Comprehensive Allergy and Asthma Associates

Physicians:

1. CATHY WEISS GREEN, M.D.
Earned her degree with honors at the University of Southern California Medical School in Los Angeles. She achieved pediatric board certification in 1992 after completing residency and chief residency training at the University of Michigan Hospital and Cedars Sinai Medical Center. Awarded a UCLA clinical assistant professor title in 1996, academic achievements included the following: participation in the development of the Cedars Sinai hospital-wide pediatric asthma guidelines; development of a JHACO featured Pediatric Quality Assurance Program for the Cedars Sinai emergency department; and presentation of in-services, lectures, and case conferences to staff physicians, pediatric residents/interns, nurses and paramedics.

In 2000, as an integral part of fellowship training at Harbor-UCLA in allergy/immunology, she developed an asthma outreach program for the Torrance and Los Angeles Unified School District's nurses, health aids and educators in addition to participating as co-investigator in the Salmeterol Multicenter Asthma Research Trial.

After fellowship completion in July 2002, she was awarded an UCLA faculty position at Cedars-Sinai Medical Center as an allergist and immunologist. Her clinical responsibilities at Cedars Sinai were as follows: directing the allergy and immunology resident elective, presenting the resident allergy and immunology lecture series, and participating in clinical case conference and grand round presentations. In 2003, Dr. Green received board certification in adult and pediatric allergy and immunology. In 2005, she was awarded a UCLA clinical associate professor title for her academic achievements.

Dr. Green is a member of the American Academy of Allergy Asthma and Immunology, The American College of Allergy Asthma and Immunology, The Los Angeles Society of Allergy and Asthma, and The Los Angeles County Medical Association. Dr. Green is an allergist and immunologist who currently specializes in the evaluation of allergic and immunologic conditions for both adults and children. Dr. Green practices with Dr. Catherine Fuller for Comprehensive Allergy and Asthma Associates in West Los Angeles. Her previous experience as an allergist and immunologist includes Dr. Green's five year association with the Allergy and Clinical Immunology Medical Group in Santa Monica California. In addition, she was the Principal Investigator for the Omalizumab (Xolair) Excels clinical research trial. Dr. Green is an allergist and immunologist whose current areas of expertise include adult and childhood asthma, food allergy and anaphylaxis, allergic rhinitis and sinusitis, acute and chronic urticaria, atopic dermatitis, medication reactions, hymenoptera sensitivity, and immunodeficiency diseases

2. Catherine Fuller, M.D.
Earned her medical degree from the University of North Carolina At Chapel Hill. She completed her residency in Pediatrics at UCLA. Her fellowship in allergy and immunology was completed at Children's Hospital of Los Angeles. Dr. Fuller is an Assistant Clinical Instructor at the David Geffen School of Medicine at UCLA.

Dr. Fuller is a Diplomate of the American Board of Pediatrics and the American Board of Allergy and Immunology. She is a member of the American Academy of Allergy and Asthma, the American College of Allergy and the Joint Council of Allergy and Immunology. She is in private practice in West Los Angeles.











3. Staff

(Top) Dr. Green; Dr. Fuller; Tessa; (Front) Karen; Lilia; Michelle

Michelle Geelhoed is a Certified Physician's Assistant whose primary goal is to provide top quality care to our patients. She received her Masters in Physician Assistant Studies from the University of Southern California (USC) in 2005. She has been a member of the Phi Kappa Phi honor society since 2004. Prior to joining Comprehensive Allergy and Asthma Associates, Michelle worked as a physician's assistant for a family practice clinic in Los Angeles. In addition, she worked for four years as a medical assistant in an allergy practice. She also worked as a research specialist at Children's Hospital of Los Angeles where she studied white blood cell movement and sickle cell anemia. Michelle is certified in cardiopulmonary resuscitation, advanced cardiac life support, and pediatric advanced life support.

Lilia Yumul is a dedicated career nurse who puts patients first. She has been a licensed vocational nurse (LVN) since 1984 and a registered nurse (RN) since 1994. She has sixteen years of experience in the field of allergy and immunology and has had additional experience in the fields of cardiology, urology and gastroenterology. She also worked as an ER/express care nurse for seven years. Lilia has certification in cardiopulmonary resuscitation (CPR), advanced cardiac life support (ACLS) and pediatric advanced life support (PALS).

