- Osteoporosis
- Headaches
- Warts
- ArthritisAutoimmune disease may be limited to a single tissue or organ, or may be more global in nature (e.g., autoimmune hemolytic anemia and systemic lupus erythematosis or rheumatoid arthritis). Gastrointestinal symptoms in immunodeficient patients may be secondary to autoimmune disease (e.g., inflammatory bowel disease, lymphoid hyperplasia, Celiac disease, atrophic gastritis with pernicious anemia) or infections (Giardia lamblia, rotavirus, cryptosporidiosis).
- SinusitisUnderlying problems may include environmental allergy, pollution exposure (e.g. exposure to cigarette smoke), related medical problems (gastroesophageal reflux disease, chronic sinusitis, etc.), stress, insufficient medical management of chronic inflammation of the airways, inconsistent physician followup and/or poor patient compliance with physician recommendations.
- Medical Weight LossCeliac disease (non-IgE-mediated) or celiac sprue, is a chronic adverse reaction to gluten. Symptoms include recurrent cramps, bloating, weight loss and bowel problems. Those with Celiac disease will not lose their sensitivity to gluten in wheat. Therefore, lifelong elimination of gluten is necessary.
- Pediatric CareFlu vaccines contain a tiny amount of egg. Individuals with egg allergy should undergo allergy skin testing with the vaccine and if necessary be desensitized to the vaccine if the skin test is positive. [American Academy of Pediatrics (AAP) recommends that the MMR vaccine can be safely administered to all patients with egg allergy.]
- Smoking CessationCOPD is usually caused by cigarette smoking while asthma is not cause by smoking, although it will be worsened by smoking. Asthma is frequently associated with allergy while COPD is not. Asthma is usually highly responsive to medications, and avoidance of symptoms triggers usually results in reversibility of airway obstruction. In contrast, the airway obstruction in COPD rarely shows much reversibility with treatment. However, the progression of COPD may be stopped or slowed down with smoking cessation. An allergist or pulmonologist can tell the difference between asthma and COPD and offer appropriate treatment.
- Ear InfectionsRecurrent infections of the respiratory tract (e.g., lungs, sinuses, ears, nose and throat) are common clinical presentations of patients that are often referred to an allergist/immunologist for evaluation. Many patients who have received multiple courses of antibiotics for frequent sinus infections, colds, chest infections, ear infections and sore throats are evaluated yearly for defects of the immune system. In most cases, these infections turn out to be due to respiratory allergy or simply frequent infections. However, in a few cases, a specific immunodeficiency will be diagnosed and the resulting treatment may be lifesaving.
- Family Practice
- Emergency CareAt The Asthma Center, we treat a variety of patients of all ages, some of which have diminished immune systems or pre-existing conditions putting such individuals at risk for more severe complications of coronavirus infection. Many of our patients require in-office care to maintain control of upper and lower respiratory problems and remain free of flares and compilations. By controlling your symtpoms, this can prevent urgent care, emergency room and hospital visits – this will reduce your chance of getting coronavirus.
- Constipation
- Flu ShotsWalk-in flu shots available in all locations throughout Delaware Valley including Philadelphia (Center City, Society Hill, Northeast), The Main Line (Bala Cynwyd), Bucks County (Langhorne), and South Jersey (Mt. Laurel, Woodbury, Hamilton, Forked River).
- Irritable Bowel SyndromeIrritable bowel syndrome. This recurrent or chronic condition is often associated with cramping, constipation and diarrhea following meals. Symptoms may arise from the inability of gut bacteria to breakdown certain sugar carbohydrates and sugar alcohols.
- Bronchitis
- Diarrhea
- Pneumonia
- ImmunizationsThe influenza vaccine (flu shot) is an immunization which helps the body avoid or minimize the effects of infection with the influenza virus (“the flu”). It protects against infection with the most common strains of the influenza virus which are circulating throughout the world that particular year.
- GlaucomaIn severe cases, a burst of oral corticosteroids or frequent application of topical corticosteroids is needed to relieve unbearable symptoms. Prolonged use of corticosteroids should be avoided because of their association with the complication of glaucoma and/or cataracts.
