With today’s busy lifestyles, many people find it difficult to include even an extra one-half hour into their day. For those with bothersome nasal and eye allergies that do not respond well to avoidance measures and allergy medications, allergen immunotherapy (allergy shots) can be the answer that can finally provide relief. Allergy shots can be extremely effective in combating allergies and provide long-lasting symptom improvement, but it can be somewhat time consuming for our hectic schedules.

As mentioned previously, allergy shots work by making the body’s immune system more tolerant to allergens and include two separate phases, build-up and maintenance. The build-up phase includes weekly or twice weekly injections until the final dose is received at which point the maintenance phase begins. Once the maintenance phase has been reached, the frequency will begin to decrease to a monthly injection. The doses at or very near the maintenance phase contain enough allergen to begin to provide improvement in allergy symptoms. The problem is that it may take 6 months to build up to the final dose, and many of us would like to be able to feel better faster.

Luckily there is another option, and it is called RUSH Immunotherapy. Rush immunotherapy is a technique that accelerates the administration of allergen injections and therefore shortens the time frame required to obtain relief from allergies. Conventional immunotherapy consists of weekly or twice weekly build-up allergen injections, administered over a period of four to six months in increasing doses until the final dose is reached. Rush immunotherapy procedures are designed to reach maintenance much faster than can be achieved with conventional immunotherapy.

The Rush procedure begins with administering allergy medications such as prednisone and antihistamines prior to the office visit. On the day of Rush, one will receive increasing doses of their allergy shots over 6 hours, and the doses are increased to about 1/10^th of the full maintenance dose. This avoids the first 14 office visits for conventional immunotherapy and allows clinical improvement to occur much faster. Full maintenance is usually reached within about 1-2 months.

There are multiple advantages of Rush immunotherapy.

• More rapid clinical improvement resulting in quicker relief – Rush immunotherapy induces the immunologic changes that occur during the build-up phase more rapidly than conventional schedules. Thus, patients experience clinical benefit sooner. Some patients will even notice improvement soon after completing the rush procedure.
  
• Fewer visits for allergy injections with greater convenience - Inconvenience is the most common reason patients discontinue conventional immunotherapy. Rush immunotherapy involves fewer office visits and makes it easier to fully complete the therapy. It also permits individuals who live long distances from an allergy clinic to receive allergy shots on a less frequent basis, therefore significantly reducing the number of visits and commuting time. In addition, Rush immunotherapy accommodates busy schedules, especially for individuals who travel frequently.

• Reduced cost — Rush schedules involve fewer total injections and so can be less costly by reducing the number of office visits and insurance copays.

There is an increased rate of allergic reactions with Rush when compared to conventional immunotherapy, but most are mild and are easily treated. In addition, proper precautions, effective premedication and monitoring protocols are in place to reduce this risk. Rush immunotherapy is not for everyone, particularly those with severe asthma and young children, and our allergists here at Atlanta ENT, Sinus & Allergy can help you decide what are the best options for you.

Atlanta ENT, Sinus & Allergy Associates’ board-certified allergists have numerous years combined with Rush Immunotherapy and have been properly trained in this technique. When it comes to the newest treatments, therapies and procedures, Atlanta ENT, Sinus & Allergy is on the cutting edge of these technologies. If you have problems with your allergies, ask your doctor about Atlanta ENT, Sinus & Allergy Associates or feel free to give us a call and make an appointment to find out more about how Rush Immunotherapy can help you with your allergies and help you breathe better and feel better…. FASTER

Avoidance measures and environmental controls are the first step to help allergy symptoms. For pollens from trees, grasses and weeds there are some simple measures that can be performed such as:

• Keeping your car windows closed and your windows and doors closed at home
• Avoiding long periods of time outside during high pollen counts particularly in the morning
• Wear a mask if you are outside working in the yard to help filter pollen
• Using the air conditioner to filter the air in your home
• Showering before bed or after long periods of time outside to wash the pollen off

There are several effective medications that can be used to help block the symptoms of allergies. Antihistamines are safe, work quickly and can be quite effective. Some antihistamines require a prescription, but there are many non-drowsy antihistamines that are available over the counter and include: loratadine (Claritin), cetirizine (Zyrtec), and fexofenadine (Allegra). Other over the counter medications are decongestants that come in both oral and nasal spray form, but these are better used only occasionally due to possible side effects such as fast heart rate, high blood pressure, jitteriness and insomnia with the oral formulations and rebound nasal congestion with the nasal spray formulations. Prescription forms of anti-inflammatory and antihistamine nasal sprays are also available and are very effective and safer to use for longer periods of time.

