING? Yes. HOW LONG DOES THE TEST TAKE? The allergy testing alone will take about 60-90 minutes. Most of this time, however, is spent waiting for the test to react on your skin. CAN CHILDREN BE ALLERGY TESTED? Yes. In our office the testing procedure and the number of tests which are done on a child are different than the testing done on an adult. Rest assured, however, that you, the parent (after discussion with Dr. Accetta) will decide when and if your child will be allergy tested HOW OLD DOES A CHILD NEED TO BE BEFORE ALLERGY TESTING CAN BE DONE? Despite the old wives' tale, allergy testing can even be done on infants if it is medically necessary. WHAT ARE THE THINGS THAT I WILL BE TESTED FOR? We test you for common inhalants such as grass, trees, ragweed, dust and animals, as well as several foods. However, if a food allergy is possibly the cause of your symptoms, Dr. Accetta may want to test for a wide variety of foods. WHEN WILL I LEARN THE RESULTS OF THE ALLERGY TESTING? The results will be given to you at the conclusion of the testing procedure. ARE THERE BLOOD TESTS AVAILABLE, INSTEAD OF THE SKIN TESTS? Yes. However, these are more expensive, the results are not available for 1-2 weeks and they are not as accurate as the skin tests. Also, many insurance plans may not cover the cost of such tests except under certain circumstances. HOW YOUNG CAN A CHILD BE SEEN FOR ALLERGIES OR ASTHMA? Because Dr. Accetta was a pediatrician before he became an allergist, he is quite comfortable caring for children of all ages. Therefore, the time to see an allergist is when it is needed, rather than at any specific age. For questions regarding allergy testing in children, refer to the section on allergy testing. Bee Sting Allergy When a honey bee, wasp, hornet or yellow jacket stings, it injects a poison called venom. The non-allergic person who has a normal reaction to the bee can have pain, redness, itching and swelling at the injection site. The reaction usually begins within minutes, and can last for several days. If a person is allergic to the stinging insect, any or all of the following may occur: generalized itching or swelling, difficulty breathing, swollen tongue, nausea, vomiting, cramps, diarrhea, dizziness, loss of consciousness, drop in blood pressure and even death. IF YOU ARE STUNG: Remove the stinger if one is present (only the honey bee leaves a stinger) with a quick scrape of the fingernail or a plastic credit card. DO NOT SQUEEZE THE SAC because this will inject even more venom into you. IF YOU HAVE HAD A SEVERE REACTION: You need to be evaluated by an allergist. If you are allergic, you should carry a special epinephrine kit with you at all times from early March until the ground is frozen (usually around Thanksgiving), and you should wear a medical alert bracelet. If you are stung and have any difficulty breathing, swallowing or speaking, or generalized itchy skin or hives (adults only), use the Epipen, and then call 911. YOU MUST GO THE HOSPITAL BY AMBULANCE IF YOU HAVE A GENERALIZED REACTION OR USE THE EPIPEN! ALLERGY SHOTS FOR BEE STING ALLERGY: Allergy shots, made from pure bee venom may be recommended. These shots are very effective and provide complete protection for about 98% of people who receive them. Over a period of several years, most people are cured of their bee sting allergy. RESCUE INHALERS: Beta agonist drugs (VENTOLIN, PROVENTIL, BRETHAIR, XOPINEX, ALUPENT, ALBUTEROL) relax the smooth muscles surrounding the bronchial tubes and cause bronchodilation (opening the bronchial tubes). When used as an inhaler or in a nebulizer, these drugs begin to work within minutes, have few side effects and are effective for 4-6 hours. They are the drugs of choice to treat an asthma attack. They are also used frequently to prevent exercise induced asthma. Since asthma is due to inflammation (irritation) of the bronchial tubes, most asthmatics should use an anti-inflammatory drug daily. Also, if you find that you are using the beta agonist inhaler routinely, this usually indicates that your asthma is not well controlled and you should see the doctor for further evaluation. Side effects: These are usually mild: anxiety, muscle tremors, increased heart rate. These side effects can often be avoided by decreasing the dose or switching to a different brand. There have been several reports associating regular usage (as opposed to as-needed usage) of these drugs to a worsening of asthma. The reasons for this remain unclear. What should you do? You should not stop using your beta agonist inhaler, but you should periodically