Living with allergies ranges from mildly annoying to truly life-threatening. Confidence in your doctor’s knowledge and credentials is vital. We take a personal approach for each child and adult to diagnose issues, perform tests, educate patients, and develop the best treatment plan. Our board-certified physicians have the expertise and qualifications to treat both common and rare conditions. Kern and Tulare County residents don’t have to drive all the way to L.A. or San Francisco to get the best allergy and asthma care possible.

Allergy Skin Testing

Allergy Skin Testing detects the presence of allergic (IgE) antibodies against allergens including pollens, molds, dust mites, animal dander, and foods. The skin prick test takes about 30-45 minutes and can be safely performed on children as young as 18 months of age. We use a plastic device to apply FDA-approved drops of food or environmental allergens of interest to the patient’s back. After 20 minutes, the back is examined for small bumps in millimeters to the corresponding allergens. The bumps are measured and recorded and allow the providers to determine your allergy status. No antihistamine products may be used for 7 days before testing for the results to be accurate. After the skin test, patients know which environmental exposures are causing their symptoms and what foods must be avoided. The skin test is also useful in discussing allergen avoidance measures, and plays a critical role when discussing therapeutic options.

Allergen Immunotherapy (Allergy Shots)

Who is a candidate for shots?

Anyone over the age of 5 that is broadly allergic on skin testing and whose allergies and asthma are either poorly controlled despite medications, or those who prefer a more natural and holistic approach.

How do allergy shots work?

Allergy shots decrease your sensitivity and allergic responses to allergens. By introducing increasing amounts of allergens under the skin, your immune response is “retrained” to be less reactive. Over 85% of allergy sufferers see significant relief from allergic triggers such as pollens, dust, molds, pets, and venoms (bee stings). This treatment modality has been shown effective for decades to help control allergies and asthma and is a holistic, natural approach.

Shot procedure

It takes about 6 months to reach the maintenance dose if receiving injections twice weekly during a build-up period. When maintenance dose is achieved, allergy shot frequency is then reduced to every 1-4 weeks based on symptoms. Allergy Shot guidelines recommend staying on maintenance shots for at least 3 to 5 years to achieve the greatest benefit. After that, most patients continue to see improvement for several years after discontinuing shot treatments. Following current guidelines, all patients must wait in the office for 20-30 minutes after receiving an allergy shot. There is a rare chance of a systemic allergic reaction, which can be properly treated in the clinic.

Sublingual Immunotherapy (Drops under the tongue)

Desensitization can also be achieved by placing drops of the allergens under the tongue on a daily basis. There is a similar build-up protocol, with duration of 3-5 years as with shots. The drops are self-administered at home without clinic s
upervision. Although not covered by insurance, this provides a treatment option for those with allergies who are unable to come into the clinic for the required shot frequency.      

 

Dermatology & Atopy Patch Testing

Medical conditions of the skin have numerous causes and effects. Left untreated, scratching an itchy rash can lead to infection and scarring. Many skin irritants are easy to treat and manage.

Atopic Dermatitis/Eczema

Atopic Dermatitis/Eczema shows up on elbows, knees, ankles, face/cheeks in children and adults or diffusely distributed on infants and includes: – Redness – Dryness – Itching of the skin It is caused by abnormalities of the skin barrier and skin immunity, and can sometimes be flared by specific food ingestion. Patients with atopic dermatitis/eczema are more susceptible to allergies and asthma.

Contact or Irritant Dermatitis

Contact or Irritant Dermatitis is an allergic reaction to substances such as latex, fragrances, metals, and preservatives coming in contact with the skin. Such allergies are diagnosed with a thorough history of the problem, and sometimes applying a PATCH (TRUE) test to aide in chemical allergies.

Unknown rashes

Unknown rashes may be determined by Punch Skin Biopsies and lab testing. Treatment of a Dermatitis focuses on finding the cause of the problem whenever possible. In addition, discovering exacerbating factors and exposures are an important variable. Reducing itching and improving the inflammation in the skin and breaking the “scratch-itch” cycle are critical to achieve resolution.

Rhinolaryngoscopy

Nasal and sinus inflammation often create symptoms that lead to a consultation. A correct diagnosis provides the quickest path to correcting or managing the problem. Rhinolaryngoscopy is a test that determines anatomical abnormalities in the nose or upper airway. The test inserts a fiberoptic camera in the nostrils for direct visualization of the tissues. It also can be used to diagnose infections, polyps in the nasal passages, anatomical abnormalities, and to see the larynx. If abnormalities are found with rhinolaryngoscopy, medication may control the problem, or some conditions will require evaluation by a surgeon.

Pulmonary Function Testing

Do I have asthma? Do I have COPD?

Allergists are experts in Asthma and COPD. Breathing troubles are unpleasant, frightening, and can be life-threatening to both children and adults. But there’s no need to guess and to live with reduced quality of life. Based on your symptoms and personal history, we will recommend one or more tests to determine the correct diagnosis as well as the best method of treatment. Pulmonary Function Testing (PFT) also known as Spirometry, measures the patient’s lung function compared to healthy individuals of the same age, gender, height, and race. Patients blow hard and long into a mouthpiece, and are given grades (A-F) on several lung parameters. After administering albuterol, an inhalant treatment, several breathing maneuvers are repeated. This accurately and objectively directs us to a diagnosis of normal, asthma, or COPD, as well as check for medication responses and follow lung capacity as time progresses. Spirometry can typically be performed in ages 5 and above. Based on the results of the test, we provide an accurate diagnosis (no more guessing!) and talk about treatment options. Following asthma guidelines, treatment options include different pills, inhalers, and injections that maximize lung function while not over- or under-medicating.

Immune Deficiency

Is my Immune System normal?

For individuals with recurrent infections (typically 5 or more a year) requiring antibiotics, the answer may be “No!” Immune Deficiency is evaluated by clinical history of infection frequency and severity and by comprehensive qualitative and quantitative immune blood testing. If abnormal, treatment options are available to boost the immune response. The most common therapeutic option is giving supplemental immunoglobulin or Gamma. This can be done intravenously (IVIg) or subcutaneously (SCIg). In effect, this treatment gives more “bullets” to your “army” to fight off infections. This treatment can be quite helpful to reduce both infection severity and frequency.