Sometimes avoidance measures and medications are not enough to control one’s allergy symptoms, so another option is allergen immunotherapy (aka allergy shots). An allergy injection is not a medicine but works more like a vaccine. For example, if someone is allergic to grass and is on allergen immunotherapy then they would be receiving the actual extracted grass pollen in an injection form of the same grass pollen that they had been breathing in the outside air.

Allergen immunotherapy works by making the body’s immune system more tolerant to the allergens that are causing allergy symptoms, and this form of treatment can be very effective. There are 2 separate phases of allergy immunotherapy, build-up phase and maintenance phase. The build-up phase includes weekly or twice weekly injections until the final dose is received. Once the final dose is reached then this is now called the maintenance phase. After the maintenance phase has been reached, the frequency will begin to decrease to a monthly injection. Allergy shots at this maintenance phase are continued for 3-5 years after which time there is persistence of improvement even after discontinuing shots.

You do not have to suffer from allergies, so don’t miss out on how allergy skin testing and possibly allergen immunotherapy can help you. If you have bothersome and problematic allergy symptoms, give us a call here at Atlanta ENT, Sinus & Allergy Associates for a complete allergy evaluation from top-notched board-certified allergists.

It is understandable why some people with nasal allergies may think that their allergies are due to the pollen generated by colorful flowers in their flower beds, but actually it’s mainly the trees without large impressive flowers that cause the majority of the problems. This is because most of the colorful flowers of small plants are insect pollinated rather than wind pollinated and therefore the amount of pollen in the air for these types of plants is quite low. On the other hand, many trees are wind pollinated and these are usually the most allergenic trees. However, there are also several trees that are mainly insect pollinated, so this means that some trees are common culprits of nasal allergies while others are not.

Some of the most allergenic trees are birch, oak, and cypress. These trees have very allergenic proteins in their pollen and they are suspended in the air in relatively high concentrations. Other important trees that cause nasal allergies include maple and elm, but there many others with varying degrees of allergenicity. Interestingly, pine tree pollen is only occasionally associated with allergies, although this is mainly the pollen that we find on our cars. This is partly due to the relatively large size and weight of its pollen grains. Since pine pollen is large and heavy, it falls to the ground and on our vehicles which means that there is not much of it suspended in the air to be inhaled and cause nasal allergy symptoms.

Knowing which trees one may be allergic to can be easily determined by simple skin testing. If you think that you or your family member may be suffering from nasal allergies this spring season, then feel free to give us a call to schedule an appointment. The allergists here at Atlanta ENT, Sinus & Allergy associates are board certified in Allergy/Immunology and are ready to help you breathe better and feel better.

This study looked at several factors that could contribute to developing allergic rhinitis with the goal of determining a predictive model. The items listed below were identified as risk factors for developing new allergies in children who did not already have nasal allergies:

• Female
• High socioeconomic status
• Parental history of asthma
• Not exclusively breast feeding for < 2 months
• Positive skin tests to indoor allergens
• Positive skin tests to outdoor allergens

Having a positive skin test to outdoor allergens before having symptoms of nasal allergies was the most significant and important risk factor. In addition, children with all of the above risk factors had an approximately one hundred times higher estimated risk for developing allergic rhinitis.

Although one cannot say with 100% certainty who will develop allergies, this study helps physicians determine who is most likely to develop allergies as they grow older. If a child has several of these risk factors, their primary care physician will be more on the look-out for the tell-tale signs and will be more likely to advise an evaluation by a certified allergist. Allergists will also use the information provided by this study and may suggest simple skin testing to help determine the appropriate diagnosis and guide proper treatment. Our allergists here at Atlanta ENT, Sinus and Allergy are readily available to help you and your child determine the correct diagnosis and provide optimal management - so feel free to give us a call.

Often when people say that they have “allergies,” they are actually referring to their bothersome nose symptoms such as nasal congestion, runny nose and sneezing. The medical term for these nose symptoms is called rhinitis. Rhinitis can be due to allergic causes, but it can also be from nonallergic causes. Allergic rhinitis refers to nasal symptoms that are often caused by inhaled substances including pollen, cat dander and molds. However, there are many causes that can mimic allergy resulting in allergy-like symptoms yet not be true allergy. Nonallergic rhinitis symptoms can be just as problematic as true allergic rhinitis symptoms, and it is therefore imperative that the distinction between the two be made for successful treatment.

