You may be charged a no-show fee if you fail to arrive for your appointment and do not cancel at least 24 hours before your scheduled appointment. Please make every effort to be courteous to others and cancel or reschedule your appointments as soon as possible to allow other patients to access those available appointment options.
Your physician will take a complete history, perform a physical, and may recommend testing to be done that day. Some appointments are purposefully set up to only accomplish a consultation and testing will be performed on a separate date, especially for drug and stinging insect allergies. The testing may include skin testing, lung function testing or other various forms of testing needed to evaluate your symptoms. Once testing is complete, your doctor will review the results and recommended plan of treatment. For more information, see the Your First Visit page.
Limited skin testing can be done even on small infants. The best approach is to have a consultation visit with one of our physicians to discuss your child’s history and determine the best course of testing for your child.
You should check with your insurance regarding the need for a referral to come and see us. All insurance plans are different. Most of our patients have been referred by friends and family members.
No. Your primary care doctor is not obligated to provide us with a referral. You will need to contact your primary care doctor for a referral. If we have not received the referral by the time of your visit, you will need to reschedule your appointment. We will notify you if your previous referral has expired. Remember that most primary care physicians require 5 business days to provide a referral.
Most often we can accommodate a new patient appointment within 48 hours. However, this may depend on the season. Please also note, you must be off antihistamines for 7 days or more to have allergy skin testing.
After skin testing has been done, your physician will write specific orders regarding what should be included in your allergy injections. Your allergy extract (which is prepared and tailored specifically for you) contains many or all of the things to which you tested positive. Allergy injections are used to reduce your sensitivity to specific allergens by producing certain immunological changes. By injecting increasing amounts of allergens to which you are sensitive, the degree of sensitivity is progressively decreased to those specific allergens. This occurs in part because one of the protective antibodies, IgG, is increased during allergy injections, and serves to protect the individual by blocking the IgE response which causes the release of the mediators leading to the allergic symptoms. Studies have shown that other safe, but complex, immunologic changes also occur in the development of tolerance to an allergen. In order to insure that these changes take place and maintain protection, it is important to receive allergy injections on a regular basis at an interval directed by the physician. Treatment with allergy injections takes place over a three to five year period of time to maximize the effectiveness of the therapy.
If the patient is a child, he or she will lie on their stomach and rows of antigen drops are placed on the back using a multitest device. If the patient is an adult, the tests are usually placed on both arms. Then each drop is lightly pricked to allow the antigen to enter the skin. The multitest is a white plastic device with 8 prongs on it that are very prickly, but does not contain needles. The patient then has a 15-20 minute wait. The testing is then measured and recorded. The doctor then will review all results with the patient/parent. The most difficult part for a child is usually the need to lie still and the waiting time in between the testing steps. We can have children get up after tests are applied. It is helpful to bring books, handheld games, tablets, etc., to help with the waiting time. In some case, further testing is done, called intradermal testing, which uses needles and is somewhat similar to the placement of a tuberculosis skin test, but this is rarely done on children.
We manage the care for patients ranging from small infants to elderly patients. We can work in conjunction with your pediatrician to provide a continuity of care. Many times your pediatrician will recommend our involvement in your child’s care. Our physicians are board certified in pediatric as well as adult allergy/immunology.
Blood testing is generally more expensive, and the results are not available for about one week after a blood sample is obtained. In many cases skin testing can identify an allergy that is missed by blood testing. Allergy skin testing also allows us to obtain results and to develop a treatment plan at the time of your visit. However, in a few cases, skin testing cannot be performed. In those situations, your doctor will help determine whether blood testing is needed for evaluation. The office has a phlebotomist with more than 10 years of experience in pediatric phlebotomy, so blood samples can be drawn in our office if needed.
Testing for many items can be performed. Allergy to airborne allergens, like pollens, molds, and dust mites are the most common types of allergy–so they are the ones most commonly tested for. We can also test for foods, stinging insects, and a limited number of medications and vaccines. There are not reliable allergy tests for most types of medications, including antibiotics. There are no reliable tests for food additives or preservatives. We can also perform Patch Testing to test for contact allergy to common substances.
The delayed reaction is simply an irritation and can be comforted with ice, benadryl, and over-the counter hydrocortisone 1% cream. It does not change any diagnostic outcome of the skin testing.
An allergy is when your immune system mistakes a harmless substance for a dangerous one and triggers the release of chemicals into your body, thus creating symptoms like runny nose, sneezing, watery eyes, itching and in some cases, more serious symptoms like coughing or wheezing, swelling of the throat and tongue, and in the worst case anaphylaxis.
Allergy shots increase your tolerance to the harmful allergen. By injecting gradually increasing doses of the offending allergen extract, the immune system builds up a tolerance to that allergen so that it is no longer seen as a threat to your body. Allergy shots slow down and reduce the production of the IgE antibody. You can think of each shot as adding a brick to the “wall of protection” against things that trigger your allergies.
If you are able to avoid the trigger of your allergies or if usual doses of medications control your symptoms, then immunotherapy might not be needed. While allergy shots have been proven effective against inhalant allergies and stinging insect allergies, they are not used for food allergies. If any of the following applies to you, then you may be a candidate for allergy shots:
- If the medications to control your symptoms (i.e., antihistamines, decongestants) do not work.
