Slide presentation by Dr. Jeff Hallett from Texas Public Radio's Think Science event held at the Pearl Studio on May 17, 2019.

1. Texas Public RadioTexas Public Radio
Think Science:Think Science:
AllergiesAllergies

3. THINK SCIENCE: ALLERGIES CERTIFIED ALLERGY & ASTHMA OF SAN
ANTONIO
Jeffrey S. Hallett, MDJeffrey S. Hallett, MD
Daniel A. Ramirez, Jr., M.D.Daniel A. Ramirez, Jr., M.D.
Robert M, Ramirez, M.D.Robert M, Ramirez, M.D.
Daniel A. Ramirez, Sr., M.D.Daniel A. Ramirez, Sr., M.D.
Robert L. Jacobs, M.D.Robert L. Jacobs, M.D.

4. THINK SCIENCE: ALLERGIES CERTIFIED ALLERGY & ASTHMA OF SAN
ANTONIO
Jeffrey S. Hallett, MDJeffrey S. Hallett, MD
Daniel A. Ramirez, Jr., M.D.Daniel A. Ramirez, Jr., M.D.
Robert M, Ramirez, M.D.Robert M, Ramirez, M.D.
Daniel A. Ramirez, Sr., M.D.Daniel A. Ramirez, Sr., M.D.
Robert L. Jacobs, M.D.Robert L. Jacobs, M.D.
Medical Center Office:Medical Center Office:
8285 Fredericksburg Road8285 Fredericksburg Road
TEL 210-614-3923TEL 210-614-3923
Alamo Heights Office:Alamo Heights Office:
999 E. Basse Road999 E. Basse Road
TEL 210-822-5300TEL 210-822-5300

5. THINK SCIENCE: ALLERGIES CERTIFIED ALLERGY & ASTHMA OF SAN
ANTONIO
 West Virginia nativeWest Virginia native
 West Virginia University ( BA & MD )West Virginia University ( BA & MD )
 Residency & Fellowship at Wilford HallResidency & Fellowship at Wilford Hall
 Air Force staff allergist – 4 yearsAir Force staff allergist – 4 years
 Solo private practice in Austin /Solo private practice in Austin /
Round Rock 25+ yearsRound Rock 25+ years
 Certified Allergy & Asthma 2+ yearsCertified Allergy & Asthma 2+ years
 Special area of interest -Special area of interest -
respiratory allergies / immunotherapyrespiratory allergies / immunotherapy
Jeff Hallett, MDJeff Hallett, MD

6. THINK SCIENCE: ALLERGIES CERTIFIED ALLERGY & ASTHMA OF SAN
ANTONIO
What exactly do allergists treat?What exactly do allergists treat?
 Allergic respiratory diseasesAllergic respiratory diseases
Allergic Rhinitis and AsthmaAllergic Rhinitis and Asthma
 Recurrent infections - immunodeficiencyRecurrent infections - immunodeficiency
 Foods allergiesFoods allergies
 Hymenoptera (stinging insect) allergiesHymenoptera (stinging insect) allergies
 Allergic skin disordersAllergic skin disorders
 Urticaria (“hives”)Urticaria (“hives”)
 Angioedema (“swelling”)Angioedema (“swelling”)
 Atopic dermatitis (“eczema”)Atopic dermatitis (“eczema”)
 Medication reactionsMedication reactions

7. THINK SCIENCE: ALLERGIES CERTIFIED ALLERGY & ASTHMA OF SAN
ANTONIO
What exactly do allergists treat?What exactly do allergists treat?
 Allergic skin disordersAllergic skin disorders
 Urticaria (“hives”)Urticaria (“hives”)
 Angioedema (“swelling”)Angioedema (“swelling”)
 Atopic dermatitis (“eczema”)Atopic dermatitis (“eczema”)
 Medication reactionsMedication reactions
Allergic rhinitis and asthmaAllergic rhinitis and asthma
 Allergic respiratory diseasesAllergic respiratory diseases
Allergic Rhinitis and AsthmaAllergic Rhinitis and Asthma
 Recurrent infections - immunodeficiencyRecurrent infections - immunodeficiency
 Foods allergiesFoods allergies
 Hymenoptera (stinging insect) allergiesHymenoptera (stinging insect) allergies

8. AllergicAllergic
RhinitisRhinitis
““hayfever”hayfever”
( AKA Complete Misery )( AKA Complete Misery )
THINK SCIENCE: ALLERGIES CERTIFIED ALLERGY & ASTHMA OF SAN
ANTONIO

