Aspirin exacerbated respiratory disease (AERD)

Have you been diagnosed with asthma? Have you ever ingested aspirin or any other NSAIDs accompanied with difficulty breathing, rhinorrhea, and/or nasal congestion?

You may be experiencing what is known as the Aspirin-Triad, also known as Aspirin-Exacerbated Respiratory Disease (AERD). In mild asthmatics, 5-10% of the population may experience AERD, however 24% of people with severe asthma may suffer from AERD. More specifically, the aspirin-triad consists of nasal polyps, severe bronchial asthma, and an intolerance to Aspirin or other NSAIDs. Other symptoms could include wheezing, coughing, rhinorrhea, asthma attacks, anaphylaxis, and sometimes urticaria.

Can this be treated?

Treatment in people experiencing AERD is the same as treatment with all others with asthma. However, some patients could opt to do an aspirin desensitization procedure at a clinic or hospital. If nasal polyps occur, surgery may be required for removal, but they will typically recur.

Are there tests for diagnosis?

In vitro tests to identify aspirin-intolerant individuals are currently being investigated. However, diagnosis of AERD is usually based on the history of said reactions to NSAIDs.

Angioedema

Do you experience sudden swelling below the skin around the lips, eyes, hands, feet, throat or genitals that are painful and maybe itchy?

You may have Angioedema. Acute episodes often involve the lip, eyes, and face; however, angioedema may affect other parts of body, including respiratory and gastrointestinal (GI) mucosa. The swelling may form a line or be more spread out and may be associated with local burning sensation and pain. Laryngeal swelling can be life-threatening. Severe attacks of angioedema can herald the onset of systemic anaphylaxis, characterized initially by dyspnea.

What causes angioedema?

Angioedema may be caused by food or airborne allergens, exposure to water, sunlight, cold, heat, insect bites, or medication. Angioedema caused by an allergic reaction to a food, drug or environmental allergen is called Allergic Angioedema. Allergic angioedema is often associated with hives (urticaria). A form of angioedema, called Hereditary Angioedema, runs in families and has different triggers, complications, and treatments.. Many cases of angioedema occur in patients with urticaria.

What is the difference between angioedema and hives?

Angioedema is swelling that is similar to hives (urticaria), but the swelling is under the skin instead of on the surface. Hives, often called welts, are a surface swelling can also develop with angioedema. It is possible to have angioedema without hives.

What tests are used to diagnose angioedema?

Most mild cases of angioedema do not require laboratory testing. Suspected allergies to food, stinging insects, latex, and antibiotics can be screened and diagnosed. However, environmental allergen screening for patients with angioedema is limited and may not be definitive. A physical exam with your primary care physician or allergist might reveal abnormal sounds (stridor) when you breathe in which may indicate laryngeal angioedema. Blood tests may be ordered for patient with angioedema without urticaria and/or with recurrent episodes (see Hereditary Angioedema).

Can this condition be treated?

Yes. Mild symptoms may not need critical treatment. Moderate to severe symptoms may need to be treated. Breathing difficulty, especially associated with laryngeal angioedema, is an emergency condition as it is a symptom of anaphylaxis (see Anaphylaxis), and may need injection of epinephrine and a visit to the emergency room. For patients with Hereditary Angioedema, see Hereditary Angioedema.

Anaphylaxis

Have you ever experienced an allergic reaction that included one or more of the following symptoms: throat swelling, itchy red rashes or hives, wheezing, trouble breathing or swallowing, vomiting, change of color to face or body, diarrhea or faintness?

You may have had anaphylaxis. Anaphylaxis is a serious, life-threatening allergic reaction. The most common anaphylactic reactions are to foods, insect stings, medications and latex. Symptoms of anaphylaxis typically start within 5 to 30 minutes of coming into contact with the allergen. If you are allergic to a substance, your immune system overreacts to this allergen by releasing chemicals that cause allergy symptoms.Typically, these bothersome symptoms occur in one location of the body. However, some patients are susceptible to a much more serious anaphylactic reaction that typically affects more than one part of the body at the same time.

