Allergist | Asthma | Immunology |Allergic Dermatology
Dr. Audrey Weissman specializes in a wide variety of allergy and asthma testing procedures and treatments for both adults and children. Below, we have outlined some areas of Dr. Weissman's expertise. Dr. Weissman is one of the few New York allergists who treat both adults and children. At Rego Park Medical Associates we strive to treat all conditions while incorporating the most current available treatment modalities and medications.
Sinusitis refers to any kind of inflammation or irritation of the sinuses. This is typically caused by bacterial infections. Since the sinuses connect directly with the nose, usually the main signs of a sinus infection are a stuffy nose and drainage from the nose. The reason that sinusitis can be so debilitating, and why it can become serious when complications occur, is that sinus infections weaken the body's defense mechanism for most infections via the cilia; worsening your sinuses until getting treated. Your very breathing is dependent on clear sinuses, making sinusitis particularly unpleasant.
Dr. Audrey Weissman, our certified allergist and Grace, our registered nurse are specially trained in the treatment of allergic conditions. As a first step towards diagnosing allergies, an extensive history and physical would be performed in our office. If your history indicates possible allergic problems, we would suggest allergy skin and/or blood testing.
Common Terms and Procedures
An aberrant immune response following repeated exposure to otherwise harmless substances such as animal dander, pollen, dust, mold spores, medications or foods.
Allergic rhinitis (seasonal and perennial)
Inflammation of the nasal mucous membranes due to an allergic response to either indoor and/or outdoor allergens.
Allergic contact dermatitis (contact eczema)
A type of itchy rash caused by an allergic reaction to specific chemical substances that contact the skin. Dr. Weissman has an interest in the diagnosis and treatment of contact dermatitis and uses a greatly expanded panel of allergens from Smart Practice, Canada using the Allergeze method to improve diagnosis. Most doctors only use the T.R.U.E. patch test which has a limited amount of allergens. In North America, the most common contact allergen is to the metal, specifically nickel sulfate, which is used in most jewelry.
A medical emergency which involves an acute systemic (affecting the entire body) allergic reaction. It occurs after exposure to an allergen to which a person was previously sensitized. This reaction can be life-threatening.
A non-itching reaction in the skin's underlying tissue marked by swelling and red blotches, this often involves the face and hands. It can be very dramatic and even restrict breathing, similar in pathology to hives (urticaria), but occurs in deeper tissue.
A chronic, inflammatory lung disease characterized by recurrent breathing problems. Episodes of asthma can be triggered by allergens, infection, exercise, cold air and other factors. This condition is becoming more common in both adults and pediatric patients.
Asthma in pregnancy
Pregnant patients with asthma need close monitoring to maximize their lung function and minimize possible adverse effects to the fetus from lack of oxygen or medication reactions. They also need proper selection of medications during pregnancy.
An inflammation of the bronchi (lung airways), resulting in persistent cough. Bronchitis is more common in smokers and in areas with high air pollution.
An adverse immune reaction following contact with otherwise harmless drugs, usually manifested as a rash or other systemic complaints, up to and including anaphylaxis.
An inflammation of the skin, usually causing itching and sometimes accompanied by crusting, scaling or blisters. A type of eczema often made worse by allergen exposure is termed "atopic dermatitis". This condition is particularly common in pediatric patients.
An adverse immune reaction following contact with otherwise harmless foods, the manifestations of this reaction may range from mild to life-threatening. These reactions may be found in both children and adults.
A range of disorders, both inherited and acquired, that result in the dysfunction of part or all of the normal immune response.
An adverse immune reaction following contact with insect stings (i.e. honeybees or yellow jackets). The manifestations of this reaction may range from mild to life-threatening.
A respiratory disorder directly related to inhaling fumes, gases, dust or other potentially harmful substances while "on the job". With occupational asthma, symptoms of asthma may develop for the first time in a previously healthy worker, or pre-existing asthma may be aggravated by exposures within the work place.
An inflammation or infection of the middle ear , commonly found in infants and children with allergic rhinitis.
An inflammation of the nasal passages, often due to an allergy to pollen, dust or other airborne substances. Seasonal allergic rhinitis, also known as "hay fever", is a disorder characterized by sneezing, itching, runny nose accompanied by nasal congestion. Another common form of rhinitis; non-allergic rhinitis, or vasomotor rhinitis, is usually triggered by certain factors, such as strong smells, pollution, particulate matter in the air, smoke and other irritants.
An acute or chronic inflammatory condition of the sinuses, often caused by a bacterial or viral infection, which can be associated with chronic nasal allergies.
An allergic reaction of the skin which is characterized by the development of itchy, raised welts, most often resembling mosquito bites. There are many reasons why hives occur. Allergy testing and a thorough history taking can be of great value in determining the cause of urticaria.
