We diagnose and treat a variety of symptoms and conditions associated with allergy, asthma and immunology at all of our locations.

Nasal/Environmental Allergies

Nasal allergies may also be referred to as hay fever or allergic rhinitis. This is an allergic reaction to elements in the environment, such as trees, grass and weed pollens, pet dander, molds and cockroaches. If you are allergic to pollens you may only be symptomatic at certain times of the year. If you are allergic to indoor allergens, such as pet dander, you may experience symptoms year round.
Symptoms include:
  • Runny nose
  • Itchy, watery eyes
  • Chronic nasal congestion and snoring
  • Itchy roof of the mouth or throat
  • Frequent sneezing
  • Dark circles under the eye
Your allergist will take a complete medical history, perform a physical examination and prescribe the appropriate tests. Skin testing is the main tool used to identify what you are allergic to. Skin testing consists of introducing small amounts of allergens into the skin. Your reaction to each allergen will determine if you are allergic to it and the level of severity.

Pet Allergies

Pets play such an important role in so many peoples’ lives. They are considered to be part of the family. To many people, however, they can cause mild to severe allergic reactions. The most common animal allergies are cats and dogs. However, any warm blooded animal, including birds, rabbits and horses, can cause allergy problems. Pets can cause problems to allergic patients in several ways. Their dander, or skin flakes, as well as their saliva and urine, can cause an allergic reaction.

Some allergic patients may have severe reactions, such as wheezing and shortness of breath, after exposure to certain pets. Typically, reactions will occur quickly after exposure to the animal. For some people, however, the symptoms build and become most severe 12 hours after their contact with the animal.
If pet allergies are suspected, your doctor will recommend skin testing to determine what all you are allergic to and the level of severity.

Food Allergies

For an individual who has food allergies, enjoying a peanut butter sandwich can cause reactions that range from mild to severe, including a life threatening allergic reaction called anaphylaxis. Reactions usually appear within minutes after consumption, but can occur after several hours. It is estimated that food allergies now affect an estimated 15 million people in the United States alone.

While it is possible for almost any food to cause some level of an allergic reaction, there are 8 foods that account for the vast majority of allergic food reactions in the United States. These are commonly referred to as the “Big Eight”.
  • Peanut
  • Tree nuts (walnuts, pecans, cashews)
  • Milk
  • Egg
  • Wheat
  • Soy
  • Fish
  • Shellfish (the most common food allergy for adults)
Sesame allergy would now probably be considered the 9th on the list, as it is becoming increasingly more common in the United States.
Food allergies occur when the body’s immune system mistakes a food (the trigger) as “dangerous” and produces an antibody (immunoglobulin E or IgE) that reacts with the allergen and releases chemicals in the body which cause the allergic reaction


Asthma is a chronic lung disease in which the lining of the airways becomes inflamed and swollen and muscle spasms restrict the flow of air to the lungs. It is a relatively common condition and the incidence of the disease has grown in recent years. Currently, it is estimated that close to 15 million Americans have asthma. Children account for a significant portion of asthmatics. Asthmatic and allergic disorders rank at the top of childhood diseases.

Although the exact cause of asthma is still being studied, it is known to be a combination of inflammation of the lung combined with narrowing of the lung passages activated by the body’s immune system. There are a number of factors that are known to trigger an asthma episode.

The diagnosis of asthma can be difficult at times. The doctor will do a complete medical history, perform a physical exam and order lung function tests. Allergy testing may also obe recommended to see if allergens are causing your asthma to become worse. Skin testing or blood testing is routinely used to identify your specific allergy triggers.


Approximately 20% of the population will experience hives at some point in their lives. The medical term for hives is urticaria. Hives can form anywhere on the body. They can be painful and embarrassing for many people, especially children. Typically a person will experience itching first, followed by the development of red, raised welts on the skin. The raised welt is also referred to as a wheal. Hives can vary greatly in size and also may join together to form larger areas referred to as plaques. There are two main types of hives:

  • Acute urticaria: These hives last less than 6 weeks. Acute urticaria can be caused by many things including allergens (foods, latex, medications) and physical factors (exercise). The most common causes of acute hives are foods, medications, insect bites or infections. While acute hives will fade on their own, the short term use of an antihistamine is often recommended.
  • Chronic urticaria: These hives last longer than 6 weeks. Chronic urticaria is much rarer than acute urticaria. The cause of chronic urticaria is typically more difficult to identify.

Urticaria can also be one of the first symptoms of a severe allergic reaction known as anaphylaxis. Anaphylaxis can cause difficulty breathing, a feeling that you are about to faint, and sometimes loss of consciousness. It is a life-threatening condition and needs emergency treatment.

Fortunately, in many cases the trigger of acute hives is quite easily determined. The cause of chronic urticaria is more difficult to determine. For most people the cause is not determined. Your allergist will do a detailed history, physical exam and prescribe appropriate tests to help identify the cause. If you suffer from hives, your doctor will consult with you on the treatment plan best for you.

Tests and Treatments Offered


Skin Testing

Skin testing is the most convenient, efficient, and reliable procedure used to aid us in the diagnosis of suspected allergies in you or your child. In this procedure, solutions made from extracts of pollen from trees, weeds, grasses, mold spores, house dust, foods, cats, dogs, etc. are placed in the superficial layer of the skin. This is the most common method of skin testing and is often referred to as the "prick" method. These tests are performed on your back and/or on your arm depending on the number of skin tests to be performed.

