Dr. Agbetoba talks about testing for the most common allergens in Texas.
Shelby Stockton: (00:00)
Welcome to the Texas ENT Audio blog. I'm your host, Shelby Stockton, and today I had the opportunity to sit down with otolaryngologist Dr. Abib Agbetoba. Texas is a hotbed for allergies. So Dr. Agbetoba talks about the most common allergens in Texas and how he and his colleagues test for them. We discuss different treatment options like allergy shots and allergy drops, and the duration of allergy treatment from patient to patient. If you suffer from seasonal allergies and are curious about treatments, take some time to listen to Dr. Agbetoba's advice.
Dr. Agbetoba, it's so great to see you again.
Dr. Abib Agbetoba (00:40):
Thanks for having me. It's great to be back.
Shelby Stockton (00:43):
So we're going to talk about allergies, one of our favorite subjects. My first question for you is how do Texas ENT specialists test for allergies?
Dr. Abib Agbetoba (00:51):
Yeah, so I think one of the great things about our practice is that we provide all forms of allergy testing. So it's really individualized. Some tests are going to be better for other patients, and some tests are not going to be good for certain patients because it may put them at certain levels of risk. And so we want our test to be as accurate as possible to pick up any and everything that you may be allergic to. And we want our tests to really not cause our patients any harm. So we want a safe, reliable, and accurate test. So there's a number of different types of testing. There are blood allergy testing, which we can offer to patients who for whatever reason can't undergo allergy testing. But there's also skin testing. And at Texas ENT, we feel that skin testing, specifically intradermal skin testing is the most sensitive and the most accurate, meaning that it's going to be very precise in figuring out what you're allergic to, but it's also going to be very sensitive.
So sometimes tests can miss things. On a clinical level, you may go outside and mow the grass and get a lot of water, itchy eyes, nasal congestion and drainage type symptoms. And then we may test you for grass using a blood test, and that blood test for whatever reason, may not pick up that you're allergic to. Now, obviously as a patient, you care about what's clinically relevant, what is driving your symptoms, and we feel that with our skin testing at our practice, we can pick up on that. And obviously that goes a long way as far as not just identifying what you're allergic to, but also treating what you're allergic to.
The skin testing that we offer in our practice involve either a prick test or some combination of a prick and intradermal skin testing. Not to get into the weeds of it all, but prick testing is a good option for smaller kids or people who are very, very allergic to certain things where we don't necessarily need to do the intradermal testing. It's also a quicker test and sometimes it's more than sufficient. The intradermal test is the more detailed and involved testing. Our team of allergy nurses are very, very well-trained, very, very well-equipped to basically have you undergo this form of testing that does take a little bit more time, but may end up being the most effective as far as again, identifying what it is you're allergic to. As far as also giving us an idea of how severe that allergy is.
Shelby Stockton (03:27):
What are some of the common allergies in Texas that you test for?
Dr. Abib Agbetoba (03:31):
So we test for a variety of different things in the southwest region, okay? Allergies are funny because there's a lot of cross reactivity, so you may be allergic to a certain type of tree like cedar, but then can have a cross reactivity with other type of trees that grow in other regions. So yes, it's very important to kind of understand what you're allergic to in the area that you live in, because that's what you're going to be most exposed to. But it's also important to understand that an allergen in one area can look very, very much like a different allergen in another area. So that's important to keep in the back of our mind once we talk about allergy treatment a little bit later on. We test for a variety of outdoor allergens, environmental allergens, which include trees, grasses, as well as ragweeds. And these are going to cover some of the more seasonal allergens throughout the spring, summer, and fall.
We also test for things that occur year round that are floating around in the environment such as mold, particularly here in Houston, in the human environment, mold at certain times of the year can be very, very aggressive, if you're wondering why symptoms are flaring up at certain times of the year where the pollen count may otherwise be low. And then we test for a number of indoor allergens. I think one of the biggest misconception is that allergies are due to outdoor pollens, and that's really just not a case. You can be just as allergic to something indoor as you are to something outdoor. And the indoor allergens include things like pet dander, so cats, dogs, horses, as well as things like the smites. So we want to basically encompass anything that may be floating around in the environment that you may inhale, ingest, and try and get a good sense of what your overall allergy profile is so that we can better treat you.
Shelby Stockton (05:25):
What's the difference between allergy shots versus allergy drops?