Nonallergic rhinitis is more often associated with symptoms such as nasal congestion, post-nasal drip, and sneezing, and less often associated with itching of the nose and eyes. Symptoms are usually year-round but can be worsened by weather changes. In addition, irritants such as smoke, cleaning agents, perfumes, scented candles and air fresheners are common triggers. To make things even more confusing, it is estimated that up to 50% of people with non-allergic rhinitis may also have allergic rhinitis.

So for the patient who was wondering how she could have such bothersome nasal symptoms and negative skin tests, I explained to her that her symptoms may be due to a disorder called nonallergic rhinitis. After providing education on what could be triggering her symptoms and starting specific nasal spray medications that typically work better for non-allergic rhinitis, she returned to the office for her follow-up visit stating that she could breathe better, sleep better and was overall feeling much better.

If you feel that you are having persistent and bothersome nasal symptoms then we welcome you to give us a call here at Atlanta ENT, Sinus & Allergy Associates. We have Allergy and ENT specialists available who will provide you with top quality care to help you breathe better, sleep better, and feel better.

Dr. Rodney Johnson

When referring to nasal and eye allergies, the most common culprits during the winter season are indoor allergens.  People usually spend more time indoors during the winter, so nasal allergies can worsen to indoor allergens.  Common indoor allergens include: dust mites, pets, mold and even cockroach and mice. Common outdoor allergens are usually pollens and outdoor molds.  As a general rule, trees pollinate during the spring, grass during the summer, and weeds during the fall. However there is a wide variation of these pollination times depending upon where you live.  For example, in areas where the temperature seldom drops below freezing, such as southern Florida, there can be year-round pollen in the air due to many plants having very long pollination seasons.

Here in the Southeast, this winter season has been particularly warm as in many other regions of the U.S.  Because of this warmth, some trees have already begun to pollinate.  Typically the Juniper family of trees, also known as the “cedars,” begins pollinating first among the trees.  This can be as early as late February, however local pollen counts have already begun detecting Juniper pollen this year.  This early pollination may be a reason that some people who normally do not have nasal allergy symptoms during the winter have already begun having problems with sneezing, runny nose, nasal congestion and itchy eyes.  Physicians specializing in Allergy are available at Atlanta ENT, Sinus & Allergy Associates and can help you identify what you may be allergic to through simple skin testing. You can then follow your local pollen count at www.pollen.com which can help you determine what may be triggering your symptoms, as well as know what times to pay particular attention to incorporating strict avoidance measures.

Recently, a 7 year old girl with a peanut food allergy died after accidentally eating peanut on the school playground. The unfortunate death of this individual underscores the importance of having a food allergy action plan for those with life-threatening food allergies. The main purpose of food allergy action plans is to assist with recognizing and treating allergic reactions and/or anaphylaxis upon accidental exposures to foods.

Realistically, being able to avoid any particular food 100% of the time is nearly impossible. Because complete avoidance is extremely difficult, an allergic reaction in food-allergic individuals should be considered inevitable. It’s not a question of IF; it’s a question of WHEN. In addition, without the guidance of food allergy action plans, it is unreasonable to expect someone who is unfamiliar with food allergies to recognize symptoms and quickly treat a food allergy reaction.

Due to these reasons, it is essential to have a written food allergy action plan for all caretakers of individuals with food allergies. A written food allergy action plan specifically describes the signs and symptoms requiring epinephrine injection versus merely an antihistamine such as Benadryl.

A food allergy action plan provides step-by-step instructions on when to use epinephrine, proper medication doses, as well as detailed instructions on how to properly administer epinephrine via an autoinjector.
It is always advisable to review the food allergy action plan and have all questions answered by an allergist or other qualified healthcare professional. Practicing and demonstrating proper technique with an epinephrine autoinjector trainer (an epinephrine autoinjector that contains no needle or medication) in the presence of your health care provider is strongly encouraged. An example of a food allergy action plan can be found at the Food Allergy & Anaphylaxis Network and downloaded at www.foodallergy.org, although there are many other similar plans available. Following a personalized action plan will help ensure that an allergic reaction can be quickly and properly managed to help prevent fatal allergic reactions. To learn more about food allergies, visit our website’s section on food allergies - www.atlantaent.com/Allergies_Children.

Dr. Rodney Johnson

With Dr. Tritt, I was shown a completely different, better route for treatment. He reviewed my findings from the exam with me and agreed on sinus surgery. That was a big change from what I had gone in for. Dr. Tritt’s thorough examination revealed that my sinuses were filled with severely infected polyps. The infection from the polyps was so massive that my sinus passages could not drain. Dr. Tritt explained he would be doing laser surgery and that his prognosis was good for me.

