New Patients: Preparing for Your Visit

Skin prick testing is often used to help determine environmental, food or drug allergies. No needles are used -- instead, a small amount of the allergen is placed on the skin with a small prick. The area is then read 15-20 minutes afterwards to see if the area is positive (if a small local hive has formed). Many skin prick tests are often placed during a new visit. If you believe you will be undergoing skin prick testing for allergies please remain off medications such as antihistamines for at least 5-7 days prior to testing. Please click HERE for a full list of medications to avoid. It is safe to continue taking Singulair, asthma inhalers, and steroid nose sprays as they will not interfere with skin testing.

Patch testing involves testing for different types of allergic reactions that are not detected during normal skin testing. The classic example is nickel allergy, but it is also used commonly for patients who may be having contact dermatitis reactions to their cosmetics or shampoo.  It can also be used for further evaluation of eosinophilic esophagitis. This procedure involves placement of the patch containing the allergen on a clear area of the skin, usually the back. The patch is then removed 48 hours later and the test is read. The patch is not to be removed during this 48 hour period and should have little or no contact with water. There may be some mild itching and  irritation while wearing the patch.

Intradermal skin testing is used in some cases to help further evaluate environmental allergy when the skin prick test does not show any allergies, yet there is still suspicion that the patient is allergic. It is also used for drug and venom allergy evaluations. It is never used to diagnose food allergy. This procedure usually follows negative skin prick testing in select patients. A small needle is inserted into the top of the skin and a small amount of allergen is injected, creating a small bubble. The test is then read 15-20 minutes later. Multiple intradermal tests can be placed during a visit to assess allergy to multiple items in question. If you believe you will be undergoing intradermal testing for allergies, please remain off medications such as antihistamines for at least 5-7 days prior to testing.

It is of utmost importance to know how your insurance covers allergy evaluations, imaging and blood tests.  It is generally covered, but oftentimes patients have not met their annual deductible and have to pay-out-pocket until it is met. Sometimes there is a co-insurance split between the patient and the insurance company. It you have concerns about insurance coverage, it is your responsibility to know your policy and how it affects you prior to your appointment so we can work within your needs. This should be located in your explanation of benefits, or EOB. You can also call your insurance to figure exact out-of-pocket costs for potential procedures before you arrive. Everyone should know how their health insurance policy works - you never know when you are going to need it!

Here are some helpful CPT codes if discussing allergy coverage with your insurance:

Allergy prick test:  95004 x the number of tests placed. The average number for a standard environmental skin test is around 50 tests. It could be more or less than this, though.

Intradermal allergy test: 95024 x the number of tests placed.

Oral challenge: 95076 (first two hours); 95079 (each additional hour)

Rapid desensitization: 95180 x the number of hours.

Venom skin test: code 95017 x the number of tests placed.

Drug skin test: code 95018 x the number of tests placed.

Patch test: code 95044 x the number of tests placed.

Baseline spirometry: 94010

Flow volume loop: 94375

Pre and post-bronchodilator evaluation: 94060

Exhaled nitric oxide: 95012

Fiberoptic laryngoscopy: 31575

Fiberoptic nasal endoscopy: 31231

Fiberoptic nasopharyngoscopy: 95211

Allergy injection bills are even more complicated. Click HERE for a handout trying to explain how they work with your insurance.

Insurance We Accept

This list is subject to change.  Our front desk would be happy to provide you the most up-to-date insurance information.

• Aetna
• Beech Street PPO
• Blue Cross Blue Shield (BCBS) of Kansas City. We accept all BCBS plans EXCEPT BCBS HMOs of any type.
• Blue Cross Blue Shield Exchange Plans. We accept YBS and YBX but not YBZ or YBT
• Care Improvement plus - Medicare Replacement
• CIGNA
• Coventry. All plans EXCEPT Coventry Advantra HMO. We do accept Coventry Advantra PPO.
• First Health Network
• Great-West Healthcare
• Healthlink (HMO)
• Humana
• Choicecare (Humana)
• MULTIPLAN
• PCHS (Private Healthcare Systems)
• ProvidiDRS Care Network
• Pyramid Medicare Advantage PPO
• Sterling Medicare Advantage PPO
• Triwest / Tricare (BCBSKC)
• United Healthcare
• Medicare
• Railroad Medicare
• Self-pay

We are one of only a few clinics in the nation to offer oral immunotherapy (OIT) to foods. Our treatment provides a long-term solution for wheat, egg, peanut, tree nut, and milk allergic patients. The program will take about nine to 12 months. At the end of the program, most patients with allergies to wheat, egg, peanut, tree nut, or milk are able to consume these foods with no allergic reaction.

More than 75% of patients using these protocols can consume foods that once threatened their health.

The treatment works by introducing minute doses of wheat, egg, peanut or milk in solution for approximately nine to 12 months (time period varies on individual differences). The program then progresses to small doses of the whole food for an additional several months, allowing the patient to eat these foods. As a result, the vast majority of patients are able to consume wheat, eggs, peanuts, tree nuts and/or milk without any adverse reactions.

What to Expect from Our Food Allergy Program

The initial evaluation may involve a combination of skin prick testing and/or blood testing for the allergy, in addition to a detailed history and physical. Depending on the history of the reactions combined with what the allergy testing shows, a food oral challenge might be performed at a subsequent visit to ensure that the food allergy has not been outgrown and to assess the level of sensitivity to the food in question.  

