Symptoms of nasal congestion or stuffiness, frequent sneezing or runny nose may be from rhinitis. Eye symptoms may include itching, running and redness. There are two types of rhinitis.
Allergic rhinitis is caused by environmental allergens like pollen, molds, animals or dust mites. These substances are usually harmless but can cause allergy symptoms in certain people. The body's immune system interprets the allergens as invaders, and produces antibodies called immunoglobulin E (IgE). IgE stimulates immune cells to defend the body by secreting histamine and other chemicals. Histamine causes sneezing, itching and runny nose, which are an attempt to expel these invaders.
Allergic rhinitis is diagnosed through skin prick testing, which identifies the presence of allergen specific IgE. Treatment involves avoidance of triggers, medication to treat symptoms and allergy immunotherapy, or allergy shots, to modify the immune system. Over time allergy immunotherapy achieves desensitization to the allergic trigger.
Nonallergic rhinitis may be caused by irritants, medications or structural reasons, and lead to symptoms similar to allergic rhinitis. Typical irritant triggers are strong odors, change in weather, pollutants, and dust. Drugs with side effects of nasal symptoms may include blood pressure medications, oral contraceptives or erectile dysfunction medication. Medical therapy is the mainstay of treatment.
Dr. Amy Schiffman, board certified allergist in Boca Raton, Florida works with you to develop an individualized plan to help alleviate your symptoms.
Asthma is a chronic inflammatory condition of the airways, or bronchial tubes, in the lungs. Asthmatic inflammation causes the airways to become swollen, narrow and fill with mucus, which leads to shortness of breath, chest tightness, and often, chronic cough. Symptoms can vary with age, season, environment, activity, and even stress. People with a family history of asthma or allergies are more prone to developing asthma.
Diagnosing asthma and identifying triggers are key steps to minimizing symptoms. Thorough history, breathing tests and skin test aid in diagnosis. Although there is no cure for asthma, effective management can limit symptoms, manage the condition and improve your quality of life. Therapy may involve oral, inhaled and injectable medications, as well as allergy shots. Working with Dr. Amy Schiffman in Boca Raton, Florida, a personalized treatment plan will be developed to empower you to take control of your disease and live your best life.
Food allergy is a potentially serious immune response to eating a specific food. Eight types of foods account for over 90% of allergic reactions: milk, egg, peanuts, tree nuts, fish, shellfish, wheat and soy. The body interprets the normally safe allergen as a foreign invader and mounts a response, usually within minutes. The symptoms and severity of allergic reaction vary from person-to-person. The most common symptoms of food allergic reactions are hives, itching, vomiting, diarrhea, swelling of face, tongue and lips, and wheezing. Rarely, a reaction may involve breathing problems and low blood pressure, which may be severe.
The prevalence of food allergies is on the rise. Researchers estimate that food allergy affects a 4-7% of children and 5% of adults in the United States, and food allergy is becoming more common. Children with food allergy are more likely to have asthma and skin allergy.
Thorough history, skin tests and possibly blood tests aid in the initial evaluation. Oral challenge is the gold standard for identification of food allergy, and may be conducted if the diagnosis is questionable, or to help identify the threshold of reactivity.
Standard management of food allergy is prevention through avoidance of trigger food, and management of symptoms. An allergy action plan will be developed to help educate you and school personnel on the use of medications to stop symptoms.
Numerous studies have been conducted on modifying the immune system through introduction of the allergen by mouth, sublingually, or through the skin. Oral immunotherapy (OIT), which involves slow, steady desensitization by eating small, gradually increasing amounts of a food protein, has been shown to effectively suppress the allergic response in children. OIT is only conducted under the direction of a board-certified allergist and immunologist. Dr. Amy Schiffman in Boca Raton, Florida, can discuss whether this therapy is right for you or your child.
Immune deficiency typically presents in a child or adult, as recurrent infections over a short period of time. Most often, infections involve the respiratory tract, but may also affect the skin, gastrointestinal, brain and spinal cord, or urinary tracts. Ineffectual immune system function may also result in auto-immune disease. Additional signs the immune system is not working properly is atypical infections, fatigue, and weight loss.
Immunodeficiencies can occur because of medications, genetics, malignancy or cancer therapy. If you or your child have repeated, persistent or unusual infections, severe infections which require hospitalization or intravenous antibiotics, or a family history of frequent infection, an immune evaluation may be beneficial. Thorough history, exam, lab testing, and immune system challenge are part of the process.