review your need for this medication with your doctor. SEREVENT (Salmeterol), FORADIL (Formoterol): These are also bronchodilators, but unlike the other beta agonist drugs. Serevent can take 30 minutes for it to work, and lasts for up to 12 hours. Foradil also works for 12 hours, but begins to work within 15 minutes. YOU SHOULD NEVER USE THESE DRUGS AS A RESCUE MEDICATION DURING AN ASTHMA ATTACK! CONTROLLER MEDICATIONS (anti-inflammatory medications) Almost all asthmatics except those with very mild asthma (less than three mild episodes of mild asthma per week) should use an anti-inflammatory medication daily. If you use these drugs daily, you will generally control your asthma better and be able to decrease your usage of the beta agonist drugs. Since these drugs do not relax the bronchial tubes, you still need to have a beta agonist drug available to use when needed. There are two classes of anti-inflammatory inhalers: non-steroids (cromolyn sodium and nedocromil sodium), and corticosteroids (Aerobid, Advair, Azmacort,Azmanex, Beclovent, Qvar, Flovent, Symbicort and Pulmicort). CROMOLYN SODIUM & NEDOCROMIL SODIUM: These are very safe, non-cortisone drugs. They have a somewhat bitter taste when inhaled. They can cause a mild cough when inhaled. INHALED CORTICOSTEROIDS (steroids): These tend to be among the most effective and powerful drugs to treat asthma. Side effects: thrush ( a fungus infection in the mouth which is rare if you rinse your mouth after using the inhaler), hoarse voice, mild cough immediately after using the inhaler. High dose inhaled steroids are used for many severe asthmatics and may cause additional side effects, but these are generally fewer and less severe than when taking the drug as a pill. ADVAIR: Advair is a combination of a steroid (Flovent) and a long acting beta agonist (Serevent- see above). Never use more than one inhallation twice daily. SYMBICORT: Similar to Advair, except that some relief can be felt within 3 to 15 minutes after it is used. Do not use more than 2 inhalations twice daily. POINTS TO REMEMBER: -No drug is 100% safe -Use a beta agonist when necessary to control acute symptoms -If you have any asthma symptoms more than twice each week you should usually use an inhaled anti-inflammatory drug -Signs of unstable asthma include frequent flare-ups or frequent usage of a beta agonist inhaler -Almost all asthmatics (even infants!) who have asthma should be using an anti-inflammatory medication WHAT ARE STEROIDS? Everyone makes steroids, which are essential for maintaining health. There are two groups of steroids: anabolic steroids which have been abused by athletes, and corticosteroids. In this article, the term steroids will refer only to corticosteroids. THE HISTORY OF STEROIDS: Steroids were first used in the late 1940s. Physicians thought that they had found a miracle cure for asthma and other diseases until patients began to develop significant side effects. Because of these side effects, many physicians and patients developed a steroid phobia (fear of steroids). However, we now know a good deal about these medications, and the side effects can frequently be avoided or minimized if the steroids are used carefully. TYPES OF STEROIDS: Steroids may be injected, inhaled into the lungs or nose, taken by mouth or used on the skin. The oral and injected steroids are powerful and act quickly but side effects are also more frequent. We prefer to use inhaled steroids to treat asthma or severe nasal symptoms because the drug is delivered to the lungs or nose and in small amounts. Since inhaled steroids are much safer, they are suitable for long term usage. HOW STEROIDS WORK: Steroids are powerful anti-inflammatory drugs used to treat inflammation (irritation) of the skin, joints, and airway. SIDE EFFECTS OF INHALED STEROIDS: If you develop a BLOODY NOSE while using nasal steroids, stop the medication for several days and then restart it. If the bloody nose reoccurs, call the doctor. THRUSH (a fungus infection in the mouth) and HOARSENESS are common when taking inhaled steroids for asthma but can usually be avoided by using a spacer device and rinsing your mouth after using the inhaler. If you are taking very high doses of inhaled steroids, you may develop some of the same symptoms noted when taking oral steroids (see below). CONCERNS FOR CHILDREN USING INHALED STEROIDS: For many years there has been a concern that children using inhaled steroids might not reach there full adult height. However, a study published by The New England Journal of Medicine on October 12, 2000 (Effect of