The first visit of the oral immunotherapy process is a full day, during which the child will receive multiple doses of very small amounts of diluted milk, diluted wheat powder, diluted peanut or tree nut powder, or diluted egg powder. The child will return every two weeks for dose increases followed by one hour of observation. Between each visit the patient will take one dose of the desensitization (allergenic) food each day at home. Once oral immunotherapy is complete, the previously allergenic food can be freely included in the diet. The food must be eaten daily to maintain the ability to eat it safely.

Want to know more about treating your child’s food allergy?

If you are interested in learning more about how your child can be treated for food allergies, please contact our office. Most insurance policies cover this treatment. We invite you to call us and find out how we can help your child, as well as your whole family, live without a fear of food.

We recommend a consult to sit down and discuss if OIT is right for you or your child. We fully discuss any possible outcomes, success, failure, and possible adverse outcomes. We also discuss anxieties/fears involved with considering OIT.

Our Promise to You

* Our goal is to treat and to substantially improve the quality of life in food allergic kids and adults.

* We pledge an open and honest discussion on food allergies and treatment.

* OIT has been extensively studied with many successful clinical trials performed at Duke, Johns Hopkins, Mount Sinai, and many of the other top allergy institutions around the world.

*Hundreds of children and adults have successfully completed OIT supervised by board-certified allergists across the country and around the world.

Frequently Asked Questions

Is this FDA approved?

OIT does not utilize a medical device or medication and therefore does not fall under the purview of the FDA. It will neither be approved or disapproved by the FDA.

Why are there not more allergists performing this procedure?

Although OIT is well-studied, there is not a consensus for a standard protocol to follow. Many allergists do not have the experience or choose not to perform oral food challenges. The primary researchers, despite a decade of strong clinical positive results, have not promoted OIT as ready for general treatment.

Why has the Center for Allergy & Immunology started offering OIT?

There are more than 45 journal articles published in the leading allergy journals around the world all showing success with this therapy. Hundreds of patients have been successfully treated using these protocols, with an over 75% completion rate. Studies have shown a significant improvement in quality of life for patients who have undergone these protocols.

Challenge Testing

In some patients food or drug challenges are used.  Please allow 4-5 hours in clinic for a complete challenge. Here, a patient is given increasing amounts of the allergen in question at regular intervals until a normal serving or dose is achieved. The patient is checked on regularly. Once this has been achieved, the patient is still observed in the clinic for two hours afterwards to make sure that there is not an adverse reaction. If you believe you will be undergoing a challenge, please remain off medications such as antihistamines for at least 5-7 days prior to testing.

Immunotherapy treatment (allergy shots) is based on a century-old concept that the immune system can be desensitized to specific allergens that trigger allergy symptoms. These symptoms may be caused by allergic respiratory conditions such as allergic rhinitis (hay fever) and asthma. 

While common allergy medications often control symptoms (but not always); if you stop taking the medication(s), your allergy symptoms return shortly afterward. 

Allergy shots can potentially lead to lasting remission of allergy symptoms, and it may play a preventive role in terms of development of asthma and new allergies.

The Process

Treatment involves injecting the allergen(s), causing the allergy symptoms. These allergens are identified by a combination of a medical evaluation performed by a board-certified allergist/immunologist and allergy skin or allergy blood tests.

The treatment begins with a build-up phase. Injections containing increasing amounts of the allergens are given 1 to 2 times a week until the target dose is reached. This target dose varies from person to person. The target dose may be reached in 3 to 6 months with a conventional schedule (one dose increase per visit) but may be achieved in shorter period of time with less visits with accelerated schedules such as rush immunotherapy.

The maintenance phase begins when the target dose is reached. Once the maintenance dose is reached, the time between the allergy injections can be increased and generally ranges from every three to four weeks. Maintenance immunotherapy treatment is generally continued for three to five years.

Some people have lasting remission of their allergy symptoms but others may relapse after discontinuing immunotherapy, so the duration of allergen immunotherapy varies from person to person.

Risks involved with the immunotherapy approach are rare, but may include serious life-threatening anaphylaxis. For that reason, immunotherapy should only be given under the supervision of a physician or qualified physician extender (nurse practitioner or physician assistant) in a facility equipped with proper staff and equipment to identify and treat allergic reactions.

The decision to begin immunotherapy will be based on several factors:

• Length of allergy season and severity of symptoms
• How well medications and avoiding allergens control allergy symptoms
• Desire to avoid long-term medication use
• Time. Immunotherapy will require a significant time commitment during the build-up phase, and a less frequent commitment during the maintenance phase

Out-of-pocket costs vary depending on insurance coverage.

Rush Immunotherapy

By performing rush immunotherapy, a patient can reach maintenance dosing much quicker. The process is accomplished over one day. The patient takes medications to help prevent allergic reactions for the three days prior to the procedure. At the end of the day, the patient is where they would be if they had received 15 injections in the conventional build-up schedule (about halfway to maintenance). The patient will still need to complete the last half of the build-up conventionally. Allergic reactions are more common in rush patients, and it is not for everyone, but many patients appreciate the ability to reach maintenance more quickly because that is typically when allergic symptoms begin to improve.

Sublingual Immunotherapy

Sublingual immunotherapy (SLIT) is placing the allergen under the tongue everyday in order to build immune tolerance. There are currently sublingual immunotherapy tablets approved by the FDA and available by prescription. They are approved for use in patients with ragweed allergy and grass allergy. Allergy shots are probably more effective, but because of the time commitment involved with the injections some people prefer a sublingual alternative that can be done at home.