9. THINK SCIENCE: ALLERGIES CERTIFIED ALLERGY & ASTHMA OF SAN
ANTONIO
Allergic Rhinitis:Allergic Rhinitis: SYMPTOMSSYMPTOMS
 Runny nose and nasal congestionRunny nose and nasal congestion
 Watery, itchy, red eyesWatery, itchy, red eyes
 Sneezing – spasmsSneezing – spasms
 CoughingCoughing
 Itching of the nose, mouth, throat, earsItching of the nose, mouth, throat, ears
 Dark circles, puffy eyes – “shiners”Dark circles, puffy eyes – “shiners”
 Postnasal dripPostnasal drip
 Fatigue / grumpiness / headachesFatigue / grumpiness / headaches

10. THINK SCIENCE: ALLERGIES CERTIFIED ALLERGY & ASTHMA OF SAN
ANTONIO
Is it allergies or a common cold?
Allergic RhinitisAllergic Rhinitis Common ColdCommon Cold
Signs andSigns and
symptomssymptoms
Runny nose with thin,Runny nose with thin,
watery discharge;watery discharge;
no feverno fever
Runny nose with wateryRunny nose with watery
or thick yellowor thick yellow
discharge;discharge;
body aches;body aches;
low-grade feverlow-grade fever
OnsetOnset Immediately afterImmediately after
exposure to allergensexposure to allergens
One to three days afterOne to three days after
exposure to a cold virusexposure to a cold virus
Duration ofDuration of
symptoms …symptoms …
As long as you areAs long as you are
exposed to the allergensexposed to the allergens
Three to seven daysThree to seven days
Allergic Rhinitis:Allergic Rhinitis: SYMPTOMSSYMPTOMS

11. THINK SCIENCE: ALLERGIES CERTIFIED ALLERGY & ASTHMA OF SAN
ANTONIO
THE TEXAS PATTERN ….THE TEXAS PATTERN ….
WINTER -WINTER - Mountain CedarMountain Cedar
SPRING -SPRING - Trees (Oak)Trees (Oak)
SUMMER -SUMMER - GrassesGrasses
FALL -FALL - WeedsWeeds
ALL YEAR -ALL YEAR - MoldsMolds
Dust MitesDust Mites
Animal DandersAnimal Danders
Allergic Rhinitis:Allergic Rhinitis: CAUSESCAUSES

12.  Reduced quality of life –Reduced quality of life –
interference with work, school,interference with work, school,
leisure activities;leisure activities;
… loss of productivity… loss of productivity
 Poor sleep – fatigue and malaisePoor sleep – fatigue and malaise
 Worsening asthmaWorsening asthma
 SinusitisSinusitis
 Ear infections (otitis)Ear infections (otitis)
THINK SCIENCE: ALLERGIES CERTIFIED ALLERGY & ASTHMA OF SAN
ANTONIO
Allergic Rhinitis:Allergic Rhinitis: COMPLICATIONSCOMPLICATIONS

13. THINK SCIENCE: ALLERGIES CERTIFIED ALLERGY & ASTHMA OF SAN
ANTONIO
Allergic Rhinitis:Allergic Rhinitis: DIAGNOSISDIAGNOSIS
SKINSKIN
TESTINGTESTING
BLOODBLOOD
TESTINGTESTING
PULMONARYPULMONARY
FUNCTIONFUNCTION
TESTINGTESTING
HISTORYHISTORY
ANDAND
EXAMEXAM

14. THINK SCIENCE: ALLERGIES CERTIFIED ALLERGY & ASTHMA OF SAN
ANTONIO
AvoidanceAvoidance
MedicationsMedications
ImmunotherapyImmunotherapy
Allergic Rhinitis:Allergic Rhinitis: TREATMENTTREATMENT

15. THINK SCIENCE: ALLERGIES CERTIFIED ALLERGY & ASTHMA OF SAN
ANTONIO
AvoidanceAvoidance
MedicationsMedications
ImmunotherapyImmunotherapy
Allergic Rhinitis:Allergic Rhinitis: TREATMENTTREATMENT

16. THINK SCIENCE: ALLERGIES CERTIFIED ALLERGY & ASTHMA OF SAN
ANTONIO
AvoidanceAvoidance
MedicationsMedications
ImmunotherapyImmunotherapy
Allergic Rhinitis:Allergic Rhinitis: TREATMENTTREATMENT