long-term treatment with budesonide on adult height in children with asthma) followed children who took an inhaled steroid (budesonide) for up to thirteen years. The final adult height was less than one inch from their predicted adult height although some of the children reached their adult height later than others. The conclusion of the article was that the drug decreased the rate of growth but not the final adult height in most children. Keep in mind that poorly controlled asthma also will cause a decrease in a child's growth. SIDE EFFECTS OF ORAL STEROIDS: Mild, temporary side effects are common: increased appetite, mood swings, water retention, weight gain, acne flare-ups, muscle cramps (possibly due to loss of potassium, so drink orange juice or eat bananas), menstrual irregularities and heartburn (take the steroid with meals or use an antacid). Serious side effects can occur in patients who have diabetes, mental illness, high blood pressure or infections such as tuberculosis. Long term usage of oral steroids can cause many side effects including osteoporosis, cataracts, high blood pressure, diabetes, poor wound healing and in children, decreased growth and hip problems. Most of the more serious side effects can be avoided or minimized if the oral steroids are used for only a short period of time (usually less than two weeks) or taken every other day. If you notice symptoms other than the mild symptoms listed above, the steroid may need to be stopped, but NEVER STOP ORAL STEROIDS BEFORE SPEAKING WITH DOCTOR. Steroids can be a life saving medication, but like all other medications, they should be used carefully and exactly as prescribed. As a general rule, no allergy or asthma medications should be stopped until after you consult with your allergist or pulmonologist because the risks associated with having an asthma attack during pregnancy generally are far greater than the risks of taking the medications. In addition, the pregnant woman should try to avoid her known asthma triggers (such as exposure to smoke). SHORT ACTING BETA AGONISTS (albuterol, metaproterenol, pirbuterol): Even when not pregnant, these medications should be used only occasionally rather than on a daily basis. Studies have generally shown no significant effects on the baby from any of these inhalers when used during pregnancy. LONG ACTING BETA AGONISTS (salmeterol, formoterol): Limited data in humans has not shown any significant adverse effects during pregnancy. Either one can be added to an inhaled steroid if asthma is not well controlled. IPATROPIUM: There is limited information on animals and humans, but studies shows no significant adverse effects. However, ipatropium should only be used during pregnancy if the short acting beta agonists are ineffective during an acute asthma attack. INHALED CORTICOSTEROIDS ( beclomethasone, budesonide, flunisolide, fluticasone, triamcinolone): Inhaled steroids are considered to be the first line of drugs for asthma treatment in patients of all ages as well as during pregnancy. Since most studies have been done using budesonide, this should probably be the drug of first choice. However, as a class of drugs, they are all safe and it would be reasonable to continue any of the other corticosteroids if a woman's asthma is well controlled on that drug prior to her pregnancy. CROMOLYN SODIUM, NEDOCROMIL SODIUM: No adverse events have been reported with either of these drugs during pregnancy. ORAL CORTICOSTEROIDS (prednisone, prednisolone): Although there have been several studies showing some risks, these medications should still be used to control life threatening situations or when there are not safer alternative medications. The risk to the fetus during a serious asthma attack is probably significantly greater than the risks of using an oral steroid. MONTELUCAST, ZAFIRLUCAST, ZILEUTON): Zileuton should not be used during pregnancy. Although zafirlucast and montelucast are safe during pregnancy and are alternatives to inhaled steroids, they are not the preferred medications. ANTIHISTAMINES: Loratidine and cetirizine can be used if needed. At this time, fexofenidine (Allegra) and desloratidine (Clarinex) should be avoided. ORAL DECONGESTANTS (pseudoephedrine): Until further studies are available, it would be wise to avoid the decongestants during the first trimester due to the occurrence of a rare birth defect (gastroschisis). ALLERGY SHOTS: While it is not recommended that allergy shots be started during pregnancy, continuing the shots during pregnancy is safe. |
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