Content reviewed by Marcy D. Markes, MSN, APRN, FNP-BC
We are located in Columbia at 100 S Keene Street, Columbia, MO 65201. You can reach us by phone at (573) 777-4700. Our hours of operation are Monday – Thursday 8am-1pm and 2pm-5:00pm and Friday 8am-12pm.
It depends on the method of testing that is used. In our clinic, we use scratch testing which is needleless and virtually pain free. Some clinics use intradermal testing which uses needles to inject the allergen under the skin. We DO NOT use this method of testing because it commonly causes a dermographic (nonallergic skin) reaction that can result in false positives. This method can also be very painful.
We will test infants if they are exhibiting food allergy symptoms. Food allergies can be genetic or develop during pregnancy. We do NOT test for airborne allergies until children are closer to 2 years old and are exhibiting symptoms. Airborne allergens are developed due to exposure. The first season a child’s body will create antibodies to an allergen without showing any symptoms. The next season the child’s body will react in the form of a histamine response exhibiting common allergy symptoms. This is why we prefer to wait until they are closer to 2 years of age, but will always evaluate this on a case by case basis. Remember that if your child is old enough to have symptoms, they are old enough to have treatment.
We do use allergy desensitization, which is another name for allergy immunotherapy. The body is desensitized to patient’s airborne allergens over a period of time. The therapy is administered by subcutaneous injections either in one arm or two based on the number of allergens. Since the injections are not given in the muscle and a very tiny needle is used, the injections are usually pain free. Sometimes the allergy extract itself can burn once injected but not always, and it’s not severe.
We also offer sublingual immunotherapy (drops under the tongue) but since this therapy is not yet FDA approved, it is not covered by insurances and the cost of the serum has to be paid for by the patient directly.
No, allergy shots should not be administered at home for safety reasons. The American Academy of Allergy Asthma and Immunology has established practice parameters which states that: “Immunotherapy should be administered in a setting that permits the prompt recognition and management of adverse reactions. The preferred location for such administration is the prescribing physician’s office. However, patients can receive immunotherapy injections at another health care facility if the physician and staff at that location are trained and equipped to recognize and manage immunotherapy reactions, particularly anaphylaxis. Patients should wait at the physician’s office/medical clinic for at least 30 minutes after the immunotherapy injection or injections so that reactions can be recognized and treated promptly if they occur.”
We will do our best to accommodate everyone’s needs for receiving of immunotherapy. We have extended evening hours during the week and we are open daily Monday thru Thursday during the lunch hour. We do not require an appointment for you to receive your allergy immunotherapy injections just walk in during our normal business hours and we will gladly assist you promptly. We will also work closely with your primary care clinic in arranging for you to receive your allergy immunotherapy injections, or any other medical clinic of your choice, should it be more convenient for you.
No, hives are not always caused by an allergic reaction. Hives, or urticaria, are frustrating and sometimes difficult to treat and a good number of the cases are often classified as “idiopathic”, meaning there is not a known cause. There are other reasons, however that you can develop hives without an allergic cause. Infections, parasites, autoimmune disorders, endocrine disorders and cancers are among the other factors that can cause hives. We take a thorough family history and patient history in evaluating hives. Allergy testing is one way to eliminate sources of hives, but if the testing proves to be negative, or does not correlate with your presenting history, other causes will be and should be considered. Medications that cause hives are considered allergic in nature and should be avoided to prevent further symptoms.
We can do overnight in-home sleep studies. Currently we are working with many insurance plans in getting home sleep studies “preferred” over an institutional sleep study for those patients who we suspect uncomplicated sleep apnea. We use screening questionnaires and your history to determine if sleep may be a problem for you and will discuss options that are available in the evaluation of symptoms such as chronic fatigue, headaches, irritability, poor concentration and even behavior issues in children. Institutional sleep studies currently have a very long wait time and most patients prefer to perform this type of study in the comfort of their own home. Not everyone is right for an in-home sleep study and the decision to choose this over an institution will need to be discussed with one of our providers. So if you exhibit any of the symptoms above, or if you or your significant other snores, it could be a sign of sleep apnea. Call us for an evaluation. It may even be possible to arrange a free sleep screen at home to further evaluate the need for a formal sleep study.