Karen Ariola is a recent graduate of UCLA and hopes to pursue a career in the field of medicine. She has worked as an allergy office assistant for two years. Karen is cheerful and available to help facilititate patient care. She has experience with allergy skin testing and allergy shots as well as a wide range of administrative duties.
Conditions:
Atopic Dermatitis (a form of Eczema):
Atopic eczema also known as atopic dermatitis is a skin rash that is made worse by allergies. The rash is dry and itchy and most commonly occurs in infants and young children but can occur at any age. Food allergies and certain environmental allergies can trigger outbreaks of Atopic Dermatitis. Allergy Skin Testing and sometimes ImmunoCAP IgE blood testing are used to identify allergens that are triggering the dry itchy rash outbreaks. Treatment includes environmental control, dietary intervention and topical anti-inflammatory creams to help treat the rash.

Allergy will cause flare-ups of atopic dermatitis. Therefore, measures to reduce allergen exposure help to minimize the need for anti-inflammatory creams. This preserves skin integrity by minimizing medication use.

Staphylocccus Aureus is a bacteria that lives in the skin. When itchy skin inflamed by atopic dermatitis is scratched, overgrowth of the "Staph" bacteria occurs. This particular bacteria further inflames the dry itchy skin making the rash worse. In addition to anti-inflammatory creams, it is important to treat inflamed skin with topical antibiotic therapy to help further control the inflammatory cycle. When atopic dermatitis with "Staph" overgrowth is severe, oral antibiotics to treat the "Staph" bacteria may be required to calm the inflammatory reaction

Effective treatment of atopic dermatitis is a must to prevent progression. A comprehensive treatment plan which begins with identifying the allergens underlying flare-ups, allergen avoidance, medication use and environmental control is imperative in order to control atopic dermatitis.

Bronchial Asthma:
Bronchial Asthma is a condition that is commonly related to allergies. Symptoms of asthma include shortness of breath and wheezing, chronic cough, and wheezing with exercise. These symptoms can be caused by exposure to allergens in an allergic individual. The more severe the asthma, the more likely allergies are playing a role. At least 80% of children and 50 - 80% of adults with asthma have allergic asthma. Common allergens that flare the symptoms of asthma include pollens (grasses/trees/ weeds), dogs, cats, dust mites, molds and foods.

Allergy skin testing identifies those allergens that are likely making the symptoms of asthma worse. In addition, allergy skin testing identifies how severe of an allergy exists to these allergens.

Allergic asthma can be successfully treated with medication; however, identifying the allergens which make asthma worse is important in instituting a more comprehensive treatment plan. In addition to medication, this treatment plan would include environmental control measures, dietary intervention, and allergen immunotherapy (allergy shots). Allergy shots are indicated and are a successful treatment for allergic asthma in adults and children.

Food Allergies:
Research shows that children and adults currently have more food allergy than at anytime in the past. Symptoms of severe food allergy include hives, swelling and shortness of breath. These symptoms can be life threatening. Children and adults with severe food allergy commonly require emergency room treatment and can require admission to the hospital for treatment. In addition, less severe food allergy can worsen underlying conditions such as asthma, atopic dermatitis and sinus allergies. It can also cause heartburn, diarrhea and bloating.

Food allergies are diagnosed with specialized diagnostic testing which includes ImmunoCAP IgE blood testing and/or food allergy skin testing. Food allergies can be mild or severe. ImmunoCAP IgE blood testing and allergy skin testing as well as the symptoms you are experiencing help to define the severity of your food allergy. Testing is also used to identify the specific foods which are causing symptoms.

After specific food allergies are diagnosed, a treatment plan which includes dietary intervention, medications and at times other methods is instituted to alleviate symptoms caused be ingestion of the allergenic foods that are identified.

Hives and Swelling:
Hives or urticaria can be caused by allergies. Symptoms of hives include red blotchy patches that come and go and are often associated with welts. Hives often itch. They can progress to swelling of the deeper tissues. This is a more serious condition known as angioedema and is often painful.

Hives can be acute, lasting a period of days to weeks, or chronic, lasting months. Common allergens that cause hives acutely are medications, certain foods, latex, and bee stings. High level inhalant allergy to environmental like pollens, dogs, cats dust mites and mold can also cause hives and often leads to more chronic symptoms. Hives are not always caused by allergy and thus a comprehensive evaluation is often required when hives do not resolve easily after treatment with medication.

It is important to determine the cause of hives in order to effectively treat them. A blood work-up and allergy skin testing are methods to help identify their cause. Hives must be treated with rapid intervention which includes avoidance of allergen triggers, and treatment with appropriate medication in order to control symptoms and prevent progression. If hives are due to a condition other than allergy, this must be identified in order to effectively treat the underlying cause of the hives.

