Big Sky Ear, Nose and Throat is now part of Bozeman Deaconess Health Group.  
We are now
Bozeman Deaconess Ear, Nose & Throat and Bozeman Deaconess Audiology.  

925 Highland Blvd,
Suite 1160, Bozeman

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Respiratory allergies affect approximately 20% of the population and contribute to numerous medical disorders of the ears, nose and throat.  Symptoms can include:

  • Nasal drainage, usually clear

  • Stuffy nose

  • Sneezing

  • Watery, itchy eyes

  • Chronic cough

  • Headache

  • Asthma

  • Ear infections

What causes allergies?

Airborne pollens produced by trees, grasses, and weeds usually cause seasonal hayfever symptoms.  Year round symptoms can be caused by pets, dust and insects such as cockroaches and dust mites.  Molds are frequently an under recognized and therefore under treated source of allergies.  Recent studies have demonstrated that even low level mold allergies may be a significant cause of chronic sinus disorders.

Allergies are caused by tiny particles called antigens which react with our immune systems.  Antigens are found on pollens, pet danders, dust, molds and other substances.  The immune system may react by producing a variety of antibodies.   
IgE antibodies are the most relevant to allergies.  In allergy, an abnormal quantity of 
IgE antibodies are produced in response to common antigens.  This results in an abnormally reactive immune system.  When an antigen attaches to an IgE antibody, inflammatory mediators are released.  These inflammatory mediators cause localized reactions such as swelling, irritation, inflammation and wheezing.  If the allergic reaction is severe enough, life threatening systemic anaphylactic reactions can occur which require immediate medical attention.

Allergy treatment

      Avoidance of the offending allergen is the obvious and most simple treatment option.  Air filters will remove pollens from the air.  Mattress covers and special pillow cases will protect against dust mites.  Avoidance is often impossible or impractical.  Most patients will get rid of their allergist before they part with their dog or cat which they’re allergic to.

      Antihistamines can be taken as pills or as nasal spray or eye drops.  Histamine is one of the most important inflammatory mediators involved in allergies.  It causes swelling, inflammation and irritation.  Antihistamines block the effect of histamine.

     Nasal Sprays The nose is the organ most commonly affected by allergies.  Nasal sprays administer either corticosteroids or cromolyn sodium into the nose.  Corticosteroids are potent anti-inflammatory drugs which reduce the effects of inflammatory mediators.  Cromolyn sodium prevents release of the inflammatory mediators in response to offending antigens.

      Leukotriene Inhibitors are a new class of drugs which block the effect of inflammatory mediators.

     Immunotherapy is used to repair the immune system so that fewer IgE antibodies are produced and the offending antigens are blocked by blocking antibodies.  Once the offending antigens have been determined, serums of those antigens are administered by injection on a weekly basis.  These serums result in the production of antibodies of a different type known as IgG.  These antibodies block the antigens from reacting with the IgE antibodies.  By gradually increasing the dose of antigen injected, the number of blocking antibodies is slowly increased without causing a dangerous anaphylactic reaction.  Eventually, the blocking antibodies reduce the stimulation of the immune system to the point that fewer IgE antibodies are produced.  The dose of antigen serum is increased until an optimum symptom relieving dose is reached.  This maintenance doses is continued for several years and shots may be stopped after about five years.  At this point, the symptom relieving effect of immunotherapy usually continues after the shots are stopped.

How do we test for allergies?

Testing for allergies involves various methods of testing for the presence of IgE antibodies specific for offending antigens.  In allergic individuals, IgE antibodies will be present in the blood and blood tests may be used to determine the presence of allergies.  IgE antibodies are also found in the skin.  Skin testing is more sensitive in determining the presence of allergies and has the additional advantage that the degree of allergy to each antigen can be accurately determined.  The degree of allergy or sensitivity is important because knowing this allows us to tailor the treatment to the individual patient so that it is both safe and effective. 

The most common methods of allergy testing include prick testing and intradermal testing.  In prick testing, a needle is dipped in a solution containing a small amount of the substance (antigen) which is suspected to be causing the allergic reactions.  The skin is then pricked with the needle and observed for a reaction.  This technique is not very sensitive and will identify the offending allergen only if the patient is highly allergic.  Because of this, prick testing is usually combined with intradermal testing. 

In intradermal testing, a small amount of the antigen is injected into the skin which is observed for a reaction.  Typically, a larger amount of the antigen is injected with this technique than with prick testing.  This test is typically performed when prick testing is negative and is used to look for allergies to substances to which the patient is less sensitive.  Even in conjunction with prick testing, this technique has the disadvantage of not quantifying the sensitivity to the antigen.  In other words, it cannot tell us how allergic the patient is. 

Skin endpoint titration (SET) is the most accurate and sensitive test for allergies.  It can tell both what the allergy is and how sensitive the patient is.  A very dilute solution of each antigen is injected into the skin like in standard intradermal testing.  This is followed by a series of injections of progressively increasing concentration of each antigen until a local skin reaction starts to occur.  This tells us how much antigen to start with in administering immunotherapy shots.  

SET results in a precise starting point for beginning immunotherapy.  It avoids starting with too high a dose and running the risk of a life threatening anaphylactic reaction.  It also allows us to start with the highest safe dose so that we can get a response to treatment as soon as possible.  SET has been proven to be both effective and safer than other methods of initiating immunotherapy.  In fact, it is worthwhile noting that the United States Food and Drug Administration (FDA) uses skin endpoint titration as its definitive test of allergenic extracts.  The disadvantages of SET include: It is more time consuming and, like other skin tests, is inaccurate in patients taking antihistamines and steroids. 

Blood tests such as RAST are used to evaluate for the presence of allergies in situations where it is impractical to use skin tests.  Blood tests do not quantitate the degree of sensitivity as accurately as skin tests do.  Therefore the optimal starting dose for immunotherapy is more difficult to determine which results in a more conservative initial dose for immunotherapy, hence the optimal dose for relief of symptoms is not reached as quickly.  We use RAST technology when SET is impractical.

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