What tests are used to diagnose anaphylaxis?

To diagnose your risk of anaphylaxis or to determine whether previous symptoms were anaphylaxis-related, your allergist will conduct a thorough investigation of all potential causes and ask for specific details regarding all past allergic reactions.

Can this condition be treated?

Yes. Anaphylaxis requires immediate medical treatment, including an injection of epinephrine (adrenaline), calling 911, and visiting the hospital emergency room. If it isn’t treated properly, anaphylaxis can be fatal. If you are at risk of anaphylaxis, carry autoinjectable epinephrine. It is important for you, family members and others in close contact with you to know how to use the autoinjector.

Asthma

Are you having trouble breathing. Are you wheezing, coughing or have chest tightness?

You might have asthma. Asthma is a disease of inflammation in your airways, primarily your windpipes (bronchi). One may develop asthma at any age. If this happens only when you exercise, then you may have exercise-induced asthma. While there are various types of asthma, environmental allergens (e.g. pollen, dust, animals) can play a significant role in individuals developing asthma or making symptoms worse.

Can this condition be treated?

Yes. There are various medications available to treat this condition. Depending on your degree of symptoms the allergist will decide which medication is appropriate for you. Early treatment is important to prevent ongoing inflammation in your lungs.

Are there any tests for asthma?

Yes, there are various test that we do in the Allergy clinic. We offer lung function testing (e.g. spirometry) that helps guide us in our diagnosis. Also, we also test for exhaled nitrogen oxide (which determines the amount of allergic inflammation in your lungs), which helps guide our management. For any person that has asthma, we recommend to proceed with skin testing for environmental allergens (e.g. pollen, dust, cat, dog, cockroach, mold) to determine if an individual has allergies that may be contributing.

Are there any special medications that can be offered to me only in an Allergy Clinic?

Yes. One medication that is available is Xolair which is either a monthly or biweekly injection to help treat asthma. Since we are the experts in asthma and we are the only specialty that offers this medication for patients that qualify.

Atopic Dermatitis / Eczema

Do you or your child have red, itchy, scaly skin? Have these been ongoing for several years? Are over the counter meds not helping?

You might have atopic dermatitis (eczema). Eczema is common in children and is a term that describes the way the rash looks (scaly, small rough bumps, leathery patches). Eczema could be genetic due to a protein defect on your skin. However, environmental allergens (e.g. animals, dust mite) and food allergies (particularly in children play a large role).

Can this condition be treated at Raffi Tachdjan, MD?

Yes. Treating this condition is focused within our practice. Eczema can be treated with topical medications (topical steroids including other immune suppressants) and proper skin care (e.g. moisturization, oral anti-histamines). After potential triggers are identified an eczema action plan is implemented with the guidance of the allergist. Allergy shots are also shown to be moderately effective in treating eczema for individuals with environmental allergens.

Are tests offered at Raffi Tachdjan, MD?

Yes. Skin testing to environmental and food allergens are offered in order to find out what are triggering factors.

Allergic Rhinitis / Hay Fever

Do you have a stuffy or runny nose, or itching/tearing or your eyes? Are you sneezing and itching in your nose or throat? And does this happen frequently or during certain months of the year?

You might have hay fever (allergic rhinitis). Hay fever is when your body thinks something harmless like pollen or cat hair is foreign and responds by releasing chemicals known as histamines which make you have various symptoms such as itching, sneezing, and a stuffy nose.

Can this condition be treated?

Yes. We place patient’s on appropriate medications to help control their symptoms. We proceed with skin testing to see what the patient is allergic to (e.g. pollen, mold, dust mite, cockroach, cat, dog, horse, etc.). We implement preventing measures and potentially place patients on allergy shots.

What are allergy shots?

It’s injecting you with what you are allergic to so that your body becomes desensitized to it (slowly gets used to it and no longer thinks of it as a foreign body) so that through time your symptoms will decrease with the hope of using less medications.

How long do I have to be on allergy shots?

