Patient Information
The Division of Sino-Nasal Disorders and Allergy offers diagnostic services including CT scans of the sinuses, video nasal endoscopy with digital archiving, mucociliary transport study, sinus secretion aspiration, inhales and contact allergy testing, lung function testing, and food allergy testing. The division also provides several treatments for both sinus disorders and allergies.
Experience your Exam on Screen
UPMC offers cutting-edge technology in the world of sino-nasal treatment with a minimally invasive and comfortable examination process that allows patients to experience their exams on a 17-inch monitor. This new technology uses a 30-degree scope (four millimeter endoscope) to provide a more detailed examination of patients’ ears, noses, and throats. The scope is inserted in the ear, nose, and/or throat and is painless. This technology also provides a less invasive alternative to the operating room when removing nasal polyps. The 30-degree scope makes the removal of nasal polyps an in-office procedure using local anesthesia. This scope also allows for the doctor to easily take nasal cultures testing for bacteria and fungi. This new technology also records the entire examination and procedure in order to keep a visual record of the patients’ progress and treatments. The 30-degree scope is just one example of the many patient services used by sino-nasal specialists to ensure a thorough and proper diagnosis and treatment plan.
Diagnostic Services
The Division of Sino-Nasal Disorders and Allergy uses the following tests and procedures to help diagnose sinus problems and recommend a course of treatment.
CT Scans of the Sinus
A computed tomography (CT) scan is the type of image preferred for analyzing the anatomy of the sinuses. At the Division of Sino-Nasal Disorders and Allergy, the physician always orders a CT scan before suggesting sinus surgery.
Video Nasal Endoscopy
An endoscope is a slender instrument with a video camera attached. The endoscope is inserted about three inches into the nose to enable the physician to see the drainage sites from the sinuses and the back of the nose (outflow tracts). Before endoscopy, the nose will be decongested and anesthetized. The anesthetic (lidocaine) spray will temporarily numb the throat. The procedure causes little discomfort, and patients may resume normal activities after the examination.
Mucociliary Transport Study
This test evaluates the ability of the lining of the nose to carry the mucus that cleanses the nose. Patients with abnormalities of the mucus or cilia, the normal microscopic structures that move the mucus within the nose, have increased nasal problems. Examples of patients with impaired mucociliary transport are those with cystic fibrosis, primary ciliary dysmotility syndrome, Kartageners syndrome, or repeated, prolonged infections. Mechanical cleaning of the nose with topical antibiotics and saline solution is important in treating this condition.
Sinus Secretion Aspiration
The pus draining from the sinuses is visualized with a slender telescope inserted into the nose and directly suctioned for culture. A specialist can determine what kinds of bacteria may be causing infection or inflammation. The specimen will be sent to the microbiology laboratory for microscopic analysis and culture. The patient will be informed of the results of the procedure within days, and the most appropriate antibiotic to treat the infection will be prescribed.
Allergy Testing
Allergy Testing: inhaled and contact allergies tests for allergic reactions to inhalants to determine if a person is allergic to an inhalant; that is, an allergen that can be inhaled, such as pollen, mold, cat dander, or dust mites; forms of skin testing known as prick testing and skin endpoint titration are performed. In this procedure, a minute amount of the suspected allergen is placed under the top layer of the skin on the upper arm. Skin-prick testing is used as a first screening and skin endpoint titration is used to determine how allergic the patient is.
Patch testing is used to determine the cause of a contact allergy; that is, an allergy that results after a person comes into contact with an allergen. Common causes of contact allergies are makeup and latex. A patch test is used to determine whether a substance that should not be injected into the skin; for example, metals such as nickel, causes an allergy. In a patch test, the suspected allergen is attached to a nonreactive backing, which holds the allergen against the skin for 48 to 72 hours.
Allergy Testing: Food Allergies
An adverse reaction to food can be categorized as either a food intolerance or food allergy. The main difference between these two is that food intolerance does not involve the immune system; a food allergy does. Food intolerance can usually be helped by some means, such as by taking a dietary enzyme supplement. The symptoms of a food allergy may be treatable, but the allergy itself may not be correctable.
A common example of food intolerance is that caused by lactose deficiency. A person with lactose deficiency experiences discomfort and other symptoms after eating dairy products because his or her body does not produce enough lactase, the enzyme needed to digest dairy foods. A person with lactose intolerance can address the problem by taking a lactase supplement. In contrast, an allergy to dairy products cannot be corrected by taking a supplement.
The eight most common food allergens cause more than 90 percent of all allergic reactions to foods. These common allergens are milk, eggs, peanuts, tree nuts, soy, wheat, fish, and shellfish.
Many tests for food allergy involve testing for immunoglobulin E (IgE). Immunoglobulins are proteins, most of which help protect the body from infection. IgE can be different. In about 20 percent of humans, IgE reacts against substances that are harmless, such as pollen grains, animal dander, and some food proteins. It is involved in causing allergic asthma and allergic rhinitis (hay fever) and, in many cases, the symptoms of sneezing, swelling, redness, and itchiness. People who suffer from allergies are those whose IgE reacts to allergens.
