Understanding Pollen Counts

The term pollen count (or mold count) is very common and you’ve probably seen this on the news: “ pollen count today ”. But what exactly is a pollen count and how does it related to your allergies?

Pollen counts aren’t exactly ‘counts’. They are, more so, forecasts that give an estimate of how much pollen is in the air. The pollen is divided into categories of tree pollen, grass pollen and weed pollen. They are associated with specific numbers in addition to the levels high, medium and low.

Some reports go into more detail about which specific pollens are in the air, such as oak tree or ragweed.

Many people think that if a pollen count is high, they will experience a high level of allergy symptoms that day. But that is not always the case. There are too many variables to be able to say that for sure.

One of the first variables lies in the way the pollen counts are obtained. Most pollen counters are placed on tall buildings and they collect samples of pollen from the air. These samples are examined under a microscope and counted. The results are then extrapolated to make an estimate of how much pollen is in the air.

It is important to note that the levels of pollen (high, medium or low) are reported based on averages of pollen collected over the years. Also, these counts are not full-proof due to factors such as time of day collected, weather changes, and the area from which the pollen was collected.

Other factors that affect pollen counts include the types of local plants in the area where the pollen was collected and the fact that the types and amounts of pollen collected change over the course of a day and from day to day.

Lastly, what these counts mean to allergy sufferers can differ. For one person, a high pollen count of ragweed could cause severe allergy symptoms and for another person, it could cause only mild symptom. This just depends on how allergic a person is to the pollen in question.

Now when you see “ pollen count today ” on the news, you’ll know exactly what they’re talking about. Pollen counts can be helpful if you know what you’re allergic to and what reactions you have at the different levels. Find out today’s pollen count on our website or come in and find out what you’re allergic to!

How do Allergy Shots Work?

How do Allergy Shots Work?

Allergy shots, also known as Allergen immunotherapy, is a form of long-term treatment that decreases symptoms for many people with allergic rhinitis, allergic asthma, conjunctivitis (eye allergy) or stinging insect allergy.

Immunotherapy works by decreasing sensitivity to allergens. These shots often lead to lasting relief of allergy symptoms even after treatment is stopped. This potential for life-long treatment is what makes allergy shots a cost-effective, beneficial treatment approach for many people.


Who Can Benefit from Allergy Shots?

Both children and adults can receive allergy shots. When considering allergy shots for an older adult, medical conditions such as cardiac disease should be taken into consideration and discussed with us first.

We typically decide if allergy shots are right for you based on the following criteria:
•    Length of allergy season and severity of your symptoms
•    How well medications and/or environmental controls are helping your allergy symptoms
•    Your desire to avoid long-term medication use
•    Time available for treatment (allergy shots requires a significant commitment)
•    Cost, which may vary depending on region and insurance coverage

Unfortunately, allergy shots are not used to treat food allergies. The best option for people with food allergies is to strictly avoid that food.


How Do They Work?

Have you ever gotten a vaccine? Well allergy shots work the same way. Your body responds to injected amounts of a particular allergen, given in gradually increasing doses. Over time, you develop immunity or tolerance to the allergen.

There are two phases of allergy shots:
•    Build-up phase– Over the course of about 3-6 months, you receive shots with increasing amounts of allergens about one to two times per week.
•    Maintenance phase– This phase starts after the effective dose is reached. The effective maintenance dose depends on your level of allergen sensitivity and your response to the build-up phase. Over the course of this phase, there will be longer periods of time between treatments, ranging from two to four weeks. We will decide what range is best for you.

Do allergy shots work? Yes, but they do not work for everyone. Also, they require a lot of patience and consistency. It may take up to a year on the maintenance dose to notice an improvement. If the allergy shots are successful, maintenance treatment is generally continued for three to five years. Any decision to stop allergy shots should be discussed with us first.



Allergy Induced Asthma

This article has been adapted from Thanai Pongdee, MD, FAAAAI

Oftentimes, it can be hard to discern whether an individual’s asthma is caused by allergies or not. Allergic and non-allergic asthma have similar symptoms but the causes are different.


Allergy Induced Asthma Causes

Allergy induced asthma is the most common form of asthma. If this is the type of asthma you have, it will be triggered by the inhaling of allergens. Allergens come in many different forms such as dust mites, pet dander, pollen or mold.

In allergy induced asthma, the allergen triggers a response that starts in the immune system. Through a complex reaction, these allergens then cause the passages in the airways of the lungs to become inflamed. This inflammation is what causes coughing, wheezing and other asthma symptoms.

Exposure to allergens may trigger the symptoms, but the real culprit in allergic asthma is the IgE antibody. The IgE antibody is produced by the body in response to allergen exposure. The combination of the antibody with allergens results in the release of potent chemicals called mediators. The mediators cause inflammation of the airways, resulting in symptoms of asthma.


Other Asthma Causes

Some people have asthma that is not triggered by allergens. Asthma symptoms may also be triggered by exercise, viral or bacterial infections, cold air or by related conditions such as gastroesophageal reflux disease (GERD).

