What is Sinusitis?


If you have nasal congestion, facial pressure, cough and thick nasal discharge, you may have rhinosinusitis, commonly referred to as sinusitis.

Your sinuses are hollow cavities within your cheekbones, around your eyes and behind your nose. They contain mucus, which helps to warm, moisten and filter the air you breathe. When something blocks the mucus from draining normally, an infection can occur.

Acute Sinusitis

Acute sinusitis refers to sinusitis symptoms lasting less than four weeks. Most cases begin as a common cold. Symptoms often go away within a week to 10 days; but in some people, a bacterial infection develops.

Chronic Sinusitis

Chronic sinusitis, also referred to as chronic rhinosinusitis, is often diagnosed when symptoms have gone on for more than 12 weeks, despite medical treatment.

People with allergic rhinitis or asthma are more likely to suffer from chronic sinusitis. This is because the airways are more likely to become inflamed when allergic rhinitis or asthma are present. Sinusitis may also be caused by an infection, a fungus, deviated nasal septum, nasal polyps or in rare cases an immune system deficiency.


Sinusitis symptoms, whether acute or chronic, frequently develop after a cold or during times of severe or ongoing allergic rhinitis symptoms. The most obvious sign of sinusitis is a painful pressure in the cheeks and forehead. Other symptoms include:
•    Thick yellow-green nasal discharge
•    Postnasal drip, often with a bad taste
•    Cough
•    Congestion
•    Toothache
In cases of acute sinusitis, a fever may develop.

Allergy testing performed by an allergist / immunologist can identify what allergic triggers might be behind your chronic or reoccurring sinus infections.

In chronic or severe cases, your doctor may also examine your nasal passages using a technique called rhinoscopy or nasal endoscopy. In this procedure, a thin, flexible instrument is inserted up the nostril to view the sinus passages and look for blockages.

If you come in to see us, we may order an MRI or CT scan to look for abnormalities in the sinuses – narrow drainage passages, polyps or a deviated septum.

Make an appointment with us right away if you have: a fever, pain or swelling in the face or eye, redness on the cheek or around the eye, severe headaches, confusion or a stiff neck.


The 411 on Hives

A rash showed up on your skin. Now what? Don’t panic. We will go over the possible cause of hives and help you figure out why in the world you have them!

What are Hives?
Hives, also known as urticaria, is an outbreak of swollen, pale red bumps or plaques (wheals) on the skin that appear suddenly — either as a result of the body’s reaction to certain allergens, or for unknown reasons.

Hives can itch, burn or sting. They can appear in different sizes and on different areas of your skin. They can even show up on including lips, tongue, or ears.

Many times the hives may occur with or without angioedema. Angioedema is when the swelling occurs beneath the skin instead of on the surface. Angioedema is typically characterized by deep tissue swelling, commonly around the eyes, ears and lips. Sometimes it can be found on the genitals, hands, and feet. Most episodes of swelling go away in less than 48-72 hours.

Angioedema of the throat, tongue, or lungs can block the airways, and can be life-threatening, but such life-threatening episodes are uncommon.

What Causes Hives and Angioedema?
Viral infections are the most common cause. However allergic reactions to medications, insect stings, sunlight exposure, or physical stimuli such as temperature and vibration can cause urticaria and angioedema. It’s sometimes impossible to find out exactly why a person has urticaria and angioedema.

Think you Might have Urticaria or Angioedema?
Come in and see us. A thorough history and physical exam will be performed in an attempt to find the possible cause. Some specific tests for common causes of urticaria and angioedema may also be performed.

Skin tests may be performed to determine if  you are allergic to a specific allergen. Blood tests may also be done to determine if a systemic illness is present.

How is Urticaria/Angioedema Treated?
The best treatment for hives and angiodema is to identify and remove the trigger if one is identified, but this is often not possible. Antihistamines are usually prescribed by your doctor to provide relief from symptoms. Antihistamines work best if taken on a regular schedule to prevent hives from forming. If the urticaria and angioedema is persistent, we may opt to treat with a combination of medications. Though oral corticosteroids may be prescribed, we would try to find the safest and most effective treatment plan for each individual patient. An injectable drug, omalizumab (Xolair), is also approved to treat chronic hives in those at least 12 years of age.

All patients with urticaria and angioedema should see a healthcare professional with expertise on this condition.

Vandana K. Patel, MD, FAAAAI

Best Way to Potentially Prevent a Peanut Allergy

BY VANDANA K. PATEL, M.D. AND JENNIFER L. CAICEDO, M.D. (Providers at Asthma & Allergy Specialists, PA)

As allergists, we often get the question, “Why do so many kids have a peanut allergy?” This isn’t an incorrect observation, as the number of children in the United States with peanut allergy has tripled in the past 10 years, while doubling in most other Western countries. The rate of increase was so alarming that Professor Gideon Lack and his team at King’s College in London wanted to see if early introduction of peanuts would offer protection from developing peanut allergies.

The study titled “Learning Early About Peanut Allergy”(LEAP) randomly assigned 640 infants between the ages of 4 and 11 months with severe eczema, egg allergy, or both, to either avoid or consume peanuts until 5 years of age. Remarkably, the overall prevalence of peanut allergy in the avoidance group was 17 percent compared to only 3 percent in the consumption group. Earlier introduction of peanuts to infants in the study decreased their risk of developing peanut allergy by a staggering 70 percent to 80 percent.