- If the medication used to control your symptoms produces too many side effects.
- If complications (i.e., sinus infections, ear infections) develop.
- If you have asthma triggered by allergies.
- If you are at risk of developing anaphylaxis (a severe reaction that, in some cases, may be fatal) when exposed to an allergen, such as a stinging insect. (As noted above – allergy shots are not used for food allergy.)
- If medications control your symptoms, but your symptoms flare back up every time you try to reduce your medications.
- If you can’t effectively avoid things that trigger your allergies.
- If you would rather take a series of allergy shots than daily medications.
- If you would rather treat the actual problem rather than just use medications to control symptoms. Allergy shots are the only potential cure that is FDA approved.
- If cost of the medications is a burden, allergy shots are very cost effective compared to the use of daily prescription medications over several years.
Allergy shots are typically started on a weekly schedule during the build-up phase. This can be accelerated under certain circumstances (cluster or rush immunotherapy) and this may be discussed with your allergist. Symptomatic improvement may occur within the first 3-6 months with full benefit usually seen with the first 12-18 months.
After a maintenance dose is reached, your allergist will determine when to decrease the interval between shots (for example, every 2 weeks, every 3 weeks, every 4 weeks). This usually occurs at 6 to 12 month intervals but is also affected by how your allergy symptoms are responding to treatment. Most people will be able to stop their injections after about 3 to 5 years.
Board-certified allergists are specially trained to safely utilize potent allergy extracts which are more complicated to use, but which provide significantly greater benefit than the low-dose allergy extracts used by physicians not specifically trained in the sub-specialty of Allergy/Immunology. You should always consult with a Board Certified Allergist before beginning a program of allergy shots.
The out of pocket cost will depend on the individual’s insurance policy. Studies have shown that allergy shots are a very cost-effective way to treat allergies. They have been shown to reduce medication requirements and improve the quality of life in those patients who take them. They are the only long-term way to bring symptoms under control in those patients who have significant allergic disease.
Allergy injections are the standard of care from The American Academy of Allergy and Immunology. Other treatment modalities, such as sublingual immunotherapy are FDA approved only for grass and ragweed pollens (not tree pollens, other weed pollens, molds, cat, dog, or house dust mites). The sublingual drops used by some doctors are not approved by the FDA for immunotherapy and have been found to be less effective than allergy injections in studies.
A large local reaction does not mean a patient is having a systemic reaction. It can be comforted with ice, ibuprofen, acetaminophen or Benadryl and should be reported to the nurse the next time you are in for an injection. It does not require further treatment and it is not necessary to call the on call Doctor after hours to be reported.
Yes, asthma is a very treatable disease. With appropriate treatment plans and consistent physician monitoring and evaluation, you can control your asthma and not have your asthma control you.
Coughing, wheezing, shortness of breath, tightness in chest, frequent or lingering bronchitis, and exercise intolerance are just a few of the potential signs and symptoms that may indicate a reason to investigate a possible asthma problem.
Yes, acid reflux can contribute to cough, shortness of breath, and tightness in chest. It has been reported that 45-70% of adults with asthma also have Gastroesophageal Reflux Disease (GERD).
Allergies and sinus issues often co-exist and managing the allergy component may in fact prove helpful in decreasing the frequency and severity of sinus infections. In addition, some people who have recurrent or chronic sinus infections may have a problem with their immune system, which can be evaluated by one of the physicians at Allergy, Asthma & Sinus Care Center.
Call your pharmacy. They will then contact us if they need more information or refill authorization. You can also sign up for our Patient Portal and request a refill electronically at your convenience.
Many insurances require a patient to have tried other less expensive medications in a certain drug class before they will consider paying for a particular drug. If this is the case, the process requires the doctor’s office to call the insurance and answer questions or complete paperwork regarding the patient’s medical and medication history. This process requires several days to accomplish. We will notify you and your pharmacy when we get a determination from the insurance. Please bear in mind, that the rules of your insurance might prevent us from getting your medication approved.
Part of helping to manage your condition involves seeing you regularly to ensure that your symptoms are controlled, and that you are not on too much or too little medication. For many stable conditions, we will only need to see you once a year. Other conditions will require you to be seen more often. We will not refill any medications if you have not been seen in our office in the past year.
It is our policy to not call in a prescription for antibiotics without medical evaluation in our office. If you are ill, you should contact our office for an appointment. In some cases, you might need an antibiotic. In some circumstances, you might need more than an antibiotic. In addition, many upper respiratory infections are viral infections and do not require antibiotics. The best way for us to provide you with the best care is to see you in the office. We have openings daily for same-day visits.
All plans have different benefits. Our staff can assist you in investigating your benefits, but in most cases your insurance company can give an estimate regarding out of pocket (deductible) expenses. However, we cannot be 100% certain of what your insurer will cover until after we have submitted the charges for our services. We encourage you to check with your company for your exact covered benefits.
You will be identified as a “self-pay” patient and will need to pay at your time of service.
No, if you disagree with the payment, you need to call the customer service department at the number on the back of your insurance card.
We do not participate in straight Medicaid, but we do participate in Home State Health, one of the managed Medicaid plans in Missouri.
No, allergy shots are given by a nurse and the only time you are charged for an office visit is when you see a doctor. However, depending on your insurance, you may be responsible for all or a portion of the allergy injection administration fees.