Knowing if your asthma is allergic or not is important for treating your condition. Given the relationship between allergies and asthma, an allergist/immunologist is the best qualified physician to diagnose your symptoms and help you manage your asthma.

Make an appointment today so we can help you find the cause of your asthma. We will do the best we can to improve your quality of life!



Antihistamines: What You Need to Know

So you have allergies. Now what? Antihistamines are typically the first thing people try to alleviate the symptoms of allergies. Before you head to your local drug store, read this article to find out a little more about them!

How Do Antihistamines Work?

When your body comes into contact with whatever you’re allergic to, whether it be dogs or dust, it creates chemicals called histamines. These chemicals cause changes in the tissues which result in symptoms such as stuffy nose, runny nose and eyes, and/or itchy eyes, nose, and sometimes mouth. Some people even develop a rash, called hives.

Antihistamines help to reduce allergy symptoms by reducing or blocking the histamines, hence the name antihistamines.

These medicines work well to relieve symptoms of different types of allergies, including hay fever, indoor allergies, and food allergies. But, unfortunately, they can’t relieve every symptom.

To treat nasal congestion, your doctor may recommend a nasal spray. These medications work best at relieving nasal congestion and come in the form of intranasal steroids, antihistamines, and even combinations of the two medications together.

Are there Different Types of Antihistamines?

Yes! Antihistamines can come in the form of tablets, capsules, liquids, nasal sprays, and eye drops. You can purchase some antihistamines over the counter, but some are only available by prescription.

Some prescription antihistamines include Optivar, Astelin, Patanase, Astepro, Palgic, Pataday, Atarax, Vistaril.

You are probably more familiar with the OTC antihistamines include Zyrtec, Chlor-Trimeton, Benadryl, Allegra, Alavert, Claritin, and most recently Xyzal has gone over the counter.

Side Effects of Antihistamines

There are 3 generations of antihistamines. Older generations tend to cause more side effects, particularly drowsiness.

Newer antihistamines have fewer side effects, so they may be a better choice for some people.

Some of the main side effects of antihistamines include dry mouth, drowsiness, dizziness, nausea and vomiting, restlessness or moodiness (in some children), trouble urinating or not being able to urinate, blurred vision and confusion.

If you take an antihistamine that causes drowsiness, do so before bedtime. Don’t take it during the day before you drive or use machinery.

Read the label before you take an allergy drug. Antihistamines may interact with other medications you are taking.

Talk to us first if you have an enlarged prostate, heart disease, high blood pressure, thyroid problems, kidney or liver disease, a bladder obstruction, or glaucoma. Also check with us if you are pregnant or nursing.

Come in and see us, and we will help you determine your allergy triggers and figure out which combination of medications are the right solution for you!



Do You Have a Dust Mite Allergy?


If you find yourself having allergic reactions indoors, then a tiny creature you can’t even see might be the culprit. This creature is called a dust mite. Common dust mite allergy symptoms include, sneezing, runny nose, itchy, red or watery eyes, stuffy nose, itchy nose, mouth or throat, postnasal drip or cough. If your dust mite allergy triggers your asthma, you may also experience difficulty breathing, chest tightness or pain, a whistling or wheezing sound when breathing out, trouble sleeping caused by shortness of breath, coughing or wheezing.

Dust Mite Facts:

  1. Dust mites are among the most common trigger of year-round allergies and asthma.
  2. They are on every continent except Antarctica.
  3. It may not be possible to rid your home entirely of these creatures.
  4. A dust mite measures only about one-quarter to one-third of a millimeter.
  5. They are too small to see with your eyes alone.
  6. Under a microscope, they look like white bugs. They have eight legs, so they are not insects, but arthropods, like spiders.
  7. There are at least 13 species of mites.
  8. They are all well adapted to the environment inside your home.
  9. They feed mainly on the tiny flakes of human skin that people shed each day.
  10. They thrive inner layers of furniture, carpets, bedding and even stuffed toys.
  11. An average adult person may shed up to 1.5 grams of skin in a day. This is enough to feed one million dust mites!
  12. Both the body parts and the waste of dust mites are allergens for many people.
  13. In a warm, humid house, dust mites can survive all year.

Thankfully, there are ways you can prevent allergic reactions to these pesky creatures. There are many changes you can make in your home to reduce your dust mite allergy. The most common place for dust mites is the bedroom. So this is the best room to start with. Some things you can do are cover mattresses and pillows in zippered dust-proof covers, wash your sheets, rugs and blankets weekly in hot water, avoid wall-to-wall carpeting, curtains, blinds, upholstered furniture and down-filled covers and pillows in the bedroom (unless you can wash regularly in hot water), wear a filtering mask when dusting or vacuuming, and keep the humidity in your home less than 50 percent.

If you think you might have a dust mite allergy, come on in and we can find out for certain. We will also get you the treatment you need!




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.


1 2