Should an immune deficiency be identified, treatment options include observation, expectant management, immunoglobulin replacement therapy and prevention of infection. Dr. Schiffman will review risks, and benefits of various medical care and treatments. With regular attention and therapy, many patients with immunodeficiency live healthy, productive lives.
The following are immune deficiencies or disorders commonly treated by Dr. Amy Schiffman, board certified immunologist in Boca Raton, Florida:
Atopic dermatitis or eczema, is a disease of skin barrier dysfunction and disordered immune cells. Inflamed skin develops red, itchy, scaly patches. It is most common in children but can occur at any age. Atopic dermatitis is typically the first of 3 atopic disorders, atopic dermatitis, allergy and asthma, to develop.
There is no cure for atopic dermatitis, however management can effectively relieve and prevent new symptoms. It is a chronic, relapsing disease, which means it flares periodically, and then improves for extended periods of time. Poorly controlled eczema leads to inadequate sleep quality, decreased socialization, missed work and school days, and diminished quality of life.
Eczema is associated with genetic variation in skin components which help the skin retain moisture and protect you from allergens, irritants and bacteria. Immune cells play a role as well, contributing to an inflammatory state. Secondary conditions, such as skin infections, allergic contact dermatitis and irritant dermatitis, may worsen the disorder and severity of symptoms.
Evaluation involves history of eczema and other atopic conditions, skin testing to identify allergic triggers, and examination to determine if infection is present. Treatment encompasses preventing water loss, aggressive moisturization, avoiding irritants and allergens, treating infection, controlling itching and decreasing inflammation in an effort to heal the skin and prevent new outbreaks.
You and Dr. Amy Schiffman, board-certified allergist and immunologist in Boca Raton, Florida, will develop a personalized care strategy to maximize your quality of life.
Contact dermatitis is a red, itchy rash caused by direct contact with a material or product. The substance may be irritating or cause an allergic reaction. While the eruption is not life-threatening, it can be quite bothersome, uncomfortable and decrease your quality of life.
Symptoms of contact dermatitis are red, scaly or blistering lesions in areas repeatedly exposed to the reaction causing substance. The rash may occur in any area of the body, but face and hands are particularly vulnerable.
There are 2 types of contact dermatitis. Irritant contact dermatitis is the most common form. It develops when the skin’s protective barrier is disrupted. Common irritants include prolonged or frequent exposure to water, detergents, solvents, plants and pesticides. Allergic contact dermatitis results when a specific substance triggers the body’s immune system and causes localized inflammation in the exposed area. Typical allergic substances are nickel, topical medications, fragrances, formaldehyde and personal care products.
Contact dermatitis can develop at any age and can exacerbate a chronic skin condition like eczema or xerosis (dry skin). Secondary infection complicates presentation and worsens symptoms.
Identifying the trigger and avoidance are the key to halting the skin response and preventing future reaction. History and patch testing help to determine the possible cause. Topical medications may temporarily reduce inflammation, but ultimately, only discontinuing exposure will lead to resolution.
One in five people get hives – red, raised, itchy welts, also known as urticaria. Typically, hives are caused by a viral infection, or an allergic reaction to food, insect sting or drug. Usually, hives resolve within 24 hours and the episode is over in less than a week.
Infrequently, hives return on a regular basis, without an identifiable cause. When hives recur most days of the week, for longer than 6 weeks, it is termed chronic idiopathic urticaria (CIU). While the reason for chronic idiopathic urticaria is not known, immune cells called mast cells, play a role.
Evaluation of hives involves detailed history including severity, recognizable triggers, response to medications, and associated symptoms. Exam, blood test and skin testing may help determine if specific allergies or other problems, like thyroid disease or rarely malignancy, are present.
Dr. Amy Schiffman, board certified allergist in Boca Raton, Florida, can help you achieve relief. Treatment involves education, trigger avoidance, and medications to relieve and prevent symptoms. When hives continue despite standard medical therapy, immunosuppressive and biologic therapy are considered. Chronic idiopathic urticaria improves with time but may return in the future.
Hereditary angioedema (HAE) is a rare disorder characterized by recurrent episodes of severe swelling (angioedema), without itching or hives. The most common areas of the body to develop swelling are the face, limbs, gastrointestinal tract and airway. Stress or minor trauma may cause an attack but swelling can occur without any identified trigger.