Recurrent or persistent hives are best evaluated by an allergist/immunologist in order to best diagnose their underlying cause. In most cases, hives can be effectively managed when their cause is accurately identified.

Honey Bee, Yellow Jacket, and Wasp Allergy:
Allergy to bees and wasps can be life threatening. An adult or child with any reaction to a bee sting that is more than mild and localized should be evaluated by an allergist. Local swelling is defined as swelling that does not progress beyond the part of the body that is stung. Any reaction other than a local reaction may indicate allergy to bee venom that may be serious. Even hives after a bee sting may be a sign that there is danger of a much more serious reaction if you were to be stung again.

Specialized blood testing and venom allergy skin testing are methods that are used to determine the severity of bee sting allergies and the need for further treatment. Venom allergy shots are effective for the treatment of potentially life threatening bee sting allergies. Treatment with venom allergy shots (venom immunotherapy) is at least 5 years and is instituted when there is a risk of a life threatening reaction to a subsequent bee sting. Injectable Epinephrine also is used to provide additional protection.

Identification and treatment of severe bee sting allergy before the next sting can be life saving. Therefore, it is imperative that rapid evaluation by an allergist be performed and treatment be instituted when indicated in all cases of systemic (full body reactions) to bee stings.

Immunodeficiency Conditions:
Immunodeficiency conditions present with recurrent infections. The severity and the frequency of these infections generally reflects the severity of the underlying immunodeficiency condition.

Most immunodeficiencies are mild; however; there are immunodeficiency conditions that are severe and present with severe infections such as recurrent pneumonia and meningitis. The most common immunodeficiency condition is IgA deficiency. Recurrent respiratory infections are associated with this deficiency. Blood tests which assess immunoglobulin levels, specific antibody levels, specific lymphocyte counts and other immune function will diagnose immunodeficiency conditions. Blood tests can also determine which part of the immune system is affected. In additon, an evaluation for the presence allergy is typically useful since allergic conditions are often associated with recurrent less severe infections. Allergy is most commonly diagnosed by allergy skin testing and ImmunoCAP IgE blood testing when indicated.

Once an immunodeficiency condition is diagnosed, treatment will help to boost the deficient portion of the immune system to better fight infection. The most common therapies include vaccination with Pneumovax and Intravenous Immunoglobulin; however others are available.

Nasal, Sinus and Eye Allergies:
Nasal allergies (allergic rhinitis) and sinus allergies (allergic sinusitis) are common. Symptoms of nasal allergies include nasal congestion, sneezing and itching of the nose. These symptoms are sometimes associated with itchy, watery eyes known as allergic conjunctivitis. Common sinus allergy symptoms are sinus pressure, headache, post-nasal drip and cough. Nasal and sinus allergies are often associated with recurrent sinus infections. Children with these allergies can also have recurrent ear infections.

Common allergens that cause nasal sinus and eye allergies include pollens (grasses/trees/weeds), dogs, cats, dust mites, molds and various foods. Allergy skin testing is used to identify the allergens that cause these symptoms. A typical panel of 72 allergens will identify many of the common allergens that are responsible for your symptoms.

Medications, in addition to environmental control measures and dietary intervention (when indicated), successfully control symptoms of nasal, sinus, and eye allergies. When symptoms are year round or more severe, allergen immunotherapy (allergy shots) are a very effective therapy for adults and children with these conditions.

Allergy shots are not a medication but contain allergens that produce immune tolerance to the allergens that cause your allergic symptoms. The course of allergen immunotherapy (allergy shots) is typically 3-5 years. Studies show that allergy shots will decrease symptoms and medication use for patients with nasal, sinus and eye allergies.

Pet Allergies:
Animal dander (skin shedding or epidermal scales of animals) is an important cause of allergic reactions to pets. Exposure to the saliva, fur, and the urine of pets can also result in allergic symptoms. Many people have beloved pets in their household and despite allergy to them, do not realistically want to get rid of these pets. In cases of mild sensitivity, keeping your pet outside the home and removing your pet from the bedroom will likely improve your allergic symptoms. It is important to remember that even if a pet is completely removed from the home, it often takes several months until the animal dander is no longer a problem.