Patient’s are placed on allergy shots for 3-5 years. With our standard protocol patient’s may come in 1-2 times a week to get their shot until they build up to their therapeutic dose (the top dose). Once reaching top dose patients come less often. Eventually patients receive shots only once a month.

Is there a quicker way for me to get to my therapeutic dose?

Yes there is. We offer cluster immunotherapy (allergy shots). We have a protocol in place whereby you may go through a vial in one day. With this protocol people can reach their therapeutic dose in as soon as 3.5 weeks instead of several months.

Has the medical literature shown this to be effective?

Yes. Through evidence based medicine this has shown to be highly effective for hay fever and to help improve allergic asthma.

Chronic Cough

Have you been struggling with a cough that has last for several weeks?

You might have a chronic cough. A chronic cough is diagnosed if your cough lasts eight weeks or longer for adults, and four weeks or longer in children. Although, this is not a sign of a serious medical problem, it could cause some discomfort. Chronic coughs can be disruptive to your sleep and thus, cause exhaustion. Severe cases can lead to vomiting, lightheadedness, rib fractures, and even depression. Some underlying causes that lead to chronic coughing include infections, acid reflux, asthma, postnasal drip, and tobacco use.

Can this condition be treated?

Yes. There are many types of treatment for a chronic cough depending on the underlying cause. Antihistamines and decongestants will help control allergies and postnasal drip. Inhalers can be prescribed for asthma-related coughs. Acid blockers may help control acid reflux, which can exacerbate coughing. Antibiotics can be prescribed for any bacterial infections.

Are there tests for diagnosis?

A: Yes. Your doctor could perform different tests to check your breathing capacity and functionality to determine any underlying causes for your cough. An X-ray or CT scan can allow your doctor to look for signs of infections. A spirometry test will allow your doctor to diagnose for asthma depending on your lung capacity and how fast you can exhale. In addition to these tests, if your mucus is discolored, your doctor will be able to order a lab to sample for any bacterial infections. Lastly, your doctor might resort to performing an endoscopy, which utilizes a camera on a flexible tube to insert into your windpipe for examination of any possible abnormalities.

Chronic Sinusitis

Do feel sinus pressure and often get sinus infections? Do you have nasal congestion and have thick yellow-green nasal discharge?

You might have sinusitis. Sinusitis occurs when the cavities around the nasal passage become inflamed; this often occurs due to an upper respiratory infection or as a result of uncontrolled hayfever (e.g allergies to inhalents such as pollen). If your symptoms of facial pressure, congestion and nasal discharge last for more than 12 weeks, despite taking medicine, then you might have chronic sinusitis.

Can this condition be treated at Raffi Tachdjan, MD?

Yes. Our allergists can prescribe various medications such as nasal corticosteriods, antihistamines, or saline irrigation to alleviate symptoms. Appropriate testing in the form of environment or aeroallergen skin testing and evaluation of the immune system can be helpful in implementing nasal care and medical management. After testing, the allergist will determine if immunotherapy (allergy shots) may be suitable for you.

What tests are there to diagnose sinusitis?

A rhinoscopy (nasal endoscopy), inserting a thin tube with a fiber-optic light through your nose to examine your sinuses, can be performed at the clinic to screen for chronic sinusitis. Computerized tomography (CT) or x-ray can provide useful images of your sinuses and indicate deep inflammation. Environmental skin tests can also be conducted to find the trigger or allergen that is aggravating your symptoms.

Chronic Urticaria / Hives

What can I do if I get itchy hives that change shape, or vanish and reappear without any known triggers?

You might have urticaria, which are hives that usually turn white when pressed against (this is called blanching). Hives are usually not a life-threatening condition. However, if your hives are accompanied by difficulty breathing or swelling of your tongue or throat, you should call 911. Individuals with urticaria may have allergic triggers, and some may not have a known underlying cause (idiopathic urticaria).

What if hives persist past 6 weeks?

Hives persisting beyond 6 weeks are called chronic idiopathic urticaria.

Are there any tests available to find out what causes the urticaria?

