There are over 300 different conditions that make up Primary Immunodeficiency Diseases (PIDDs). Most of the conditions are related to your genetic makeup and are inherited, but they can show up at any time: birth, childhood, or even adulthood. PIDDs are rare and affect approximately 1 out of every 500 people.
PIDDs are usually associated with recurrent and severe bacterial infections and many times these infections are difficult to treat. Warning signs of PIDD include recurrent ear infections in the last year (4 or more for children and 2 or more for adults), two or more serious sinus infections within one year, two or more months of using antibiotics without much benefit, multiple episodes of pneumonias, chronic diarrhea with weight loss, recurrent viral infections in adults (such as colds, herpes, warts, etc), recurrent deep skin abscesses or boils, need for IV antibiotics to clear infections, infections with normally harmless bacteria, persistent thrush or fungal infection, multiple episodes of sepsis (blood infections), or family history of PIDD.
It is important to first rule out other conditions that could contribute to recurrent infections such as uncontrolled allergies, chronic sinus disease, enlarged tonsils and adenoids, or cystic fibrosis. If there is still concern for PIDD, your provider at AAAI can obtain laboratory studies (blood work) to check your immune system and further evaluate if there is evidence of an immune problem. It is important to note that PIDDs are not the same as auto-immune conditions such as rheumatoid arthritis or lupus, which are conditions that can only be diagnosed and treated by a rheumatologist.
There are many ways that allergies can be evaluated, and some people are not familiar with the different types of tests available. The way that allergy testing is performed has changed slightly over the years, allowing the procedure to be relatively painless for most people. Let’s review the different types of testing done in the allergy clinic!
Skin prick testing: Skin testing, also referred to as “scratch” testing is the most common way that we evaluate allergies. Skin testing involves a small amount of allergens being “pricked” onto the surface of your skin, often with a small plastic device that looks like a toothpick. If you are sensitized to an allergen, this will trigger a reaction on your skin and cause a wheal or hive, similar to an insect bite. Skin testing usually takes about 15 minutes. Skin prick testing is performed for evaluation of possible environmental triggers such as pollens, molds, and animal dander. Skin prick testing is also performed for food allergy if there is a history of allergic reactions to a food (called IgE-mediated food allergy). Skin testing to foods can cause false positives and testing alone does not mean you are allergic to a food. Drug allergies such as penicillin are also evaluated via skin testing.
Intradermal testing: Intradermal testing can also be performed for evaluation of environmental triggers, insect allergy, or drug allergy. This involves a small amount of allergen placed just below the surface of the skin with a very small needle.
Blood tests: Blood tests can be performed for environmental allergens, insect venoms, and food allergies. Blood testing measures allergic antibodies in your blood. Like skin testing, blood testing to foods without a history of reaction to food can sometimes give false positives, and a positive test alone does not diagnose food allergy.
Challenge tests: Challenge tests are done in-office and involve the allergen being taken by mouth (such as foods of drug allergies). Challenge tests are among the most accurate tests to diagnose food allergy, and can help differentiate false positives or if someone has outgrown their food allergy.
Patch testing: Chemical patch testing is a way to evaluate for chemicals or metals that could be causing allergic reactions on the skin. Patch testing involves application of a chemical patch onto the back, with delayed readings in office in 2-3 days or longer, depending on the situation.
Caution!!! There are several tests available over the counter or online labeled as “food sensitivity tests”. These tests are not recommended and do not provide accurate results. Other tests such as food IgG testing, mail-in fingerstick allergy testing, kinesiology muscle testing, hair analysis, ALCAT testing, or neutralization testing are not recommended due to lack of scientific evidence that they correlate with any food allergies.
Your allergy provider will work with you to determine what type of testing is necessary to determine the cause of your symptoms and help guide further treatment.
Hives or welts are itchy, raised, red areas on skin. About 25% of people experience hives sometime in their life. Hives can occur at any age. Most of the time, hives are not dangerous. Hives are classified based on how long they have been occurring and how long they last. Sudden hives that develop immediately after ingestion of a food or medication may suggest a food or drug allergy. Hives that occur randomly are called “spontaneous urticaria.” Most of the time, this is due to viral infection/illness or is considered to be an auto-immune condition. Spontaneous hives often have no specific trigger and can be very frustrating to patients. Chronic hives are hives that have been ongoing for 6 weeks or more. In general, the longer hives have been going on, the less likely it is a food, medication, or other substance causing them. Sometimes hives occur with swelling of lips, eyelids, hands, and feet. Over half of patients with chronic hives respond to antihistamines. The antihistamines can even help make the hive condition go away for good. Some people require Omalizumab, which is a once-monthly injection, to treat chronic hives. Chronic hives usually resolve within 3-5 years. Your allergy provider can work with you to determine if there is an underlying cause to your hives, and the treatment options available, so you can be itch and hive-free!
Vasomotor Rhinitis
Vasomotor rhinitis is a condition that causes chronic sneezing, congestion, or runny nose that can be triggered by pollutants like a dusty environment, odors, foods or beverages, or weather changes. These symptoms can often seem like typical allergic rhinitis (hay fever) symptoms. About 50% of patients with allergies will have some type of vasomotor rhinitis. While vasomotor rhinitis can cause similar symptoms, what is going on in the body is much different. In allergic rhinitis, your immune system is involved and has formed antibodies to the trigger, such as pollen. In vasomotor rhinitis, the triggers merely cause an irritation which causes congestion, sneezing, runny nose. Have you ever had a runny nose from eating a spicy food? That’s a kind of vasomotor rhinitis called gustatory rhinitis.
Many patients will have mild symptoms but if symptoms are constant and very irritating, there are treatment options to help control symptoms. Often, allergy testing will be performed to see how to best manage symptoms. Often times, patients will mistakenly think they may be allergic to a smell or a food, when it’s actually vasomotor rhinitis! It’s important to discuss with your allergist if you are experiencing symptoms like these and have questions, so they can come up with the best recommendations for you!