Swelling of the gastrointestinal tracts leads to symptoms of excruciating abdominal pain, nausea and vomiting. Respiratory tract edema may restrict breathing and lead to severe obstruction of the airway, which may be life threatening. Some people develop a non-itchy rash, called erythema marginatum, during attacks. Swelling and associated symptoms do not respond to standard medications, such as antihistamine, steroids or epinephrine, used to treat allergic swelling.
Symptoms of hereditary angioedema usually begin in childhood and worsen during puberty. Typically, attacks occur every 1 to 2 weeks, and last for 3 to 4 days. The frequency of attacks can vary greatly.
There are 2 main types of angioedema, the inherited and the acquired disorders. Hereditary angioedema occurs due to a missing or dysfunctional protein, C1-inhibitor. For the most part the defective gene is inherited, but spontaneous mutations occur. Symptoms presents early in life. Other family members may have experienced unexplained, sudden swelling. Acquired angioedema may be a result of autoimmune disorders or malignancy, and typically occurs in older individuals.
Evaluation involves history and lab testing to confirm the diagnosis. Therapy to prevent or stop symptoms, is determined based on frequency of angioedema and personal preference.
Cough is one of the most common reasons for seeing a doctor. Cough which lasts eight weeks or longer in adults, or four weeks in children, is termed chronic cough. Chronic cough is both disruptive and worrisome. Coughing interrupts sleep, affects school and work performance, and can be embarrassing. It may also lead to additional physical symptoms ranging from muscle pain to urinary incontinence.
Numerous conditions can cause recurrent cough, but the following causes, alone or in combination, are responsible for most of the cases.
Post nasal drip occurs when sinuses or nose produce extra mucus, it drips down the throat and triggers a cough reflex.
Asthma is an inflammatory condition of the airways, which may be a chronic disorder, or occur after upper respiratory tract infection. Cough-variant asthma is a sub-type of asthma which is more active in the evenings.
Gastroesophageal reflux disease (GERD) is a common condition in which acid flows back into the esophagus. Irritation of the esophageal lining causes chronic cough, which may further worsen the acid reflux.
Infection of the upper respiratory tract may lead to lingering cough, even after the other symptoms have gone away. Cough is often the last symptom to resolve.
Blood pressure drugs, specifically angiotensin converting enzyme inhibitors, may cause a chronic dry cough, which can develop after a couple of weeks or years on the medication.
Chronic bronchitis, which is a form of chronic obstructive pulmonary disease, is a type of chronic inflammatory lung disease which mostly affects smokers or former smokers. Cough productive of thick sputum is the main complaint in people with chronic bronchitis.
Together you and Dr. Amy Schiffman, board certified allergist and immunologist in Boca Raton, Florida, will determine the most likely causes and best management of your cough.
Nasal polyps are soft, painless, noncancerous growths on the lining of nasal passages or sinuses. They resemble tiny grapes. They result from chronic inflammation due to asthma, recurring infection, allergies, drug sensitivity or certain immune disorders.
Small polyps may not cause symptoms. However larger growths obstruct the nasal passages and natural drainage of the sinuses. They lead to breathing problems, recurrent infections and lost sense of smell.
Determining if there is an allergic or immunologic basis to polyps will help guide therapy. Medications can help shrink or eliminate polyps, but surgery may be required to remove them. Allergy shots have been shown to prevent regrowth and reduce the number of repeat surgeries.
Eosinophilic esophagitis (EoE) is a chronic, allergic inflammatory disease of the esophagus. It occurs when eosinophils, a type of white blood cell, accumulate in the esophagus, despite acid-blocking medications. The esophagus is the tube that brings food from the mouth to the stomach. This buildup, which is a reaction to foods, allergens or acid reflux, can inflame or injure the esophageal tissue.
Symptoms can mimic acid reflux disease, but also include difficulty swallowing, chest pain, pain with swallowing, regurgitation and food impaction. Children typically have vomiting, difficulty with feeding, abdominal pain, poor growth and failure to gain weight. In some people, uncontrolled eosinophilic esophagitis can lead to scarring and narrowing of the esophagus, and perforation, a tear in the tissue which lines the esophagus.