Yes, not only do we have skin testing to various inhaled and ingested allergen, we also may run some blood work for laboratory markers of inflammation and allergy.

Is this condition treatable?

Yes. There have been tremendous recent advances in treating urticaria. The first line of therapy is usually antihistamines, but one of the latest treatments is an injection that is administered once or twice a month called omalizumab (Xolair).

Contact Dermatitis / Eczema

Do you have a red rash around your eyes and face? Are you getting a rash upon being in contact with certain chemicals (cosmetics, latex, perfumes)?
You might have contact dermatitis. Contact dermatitis occurs when your skin comes in contact with certain chemicals such as latex, perfumes, dyes, soaps, etc. and thinks of it as a foreign object causing release of certain immune mediators that cause a person to break out in a rash.

Can this condition be treated at Raffi Tachdjan, MD?
A: Yes. Various topical medications are used to suppress the immune response and reduce inflammation (e.g. topical steroids). The allergist can perform a series of test to develop avoidance measures. After appropriate testing, a comprehensive list of household items and beauty products that ARE SAFE for you to use will be provided.

Are there any tests for contact dermatitis?
Yes. We offer patch testing. We apply a patch on your back to find out which substances you are allergic to. This test will take 3 visits to complete. We will apply the patch on your back on the first visit. We will read the test 48 hours later and do a final reading 72 hours later.

COPD

Are you experiencing shortness of breath, wheezing, chest tightness and coughing that has started at a later age in life? Have you smoked cigarettes for long periods of time?

A: You might have chronic obstructive pulmonary disease (COPD). COPD is a condition that disrupts airflow in and out of your lungs. COPD may manifest as any one of these conditions: chronic bronchitis (inflammation of the airways which causes cough and increased mucus), emphysema (damaged air sacs), or bronchiectasis (abnormal widening of the windpipes and its branches)

What is the difference between COPD and asthma?

COPD and asthma have a lot of overlap in their symptoms (shortness of breath, wheezing, chest tightness); therefore, it is important to be evaluated by an allergist to determine which types of treatment are appropriate.

What tests are used to diagnose COPD at Raffi Tachdjan, MD?

COPD is diagnosed by evaluation of medical history and lung function testing (e.g. spirometry). Based on the results of the tests, the allergist will implement medical management of your symptoms.

Drug Allergy

Do you feel that you have developed itchiness of your skin, a rash, swelling, or had trouble breathing after taking a medication?

You might have a drug allergy. Drug allergies occur when your body thinks a particular medication is a foreign substance and causes an immune reaction that causes rash, swelling, itchiness, throat tightness, or shortness of breath. This can be life threatening and as a result it becomes important to know which medications to avoid.

Can this condition be treated?

Yes. Depending on the type of reaction the allergist will determine if avoiding the medication is the best approach or further testing needs to be pursued. We have protocols in place to help desensitize (get your body to become more tolerant to the medication) you to particular medications so you may take them if they are absolutely indicated.

Are there any tests for drug allergies?

Yes, we proceed with drug skin testing to see what the patient is allergic to. We also offer drug challenges (whereby a patient is giving increasing amount of a medication to see if they are able to tolerate it) at the clinic.

Eosinophilic Esophagitis

Do you regularly throw-up, have stomach pain, or feel a particular food gets stuck in your throat?

You might have Eosinophilic Esophagitis (EoE). EoE occurs when the tube that sends food from your mouth to your stomach (esophagus) becomes inflamed and swollen as a result of constant exposure with a particular food that you are allergic too. Increasing inflammation can cause food to get stuck in your throat.

Are there treatment options offered at Raffi Tachdjan, MD?

Yes. Our allergists can prescribe oral viscous budesonide (a type of steriod) or swallow inhaled budesonide to control EoE. However, since lack of treatment can lead to very serious adverse effects, it is vital to see an Allergist. Food skin prick testing, removal of certain foods from your diet and implementation of a food action plan will help to treat EoE symptoms.

Are there any tests offered for EoE at Raffi Tachdjan, MDl?

