Frequently Asked Questions

FAQ's

WHAT IS AN ALLERGIST?

An allergist is a physician who has special training in the field of allergy and immunology. After 3 years of residency training in internal medicine or pediatrics, a physician can specialize in allergy and immunology after spending at least 2 years of special training in academic institutions that are accredited, and offer such training. At the end of the training, the physician can become board certified. Therefore, it takes at least 5 years after finishing medical school to become a specialist in the field of allergy and immunology.

WHAT DOES IT MEAN TO BE BOARD CERTIFIED?

A board certified allergist immunologist finishes at least 5 years of training after medical school, is recommended by his or her peers in the field of allergy and immunology, and passes an exam administered by the American Board of Allergy and Immunology. As a result of these accomplishments, the physician who is now both trained and board certified, has the knowledge and the capacity to understand the needs of and manage those patients with allergic conditions with a foundation superior to other physicians who do not have that high level of training. Because of the changing facets of this field, the advances of which occur almost on an annual basis, the American Board of Allergy and Immunology recommends that physicians keep up with new information via conferences, continuing medical education, and repeating the board exam, either on a compulsory or voluntary basis, at least every 10 years. Dr. Saadeh was board certified in this field after finishing his training. He voluntarily participates in the continuing medical education and recertification. He does so to make certain his patients are getting state of the art diagnostics and treatments.

CAN ANY PHYSICIAN DIAGNOSE AND TREAT ALLERGIES?

The field of allergy and immunology is best managed by an allergist and immunologist who is board certified. There are other physicians in different types of specialties such as family medicine, internal medicine, pediatrics, and ear nose and throat specialists who are interested in diagnosing and treating patients with allergic rhinitis. Unfortunately, even though they may provide some level of care, it is the allergist and immunologist who can identify specific allergens that are contributing to symptoms, and determine whether allergen immunotherapy (allergy serum) will help. The allergy immunologist provides serum that is custom-made based on the results of results of a patient’s skin testing. Other providers who are not experts in the field may be providing a generic serum for almost everyone and customized to no one. That type of treatment may help some patients to a degree, but does not provide optimal treatment. In the long run, that one size fits all approach may not bring adequate control of symptoms. At Allergy A.R.T.S., we provide serum that is customized based on the results of individuals’ skin test reactions. The results are as close as scientifically possible, and are based on recommendations of the American Academy of Allergy, Asthma, and Immunology as well as the American College of Asthma, Allergy and Immunology. We make sure that when our patients receive allergen immunotherapy or allergy shots, they are getting the highest standards in terms of quality control, sterility, and education while receiving these injections. Therefore, it is in the best interest of the patient who has allergies that are not well controlled, to consult with an allergist immunologist who has the special training and certification such as what you find at Allergy A.R.T.S.

WHAT IS IN THE ALLERGY SHOT AND HOW IS IT ADMINISTERED?

Allergy shots are administered via the subcutaneous route. They are compounded based on the results of individual skin test reactions, formulated in a sterile fashion, and accompanied by education prior to and throughout administration to make sure that our patients understand the mechanism by which these allergens work. The serum is formulated by inclusion of inhalant allergens that showed high reactivity on a skin test such as house dust, pollen, mold, or animal dander. These antigens are standardized and specific to each patient. They are given in low dilutions and advanced gradually to achieve an ideal dose with which symptoms are well controlled, and the injections well tolerated. Usually it takes anywhere from 6 weeks to 3 months to begin seeing improvement in symptoms, although some patients notice improvement earlier than that. Some other patients may not experience adequate improvement in their condition for 6 months and, rarely, even up to a year. Therefore, it is important to be patient while receiving these injections. Allergy A.R.T.S. provides the most efficacious serum based on the results of testing; tailored to the patients’ needs.

IS ALLERGY A.R.T.S THE RIGHT PLACE FOR ME TO SEEK TREATMENT FOR ALLERGIES?