Your gastroenterologist and allergist will work together to diagnosis and manage eosinophilic esophagitis. Endoscopy (examining the esophagus with a camera), biopsy (taking a tissue sample), blood tests and skin tests are utilized to diagnose and follow the condition.
Eosinophilic esophagitis is a chronic relapsing disease, which means most people will require continued treatment to limit inflammation and improve symptoms. Treatment options include dietary therapy, acid blocking medications, and topical steroids. Working with Dr. Amy Schiffman, board certified allergist and immunologist in Boca Raton, Florida, a care plan will be customized to reflect your choice of therapy. Lifestyle changes to minimize reflux symptoms complement treatment. Maximizing control of environmental allergies with medications and allergen immunotherapy help regulate inflammation and improve quality of life.
Drug allergy is an abnormal immune system response to a medication. The most common symptoms are hives, rash or fever. Severity varies from an uncomfortable, itchy rash to life-threatening anaphylaxis. While prescription, herbal and over the counter substances can all cause a reaction, drug allergy is more likely with certain medications, such as antibiotics and pain relievers.
Drug allergy can be very complicated. Multiple factors are considered during the evaluation, including detailed account of symptoms, type of underlying illness, incomplete memory of the incident, and length of time since the reaction. Skin testing and graded oral challenge can be utilized to evaluate a mild, moderate or remote reaction. Typically, patients who have experienced severe skin and organ symptoms reactions are not re-challenged.
Penicillin allergy testing effectively evaluates for the presence of immediate, life-threatening hypersensitivity. Penicillin and related antibiotics are the most commonly used antibiotics. They are active against a wide variety of infections and are generally well tolerated. Testing in advance of an acute need allows you to be treated with a penicillin based therapy that may be more effective, less costly, and leads to less antibiotic resistance.
Testing for sensitivity to other antibiotics, local anesthetics, corticosteroids and pain relievers is also considered, with the goal of finding a therapeutic option that is well tolerated. Dr. Amy Schiffman, board certified allergy and immunologist in Boca Raton, Florida will help evaluate your reaction, and determine the next best course of action.
While most people develop itching, redness and swelling at the site of an insect sting, a few individuals are allergic to the venom, and may develop severe, body wide symptoms, called anaphylaxis.
Anaphylaxis is a serious, potentially life-threatening reaction. Symptoms of anaphylaxis involve two or more systems in the body. Skin reactions are the most visible, and present with hives, itching and flushed or pale skin. Difficulty breathing, swelling of throat and tongue, abdominal cramping, nausea and diarrhea may occur. In severe cases blood pressure my drop, resulting in dizziness and loss of consciousness. This type of reaction requires emergency treatment with epinephrine, to halt and reverse symptoms.
Identifying the type of insect is the first step in the evaluation process. A detailed history which includes activity and location during sting, will provide clues on the type of insect. Skin tests and blood tests are also utilized. Dr. Amy Schiffman will provide education on preventing recurrent stings, and how and when to utilize auto injectable epinephrine. Venom allergy shots are considered, to reduce sensitivity to insect stings, and allow you to feel confidant and safe during outdoor activities.
Anaphylaxis is a severe allergic reaction, that is potentially life-threatening and requires emergency treatment. The body’s immune system views a normally harmless substance as dangerous. During the first exposure, IgE antibody is produced to the specific element. The allergen specific IgE collect on the surface of immune cells called mast cells. Within minutes of a second exposure, mast cells release their contents, such as histamine and tryptase, and anaphylaxis occurs.
Signs and symptoms of anaphylaxis involve two or more systems in the body. Skin reactions are the most visible, and present with hives, itching and flushed or pale skin. Difficulty breathing, swelling of throat and tongue, abdominal cramping nausea and diarrhea may occur. In severe cases blood pressure may drop, resulting in dizziness and loss of consciousness.
In most cases of anaphylaxis, the trigger is identified as a food, drug, or insect sting. Less common causes include exercise, latex, and mast cell disorders. In rare cases, the cause is not determined, which is termed idiopathic anaphylaxis.
History and testing help identify the reason for this potentially life-threatening reaction. Heightened awareness, avoiding known triggers, if possible, and self-injectable epinephrine are the mainstay of therapy. Dr. Amy Schiffman, a board-certified allergist and immunologist in Boca Raton, Florida will develop a treatment plan and assess if decreasing sensitivity through allergy shots or oral immunotherapy is advised.