Procedures performed by Dr. Audrey Weissman
Treatment and diagnosis of allergic and pulmonary conditions can vary depending on the severity and duration of the discomfort, reaction, and/or condition. At Rego Park Medical Associates., we use our expertise in the most current testing methodologies and procedures to diagnose our patients.
Please see the description below.
Allergy skin testing
The scratch, or more accurately, the prick-puncture test (one of the most common methods) involves placement of a small amount of suspected allergy-causing substances (allergens) on the skin (usually the forearm, upper arm, or the back), and then pricking the skin so that the allergen is introduced under the skin surface. The skin is observed closely for signs of a reaction, usually swelling and redness of the site – a controlled hive with a so-called wheal and flare. Results are usually obtained within about 20 minutes. Several suspected allergens can be tested at the same time.
A similar method involves injection of a small amount of allergen within the surface of the skin (intradermal skin testing) to test for allergies in adults as a more sensitive version of the skin prick test.
IMMUNO CAP-RAST -FAST testing
A sensitive and specific blood test for allergies- used in conjunction with allergy skin testing for diagnosis of allergies. It offers the advantage of not having to stop any medicines for the purpose of allergy testing.
Immunotherapy ("allergy shots , desensitization or allergy vaccinations ")
A form of preventive and anti-inflammatory treatment of allergy to substances such as pollen, dust mites, mold and stinging insect venom. It involves administering gradually increasing doses of the substance (allergen) to which the person is allergic. The incremental increases of the allergen cause the immune system to become less sensitive to the substance over time, which reduces the symptoms of allergy when the substances are encountered in the future. The benefits of allergy shots can last for years after a full course of treatment.
Administration of immunomodulatory agents
Medications that can increase or suppress immune responses of the body, given for autoimmune diseases or immunodeficiency. Administration of Xolair, a novel treatment for asthma, is one of the newest immunomodulatory agents used in our practice.
A form of skin testing in which suspected allergens are applied to the skin, covered and observed for several days to see if a reaction occurs. This is often used in identifying the possible causes of allergic contact dermatitis.
A peak flow meter is a small, hand-held device used to manage asthma by monitoring lung capacity. The peak flow meter measures the patient’s ability to expel air from the lungs, or peak expiratory flow rate (PEFR). From these changes in measurement, patients and doctors may determine lung functionality, severity of asthma symptoms, and treatment options.
A procedure in which a thin, lighted tube is inserted into the nasal cavity to look for possible causes of nasal congestion, loss of sense of smell, or other common sinus problems.
Spirometry/Pulmonary Function Testing/Bronchospasm Evaluation/DLCO/NIOX
This is a test that measures how well the lungs perform. It gives doctors an objective measure of how well the lungs are functioning, and is most useful when assessing for obstructive lung diseases such as asthma or chronic obstructive pulmonary disease (COPD). Often, a bronchodilator such as albuterol, may be used to assist in the diagnosis of asthma/COPD.
What is Sinusitis?
Sinusitis is usually divided in two categories by physicians:
Acute Sinusitis — usually lasts for 3 weeks, or less
Chronic — lasting longer than 6 weeks, but can continue for months or even years
Recurrent — refers to having several acute attacks within a year
Health care experts estimate that 37 million Americans are affected by sinusitis every year. In addition, health care workers report 33 million cases of chronic sinusitis to the US Centers of Disease Control and Prevention every year. Furthermore, Americans spend billions of dollars each year for medications, either over the counter or prescription that promise relief from their sinus symptoms.
What are Sinuses?
Let us attempt to demystify the often-misunderstood topic of sinus congestion, sinus headaches and sinusitis.
The Sinuses are air cavities in the human body, in this case the skull. The cavities next to the nose are called paranasal sinuses and are the ones that bother most people, when they say they suffer from sinus congestion and pressure.
Paranasal Sinusitis Types
There are four different paranasal sinuses:
· Frontal Sinuses—overly the eyes in the brow area.
· Maxillary Sinuses—directly underneath the cheek bones.
· Ethmoid Sinuses—found directly behind the bridge of the nose and between the eyes.
· Sphenoid Sinuses—found behind the ethmoids in the upper region of the nose and behind the eyes.
Each sinus has an opening, called an ostium, into the nose which serves to exchange air and mucus produced. The opening is joined to nasal passages by a continuous mucous membrane. Anything that causes a swelling in the nose such as an infection or an allergic reaction, can affect the sinuses. When air gets trapped within a blocked sinus, along with pus or other secretions, it can cause pressure on the sinus wall. Also, if air is prevented from entering a paranasal sinus by a swollen membrane at the ostium, a vacuum can be created which also causes discomfort.
Symptoms of Sinusitis
What are Sinusitis Symptoms?
The location of your sinus discomfort depends on which sinus is affected.
Infection of the maxillary sinuses can cause your upper jaw, and sometimes, teeth to ache and your cheeks to become tender to touch.