Allergy A.R.T.S. provides the most up-to-date diagnostics, education, research, and management for patients with allergic rhinitis, asthma, eczema, urticaria, and autoimmune conditions; as well as other diseases as described elsewhere on our website. Rest assured that Dr. Saadeh educates his staff including mid-levels on a continuing basis. Know that he keeps up with his continuing medical education, voluntary board certifications, and is recognized as one of the top peers in the field of allergy immunology and rheumatology. Please feel free to access his CV on this website for further information. Therefore, Allergy A.R.T.S. should naturally be considered the right place for you to be treated for your allergies and other conditions listed below.

CAN AN ALLERGIST WHO IS BOARD CERTIFIED CARE FOR ASTHMA PATIENTS? HOW ABOUT COPD?

Asthma is a condition that is triggered by allergens, irritants, and environmental conditions. An allergist is considered to also be an expert in the treatment of asthma. Asthma is an inflammatory condition that results in airway obstruction, inflammation inside the airways, and is demonstrated by hyperactive airways. Asthma can be subtle, and may result in only fatigue. It can be severe, and associated with wheezing. At ALLERGY A.R.T.S., we provide the most advanced diagnostics; such as impulse oscillometry, nitric oxide measurements in addition to traditional spirometry. These diagnostics are invaluable in determining mechanism of symptoms in comparison to less sophisticated tests. We also participate in the diagnosis of vocal cord dysfunction via impulse oscillometry. As we treat the nasal conditions, such as allergic rhinitis, asthma can also be a comorbid complication. We provide up to date treatment of asthma including standard rescue and management inhalers, education, and biologics, if indicated. Many physicians are unfamiliar with current, third line, approaches to asthma management for which standard care fails. Asthma management is also a component of the specialty of allergy and immunology. Based upon these up to date diagnoses and treatment options, rest assured that you will be provided with the best care. That approach to care will, most likely, result in control, and perhaps remission of your asthma.

COPD, or chronic obstructive pulmonary disease is also managed at ALLERGY A.R.T.S. in a manner that many other specialists don’t provide. This condition can overlap, or be masked by comorbid asthma, although it is a totally different condition by itself. It can also be precipitated by allergic rhinitis or hay fever. Advanced diagnosis and treatment of COPD is a standard of care available at ALLERGY ARTS.

WHAT IS ALLERGIC RHINITIS?

Allergic rhinitis, also known as hay fever, is a condition in which there is inflammation in the nasal passages as a result of allergies. In this condition a protein that is an immunoglobulin known as IgE (present in our body to fight parasites), is being made against inert substances such as pollen or house dust mites. In other words, this condition is the result of inappropriate response of the immune system that results in inflammation. The symptoms are mostly runny nose, sneezing, itching, and congestion. There are at least 20%, and in some statistics 40%, of the population in the U.S. that experience allergic rhinitis. Many of these patients are controlled either with over-the-counter medications or some prescription medications. However, if the symptoms are not well controlled, the best approach is to consult with a board certified allergist and immunologist such as Allergy A.R.T.S. offers, and consider allergen immunotherapy or injections if indicated.

HOW DO I KNOW IF I HAVE AN IMMUNE DEFICIENCY?

An immune deficiency is the result of inability of the immune system to fight routine infections. Contrary to common belief, these conditions can have adult onset as well as such in childhood. Many with this condition have been diagnosed in adulthood. Immune deficiency can be suspected in patients who have recurrent infections such as sinusitis or pneumonia; even with adequate control of other conditions such as allergic rhinitis or asthma. These patients can be treated with immunoglobulin replacement that can be given intravenously or subcutaneously. At Allergy ARTS, we provide in-house diagnosis of immune deficiency via our advanced laboratory equipment and state of the art treatment in-house or at another location such as home accompanied by continued monitoring.

WHAT IS A RHEUMATOLOGIST?

A rheumatologist is a physician who has special training after finishing residency in internal medicine or pediatrics. The appropriate education requires at least 2 years of additional training in the treatment of arthritic conditions such as rheumatoid arthritis and osteoarthritis. After finishing the training, the physician is recommended by a peer board of physicians, and then becomes certified after passing the special exam in rheumatology administered by the American Board of Internal Medicine or Pediatrics. Rheumatologists care for conditions such as rheumatoid arthritis, lupus, and other autoimmune conditions. A board certified rheumatologist should participate in continuing medical education, advanced diagnostic education, as well as recertification, either voluntary or compulsory, at least every 10 years. Dr. Saadeh voluntarily participates in recertification and continuing medical education in this field. He has been recognized as one of the top doctors in Texas and best doctors in the nation in the field of allergy, immunology and rheumatology.

WHAT KIND OF DISEASES FALL THE SCOPE OF AUTOIMMUNITY?

Autoimmune conditions occur when the immune system has lost the ability to recognize which is part of self or non-self. In other words, in a condition such as rheumatoid arthritis, the immune system thinks that the joint is not part of a patient’s body, therefore it starts making antibodies against the joint, and this results in inflammation. Inflammation is the result of recruitment of white blood cells and their products which are referred to as cytokines. Even though we are not certain what the trigger is for this inflammatory component, we certainly know more about the mechanisms of autoimmune conditions increasingly, and therefore, customized treatments are available, and have become more advanced over the past 15 years. These treatments can be administered either via infusion, injection, and recently, orally. In order to receive these treatments, patients should understand the indications, the benefits, the risks, as well as alternative treatments. Allergy A.R.T.S. patients are educated so they may gain understanding of all of the above. Dr. Saadeh participates in ongoing education for himself, teaching his mid-level providers, and educating patients in particular concerning disease mechanisms and the choices for treatment. Allergy A.R.T.S. also has a state of the art infusion center for patients requiring infused treatments for the control of their autoimmune disease such as rheumatoid arthritis and lupus.

Even though we are not certain what the trigger is for this inflammatory component, we certainly know more about the mechanisms of autoimmune conditions increasingly, and therefore, customized treatments are available, and have become more advanced over the past 15 years.

WHAT IS THE ROLL OF ULTRASOUND IN DIAGNOSING AND TREATING MUSCULOSKELETAL CONDITIONS? IS ALLERGY A.R.T.S THE RIGHT PLACE TO HAVE A MUSCULOSKELETAL ULTRASOUND?

Musculoskeletal ultrasound has become almost a gold standard in the diagnosis and management of musculoskeletal conditions. This modality includes the diagnosis and follow-up of patients with rheumatoid arthritis, evaluation of patients with osteoarthritis, diagnosis and management of patients with special conditions such as bursitis or tendinitis. At Allergy A.R.T.S., Dr. Saadeh has been a pioneer in the administration of musculoskeletal ultrasound in his clinical practice. The ultrasound technicians have also pioneered its use in their roles. Allergy A.R.T.S. was the fourth facility in the nation accredited by the American Institute of Ultrasound in Medicine (AIUM). Dr. Saadeh is also on the advisory board of the procedures journal of Journal of Ultrasound in Medicine and has published about this modality as well. Ultrasound is also important in evaluation of sports injuries. Treating sports injuries is another role of this valuable modality at Allergy A.R.T.S.

WHAT IS OSTEOPOROSIS? HOW IS IT MANAGED?

Osteoporosis is gradual decline in the bone mass particularly occurring in postmenopausal woman. This process results in fragility fractures in the hip or the spine, and can lead to increased morbidity and mortality. Osteoporosis is diagnosed via bone density. It is also managed either by oral medications or injectable medications. At Allergy A.R.T.S., our technicians are certified in performing the scans necessary for the diagnosis and education of patients with osteoporosis under the supervision of Dr. Saadeh by the ISCD.

FUTURE DIRECTIONS?

Allergy A.R.T.S. continues to pursue state of the art research in medicine to help our patients with common and difficult conditions receive the most advanced treatment. At the moment, oral immunotherapy is still experimental except in limited situations. However, it is available on a case-by-case basis at this facility. Patients have to realize that this type of treatment is still not covered by insurance companies because it is not yet FDA approved, and may not be as effective as allergen immunotherapy injections.

Regenerative medicine such as injection of stem cells from bone marrow or fat is available at Allergy A.R.T.S.. We currently provide amniotic cell injections for conditions such as osteoarthritis. Again, this treatment is still not approved by the FDA, and therefore, is not covered by insurance companies. However, we can discuss it with you on a case-by-case basis. Platelet rich plasma is also available and can be administered in individual patients if indicated. This is also in general not covered by insurance companies. These types of modalities can be discussed during your visit, and we will be happy to explain them to you if they may be indicated. You will be informed about the benefits and the risks of each of these modalities.

WHAT CONDITIONS ARE DIAGNOSED AND MANAGED BY ALLERGY A.R.T.S?

1. Allergic rhinitis

2. Asthma

3. Ocular or eye allergies; including, but not limited to allergic conjunctivitis and vernal conjunctivitis

4. Drug allergies

5. Food allergies

6. Celiac disease

7. Angioedema; both idiopathic, hereditary, or acquired.

8. Urticaria or hives

9. Eczema or dermatitis

10. Irritant and unusual allergic conditions that are identified specifically to each patient

11. COPD or chronic obstructive pulmonary disease

12. Eosinophilic esophagitis

13. Hypersensitivity pneumonitis

14. Sarcoidosis

15. Rheumatoid arthritis

16. Lupus such as systemic lupus erythematosus or lupus nephritis, or both

17. Raynaud’s phenomenon

18. Polymyositis or dermatomyositis

19. Immune deficiency such as common variable immune deficiency or X-linked immunodeficiency and other rare immune deficiencies as well

20. Sjogren’s syndrome

21. Vasculitis such as Churg-Strauss syndrome, temporal arteritis, microscopic angiitis, or Wegener’s granulomatosis

22. Vocal cord dysfunction

23. Rare lung diseases such as interstitial lung disease or pulmonary fibrosis

24. Relapsing polychondritis

25. Other rare autoimmune conditions such as Cogan syndrome, Henoch-Schönlein purpura, autoimmune hemolytic anemia

26. Osteoarthritis involving the hands, knees, hips, ankles, and other joints including the back in combination or in isolated areas

27. Tendinitis or bursitis in general

28. Ankylosing spondylitis and other related arthropathies such as psoriatic arthritis or Reiter’s syndrome

29. Arthritis associated with metabolic diseases such as hypothyroidism, inflammatory bowel disease, or hemochromatosis

30. Pseudogout or gout

31. Osteoporosis and osteopenia

32. Specific sports injuries

RESEARCH DEPARTMENT

Amarillo Center for Clinical Research (ACCR)

Following his participation in clinical trials throughout his academic and public medicine career, Dr. Saadeh wanted to continue his role in studying promising new treatments for his patients when he transitioned to private practice. He launched ACCR in the fall of 2001 in pursuit of that goal. Since then, his research department has participated in studies that eventually culminated in many of the rheumatoid arthritis, lupus, asthma, osteoarthritis, allergic rhinitis, pain, and many other conditions having safe, FDA approved, new medicines. He sponsored education for the staff. They became Certified Clinical Research Professionals through the Association of Clinical Research Professionals (ACRP). His participation contributed to the FDA approval of many innovative new treatments. He assisted in bringing choice, competition, and successful outcomes to his patients and sufferers across the world.