17. THINK SCIENCE: ALLERGIES CERTIFIED ALLERGY & ASTHMA OF SAN
ANTONIO
AvoidanceAvoidance
MedicationsMedications
ImmunotherapyImmunotherapy
Allergic Rhinitis:Allergic Rhinitis: TREATMENTTREATMENT
“Controller Meds” - Use preventatively, every day
Nasal topical corticosteroids (OTC)
Montelukast (Rx)
“Reliever Meds” - Use as needed, but safe every day
Oral antihistamines (OTC)
Topical nasal antihistamines (Rx)
Topical eye preparations (OTC / Rx)
“Supplemental Meds” - Temporary use only
Systemic corticosteroids (Rx) - (oral or injection)
Antibiotics (Rx)

18. THINK SCIENCE: ALLERGIES CERTIFIED ALLERGY & ASTHMA OF SAN
ANTONIO
AvoidanceAvoidance
MedicationsMedications
ImmunotherapyImmunotherapy
““Immunomodulation”Immunomodulation”
Allergic Rhinitis:Allergic Rhinitis: TREATMENTTREATMENT

19. THINK SCIENCE: ALLERGIES CERTIFIED ALLERGY & ASTHMA OF SAN
ANTONIO
Currently available therapies ….Currently available therapies ….
 Subcutaneous immunotherapy (SCIT) -Subcutaneous immunotherapy (SCIT) - “allergy injections”“allergy injections”
 Sublingual immunotherapy (SLIT) -Sublingual immunotherapy (SLIT) - “allergy drops”“allergy drops”
““SLIT tablets”SLIT tablets”
( Grass, Ragweed, Dust Mites only )( Grass, Ragweed, Dust Mites only )
Potential therapies ….Potential therapies ….
 Intralymphatic immunotherapy – ILITIntralymphatic immunotherapy – ILIT
 Biologics – monoclonal antibodiesBiologics – monoclonal antibodies
Allergic Rhinitis:Allergic Rhinitis: TREATMENT:TREATMENT:
IMMUNOMODULATIONIMMUNOMODULATION

20. Allergic Rhinitis:Allergic Rhinitis: TREATMENT:TREATMENT:
IMMUNOMODULATIONIMMUNOMODULATION
Currently available therapies …. SCIT vs. SLITCurrently available therapies …. SCIT vs. SLIT
THINK SCIENCE: ALLERGIES CERTIFIED ALLERGY & ASTHMA OF SAN
ANTONIO
SCIT - “Shots”SCIT - “Shots” SLIT - “Drops”SLIT - “Drops”
Injections weekly, eventually monthly Drops daily
In-office administration Home administration
Minimum 1 hour commitment 5 minute commitment
Advancement over 3-6 months Advancement over 30 days or less
Insurance coverage likely Out-of-pocket expense
Effective and safe (1% risk anaphylaxis) Effective and safer (0.01% risk anaphylaxis)

21. THINK SCIENCE: ALLERGIES CERTIFIED ALLERGY & ASTHMA OF SAN
ANTONIO
RESOURCES FOR MORE INFORMATION ….RESOURCES FOR MORE INFORMATION ….
ORGANIZATION TEL WEB
American Academy of Allergy (AAAAI)American Academy of Allergy (AAAAI) 414-272-6071414-272-6071 www.aaaai.orgwww.aaaai.org
American College of Allergy (ACAAI)American College of Allergy (ACAAI) 847-427-1200847-427-1200 www.acaai.orgwww.acaai.org
Texas Allergy Society (TAAIS)Texas Allergy Society (TAAIS) 512-451-6108512-451-6108 www.taais.orgwww.taais.org
American Lung Assoc (Texas)American Lung Assoc (Texas) 214-631-5864214-631-5864 www.lung.orgwww.lung.org
Asthma & Asthma Foundation (AAFA)Asthma & Asthma Foundation (AAFA) 800-727-8462800-727-8462 www.aafa.orgwww.aafa.org
Food Allergy Research & Education (FARE)Food Allergy Research & Education (FARE) 800-929-4040800-929-4040 www.foodallergy.orgwww.foodallergy.org
Immune Deficiency Foundation (IDF)Immune Deficiency Foundation (IDF) 800-296-4433800-296-4433 www.primaryimmune.orgwww.primaryimmune.org
Allergy & Asthma Network (AAN)Allergy & Asthma Network (AAN) 800-878-4403800-878-4403 www.allergyasthmanetwork.orgwww.allergyasthmanetwork.org

22. Don’t panic ….
Relief is possible.
THINK SCIENCE: ALLERGIES CERTIFIED ALLERGY & ASTHMA OF SAN
ANTONIO

23. THINK SCIENCE: ALLERGIES
JEFFREY S. HALLETT, M.D.
Thank you for your
attention.
And good luck with your
allergy management!