Yes, skin testing for foods is done at Raffi Tachdjan, MD, which in addition to the history helps in guiding our allergists in formulating a food action plan that will have patient eliminate foods that are thought to cause EoE. Our Allergists work in close coordination with Gastroenterologists (e.g. stomach doctors) in establishing the diagnosis as an upper endoscopy and biopsy of the esophagus needs to be done.

FPIES

Do you experience chronic vomiting and diarrhea after eating certain foods?

You may have Food Protein-Induced Enterocolitis Syndrome. FPIES is a type of food allergy affecting the gastrointestinal (GI) tract and usually involves one or more specific food. It is non-IgE mediated, meaning that allergic antibodies are not involved. Instead, it is cell mediated, meaning that it would have a delayed reaction. Classic symptoms of FPIES include profuse vomiting, diarrhea, and dehydration. Patients with FPIES may also suffer from poor growth by continually eating the food trigger. Encouragingly, most children outgrow it by age 3 or 4. These symptoms can lead to severe lethargy, change in body temperature and blood pressure.

What is the difference between regular food allergies and FPIES?

Unlike typical food allergies, symptoms of FPIES may not be immediate and do not show up on standard allergy tests. Furthermore, negative results from a food allergy test may delay the diagnosis and take the focus off the food trigger.

What tests are used to diagnose FPIES?

Unfortunately, there are currently no simple tests for FPIES. The primary test, as mentioned above, is a medically supervised oral food challenge with the trigger food. Diagnosis of FPIES can also be a challenge, as this disorder often is mistaken for a bacterial infection (sepsis) or viral illness. Although it is an allergy, it cannot be easily identified through the usual skin-prick or blood tests for food allergies. If you suspect that your child has FPIES, consult an allergist, who will take into account your child’s clinical history and symptoms and exclude other causes.

Can this condition be treated?

For this condition, strict avoidance of the trigger food(s) is key. If you or your child has FPIES, your allergist may advise you switch to using a hypoallergenic formula, such as a casein hydrolysate-based formula. If your child has solid-food FPIES, your allergist may suggest introducing yellow fruits and vegetables (pears, bananas, corn and potatoes, for example), rather than cereal.

Food Allergy

Did you eat something and develop hives or red, itchy skin? Did your hands, feet, face, or lips swell and become puffy? Did you experience throat tightness and trouble breathing?

If so, you might have a food allergy. Food allergies occur when your body considers a particular food to be a foreign substance. As a result it causes a dysregulation of your immune system releasing various mediators that results in various reactions such as hives, swelling or an anaphylactic reaction. Some of the most common food allergies in the United States are to: tree nuts, peanut, shellfish, soybean, wheat, eggs, fish, milk, wheat, and sesame seed.

Can this condition be treated?

Yes. The allergist can conduct a series of tests to determine which foods you are allergic to. Based on the history and skin test results the Allergist will determine which foods to avoid and provide a food action plan. There are certain food allergies that individual may outgrow and with the guidance of the allergist may be reintroduced in one’s life. Unlike hay fever, the symptoms associated with food allergies cannot be treated with allergy shots.

Are there any tests for food allergies?

Yes, we proceed with skin testing to see what the patient is allergic to (e.g. walnuts, orange, carrots, pork, shellfish, wheat, cinnamon etc.).

We also conduct food challenges in our clinic. This is the gold standard test to determine if a patient has allergies. If it is determined by the allergist that the risk of having a reaction is low after appropriate testing, then this is usually pursued. A protocol is followed whereby increasing amounts of the food is introduced over a couple of hours with close monitoring of patient’s vitals.

Gluten Sensitivity / Celiac Disease

Are you experiencing bloating, nausea, and vomiting after eating gluten products?

You might have gluten sensitivity. In the community, there are various types of conditions associated with gluten. There is gluten sensitivity, gluten allergy, and celiac disease; therefore, it is important to seek the help of an allergist to distinguish between these 3 possible conditions.

What tests are there to distinguish between gluten sensitivity, gluten allergy, and Celiac disease?