To diagnose food allergies, the Division of Sino-Nasal Disorders and Allergy uses:
Elimination challenge diets
Elimination diets are an essential part of diagnosing food allergies and are used to test reactions to foods that are not necessarily associated with high levels of IgE. In the diet, the patient will not eat a specific food for five days. If the patient is allergic to the withdrawn food, the period of abstinence makes him or her much more sensitive to it. On the sixth day, the patient is "challenged" with the food and will eat a small portion of it. Adverse symptoms, such as itching, gastrointestinal distress, facial pressure, or nasal congestion, indicate that the patient is allergic to the food.
In vitro testing, including radioallergosorbent (RAST) tests
In vitro testing is done outside a patient’s body. The division uses in vitro testing to detect allergies in patients who cannot undergo skin testing or who have a potentially life-threatening allergy, such as peanut anaphylaxis. It involves taking a blood sample from the patient and determining what kinds of IgE and how much of each kind are present to a particular tested food.
Skin tests
In a skin test, a small amount of a suspected allergen is placed under the top layer of the skin on the upper arm. If the skin shows a reaction, the patient is allergic to the substance.
Allergy Testing: Skin Testing
There are several methods of skin testing for allergies. The division uses both prick and intradermal dilutional testing that gives an accurate reading of the degree of allergy, and if allergy shots are to be given, allows the physician to initiate shots at the highest safe concentration. A small amount of antigen is injected under the top layers of the skin to make a small bump (4 mm) under the skin. If you are allergic, then this bump grows to a larger size in the next ten minutes. The size of this bump or welt is then measured after 10 minutes.
Full skin testing will take about two hours.
If you are a patient who will undergo allergy skin testing at the Division of Sino-Nasal Disorders and Allergy, view instructions on how to prepare for your testing appointment.
What to Do Prior to Your Allergy Skin Testing
All patients undergoing allergy skin testing must have been seen by a member of University Ear, Nose and Throat Specialists within the last six months.
Full skin testing will take about two hours. All skin testing appointments include an in-depth environmental allergy consultation and a thorough overview of the immunotherapy program. Wear a short-sleeved or sleeveless shirt and refrain from wearing perfume to the testing area. You may eat prior to allergy testing. Do not exercise vigorously before or after the testing, as it may increase the chance of a reaction.
Certain medications can change the results of your allergy tests. Before arriving for allergy testing, please note the following instructions.
1. Do not take aspirin or aspirin-containing products for 10 days prior to testing, if possible, to decrease bruising or bleeding during testing. However, if you are using aspirin for cardiac reasons or stroke prevention, you may continue to use the aspirin.
2. Do not take ibuprofen or ibuprofen-containing products (Advil, Motrin, Nuprin) for five days prior to testing to decrease bruising or bleeding. However, if you are using ibuprofen for cardiac reasons or stroke prevention, you may continue to use the ibuprofen.
3. The following common over-the-counter and prescription medications contain antihistamines and should be avoided for four days prior to your allergy testing:
- Actifed
- Allegra
- Allegra-D
- Allerest
- Alka-Seltzer Cold & Sinus
- Astelin
- Atarax
- Benadryl
- Chlorpheniramine
- Chlor-Trimeton
- Claritin
- Claritin-D
- Comhist
- CoTylenol
- Deconamine
- Dimetapp
- Drixoral
- Dramamine
- Excedrin PM
- Isoclor
- Kronofed A
- Kronofed A, Jr.
- Marax
- Midol PM
- Motrin PM
- Motrin Sinus
- Naldecon
- Nolahist
- Novahistine
- Nolamine
- Nyquil
- Optimine
- Phenergan
- Polyhistine
- Rondec
- Ru Tuss
- Semprex D
- Sominex
- Tavist I
- Tavist II
- Teldrin
- Tylenol PM
- Tylenol Allergy/Sinus
- Zyrtec
- Cough drops with liquid centers
4. You cannot be allergy tested or receive allergy injections if you are taking non-selective beta-blockers, including topically-applied beta-blocks and combination diuretics:
- Betapace (sotalol)
- Blocadren (timolol maleate)
- Brevibloc (esmolol HCL)
- Cartrol (carteolol HCL)
- Corgard (nadolol)
- Inderal (propranolol)
- Levatol (penbutolol sulfate)
- Normodyne (labetalol HCL)
- Trandate (labetalol HCL)
- Visken (pindolol)
- Zebeta or Ziac (bisoprolol fumarate)
Topically applied beta-blockers:
- Betagan (levobunolol)
- Betoptic (betaxolol)
- Ocupress (carteolol)
- Optipranolol (metipranolol)
- Timoptic (timolol)
Combination diuretics with beta-blockers:
- Corzide (nadolol-bendroflumethiazide)
- Inderide (propranolol-hydrochlorothiazide)
- Normozide or Trandate (labetalol-hydrochlorothiazide)
- Timolide (timolol-hydrochlorothiazide)
You can be tested if you are taking the following selective beta-blockers:
- Kerlone (betaxolol)
- Lopressor (metoprolol)
- Sectral (acebutolol)
- Tenormin (atenolol)
- Tenoretic (atenolol and chlorthalidone)
Please contact the Allergy Clinic at 412-692-2228 with any questions regarding the testing or restrictions.
All allergy testing is performed on the second floor of the Eye & Ear Institute, Suite 214.