Because the ethmoid sinuses are near the tear ducts, inflammation of these cavities often causes swelling of the eyelids, tearing and pressure between the eyes. Ethmoid inflammation also can cause tenderness when the sides of your nose are touched, a loss of smell sensation (anosmia) and stuffy nose.
Although the sphenoid sinuses are less frequently affected, infection in this area can cause earaches, neck pain, and deep aching at the top of your head. In real life, people with sinusitis, however, have pressure or tenderness in several locations, and their symptoms usually do not clearly indicate which sinuses are inflamed.
Other symptoms of sinusitis can include: fever, fatigue, recurrent cough that may be more severe at night and first thing in the morning, runny nose (rhinitis), or nasal congestion. Also, the drainage of mucus from the sphenoid or other sinuses down the back of your throat, which is commonly referred to as “postnasal drip” can cause you to have a sore throat. On rare occasions, acute sinusitis can result in brain or eye infection and other serious complications.
Causes of Sinusitis
Causes of Sinusitis
What are some causes of Acute Sinusitis?
Most cases of acute sinusitis start with a common cold, which is caused by a virus. These viral colds do not cause symptoms of sinusitis, but they do inflame the sinuses. Most people confuse a common cold with a sinus infection. Both the cold and the sinus inflammation usually go away without treatment in 10 to 14 days. The ensuing nasal inflammation might predispose you to develop acute sinusitis. The body reacts to a cold by producing extra mucus and sending immune cells to the lining of the nose, which, in turn congest and swell the nasal passages.
When this swelling involves the adjacent mucous membranes of your sinuses, air and mucus are trapped behind the narrowed openings of the sinuses. When your sinus openings become too narrow, mucus drainage is impaired This increase in mucus sets up prime conditions for bacteria to multiply.
Most healthy people harbor bacteria, such as Streptococcus pneumoniae and Haemophilus influenzae, in their upper respiratory tracts with no problems until the body's defenses are weakened or drainage from the sinuses is blocked by a cold or secondary to allergic rhinitis (nasal allergies). Thus, bacteria that may have been living harmlessly in your nose or throat can multiply and invade your sinuses, causing an acute sinus infection.
Sometimes, fungal infections can cause acute sinusitis. Although fungi are abundant in the environment, they usually are harmless to healthy people. Fungi or Mold, such as Aspergillus, can cause serious illness in people whose immune systems are not functioning properly. Some people with fungal sinusitis have an allergic-type reaction to the fungi. This process is now called AFS (allergic fungal sinusitis).
As stated, chronic inflammation of the sinuses and nasal passages which is often seen in people with allergic rhinitis (both indoor and outdoor), can play a significant role in the development of acute sinusitis and chronic rhinosinusitis. Non-allergic rhinitis or vasomotor rhinitis, aggravated by humidity, cold air, alcohol, perfumes, and other environmental conditions, also may be complicated by sinus infections.
Acute sinusitis is much more common in some people than in the general population. For example, sinusitis occurs more often in people who have reduced immune function (such as those with immune deficiency diseases or HIV infection); with abnormality of mucus secretion or mucus movement (such as those with cystic fibrosis) and those with nasal septum deviation (crooked “divider” of the nose).
What causes chronic sinusitis?
There isn’t one cause of chronic sinusitis, per se, but inflammation is thought to play an integral part in the development of chronic sinusitis. For example, people who suffer from asthma (inflammation of the airways) are much more likely to have frequent episodes of chronic sinusitis. This has led some researchers to investigate the link between asthma and chronic rhinosinusitis and referring to it as “one airway hypothesis”.
If you are allergic to airborne allergens, such as dust, mold, and pollen, which trigger allergic rhinitis, you may develop chronic sinusitis also. In addition, people who are allergic to fungi can develop a condition called "allergic fungal sinusitis."
Also, if you suffer from chronic sinusitis, you may also be affected by weather changes (e.g. damp weather) or air pollution, much more so than the general population.
Like acute sinusitis, you might develop chronic sinusitis if you have an immune deficiency disease or an abnormality in the way mucus moves through and from your respiratory system (e.g., immune deficiency, HIV infection, and cystic fibrosis). In addition, if you have asthma, nasal polyps (small growths in the nose), or a severe asthmatic response to aspirin and aspirin-like medicines such as ibuprofen, you may experience repeat bouts of chronic, recurrent sinusitis.
How is Sinusitis treated?
After diagnosing sinusitis and identifying a possible cause, your doctor can suggest treatments that will reduce your inflammation and relieve your symptoms.
In cases of acute sinusitis – your doctor may recommend:
· Topical or oral decongestants to reduce congestion
· Antibiotics to control a bacterial infection, if present
· An oral corticosteroid, to decrease congestion and inflammation, and help the antibiotic work better.
