CONDITIONS WE TREAT

Environmental allergies
Asthma
Contact dermatitis
Rashes
Hives
Eczema
Food Allergy
Eosinophilic esophagitis (EoE)
Sinus infections
Recurrent infections
Insect sting allergies
Drug Allergy

Environmental Allergies

When your immune system overreacts by attacking harmless things like pollens or animal dander, that’s when allergy begins.   Itchy watery eyes, sneezing, and a runny nose are common signs of allergies, but don’t overlook other symptoms that may be caused by your allergies as well.  Some of these symptoms are: 

  • Sinus infection
  • Recurrent sore throat
  • Cough
  • Altered sleep patterns
  • Fatigue and irritability
  • Headache
  • Poor school or work performance

Finding out what you are allergic to is an important first step.  Allergy tests are convenient and accurate.  Skin testing is fast and provides quick results within 15-20 minutes.   It usually costs less than allergy blood tests and picks up 20-30 percent more positive results than blood testing.  The skill of the tester may affect the results.  Therefore, the test should be done by a person with special training.

Blood tests are used if you are taking medicines that interfere with skin testing but cannot stop them or have skin conditions that do not allow for skin testing.

A positive result does not always mean that you are allergic to that allergen.  It is therefore important to have testing performed and interpreted with a board-certified allergist.  You may be able to avoid your allergens, and medicines may also help reduce your allergy symptoms.  Allergy shots may be recommended if none of these measures work well for you.

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Asthma

Many people think of asthma as an “attack:” one minute you feel okay and the next you are gasping for air.  Some believe asthmatic patients have constant symptoms and cannot be active or play sports.  But asthma can actually cause a range of symptoms, from mild to very serious.  In fact, many Olympians have asthma, and it does not stop them from realizing their goals.  

Perhaps you wheeze, making a squeaky or whistling sound when you breathe. You might have frequent chest colds or bronchitis a few times a year. Or maybe your only symptom is a cough that wakes you up at night or happens when you exercise or laugh.  You may have asthma and would benefit from the right treatment.

At premier allergy, we understand the importance of getting to the right diagnosis so that our patients can get the right treatment.   We focus on your detailed medical history, including in-depth information on your house and often your occupation or hobbies.  We utilize non-invasive lung function tests that measure how open your airways are and whether there is inflammation in your airways.  Skin tests are sometimes recommended to assess your risk for asthma and identify asthma triggers.  These tests are quick, easy, and provide you with answers at the end of your visit.

Many conditions can mimic asthma.   As the old adage goes “Not all that wheezes is asthma”.  It is important that your asthma diagnosis is established before the treatment is begun.  Our providers may recommend a methacholine challenge test which can help clarify the diagnosis for you.  Similar to other tests performed at premier allergy, methacholine is non-invasive and will provide you with a quick answer at the end of your visit.  

Most patients do well on inhalers, but for some, cutting-edge treatments such as biologics are beneficial.  Our providers will share the decision-making process with you on which treatment would be best for you based on the national guidelines for asthma treatment.  If your asthma is triggered by allergies, you should consider allergy shots. Allergy shots, which are also known as immunotherapy, are very effective in relieving allergy symptoms and, in some cases, can actually cure your allergy.

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Contact dermatitis

Itchy rashes that keep coming back may be a sign of contact dermatitis.  Contact dermatitis is a rash that occurs when your skin comes into contact with allergens.  Surprisingly, some rashes from contact dermatitis can occur in areas far away from where your skin touches the allergens.  This is called ectopic dermatitis.  Plus, there are hundreds of contact allergens that can cause contact dermatitis, and these allergens can be found in many products we use every day.  Many contact allergens are plant based, so using natural products may not always resolve your rashes.  Soaps, shampoo, detergents, cosmetics, hair care products, or even medicated creams or ointments prescribed to treat your itchy rashes are potential contact allergens.  No wonder why diagnosing contact dermatitis is challenging.   Patch testing can help us identify the allergens that may be causing your symptoms so that you can avoid them now and in the future.  

WHAT TO DO ONCE YOU IDENTIFY YOUR CONTACT ALLERGENS? 

Are you overwhelmed by the long list of weird-sounding names in your personal care products?  Not sure if the natural products are actually safe for you?  Dr. Hoontrakoon and DNP Goli’s extensive experience in working with contact allergens will help you navigate through these seemingly impossible lists and find the right products for you.

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Rashes

Most of us experience rashes at some point in our lifetime.  While most rashes go away quickly without treatment, some linger and require further treatment.  Environmental allergens, autoimmune processes, and contact allergens are among the common causes of rashes.  Our providers can help you identify the cause and guide you through the treatment process.

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Hives

Hives, also known as urticaria, affects about 20% of people at some point during their lifetime.  Hives can start as itching, followed by swollen, red welts.  Itching may be mild to severe.  Scratching, alcoholic beverages, exercise, and emotional stress may worsen itching.

Hives can come and go, lasting minutes, hours, days, several weeks, months, or even years.  There are 2 types of hives, depending on how long they last:

  • Acute urticaria: hives that last 6 weeks or less.
  • Chronic urticaria: hives that last or recur for more than 6 weeks.

In some cases, the cause of hives is obvious.  In some cases, the cause cannot be identified.  Allergy skin testing may provide useful information in some cases.  A skin biopsy and blood tests may offer insight to your hives.  If you have chronic unremitting hives that do not respond to antihistamines, a medication that acts by directly changing the behavior of the immune system, known as a biologic medication, may be helpful.  Omalizumab (Xolair) is a biologic approved for chronic idiopathic urticaria in patients 12 years and older.  Talk to our providers to see if you would be a candidate for Xolair.