Allergic conditions like allergic asthma, nasal and sinus allergies, and eye allergies are often made worse by a pet in the home. HEPA filters and HEPA vacuums can help remove animal allergens from the air and carpeting. Cats are typically more allergenic than dogs and the cat allergen called Fed-D1 will attach to clothes and furniture. It is important to keep the cat?s litter box away from the home. Washing and brushing your pets at least once weekly can also help to decrease your allergic symptoms.

Allergy to dogs, cats, rabbits and other pets can be diagnosed by allergy skin testing. When high level allergy is identified, environmental control measures, medication, and allergy shots may help to alleviate symptoms caused by your pet. If the allergy is severe enough and a more severe allergic condition such as asthma has developed, there are times when pet removal from the home may be the most reasonable option. However by working with your allergist and instituting the steps outlined above, removal of your pet from the home in most cases can be avoided.

Control Measures:
Dust Mite Control Measures:

Dust mites are microscopic creatures that live in the skin. These mites collect most commonly in bedding, mattresses, stuffed couches and pillows, carpets and stuffed animals. Certain people are allergic to dust mites and when this occurs, dust mite allergy will worsen underlying allergic conditions such as asthma, atopic dermatitis and allergic rhinitis. Dust mite allergy is most commonly diagnosed by allergy skin testing.

Dust mite control measures are important in minimizing exposure to this allergen when dust mite allergy is present. Common dust mite control measures include mattress pillow, duvet, and box spring covers, HEPA filters for the bedroom and living areas, flooring instead of carpeting, and HEPA vacuums for all carpeted areas. Additional measures include minimizing stuffed animal exposure and washing all bedding once a week in very hot water. HEPA filtration systems can also be installed in the heating and air conditioning systems in your home.

Dust mite control measures when instituted in their entirety will decrease indoor exposure to dust mite allergens. Decreasing exposure to these allergens is important in controlling allergic conditions.

Mold Control:
Mold is an indoor allergen and grows wherever there is moisture. The best way to control mold is to keep the environment clean and dry. Plumbing leaks are common causes of water intrusion in the home and will lead to mold growth. When mold spores are present in the air, allergic conditions such as asthma, hives, and nasal allergies can develop or worsen.

Allergy skin testing can detect allergy to mold. A panel of mold allergens can be placed on your back. If after placing the mold panel welts and/or redness develop, this indicates mold allergy.

There are two types of molds. Wet molds like Penicillium and Aspergillus which are typically found indoors with water intrusion (i.e. plumbing leaks) and dry molds like alternaria which are typically found outdoors. Dry molds will blow in from the desert with the dry Santa Ana winds.

If mold is present in your home, it should be remediated to prevent a flare of your allergy symptoms. If remediatation is not possible, leaving the home may be necessary to prevent worsening of allergy symptoms. In addition, dehumidification may be somewhat effective in decreasing mold growth.

Diagnosis/Treatment:
Allergy Skin Testing:
Allergy skin testing is the most common method used by allergists to determine which allergens will likely play a role in flaring allergic conditions. Common allergens include pollens from grasses, trees, weeds, and indoor allergens such as dust mites, mold, and animal allergens. Food allergens are also usually tested.

Skin testing is initially performed by superficial methods where the skin is pricked or scratched with common allergens. Injection of small amounts of allergens into the skin is then performed to confirm the negative results. This assures that allergy skin testing is not falsely read as negative.

Allergy skin testing is performed in the allergist's office and cannot be performed if a patient has taken an antihistamine (i.e. Benadryl, Zyrtec, Claritin or Allegra) typically within 7 days. Thus, it is recommended that prior to a scheduled initial consultation, patients check with the office regarding their medications.

Allergy Shots & Allergen Immunotherapy:
Allergy shots (Allergen Immunotherapy) are a very effective method used to treat certain allergic conditions. They are approved for the treatment of bronchial asthma, allergic rhinoconjunctivitis, and stinging insect allergy. Allergy shots are efficacious for both adults and children.

Allergy shots contain allergens and are not a medicine. They induce an immune tolerance so that the body becomes less allergic. They have been used by allergists since 1911 when it was discovered that by giving injections of allergens little by little, allergic symptoms did not occur when the allergens (i.e. grass pollens) were inhaled.

Allergy shots are almost painless. Shots are given once to twice weekly during the buildup phase (typically 6 months) and then once every 2 - 4 weeks. The course is typically 3 to 5 years. Studies have proven that allergy shots effectively decrease medication use and symptoms for certain allergic conditions.

Contact Us:
11645 Wilshire Blvd.
Suite 1150
Los Angeles, CA 90025
310-909-1910
310-909-1911 FAX

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