Lack and his research team concluded that there is a narrow window of opportunity to prevent peanut allergy and we must now feed our very young children peanuts. The study recommends that peanuts (in a safe/non-choking hazard form) can be introduced to infants as early as 4 months of age, but how would we in the U.S. use these learnings to help our patients?

In order to make the results from the LEAP study practical, the National Institutes of Health has released a guideline to help prevent peanut allergy in the U.S. This guideline, which speaks to BOTH the primary care provider and the pediatric allergist, is divided into three parts, depending on varying levels of risk:

The first part of the guideline addresses the HIGH RISK infants who are the ones with severe eczema, egg allergy, or both. These patients should get foods containing peanuts in their diet by 4-6 months of age, but only after either skin or blood testing. The health care provider may then give guidance regarding the introduction. A referral to an allergy specialist may also be recommended.

The second part of the guideline addresses the MODERATE RISK infants with mild to moderate eczema who should also have peanuts in their diet by 4-6 months of age.

The third part of the guideline states that children without eczema or any other food allergy can have peanuts freely introduced into their diet. Peanuts should be introduced into an infant’s diet after other solid foods have been started.

The medical community is not yet sure if the results from LEAP can be extrapolated to the introduction of other highly allergenic foods, but we anticipate that such studies (especially with regard to tree nuts and sesame) are forthcoming. Parents and caregivers are encouraged to discuss this with their primary care provider at their infant’s 4- to 6-month well visits.

Do you think you or your child might already have a peanut allergy? Schedule an appointment with us for a food allergy test.

How to Help your Kids Make Healthy Food Choices


Through our 30 years, Asthma & Allergy Specialists, PA has grown to offer a variety of services. As part of our services, we offer nutritional counseling through our on-site registered dietician, Raquel Durban. Whether you or your child is coping with food allergies, weight management, picky eating or general nutrition, Raquel can help. In addition to working with our physicians, she will partner with your health care provider to ensure everyone is in the know on helping you reach your goals.

You or your child may have struggled with or currently struggle with food, whether it be restriction or over indulgence. You’ve probably experienced, at least to some degree, a child pitching a fit about eating a new food, but this doesn’t have to be the case.

7 tips for getting your children to make nutritious food choices.

1. Avoid being the food police. Forcing kids to eat foods they dislike is a recipe for rebellion, resentment and frustration. Instead, only stock your pantry and fridge with a variety of nutritious options. That way, every dietary choice your child makes in your home will be a good one.

2. Introduce healthy new dishes each week, while continuing to serve one or two familiar foods. The goal is to quickly eliminate the worst foods your kids currently eat, followed by less-than-ideal options, as you replace them with more wholesome choices. Keep in mind that kids often need to try a new food several times before deciding they like it.

3. Make food fun! Add greens to a fruit smoothie for and create a super hero name for it. Also let kids have fun helping you cook meals or arrange foods on a plate. For younger kids, veggies may taste better when shaped into a smiley face, while older children may take pride in cooking greens they like, then being creative with spices or garnishes. Adding a little vanilla, cinnamon or cacao often goes a long way in getting kids interested in otherwise bland food.

4. Play with your food. Make learning about nutrition enjoyable by turning it into a game. You can present your kids with different foods and have thumb put thumbs up or thumbs down depending on if the snack is healthy or not.

5. Let kids choose their own “parent-approved” snacks. Another easy way to help kids make great food decisions, even at a young age, to have a “snack shelf” of nutritious foods they can reach themselves. By encouraging your kids to make their own decisions about what to eat (from an assortment of healthy options), they start learning to take responsibility for their nutrition.

6. Allow kids to make dietary mistakes — and learn from them. Since you don’t want to be the food police, avoid scolding your kids about poor dietary choices. Instead, look for opportunities to help them learn from the consequences. For example, you might point out that the gooey birthday cake your son or daughter ate a friend’s party could be what caused the tummy ache or nausea that struck afterward.

7. One of the best ways to help your kids form a healthy relationship with food is by teaching them to connect what they eat with how they feel. If your kids eat something nutritious, ask them how they feel. Suggest names for these feelings, such as “energized” or “happy.”


If you are interested in nutritional services, feel free to make an appointment on our website. Appointments are at your convenience, whether in office or through a virtual consult. We can’t wait to help you!



Asthma Management

The Experts in Asthma Mangement

Top medical professionals agree that Asthma patients are best managed by physicians with specialized training 1.     At Asthma & Allergy Specialists, our pediatric pulmonologists, Drs. William Ashe and Hugh Black have been serving the Charlotte community for more than 2 decades. Their experience and specialized training can help treat your child with asthma related breathing or lung problems. Through decades of experience they understand that infants, children and teens have unique medical needs due to their growing bodies.   Drs. Ashe and Black approach to patient care is based on an understanding of patient needs along with a calming bed side manner which has led to improved patient adherence to prescribed treatment plans.

Why do I need a pediatric pulmonologist?

A pediatric pulmonologist can provide a diagnosis, treatment and management plan for your child, from birth to age 21 that is address breathing or lung problems.  In addition our skilled nursing staff can ensure accurate spirometry which should be measured at least every 1-2 years for controlled asthmatics.1

Pediatric Pulmonologists have specialized training. They have completed at least 4 years of medical school, pediatric residency training and an additional three years of fellowship training in pediatric pulmonology.2

  1. Sharma, G. Pediatric Asthma Treatment & Management. Updated Aug 19 2016.
  2. “What is a Pediatric Pulmonologist?” Healthy Children. American Academy of Pediatrics, 21 Nov 2015. Web 22 Sept 2016.