In our office, it is common practice to give all patients a “sinusitis flow sheet”, which they follow strictly. Patients should avoid using over the counter decongestant nose drops for longer than 5 to 7 days, as they can lead to even more congestion and swelling. Patient commonly refer to this as a rebound phenomenon or as “addiction” to nose sprays.
Many cases of acute sinusitis will spontaneously resolve without antibiotics. If you have allergic disease along with infectious sinusitis, however, you may need medicine to relieve your allergy symptoms also. If you are a patient who suffers from asthma, keep in mind that an acute sinus infection usually worsens asthma symptoms.
Chronic sinusitis treatment
Doctors often find it difficult to treat chronic sinusitis successfully, realizing that symptoms persist even after taking antibiotics for a long period. In our office, we must become really creative in devising different methods getting the medication to its site of action. In general, treating chronic sinusitis is no different than treating acute sinusitis with antibiotics and decongestants. Because inflammation plays such an important role in chronic sinusitis, doctors also add topical corticosteroid nasal sprays (e.g. Flonase, Fluticasone, Nasonex, Nasacort AQ, Rhinocort AQ, Veramyst, Omnaris, Zetonna) which are used daily. Depending on the origin and predisposing factors, oral prednisone or methylprednisolone (Medrol dose pack) can be added.
Also, various combinations of oral antihistamines and leukotriene modifiers (Singulair, Zyflo) can be used. In our office, we have devised a method of direct, concentrated delivery of topical corticosteroid drops to the sinuses, thereby reducing the overall need for oral corticosteroids.
Because oral corticosteroids tend to have a wide range of side effects, it is prudent to use them with caution. In many severe cases, however, oral corticosteroid preparations are essential for proper resolution of the sinus infection.
Patients with moderate to severe asthma may have dramatic improvement of their symptoms when their chronic sinusitis is treated with antibiotics, lending more support for the “one airway” hypothesis.
Although home remedies cannot cure a sinus infection, they might give you some comfort. Inhaling steam from a vaporizer or a hot cup of water can soothe inflamed sinus cavities. Numerous studies have demonstrated the effectiveness saline nasal sprays or rinses (Netti-pot or commercially available preparations) when used as part of a general sinus care routine. Gentle heat applied over the inflamed area can also be very comforting. There are numerous folk remedies used for sinusitis too.
When medical treatment fails, sinus surgery may be the only alternative for treating chronic sinusitis. Research studies suggest that the vast majority of people who undergo surgery have fewer symptoms and a better quality of life.
In children, sinus infections can often be eliminated by removal of adenoids obstructing nasal-sinus passage drainage.
Nasal polyps which are more prevalent in people with allergies or chronic sinus infections can also interfere with sinus drainage, thereby leading to repeat bouts of sinusitis. Removal of these polyps and/or repair of a deviated septum to ensure an open airway often provides considerable relief from sinus symptoms.
The most common sinus surgery done today is functional endoscopic sinus surgery (FESS), in which the natural openings from the sinuses are enlarged to allow proper drainage. This type of surgery is less invasive than conventional sinus surgery, and serious complications are rare.
Sinusitis Diagnosis – Prevent Sinus
How is Sinusitis diagnosed?
The diagnosis is clinical. Because your nose can get stuffy when you have a condition like the common cold, you may confuse simple nasal congestion with sinusitis. A cold, however, usually lasts about 7 to 14 days and disappears without treatment. Acute sinusitis often lasts longer and typically causes more symptoms than just a cold.
Your doctor can diagnose sinusitis by listening to your symptoms, doing a physical examination, looking into your nose and larynx with a fiber optic flexible camera, or a CT (CAT scan) or MRI of the sinuses.
How can I prevent Sinusitis?
You cannot prevent sinus infections from happening, but, with proper education and recognition of symptoms, their incidence can be greatly reduced.
If you are prone to getting sinus disorders, especially if you have allergies, you should avoid cigarette smoke and other air pollutants. If your allergies inflame your nasal passages, you are more likely to have a strong reaction to all irritants.
If you suspect that your sinus inflammation may be related to dust, mold, pollen, or food-or any of the hundreds of allergens that can trigger an upper respiratory reaction-you should consult your allergist. Your allergist can use various tests to determine whether you have an allergy and its cause. This will help you take appropriate steps to reduce or limit your allergen exposure and decrease symptoms.
You may find that air travel poses a problem if you are suffering from acute or chronic sinusitis. As air pressure in a plane is reduced, pressure can build up in your head blocking your sinuses or Eustachian tubes in your ears. Therefore, you might feel discomfort in your sinus or middle ear during the plane's ascent or descent. In our office, we commonly prescribe a combination of medications which are taken before, during, and after air travel to reduce discomfort of sinuses or of the middle ear.
For further information on allergies & asthma please click on the links below: