Allergy Treatment

Allergy Samples in a Lab

Allergic otitis should be approached the same as any other allergic disease using aggressive allergy therapy just as is done for allergic asthma and allergic rhinitis. Specifically, the allergy literature states that: “allergen specific immunotherapy and allergen reduction (avoidance) are the only interventions in allergic disease with the potential to reduce symptoms in the long term.” It should be noted that allergic medications including short term steroids and antihistamines have failed to cure OME patients as they seem to only help allergic rhinitis or acute asthma or dermatitis episodes. (See Conventional allergy treatment)

Current efforts to manage patients with chronic OME or to prevent the reccurrence through the use of medication has been a dismal failure. Both the American Academy of Pediatrics and American Academy of Otolaryngology (ENT) -Head and Neck Surgery recognize that prophylactic antibiotics are not effective. The use of antibiotics themselves to treat OME have been found to be no more effective than placebo. Certainly the placement of tympanostomy tubes is effective, although opposed on emotional grounds by the parents who raise legitimate concerns regarding anesthesia risks and cost. It should be recognized that published guidelines both in the United States and Europe state that it is essential to remove the fluid from the middle ear and return the hearing back to normal as soon as possible in a child who has had unilateral effusion for six months or bilateral effusion for more than three months.

The patient with allergic otitis i.e.; chronic effusion greater than two months, a chronically draining tube or perforation or mastoid cavity, or the patient who presents with conductive hearing loss, effusion and no history of otitis media after a school screening hearing test all should be considered as possibly having allergic otitis. Diagnosis is best done using intradermal testing. Prick testing will pick up only 43% of atopics as it is done at such low concentrations so as to function only as a screening test. RAST test has been found to identify 30-60% of atopics when dealing with allergic rhinitis which is a low level allergic disease. Allergic otitis similarly is a low level disease in that most of these patients have IgE’s below 100 (Hurst, Allergy 2000). Therefore if allergy is suspected and RAST is negative, intradermal testing must be pursued.

The majority of OME patients have been found to be positive to common inhalants including: dust and molds regardless of climate, time of year or country. These are best managed by appropriate immunotherapy as would be used for patients with allergic rhinitis or allergic asthma. Recurrence rates for OME using conventional tympanostomy tube treatment runs at 25% and recurrence rates using allergy immunotherapy has been less than 5%.

If the child has allergies to foods, as is often the case (Nsouli, 1986) (Hurst, Laryngoscope, 1996) then a 7 day elimination followed by a one day challenge diet should confirm that food and the food avoided. Dairy products, orange juice, eggs are the most frequent among infants.

Once the diagnosis of OME has been made it is essential to remove the fluid and place tympanostomy tubes when appropriate and accepted indicators have been met. Once that is done the tubes will provide 6-12 months of time before they are extruded and the fluid may recur. During this time appropriate allergy diagnosis can be made using intradermal testing according to AAOA guidelines and appropriate allergen avoidance, food elimination, and/or allergy immunotherapy can be instituted.

Successful management chronic otitis media with effusion depends upon physicians recognizing 1) that OME is a physical sign of allergy, 2) that it is predominantly the atopic patient who develops OME because of the unique response of the cells in their middle ear, and 3) understand that like any other allergic disease – only until the host child is identified and treated aggressively for his allergies will the disease resolve.

Successful management chronic otitis media with effusion depends upon physicians recognizing 1) that OME is a physical sign of allergy, 2) that it is predominantly the atopic patient who develops OME because of the unique response of the cells in their middle ear, and 3) understand that like any other allergic disease – only until the host child is identified and treated aggressively for his allergies will the disease resolve.

So exactly how do I diagnose and treat a patient?

1) Determine if the child is having episodes of recurrent acute otitis media.

This is usually an infant or toddler with one infection after another every 4 to 6 weeks but usually clears in between. Follow the guidelines of the American Academy of Otolaryngology – get hearing tested and a tympanogram. If frequency warrants – that is 6-10 infections in a year or persistant hearing loss than placement of tubes will reduce the number of infections by 80% and MOST IMPORTANTLY, restore hearing immediately.

2) Determine if the child is having chronic otitis media with effusion – OME

This is the child who has only occasional infectiols but in between the fluid in one or both ears does not clear. Tympanograms are FLAT and hearing loss is present. This child needs tubes first to MOST IMPORTANTLY, restore hearing immediately. Then you have time while the tubes stay in for a year to do the appropriate allergy testing and start allergy treatment.

  • THE MOST EFFECTIVE TREATMENT THAT PROVIDES THE GREATEST LONG TERM CURE OF OME IS ALLERGY SHOTS (or drops under the tongue).
  • Antihistamines, nasal steroid sprays, prednisone rarely work.
  • Before you can treat with allergy shots, you must be tested.

There are 3 ways to test for allergy: Prick tests, Blood test, and Skin tests.

Allergy Testing.

Demonstration of any relationship of otitis or sinusitis to allergy depends first on determining if the patient is “atopic” – the medical word for allergic. A clinical diagnosis of Type I hypersensitivity, or atopy, specifically requires the detection of allergen specific IgE antibodies by means of skin testing and/or in-vitro testing. The patient may or may not be symptomatic or allergic.[129] Intradermal tests use various delivery systems (scratch, prick, IDT) to introduce antigen into the skin. The resulting wheal or bump is assumed to represent the response of the patient to specific IgE.

The last 25 years have seen the advent of increasing standardization and quantification of allergy diagnostic testing based on the original works of Noon’s prick test[116] as described in 1910. Although prick test results correlate well with symptoms, it is recognized to be highly subjective, non-standardized and has low reproducibility.[113],[25] For patients with a low sensitivity disease like sinusitis or ear disease, intradermal skin tests may have the only positive results.[36]

Serial endpoint titration as used by Ear Nose and Throat Allergists has become the standard by which all new allergens are quantified at the National Institute of Health.[114] This form of Intradermal testing(IDT) is now the approved standard for diagnosing allergy as endorsed by the American Academy of Otolaryngologic Allergy and the American Academy of Otolaryngology Head and Neck Surgery. The validity of IDT and RAST/ELISA are is also certified by the American Medical Association, and the American Academy of Allergy, Asthma and Immunology.[7],[48] Thus both the definition of atopy as “the propensity of an individual to develop IgE antibodies” and the means of testing for allergy using either clinical or biologic measures have been refined to allow a more accurate diagnosis of the atopic patient. Reliable allergy evaluations can now be performed with established testing methods and materials offering high specificity and sensitivity in both clinical and histopathology studies.

During the past 60 years sixteen investigators have used intradermal skin testing (IDT) to evaluate their entire patient populations. They have demonstrated that allergy testing and treatment are very successful (70-100%) in treating children with chronic OME. In fact, there is not a single published paper which demonstrates anything to the contrary.

Summary: OME is clinically and immunologically a separate entity from acute OM. Conventional therapy with antibiotics has proven ineffective, yet is still maintained in the current management plan of most pediatricians.[166] Eventual treatment of persistent OME with myringotomy and placement of tympanostomy tubes, although required to return the ear to normal function, is fraught with complications and only temporarily resolves the problem in a significant percentage of patients. Conventional allergists do not appreciate the fact that the middle ear is an extension of the upper respiratory system and therefore have ignored this disease. Interdermal testing is the most accurate way to diagnose allergies in these children. Skin testing is necessary before treatment by allergy shots can be individualized. Allergy shots – immunotherapy – is the most effective long term treatment for chronic ear disease.

Successful management of chronic otitis media with effusion depends on physicians being willing to recognize that OME is a sign of allergy. They must recognize that in OME it is predominantly the allergic patient who develops OME because of the unique response of the cells in their middle ear to the stimulus of viral or bacterial infections. Like any other allergic disease, only until the host is identified as being atopic and treated aggressively for his/her allergies will the disease will resolve.

22 Responses to Allergy Treatment

  • Jem says:

    Recently, I am determined to have allergy in my ear. I can’t tell what particular thing or food that I’m allergy with. My ear is always wet and sometimes itchy. The doctor recommended me to take antihistamin. My ear also has a dry skin as what the doctor said that sometimes blocking my eardrum that it made me hard to hear and uncomfortable.

    • David S Hurst MD PhD says:

      I have had only 3 patients in 30 years who had chronic ear canal drainage and excess skin production and they did have allergies. Skin testing as described in my book by an ENT allergist made the diagnosis and they cleared with allergy shots.
      Good Luck,
      Dr. Hurst

    • Sofia says:

      Jem, I had the exact same symptoms as you have for over 15 years. No doctor told me that the chronic ear troubles could be related to allergies or food intolerance. About 3 years ago I ran into a woman who mentioned that she used to have chronic sinus infections until she stopped all dairy. I decided to give it a try for one month and it got a lot better, but still not 100%.

      Since then, by trial and error (and The Carroll Food Intolerance Evaluation Method at Dr. Suhu’s office in Manhattan), I have found that if I stay away completely from all dairy, soy, eggs, and cane sugar, my ears are totally fine. If I eat the smallest piece of something containing those ingredients, my ears get wet, itchy, stuffy, and swollen and I have to be treated for an ear infection at the ear doctor.

      I have found that dust mites also affect my ears, so I have to wash the bed linen in really hot water a couple of times a week.

      I really urge you to look into the food again and do it meticulously and give it at least one month for each food. Choose one food to eliminate at a time (I would start with dairy – no yoghurt, milk, butter, sour cream, cream, etc), and read every label. Write down everything you eat and how you feel.

      Mot doctors will not be able to help with this. They tested me for food allergies in the doctors office and everything came back fine… food intolerance is different – you can often do that yourself by starting to eliminate foods known to sometimes cause problems, such as milk, egg, meat, sugar, fruit, grain, potato, soy, nuts, fish and seafood…

      I’ve had to learn how to cook and bake with replacements like rice/almond milk, agave syrup/stevia, and coconut milk instead of the things I’m intolerant to, but it’s so worth it :)

      • David S Hurst MD PhD says:

        This is good advice. The diagnosis of food allergies is in it’s infancy. We do not know as much as we like. Only 20% of food allergy goes through the IgE system and can be detected by skin or IgE blood testing (RAST or Pharmacia Cap). I use Allertes and do IgG testing. They will do 150 foods. Any Class 3 positives I then approach not with a full month elimination, but do 7 day elimination and then a full challenge. Most times you can tell if your ears and certainly your nasal congestion returns. If no trigger of symptoms, then that is most likely a safe food. Try another. Good luck.
        Dr. Hurst

    • David S Hurst MD PhD says:

      Dear Jem
      THis is more difficult. You are NOT describing MIDDLE EAR FLUID, but “ear canal dermatitis” or chronic ear canal infection. This can be from chronic cleaning the ear or fungus infection. This is most difficult. See and ENTspecialist, and you may have to see several before you get relief.
      I have had only 3 patients with chronic ear canal infections filling with dead skin. They were diagnosed with intradermal testing and treated with immunotherapy allergy shots as described in my book. Find and ENT allergist. Good luck.
      Dr. Hurst

  • Jem says:

    Thanks Sofia for this good advice. Actually, I don’t know yet what type of food I’m allergy with. My ENT told me to eat everything and list everything also so that I can identify what particular food that gives me allergy. Now, my ear goes better but it’s still itchy sometimes and still wet.

  • Jem says:

    Hi Dr. Hurst. It’s nice to hear it from a doctor. My ear gets better now. I try not to manipulate it and I don’t feel like a half-deaf or something but still, it’s wet and sometimes itchy. Is vitamin C can be a source of allergy?? I remember before that I’ve been taking viramin c for my skin and rashes came out on my arm and legs. I tried antihistamin but it didnt stop. My cousin which is a midwife told me that there is a quicker and effective cure for it. She injected me that particular anti-allergy and the rashes are gone.

  • Jem says:

    Hi Dr. Hurst. Thank you for the respond. But what’s the best thing to do??

  • Sofia says:

    Jem, I also had chronic ear canal infections and had to go every 4 months to an ENT to have him remove the dead skin and gunk with a machine. I went to several ENT doctors and they basically said that I would have to live with this. I did the skin test for environmental allergens first and they said I’m allergic to pollen, dust, mold, dander from cats and dogs. They told me it would be best to get rid of our pets (which we didn’t, thank goodness). I did another test for food allergies which didn’t indicate any allergies.

    It wasn’t until I took this into my own hands and started to eliminate one food at a time (see my previous post) until I found my answer. It took 2-3 weeks with each food elimination trial before I started to feel the result in my ears. If I’m meticulous with the food the other allergens don’t bother my ears as much.

    Recently I slipped up with the food over a few weeks while traveling abroad and I felt like I was in a vaccum – I couldn’t hear anything. When I came home the mold and pollen counts were high in my area and my ears went from bad to worse – even my teeth, face and jaw bones hurt. So I went to my ENT who drained them with the machine and told me to drop white distilled vinegar into the ears for the fungal infection. I’m back on my strict food regimen since a couple of weeks and things are 75% better, although it won’t be perfect because of the mold/pollen count in the air right now…

  • Jem says:

    I think you’re right Sofia and we have to live with this because allergy is not curable but tolerable. My ENT told me that ear allergy is the hardest ear problem because it has no cure.

    • David S Hurst MD PhD says:

      Well Jem that is the point of my book! Allergies are curable but only with immunotherapy – or allergy shots. Hundreds of double blind placebo controlled studies prove it! Good Luck Dr. Hurst

  • Ellis says:

    Hello,

    I have OME and sinustrouble over more than 25 years now.
    As an adult.
    Left side head mostly.
    Tried tubes, etc.
    Anyone good tip?

    Thanks!
    Ellis, Europe.

    • David S Hurst MD PhD says:

      Hi Ellis. That is the point of my book! Allergies cause chronic sinusitis, asthma and chronic ear disease. They are curable but only with immunotherapy – or allergy shots. Hundreds of double blind placebo controlled studies prove it! Good Luck Dr. Hurst

  • Chris cooper says:

    Deer Doctor
    I live in Quebec. Could you recommend a practitioner in Montreal or Vermont? Alternatively, where are you located in Maine? Many thanks. Chris

    • Hi Chris The easy way to find a physician who understands allergy and will test as I talk about in my book is to go to AAOAF.org and insert a zip code near you. This is the site for the American Academy of Otolaryngic allergy. Or google for the American Academy of Environmental Medicine or for The Pan American Society. All of these test for allergy using intradermal skin testing. Good Luck. Dr. Hurst
      P.S. I am just outside Portland, Maine.

  • Dave Conrad says:

    I am a 73 yr old male in relatively good health. I have had a non productive cough for approximately 40 years and in the past 5 years I have developed a constant running nose I also have had a mixed unilateral loss in my left ear that has been present for many years. I have consulted many types of Doctors for my cough and nose but have gotten no relief. I recently saw an ENT as I have also developed balance issues and my primary Doctor had noted fluid in my left mastoid while observing my head scan ordered by my neurologist. The ENt put a tube in my left ear which returned my hearing but did nothing for my other problems. The tube recently fell out and the ear is filling with fluid and my hearing is deteriorating
    Do you feel allergy treatment would be beneficial in my case?
    Thank you.

  • Teri McCurry says:

    Dr. Hurst,
    Recently I was diagnosed with adrenal fatigue. For months I have struggled with allergies…. To trees,dogs,grass…. You name it! My homeopathic doctor put me on allergy drops to help during the pollen season. My ears will get better then something triggers the sinuses and the fluid comes back. I haven’t had but one almost ear infection but with garlic drops it went away. The fluid is so annoying and I’m hoping hat the drops will help but I also have a go and I’m afraid I at need drops to take for dog allergy.

    • Hello, Teri -
      Persistent fluid in your ears is often associated with allergies. My book will outline the steps you should take, the treatments and type of physician you should seek.
      Thanks for your interest,
      Dr. Hurst

  • Denise says:

    My 13 month old son has had constant ear infections for over 6 months. We have been treating them with antibiotics and they seem to clear up, but about 4-6 days after the meds are finished, he gets another infection. 4 weeks ago, he had tubes put in but 8 days after surgery, his left ear was infected. After another round of antibiotics he now has a double ear infection again. His pediatrician is now referring us to an allergist. Is there anything specific I should mention to the Dr to make sure we are testing him correctly?
    Your website has given me hope that we can help my little guy. Thank you!

    • Denise,
      Thanks for visiting my website. As I’ve stated on this site, in my videos and in my book, many allergists will miss allergies because of their testing methods. If you’ve not already done so, get the book and look at the testing methods. Then find and ENT doctor that has also trained as an allergist. Good luck.
      Dr. Hurst

  • Janet Evans says:

    I read your book with great interest. It is clearly written and packed with sound and helpful advice. However, I have a question. Over the last four years I have been trouble with ETD and worse in one ear. My ENT consultant told me to leave it and the blocked ear would resolve itself. It never did and was followed by tinnitus. I was sent to an allergist and was told I was allergic to grass pollens, tree and dust mite. The test was only blood and a skin prick. Things have now progressively got worse and over the last few years my hearing becomes totally muffled during beginning of March and sometime in October and the hearing fluctuates in both ears terribly. I have now seen another consultant who tells me my inner ear is damaged as my balanced has been affected and the pressure tests show no pressure which indicates fluid cannot be in my middle ear. Yet, I have feelings of pressure in my ear and sometimes people sound like they are talking under water. I have been put on a low sodium diet/pills. I am concerned that none of the consultants i’ve seen so far have got to the bottom of what is causing this sensation. Have had an MRI scan which thankfully was clear – although at the time there was indication of some fluid in the ET. Is there someone in England who has followed your research and would be the right person to talk to? I feel as if i am going around the houses on this. Just as you say getting the combination of an allergist and ENT person to take on board the issues has been nigh impossible. Each seems to operate on their own. I am concerned that my problem will only get worse until the cause is addressed. Thanks for your advice. I really appreciate it.