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Eczema

Eczema or atopic dermatitis is a chronic itchy skin rash that usually co-exists in patients with allergies and asthma.  It negatively impacts quality of lives as many patients or parents with children who have atopic dermatitis would attest to.  Many can’t sleep from their relentless itching.

At premier allergy, we treat atopic dermatitis by identifying allergens that may trigger these itchy rashes.  These can be food or environmental allergens.   If pollens or pet dander trigger your eczema, allergy shots can provide you with a significant relief. 

Our patients are extensively counseled on the daily DIY at home skin hydration process.  Proper skin hydration allows skin cells to repair themselves and have a chance to heal.  Although there is no medication involved in this process, skin hydration steps play a critical role in maintaining good control of eczema.

Medications we prescribe for atopic dermatitis may range from time tested topical-medication in mild cases to state-of-the-art biologics like Dupixent in more severe cases.  Eczema treatments may have the potential to prevent the further development of other allergic diseases.

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Food allergy

Food allergy is a frightening diagnosis.  Even when you or your child are doing your best to avoid food allergens, accidental ingestion may still occur.  But avoidance and carrying epinephrine autoinjectors may not be the only tools you have to manage food allergies.  Recent studies show that some food allergies can be prevented if they are introduced early to “low-risk” babies.  Make an appointment with our provider to find out if this approach would be safe for your child.  Plus, about 10% of tree nut allergy patients and 20-25% of peanut allergic children may outgrow these allergies.  Testing can help identify these children and relieve them and their families from the burden of food allergies.

Oral peanut immunotherapy (OIT) has recently been approved by the FDA for children and adolescents 4-17 years old.  It works by exposing the child to a small amount of peanut, so they become less likely to have an allergic reaction if they accidentally eat a peanut product.  Discuss with our provider to see if this is the right treatment for your child.

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Eosinophilic esophagitis (EoE)

Do you find it difficult to swallow certain foods?  Have you had food or pills stuck in your throat or chest?  Do you have frequent heartburn?  Is your child a picky eater?  If so, EoE might be the diagnosis.  Unlike other food allergies, EoE is not life-threatening, but, left untreated, it could lead to permanent damage of your esophagus, not to mention the negative impact it has on quality of life.  Most EoE patients have environmental allergies, and while food is the main trigger for EoE, the environmental allergies need to be addressed in order to improve the outcome.  

The majority of EoE patients have more than 1 food allergen.  This makes it difficult for patients to pin down the food allergens on their own.  Our providers will guide you through the challenging process of identifying food allergens as there is no one simple test for EoE.  Some EoE patients may need to avoid 6-10 major food allergens including dairy, gluten, eggs, legumes, tree nuts, and seafood.  We understand the difficulty of a restricted diet and are committed to seeing you through this process. Our providers will not only identify food allergens for you but will also provide you with examples of grocery shopping list, recipes and simple dishes that are safe for your restricted diet.

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Sinus infections

Sinus infections are common conditions, and most of us have experienced them at least once or twice.  But if you have sinus infections more than 2-3 times a year or you often need more than 1 course of antibiotics or the symptoms never go away completely, something else besides infection may be causing your sinus symptoms.  Frequent “sinus infections” can point to environmental allergies as many sinusitis diagnoses are actually rhinitis.  In fact, recurrent sinusitis is one of the most common allergy symptoms.  Once allergies are well controlled, sinus infections often subside.   Although rare, an immunodeficiency may be the culprit. Our providers will tailor testing and treatments to fit your need.

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Recurrent infections

Our ability to fight infections depends on a healthy immune system.  When one or more components of our immune system goes awry, our risk of infection increases.  This is called immunodeficiency.   Before antibiotics became available, patients with immunodeficiencies were often presented with severe, overwhelming infections such as meningitis, bacterial pneumonia, or bone or blood infections (osteomyelitis or sepsis).  But with improvements in health care and antibiotic use, the only cue to this diagnosis may be recurrent infections.  These infections may be the same as those that are commonly seen in the community such as sinusitis but may occur at higher frequency or may be more difficult to treat.

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Insect sting allergies

It’s spring time, and you want to be exploring our beautiful Colorado landscapes.  But you worry about those bees and wasps based on your reactions to their stings in the past.  There are available tests to determine whether you are allergic to these insects and decide whether you need epinephrine auto injectors.  And if you are a candidate, venom immunotherapy can be used to reduce your risk of future reactions, so you can enjoy outdoor activities again.

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Drug allergy

Have you ever been told you’re allergic to penicillin – and then spent years avoiding penicillin and warning your doctor not to use it when treating an infection?  Many people think they’re penicillin-‐ allergic, but recent studies show that a majority of those who have been told they’re allergic to penicillin are actually not.  Non-penicillin antibiotics may offer too “broad” of a spectrum of anti-microbial coverage and can result in more side effects, some of which are serious and would have been avoidable if the patient was correctly identified as not allergic.  If you think you have a penicillin allergy, consider testing with us – 90 percent of patients tested are found not to be allergic.  That said, penicillin allergy is a life-threatening condition, and patients who are truly allergic must avoid the medication and inform (and often remind) their providers of their allergy.  Knowing for sure whether or are allergic or not is key, and our providers can help you with this.

Testing can be done for some other medications as well as penicillin.  

Herbal supplements or homeopathic medicine can cause allergic reactions just like any other medications.  Don’t overlook these supplements and medicines.  They are medications and should always be included in your current medication list.

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