Most insurances cover both allergy testing and allergy shots. We always encourage you to check with your insurance before your first appointment to make sure that allergy evaluation and treatment is not an exclusion to your policy. It is very easy to do this. Look at the back of your insurance card for the customer service number. Call the number and tell them that you want to have your allergies evaluated and that the CPT code is 95004. They will be able to tell you if you have any financial responsibility for the testing. Please be aware that if you have a deductible with your insurance, the testing may be applied to your deductible and you will be responsible for that amount if not already met. Once your deductible is met, you may also have a co-insurance. Your insurance representative should be able to help you with that also. Allergy shots are the same and should be covered under your insurance unless it is an exclusion to your policy. The code for allergy immunotherapy injections is 95115 or 95117 depending on the number needed.
Chronic obstructive pulmonary disease (COPD) is one of the most common lung diseases. There are two main forms of COPD: Chronic bronchitis, which involves a long-term cough with mucus, and emphysema, which involves destruction of the lungs over time.
Smoking is the leading cause of COPD and the more a person smokes, the more likely that person will develop COPD. However, some people smoke for years and never get COPD. In rare cases, nonsmokers who lack a protein called alpha-1 antitrypsin can develop emphysema.
Symptoms of COPD are cough, with or without mucus, fatigue, recurrent upper respiratory infections, and shortness of breath that worsens with activity, trouble catching your breath and wheezing. COPD differs from asthma in that COPD is not reversible where as asthma is. There are some people who can have both COPD and asthma and will improve with stabilization of their asthma.
Because the symptoms of COPD develop slowly, some people may not know that they have COPD. If you suspect that you may have COPD, we can help with evaluation and treatment. We offer in office spirometry that helps in distinguishing what exactly is going on, the severity of the disease and together with your history, we can work together in developing a treatment plan to allow you to do the things you want to do without limitations.
Oral steroids, like prednisone can be beneficial in helping someone through an acute severe asthma attack. The reason why you cannot take oral steroids all the time to control your asthma is that they are very harmful to the body as well as helpful. Too many oral steroids can actually induce diabetes. You must be very careful in the use of steroids especially if you have a significant history of diabetes in your family, or if you are at high risk for the development of diabetes. Have you ever been told you are “borderline” diabetic? The repeated use of oral steroids could push you to become diabetic.
Oral steroids are also very hard on your bones. They cause the bones to become brittle and if you have a history of osteoporosis, this becomes an even bigger concern. Other side effects of prednisone can include: Difficulty sleeping; feeling of a whirling motion; increased appetite; increased sweating; indigestion; mood changes; nervousness.
SEVERE side effects can occur when using prednisone and can consist of a severe allergic reaction (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); appetite loss; black, tarry stools; changes in menstrual periods; convulsions; depression; diarrhea; dizziness; exaggerated sense of well-being; fever; general body discomfort; headache; increased pressure in the eye; joint or muscle pain; mood swings; muscle weakness; personality changes; prolonged sore throat, cold, or fever; puffing of the face; severe nausea or vomiting; swelling of feet or legs; unusual weight gain; vomiting material that looks like coffee grounds; weakness; weight loss.
Inhaled steroids to treat asthma are the gold standard of therapy and are very different than the steroids that you receive by a tablet, injection or an IV. Inhaled steroid use in asthma and COPD far outweigh the risks involved and the proper use of inhaled steroids in asthmatic children actually shows that their anticipated growth is reached because of the steroid use vs what was originally thought of as a source of decreased growth velocity. Medical providers should always do their best to control asthma with inhaled steroids daily when appropriate vs the intermittent use of oral steroids.
Albuterol, a non steroid inhaler, is also used in both asthma and COPD to help with acute episodes of shortness of breath, bronchospasm and even for a pre exercise treatment for exercise induced asthma. Any use of an albuterol inhaler, other than used for pre treating exercise, more than 2 times a week should be an indicator of uncontrolled asthma and should be evaluated by a health care professional. Rule of thumb: if you are using more than one albuterol inhaler in a year, you need to be evaluated, by an asthma specialists, as your asthma is considered out of control. We can also teach you how to monitor your asthma status better at home with the use of a peak flow meter.