I was concerned, worried and a little frightened about the surgery but showed up as scheduled. The surgery went without a hitch and I was recovering an hour later with a small band aid under my nose. No packing and no bleeding. Dr. Tritt told my wife he had to remove massive amounts of tissue and restructure bone while he was operating, He later told me the operation was so extensive that he had to quit earlier than he wanted because there were more polyps than he suspected prior to the surgery. Because of Dr. Tritt’s excellent care, I healed quickly.

The end result was that now I too could be a nose breather instead of a mouth breather. Two years later I went back to Dr. Tritt for the second sinus surgery to finish the work he was not able to the first time. This procedure was as the first one had been quick, easy, little discomfort, no bleeding or packing. A small bandage was all I had to show on the outside. On the inside was a very different story. I can now breathe with complete ease. My mouth does not stay open to breath. I don’t choke when eating because I am trying to breathe while chewing.

Life has changed for the better for me. Oh, I almost forget - no more unnecessary root canals on my upper teeth since the sinus infections that contributed to them are completely gone. I have given referrals for Dr. Tritt for many years now. He is honest, very detailed oriented and truly cares for his patients. He provided the help I so desperately needed during a tough time of debilitating, chronic sinus infections. If you are having nasal/sinus problems I strongly recommend you talk to Dr. Tritt. In my mind HE IS THE BEST.

Mike Ruff

Scientific and clinical research has advanced our understanding and detection of these disorders. Most recently there was an article in the August 10, 2011 issue of the Journal of the American Medical Association (JAMA) which stated that elderly women (in their early 80s) who suffered from sleep apnea have an increased chance of suffering from dementia or mild cognitive impairment. The recommendation was for people to be aware of this increased likelihood, and in those individuals who suffer from dementia or mild cognitive impairment; they should consider obtaining an evaluation regarding sleep disorders and an overnight sleep study as indicated. This is important information as most of us either have a parent or grandparent in their later years of life, or else we are headed there ourselves, G-d willing.

Nasal CPAP is still the “gold standard” treatment for those individuals who have moderate to severe sleep apnea. Unfortunately, not everyone can tolerate nasal CPAP due to various reasons. In those situations surgery may be indicated. There are many types of surgery that may be done to help alleviate one’s sleep apnea and snoring symptoms. The more classic surgeries include nasal surgery and upper throat surgery. Yet, we have come to appreciate that the lower throat area may in some situations be the primary culprit of one’s sleep apnea, and in those situations multi-level surgery is indicated and very beneficial.

I have noticed over the last few years that many individuals have mild sleep apnea with snoring, or just snoring with no sleep apnea; and due to nasal blockage at night time have developed an elongated and enlarged uvula (the little or not so little “thing” hanging down at the back of one’s throat). I have been impressed by how much improvement and resolution of symptoms these individuals have had after nasal surgery and removing their uvula.

My overriding message is no one needs to suffer from sleep apnea and snoring symptoms, whether mild or severe, as there are many excellent treatment options available, and they can change one’s life for the better. As a specialist who has treated thousands of people with sleep apnea and snoring symptoms, I hope people seek treatment rather than suffering.

Thanks for reading this article and passing the information along to others.

(written by Ramie A. Tritt, MD on 9/5/2011)

The beauty of living in today’s world is that the extreme of treatments tried and true continue to be tweaked. In the 1960’s if you wanted a lift the only choice was a face lift. Serious surgery and severe changes that made such a huge difference in appearance were often only afforded by wealthy women. Down time of 6 weeks or more and the severity of the change causing some social stigma led many people to think about it more than once. However, by the 90’s people were spending their retirement income on lifting their younger than their years spirits.

 The 70’s, 80’s and through today have brought  us to 50 years later where we have interventions that change what we can actually see with little no downtime for healing and the benefit of seeing them immediately.

The skin, a little like muscles which strengthen and become more defined through exercise is effected by advanced technology products and procedures which now change the behavior of skin cells. Much like lazy muscles can be altered through exercise today’s skin lifting interventions retrain the skin to act younger. Exercising good habits is a necessary requirement to affording younger acting and looking skin.

Daily skin care matters greatly and finding products that work with your particular skin care needs is helpful, commitment to their use is mandatory. Minor medical interventions like fillers for deeper facial lines or lips; when coupled with or used independently with Botox solves the wrinkle dilemma for many. Laser and Intense Pulsed Light tighten the skin, remove red and brown spots and restores the youthful clear and firm complexion once held in our youth.

The basic ingredient needed is compliance. To be compliant you must like what you are doing, enjoy the outcome of the practice immediately and also see it developing over time. Again much like exercise, You just have to DO IT!