- CataractsAtopic keratoconjunctivitis is almost always bilateral, and symptoms include itching, burning, tearing, and mucoid discharge. It is frequently associated with eyelid dermatitis and chronic blepharitis and may result in visual impairment from corneal scarring. Keratoconus is a conical deformity of the cornea that is believed to result from persistent rubbing of the eyes in patients with atopic dermatitis and allergic rhinitis. Anterior subcapsular cataracts may develop during adolescence or early adult life as a complication of AD.
- Pregnancy
- Internal MedicineAll physicians in the United States are licensed to practice medicine by the states where they see patients. This however does not specify whether a physician can practice a specific medical specialty, like dermatology, orthopedics or allergy. Board-certification assures the public and medical community that the physician has completed an accredited educational program and passed evaluations to provide patients with high-quality care in allergy and immunology. The board-certification process in allergy requires medical school graduates to complete further training, including a three year residency program in pediatrics or internal medicine followed by a two to three year fellowship specializing in allergy and immunology. Completion requires passing certification examinations to uphold consistent standards across the country, and physicians must maintain their certification with continuing education throughout their careers. The allergy and immunology training prepares doctors to identify and treat immune system disorders that can cause allergies, asthma, chronic lung disease, skin diseases, and immune deficiencies. From the extensive medical training and specialization, allergists are best able to detect and treat a patient’s allergens and discern which other conditions can masquerade as allergies. Unlike ENTs, allergists do not perform surgery.
- EndoscopyHistory, physical exam, as well as diagnostic skin testing and upper endoscopy and at times CAT scans may be helpful in evaluation of patients. Appropriately chosen patients for immunotherapy do extremely well over the long term with decrease in medication requirement, improving the symptoms and improving quality of life. Sublingual immunotherapy is a new form of immunotherapy that is not as effective as conventional allergy immunotherapy but may have some role in some limited patients. There are a variety of medication choices for patients who have upper respiratory allergies of seasonal and perennial nature including intranasal or oral antihistamines, intranasal steroids, combination of intranasal antihistamine and nasal steroids, intranasal cromolyn, intransasal decongestants, oral antihistamines with and without oral decongestants, leukotriene modifiers, and intranasal anticholinergic medications. Oftentimes, we will have patients also use nasal lavages to help with clearance of mucus and improve deposition of some medications in the nasal airway.
- Lung CancerDeveloping lung cancer is 20 times more common in smokers than in non-smokers. It is estimated that approximately 80% of women that have lung cancer were smokers, and that 90% of men with lung cancer were smokers. The risk of lung cancer increases in relation to the cumulative amount of cigarette smoked and the length of time that you have smoked.
- AutismThere are several symptoms that are incorrectly linked to food allergy and may be more related to pharmacologic effects to certain foods or not related to foods at all. These include: attention deficit disorder with hyperactivity (ADHD), learning disabilities, autism, seizures, depression, bed-wetting, and fatigue.
- Attention Deficit Hyperactivity Disorder (ADHD)
- Stress ManagementAtopic dermatitis symptoms often disrupt quality of life by affecting sleep and self-esteem, as well as school and work attendance. Although eczema is not a curable disease, it usually can be successfully managed by a combination of skin care, avoidance of triggers, infection control, stress management and medical treatment.
- Depression
- Insomnia
- Anxiety
- ThyroidNasal symptoms may also be part of a more systemic inflammatory immunologic disorder like granulomatous disease, Wegner’s sarcoid, midline granuloma, amyloidosis, thyroid disease, and relapsing polychondritis. Thorough history and examination will oftentimes exclude these other conditions. In addition, it is important to identify other considerations that may affect nasal symptoms including the presence of or absence of septal deviation, adenoid or tonsillar hyperplasia, nasal polyps, nasal tumors, intranasal foreign bodies, evidence of laryngopharyngeal or gastrointestinal reflux (when stomach reflux involves the upper esophagus, voice box, throat, and pharyngeal areas.)
- MRI
- RadiologyAnaphylaxis is the most severe allergic reaction that can stem from a reaction to food, radiology dyes, bee stings, drugs, and exercise. Education and first line immediate therapy and access to our allergists in case of anaphylaxis are the answers to safely managing these severe reactions.