Food skin testing and blood tests will be done as appropriate to rule out Celiac disease and determine whether you have a true gluten allergy or just gluten sensitivity.

Can this condition be treated at Raffi Tachdjan, MD?

Yes. After appropriate testing, the allergist can educate and implement a food action plan into your diet.

Hereditary Angioedema (HAE)

Do you experience swelling on your face, hands, feet, belly or genitals BUT no itching? Are these swelling episodes painful and/or last a few days?

You might have a rare condition known as Hereditary Angioedema. Hereditary Angioedema (HAE) is a genetic disease that is passed on in families, where a child has a 50% chance of inheritance if one of his or her parents has it. The swelling break outs could be triggered by trauma, surgery, dental work, menstruation, stress, anxiety, medications or even the common cold. ACE Inhibitors have been known to increase the frequency and intensity of HAE attacks.

At what age do attacks of Hereditary Angioedema start?

The age of HAE onset varies considerably, however, in one study, half of the patients reported onset of their symptoms by the age of seven, and over two thirds became symptomatic by the age of thirteen. There also seems to be an increased frequency of attacks during puberty or adolescence.

What are the tests used to diagnose HAE?

HAE is attributed to mutations in the C1 inhibitor gene, and is currently categorized into Type I, II, and III. There are two specific blood tests that confirm HAE: C1-inhibitor quantitative (antigenic) and C1-inhibitor, functional. The most common form of the disease–Type I–is characterized by low quantitative levels of C1-inhibitor and affects about 85% of patients. Type II HAE affects the other 15% of patients who have normal or elevated levels of C1-inhibitor, but the protein does not function properly. HAE with Normal C1 Inhibitor (Type III), is harder to diagnose because the patient may have normal C1 inhibitor levels. However, a gene mutation in Factor XII may be present and thus genetic testing may be needed.

Can this condition be treated?

Yes. Depending on the severity and frequency of the HAE attacks, an HAE treatment plan can be tailored to meet each patient’s unique needs. Five HAE therapies have been FDA-approved for either preventing HAE attacks or treating acute attacks. These medications are administered either intravenously or via subcutaneous injection, and several have been approved for self-administration.

Mastocytosis

Do you have itchy skin lesions that are brownish, flat, or elevated that may lead to blistering? Do you also experience skin flushing, anaphylaxis, nausea, vomiting, low blood pressure, shortness of breath, and or fainting?

You may have urticaria pigmentosa or mastocytoma lesions, which may be a symptom of Mastocytosis. Mastocytosis is a disorder that can occur in both children and adults. It is caused by the presence of too many mast cells in your body. You can find mast cells in skin, lymph nodes, internal organs (such as the liver and spleen) and the linings of the lung, stomach, and intestine.

What tests are used to diagnose mastocytosis?

Diagnosis can include the following test and should be conducted by a physician with special knowledge of this disorder: Skin and bone marrow biopsies, Measurement of mast cell mediators in blood and urine, Blood count, Liver function studies, and Genetic tests.

Can this condition be treated?

Yes. Currently, there is no definitive treatment for mastocytosis. However, therapeutic treatment can be tailored according to the patient’s specific needs for symptomatic relief. Treatment will control the effects of mast cell by avoidance of dietary and environmental triggers as well as the use of various medications. More aggressive forms mastocytosis may require interferon or chemotherapeutic agents. Please consult with your primary care doctor or immunologist regarding this condition.

Oral Allergy Syndrome

Do you find yourself having itching or tingling of the mouth when eating various raw fruits and vegetables?

You might have oral allergy syndrome. Individuals who have allergies to pollen may develop these symptoms as certain fruits and vegetables share common proteins with various pollens.

Can a person develop more severe symptoms then just itching of the mouth?

Yes. While commonly individuals just experience itching, 1 % of individual who have this condition can develop anaphylaxis (e.g. throat tightness, difficulty breathing, decrease in blood pressure).

Are there any tests available to find out what fruits or vegetables I am allergic to?