A very small sharp plastic like device, often referred to as a "prick", with a droplet of the solution (extract) is used to barely prick the outer layer of skin placing the extract just under the skin’s surface. We utilize both individual prick applicators and multi-pronged applicators for the administration of our skin tests. The multi-pronged applicators are most often used for our pediatric patients.

Reactions to the extract, red bumps, will develop generally within 20 minutes of application. These reactions indicate positive or negative results. They are measured, interpreted and documented in your chart. Your doctor may also want you to have additional allergy testing done depending on the results of your skin test. The results of your allergy tests will be used by your doctor to develop your individualized treatment plan.

Patch Testing

Patch testing is a simple procedure to help diagnose allergic contact dermatitis and identify the causative agent(s). It is designed to help me find out whether you are allergic to the substances included on the test panels. The test patch panels contain different substances known to cause allergic contact dermatitis. The patches will be applied to your upper back. In addition to the standard patch test, you are also able to bring in your own products to be applied as a patch test.

This is a skin reaction that occurs when you touch or contact substances that you are allergic to. Your skin can be itchy, cracked, red, sore, and even bleed.
p test

Immunotherapy/Allergy Shots

Allergy shots contain small amounts of the things that you are allergic to. These things are called
allergens (or antigens). The dose of allergen starts very low and is slowly increased over many weeks. The goal is to increase your immunity (resistance) to the allergens, and to reduce your allergy symptoms. When this happens, you can take less allergy medicine.

What are the benefits of allergy shots?
  • You might be cured of your allergies.
  • You may need less allergy medicine.
  • You may be sick less often and miss less work or school because of illness.
  • You may feel better in general.
  • The shots may stop children from getting other allergies.
  • The shots may stop children with allergies from getting asthma.

Oral Food or Drug Challenge

An oral challenge is a carefully supervised procedure that can play a key role in the evaluation and management of food and drug allergies. The procedure begins with a tiny amount/dose of the food or medication. There is constant monitoring and supervision throughout the challenge. The amount/dose is increased approximately every 15 minutes. Specific monitoring protocols are followed prior to each dosage increase.


Lung function tests, also referred to as PFT’s for pulmonary function tests, are tests used to determine how well your lungs work. Spirometry is the most common of the PFT’s. It measures how much air (the volume) your lungs can hold and the speed (flow rate) you can move air in and out of your lungs. Spirometry is a very important tool used for assessing conditions such as asthma and COPD.
One of our medical assistants will guide you through the process. You will be instructed to breathe in deeply and then exhale. Then, you will be asked to breathe in and seal your lips around the spirometer's mouthpiece. With the mouth sealed around the mouthpiece, you will be asked to blow out air as hard and as fast as possible until there is absolutely no air left in the lungs. You may be asked to perform this exercise multiple times to achieve an average measurement.

There are several lung function values measured with spirometry. Your printed test results will be interpreted by your doctor to assist him in your diagnosis and making recommendations for optimum management of your condition.


Doctors define asthma as a chronic inflammatory disease of the airways. In our search for the latest and most useful technology, we have found the NIOX MINO Airway Inflammatory Monitoring System very valuable. In addition to other tools we use to diagnose respiratory symptoms and evaluate the success of therapy, the NIOX MINO gives a specific “biomarker”, a gas measuring the presence or absence of airway inflammation. The amount of NO (Nitric Oxide) exhaled out shows how much inflammation is present in your lungs.
The American Thoracic Society has published clinical guidelines for this Fractional Exhaled Nitric Oxide (FENO) and strongly recommends the use of it. This is an easy method of a simple 10 second exhalation that you or your child will find completely painless and even a little fun.

A few of the many benefits of the technology are:
  • The possibility of lowering the medication dosage when appropriate
  • The ability to adjust medication based on individual patient needs
  • Insight into your treatment’s efficacy
  • Better prediction of asthma relapse and exacerbation
  • Early identification and close monitoring of airway inflammation
We value your trust in us and are committed to offering the most up-to-date and accurate ways to control your asthma and its symptoms.


Xolair (pronounced "ZOH-lair") is a prescription medicine for patients 12 years and older with moderate to severe allergic asthma caused by year-round allergens in the air, such as dust and pet dander. Exposure to allergens is known to be the most common trigger for asthma symptoms and attacks. Your doctor will perform a skin or blood test to determine if you have allergic asthma. Depending on the severity of your asthma and effectiveness of your prescribed inhaled steroids, your doctor may recommend adding Xolair to your existing asthma treatment plan. This therapy may provide you with excellent control and end, or reduce, the dosage of oral steroids you need.

Xolair is a subcutaneous injectable (an injection just under the skin) prescription given every 2 weeks or once a month. The injection must be given in a doctor’s office. Patients receiving Xolair shots are required to stay in the office for 2 hours after receiving each of their first three injections, and ½ hour after all remaining injections. This waiting period after each injection is to allow continued patient observation, as a severe allergic reaction called anaphylaxis has occurred in some patients after they have received their shot. Xolair patients also need to come in for follow-up appointments at our office every 3 to 6 months.

Before you can start treatment your doctor will need to submit a statement of medical necessity to a Specialty Pharmacy for Xolair. There will be forms for you to sign as well. The Specialty Pharmacy is a specific type of pharmacy that handles drugs like Xolair. The Specialty Pharmacy will let you and our office know if your insurance company will cover Xolair. Most companies do, but you may need prior authorization depending on your health history and the type of plan you are on. Xolair is an expensive drug, but Xolair often provides coverage reimbursement support and patient assistance.