ALLERGY TESTING & FORMULATION OF PATIENT ALLERGY SERUMS

Dr. Saadeh oversees airborne and food allergy testing according to standards suggested by the American Academy of Allergy, Asthma, and Immunology (AAAAI). Such an approach is only taken by those in his specialty. The National Institutes of Health hold AAAAI guidelines as the “gold standard” in treating allergic complaints. The outcomes for those who seek treatment from actual allergy/immunology trained physicians are more likely to achieve favorable results. At Allergy A.R.T.S., your allergy serum is completely based upon your unique, testing results. Allergy A.R.T.S. serums are specific to every patient, and based upon the results of yours, or your loved one’s test. The serums our patients receive are mixed under stringent quality control standards that exceed minimum requirements mandated by the AAAAI.

LABORATORY

Dr. Saadeh has invested in bringing state of the art equipment and the lab specialists involved in using the results accurately to the Amarillo area. Although only part of the puzzle in making an accurate diagnosis, those results are critical in forming an appropriate treatment plan. Dr. Saadeh’s lab undergoes the same scrutiny all hospital labs and national central labs sustain through credentialing. The lab at Allergy A.R.T.S. provides the only autoimmune and allergy diagnostic in the panhandle and south plains of Texas. His lab meets requirements, and frequently, receives commendations for exceeding standards from both the Commission Office for Laboratory Accreditation (COLA) and Clinical Laboratory Improvement Act (CLIA).

CLINICAL FACILITIES

√ The west clinic wing is named in memory of Heather Alonzo. Note that a convenient drive-up portico protects patients from the weather when loading and unloading.

√ The west clinic waiting room is filled with natural light and provides comfortable seating especially designed for those with physical challenges.

√ Patient exam rooms are specially designed for the patient’s comfort and for overall efficiency and ease of professional services.

√ The infusion suite is continuously monitored, and carefully designed with the patient’s comfort in mind. Soothing colors and artwork ease the time spent in treatment.

IMAGING DEPARTMENT

Dr. Saadeh’s interest in the use of ultrasound in his practice of rheumatology began well before it became more utilized by rheumatologists. He sought initial training in Italy since availability of training for musculoskeletal use in the United States was sparse in those days. He has subsequently worked with thought leaders and clinicians around the country. Allergy A.R.T.S. was the fourth facility in the United States to attain accreditation through the American Institute for Ultrasound in Medicine for this specialty—just behind Mayo Clinic in Rochester at third. Dr. Saadeh is also a part of the editorial board for the Journal of Ultrasound in Medicine. He uses the tool both diagnostically, and to guide intervention. Through its use he can detect early inflammatory processes prior to x-ray imaging. When patients require injections for musculoskeletal pain and inflammation, the use of ultrasound brings many advantages: avoiding nerve damage, minimizing injection pain, and improved accuracy.

Dr. Saadeh’s radiology technicians are also trained and certified in performing bone densitometry.

Traditional digital X-ray imaging has its place in the practice of rheumatology and allergy/immunology. State of the art equipment operated by licensed radiology technicians is also available at Allergy A.R.T.S.

PULMONARY LAB

Advanced respiratory diagnostics are also a hallmark of Allergy A.R.T.S. Through the use of tests called impulse oscillometry spirometry (IOS), our providers can accurately diagnosis pulmonary conditions that traditional spirometry may miss. IOS works by using sound waves so a patient breathes normally during the test rather than blowing hard. These tests measure both reactance and resistance within the airways. By conducting baseline testing on a new patient and repeating tests following the implementation of a treatment plan, our providers can measure success of the treatment objectively. Body plethysmography, or “body box” as it is commonly called allows for extremely specific testing with barometric pressures maintained in a controlled setting. Methacholine challenge testing and NIOX testing are other specific tests that can assist in making more difficult diagnoses.

INFUSION SERVICES

Since some autoimmune diseases require I.V. delivery of medications, Dr. Saadeh has a professionally staffed infusion department. The nursing services staff attending to patients receiving those treatments go through training with clinical liaisons from manufacturers of each medication.