Yes, not only do we have skin testing to these food items, but, we also proceed with testing with actual fruits and vegetables with prick-prick testing, whereby, we prick the actual fruit and vegetable and then prick your skin.

Is this condition treatable?

Yes. It can be. For the most part individuals can tolerate cooked versions of these foods. A food action plan will be given by the allergist to guide you in this regard. Since there is cross-reactive with the proteins found in various pollens, allergy shots to pollens can give an approximate 50:50 chance of improvement or resolution of symptoms over time

Primary Immunodeficiency Diseases (PIDD)

Are you noticing recurring infections since childhood (e.g. bacterial (bronchitis, pneumonia, sinusitis) fungal, viral or skin infections)? Are you noticing that your child is failing to thrive?

You or your child might have primary immunodeficiency diseases (PIDD). PIDD is a condition whereby there is a defect in a component of your immune system that is putting you at increased risk of getting recurrent infections. This may be caused by either genetic or inherited defects. There are more than 150 different kinds of PIDD.

Are you noticing recurring infections that are occurring later on in your life?

You might have secondary immunodeficiency diseases. Secondary immunodeficiency diseases occur when the immune system is compromised due other factor such as malignancy (cancer), chemotherapy, HIV, burns, or poor nutrition.

Can PIDD and secondary immunodeficiency diseases be treated at Raffi Tachdjan, MD?

Yes. Depending on the type of immune deficiency, one may be eligible to receive immunoglobulin replacement therapy (specific proteins that are infused to partly replace what your immune system is lacking to be better able to fight off infections). The infusions are either given in intravenous or subcutaneous form.

Venom Allergy

Have you ever been stung by a bee, wasp, hornet, yellow jacket, or fire ant? Did you develop an itchy rash, swelling, or have trouble breathing (e.g. throat tightness or wheezing).

You might have a venom allergy. Having a venom allergy is when your body overreacts to an insect sting thinking it is a foreign object causing the release of various chemicals that cause one to break out in hives, have swelling or anaphylactic reaction (life threatening reaction).

Can this condition be treated at Raffi Tachdjan, MD?

Yes. Treating venom allergies are life saving! In severe cases, a venom allergy may lead to anaphylaxis (your airways narrowing to the point where it gets difficult to breathe) Immunotherapy (allergy shots) is proven to be an effective long-term treatment for venom allergies. Patients with history of life threatening reactions are prescribed epinephrine to inject themselves in case such a severe reactions were to occur in addition to being instructed to call 911!

Are any tests offered to diagnose venom allergies?

Yes. We proceed with a blood test and/or venom skin prick tests to determine which venom proteins you are allergic to (e.g. wasp, white-faced hornet, yellow hornet, and yellow jacket).

Vocal Cord Dysfunction

Do you experience shortness of breath, chest and/or throat tightness, frequent throat clearing, irregular hoarseness, and feeling like you are “breathing through a straw?”

You may have Vocal Cord Dysfunction. Vocal cord dysfunction (VCD) is the abnormal closing of the vocal cords when you breathe in or out. It’s also called laryngeal dysfunction or paradoxical vocal cord motion. Like asthma, vocal cord dysfunction can be triggered by breathing in lung irritants, having an upper respiratory infection or exercising.

What is the difference between VCD and asthma?

Unlike asthma, vocal cord dysfunction is NOT an immune system reaction and does NOT involve the lower airways. Treatment for the two conditions is different and thus, asthma medications do not ease the VCD symptoms. For VCD, it is harder to breathe in than breathe out when symptoms flare up. Also, results of breathing (pulmonary function) tests or other tests for asthma are often normal for people with VCD.

What tests are used to diagnose this condition?

Ways to diagnose VCD include laryngoscopy, spirometry test, and a clinical evaluation by your doctor.

Can this condition be treated?

Yes. Treatment for vocal cord dysfunction may involve panting maneuvers, speech therapy, psychological counseling and avoidance of irritants.Medication alone will not help alleviate VCD, so active participation with behavioral techniques will help control VCD.