- X-Rays
- Nuclear MedicineThe lung may be a source of immunologic iillnesses as a local process or as part of a more systemic illness. The conditions that have underlying immunologic mechanisms include hypersensitivity pneumonitis, allergic bronchopulmonary aspergillosis (ABPA), eosinophilic lung disease, antiglomerular basement membrane symdrome, Wegener’s granulomatosis, Sarcoidosis, idiopathic pulmonary fibrosis (IPF), nonspecific interstitial pneumonia, and cryptogenic organizing pneumonia or COPD of the lung. Clinical wise, the presentation of these diseases may be somewhat similar in terms of cough, chest tightness, shortness of breath, and in fact may mimic asthma, sometimes more acute symptoms like fever, chills, and dyspnea as in the case of hypersensitivity pneumonitis may be helpful. The evaluation requires an extensive history, the underlying triggers and exposures, radiographic findings, physiologic pulmonary function studies as well as blood assessments, indications and skin testing. On occasion, high index of suppression is usually required for these illnesses and depends on a very detailed environmental history. Prognoses of these illnesses vary depending on the underlying immunologic condition. On occasion when a disease state is suspected but unproven by noninvasive procedures, a diagnostic invasive procedure may be required including bronchoscopy with or without biopsy as well as an open lung biopsy. Of all the immunologic lung disease, the most common probably is Sarcoidosis as this is a systemic disease of unknown origin involving multiple organs with variable frequencies and intensities but oftentimes involves the lungs. Lung involvement usually manifests as lymph node enlargement or infiltrates in the lung with a much higher incidences in the certain populations like African Americans, Puerto Ricans and Scandinavians. Patients usually present in the third to fourth decade. This is not an infectious disease and there is no documented patient to patient transmission, although the disease may occur in families suggesting perhaps a genetic susceptibility or common exogenous exposure leading to disease. Diagnosis is made by a combination of symptoms, laboratory findings, radiographic findings, nuclear medicine findings, and pulmonary function studies and on occasion a biopsy is required.
- Orthopedics
- BotoxTreatment usually involves working with a speech pathologist and a behavioral therapist. Occasionally Botox® injections temporarily can relax vocal cords.
- Dermatology
- Acne Treatment
- UlcerThis is an aggressive treatment for symptomatic relief of a severe AD flare. A short 1-week course of systemic corticosteroids should be followed by a taper over a few days and more intensive daily skin care (i.e., increase bathing frequency and the amount and type of topical corticosteroids), due to the potential of rebound AD symptoms when discontinuing systemic corticosteroids. The side effects of repeat or prolonged courses of systemic corticosteroids include adrenal suppression, growth retardation in children, osteoporosis, hypertension, peptic ulcer, glaucoma, cataracts, and infections due to immunosuppression.
- EczemaAtopic dermatitis (AD), often termed “eczema”, is a chronic pruritic skin condition that affects about 10-20% of children and about 2-3% of adults. It is characterized by extreme itching, dry skin, scaling, erythematous papules, excoriations and exudates. These symptoms may be associated with frequent skin infections, as well as an increased incidence of allergic rhinitis, food allergy, and asthma.
- LesionsAcute AD is characterized by intensely pruritic, erythematous papules associated with excoriations, vesiculations, and serous exudate. Subacute AD is characterized by erythematous, excoriated, scaling papules. Chronic AD is characterized by thickened skin (lichenification) with accentuated markings and changes in pigmentation and fibrotic papules. Patients with chronic AD may have all three types of lesions simultaneously. In addition, patients usually complain of dry skin.
- Rashes
- Skin CareDaily skin care and moisturizing is imperative when treating AD. Improving skin hydration helps to restore skin barrier function. Daily baths in warm water lasting 10-20 minutes followed by immediate application of an effective emollient cream or ointment to lock in moisture are recommended. Some patients may use oatmeal baths to soothe the skin. Moisturizers should be scent- and irritant-free. Ointments are generally preferred, as they tend to have fewer preservatives. Crisco shortening can even be used as an inexpensive moisturizer. Newer barrier creams have been developed that help repair the skin barrier (e.g., Atopiclair, Epicream, and Mimyx). These newer barrier creams can help restore the integrity of the dry skin in AD and offer great benefit to many patients. All of these newer barrier creams require a prescription.
- Psoriasis
- Burns
- AllergiesDuring an allergy shot course of treatment, you will be re-evaluated occasionally by an allergy doctor with allergy skin testing. Based on the results of the allergy testing, subsequent changes in the allergy shot extract or schedule of the allergy injections may be necessary to obtain the best results. Our allergy doctors will usually consider discontinuing injections when you have minimum symptoms and have a normal or near-normal exam for at least one year.