Dr. Abib Agbetoba (05:31):
That is a great question. So historically, what we've known as a allergy and ENT community is treated patients with allergy shots, okay? We test you, we identify what you're allergic to. We then get those allergen extracts and we create your own individualized personalized vial. And that vial will contain everything that you were allergic to. And then through very, very small injections, we give you that over a period of time so that your body develops tolerance. So we're really trying to change things from a biochemical level. That's why we talk about the idea of a cure behind the allergy shots. The allergy shots do necessitate coming into the office. These can be broken out as far as... Or spread out over time. First year is typically around every week or so. Second year is usually every two weeks, and then the third, fourth year may be every three to four weeks.
So these do get spread out, and this is a great option for patients who can make these appointments. We're very fortunate at Texas ENT and some of our sister organizations to have a number of different offices around the area so that patients can really try and choose the site that's best for them, whether it's close to work or close to home. And these visits are very, very quick. It's not like seeing a doctor where you may have to wait a bit, but these visits are... You're in and out. We give you the shot, we watch it for a period of time, and then you're, you go on about your business in your daily life. So allergy shots, okay, again, involves obviously a shot as the name indicates. Allergy drops are a newer form of treatment that we like to offer our patients. It is basically a sublingual solution.
So very similar to shots. We take everything that you're allergic to, we put it into a vial, we create your own individualized and personalized treatment. And for us, we will ship this formula to you and give you instructions, and basically you'll apply the solution underneath the tongue. There are special immune cells and mediators that will uptake the solution and allow your body to again, build tolerance over time so that tree and grass pollen that you're so severely allergic to fades away with time. So the major difference between shots and drops are obviously, one is a shot and one is a drop. One requires that you come into the office. The other we can ship to you. The other advantage to allergy drops is that the risk of having a severe reaction is very, very low. So the one drawback to the drops is that because it's a newer form of medication, insurance coverage may be a little difficult to deal with.
And so every insurance is different, even within having a larger carrier like Blue Cross Blue Shield, or UnitedHealthcare, it's going to be a variety of different forms. So we do have a dedicated financial allergy team that will go through your insurance and give us a good sense of which option may be best for you from a financial standpoint. And then based on that and other factors, you can decide which one is best for you. But if you were to ask, they both can be equally effective. There are other more nuances that may make one a little bit better for some patients versus the other. But your ENT physician and doc can go over that in detail and give you some guidance as to which they feel may be best for you.
Shelby Stockton (09:17):
What is the duration of allergy treatment?
Dr. Abib Agbetoba (09:21):
So I'm going to use the term ideal because everyone's different. And I think if we look at it as a bell curve, the majority of patients are going to fall within this ideal parameter, and that's about three to five years. So I think it's important because that sounds like a long time to be on treatment. For many of our patients who end up on allergy treatment, the alternative is that you are on things like antihistamine, nasal sprays, montelukast, Singulair, steroids, shots, oral or other forms of steroids as well and you're doing this indefinitely. So again, the idea behind immunotherapy is that we were really going for a cure. We want to change your response to these outdoor allergens. If we really look at what an allergy is, it's basically your body and your immune system overreacting to what's in the environment. So when you breathe in cedar tree, your body does not see it as just simple cedar tree pollen.
In fact, it's this foreign invader and it causes this aggressive inflammatory response, and that happens again at a biochemical level. So with the allergy treatment, whether it shots or drops, what we're trying to do is to change your immune system so that way when everything is said and done, you breathe in cedar, your body recognizes it simply as cedar pollen, not as a foreign invader. It does not release all of those inflammatory mediators that cause up a radius symptoms of as far as water, itchy eyes, sneezing, nasal congestion, but other symptoms of fatigue, feeling tired, just not feeling like yourself, feeling ill.
We want to avoid the release of those mediators that lead to that symptom, and we want to allow your body to just recognize cedar as cedar and then have no response whatsoever. So that takes some time, and typically that's about three to five years. Again, everyone's a little bit different, but typically around the three-year mark is when we kind of assess how you're doing with symptoms and make a determination if we want to continue therapy or see if it's a good time for you to stop. Some patients see benefit as early as six weeks. Other patients, and this is rare, may need to be on therapy for more than five years. But again, consultation with your otolaryngologist, showing up at the appropriate follow-ups will allow us to individualize care to make sure that you're receiving the best treatment possible.
Shelby Stockton (11:46):
Doctor, thanks for taking time out of your lunch. I know you made this possible and we really appreciate it.
Dr. Abib Agbetoba (11:53):
Absolutely. Anytime I get a talk, allergy and rhinology, I'm always in a good mood, anytime.
Shelby Stockton (11:58):
Thank you.
