Hazelnut allergy

Hazelnut allergy

Hazelnut allergy_3

Dr. Harold Kim MD,FRCPC
Allergy and Clinical Immunology
525 Belmont Ave. West
Suite 205
Kitchener, Ontario
N2M 5E2

Allergy Shot Clinic times are as follows:

11:30 am — 1:00 pm

7:30 am — 8:30 am
3:00 pm — 6:00 pm

7:30 am — 8:30 am
2:00 pm — 4:00 pm

*Please contact the office to arrange an appointment for your first allergy shot

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Use of this Website

Welcome to the GrandRiver Allergy Clinic. The information contained in this site is for educational purposes only. It is provided as a courtesy to our patients. The information on this website and from subsequent links to other websites are intended to supplement, not substitute the advice given at our clinic. No individuals, including those under our care, should use this information for self-diagnosis or self-treatment of any condition. Only a doctor or other licensed health care professional should perform diagnosis and treatment of health conditions.

Children under 15 kg with food allergy may be at risk of having epinephrine auto-injectors administered into bone

Laura Kim , Immaculate FP Nevis , Gina Tsai , Arunmozhi Dominic , Ryan Potts , Jack Chiu  and Harold L Kim

Overview-We ultrasounded 100 children weighing less than 15 kg who have food allergy and required an epinephrine auto-injector (Epipen Jr or Allerject 0.15 mg). The needle length of the Epipen Jr is 12.7 mm. In approximately 29% of the children, the needle would hit the bone when injected with pressure. This may lead to an unpredictable delivery of the epinephrine. This could lead to suboptimal blood levels of epinephrine and or even levels that are too high leading to an unpredictable response to the drug.

The paper can be downloaded at:

Auto-injector needle length may be inadequate to deliver epinephrine intramuscularly in women with confirmed food allergy

Overview-We ultrasounded 100 adults who have food allergy and required an epinephrine auto-injector (Epipen or Allerject). The needle length of the Epipen is 15.2 mm. In approximately 28% of women, the needle would not reach the muscle for optimal delivery of the epinephrine. This could lead to suboptimal blood levels of epinephrine and therefore suboptimal response to the drug.

The paper can be downloaded at:

Patients on subcutaneous allergen immunotherapy are at risk of intramuscular injections

Overview-We ultrasounded 200 adults who were receiving allergen immunotherapy (allergy shots). The allergy injections are used to treat allergic rhinitis or hayfever. The injections are meant to be given in the subcutaneous space between the skin and the muscle in the upper arm. We found that 80% of patients have less depth to the muscle than the length of the standard allergy needle (13 mm). So 80% of patients could get the injections in the muscle. This could increase the risk of allergic reactions to the immunotherapy.

The paper can be downloaded at:

Patient Information for Allergen Immunotherapy for Allergic Rhinitis

Allergen immunotherapy, commonly known as “allergy shots”, has been a mainstay of the treatment for allergic conditions for almost 100 years. In Canada, we are exposed to many of the allergens that have been proven to be effective in this type of treatment. Therefore, many allergists recommend this type of treatment for patients across the country. In this article, we will focus on the use of year round immunotherapy in allergic rhinitis and asthma. We will discuss potential benefits, patient and allergen selection, how the injections are given and safety issues.

Immunotherapy has been shown to be effective for most allergic conditions including allergic rhinitis, asthma, atopic dermatitis and insect sting allergy. As well, there are some studies suggesting that immunotherapy may actually prevent the onset of new allergies or even asthma. The concepts behind allergen immunotherapy are very different than the other common medical treatments that we use in treating allergic conditions such as allergic rhinitis and asthma. The mechanisms behind immunotherapy seems illogical to many. Patients are injected with gradually increasing doses of the allergens that were actually causing their original symptoms. There are several studies performed over the last few decades that have clearly shown that useful changes in the immune system occur with this approach to treatment. In fact, this is the only true treatment that changes the underlying immune problems that cause allergy.

Typically, we approach the treatment of allergic rhinitis by suggesting allergen avoidance measures for the identified allergens. These allergies are identified by skin testing by an allergist. Next, we would typically recommend using non-sedating antihistamines for mild patients and intranasal corticosteroid sprays for moderate and severe patients. Often, patients do not have an adequate improvement with these medical therapies or prefer not to take these medications on an ongoing basis. At this point, allergists may recommend allergen immunotherapy. We estimate that 70 to 80% of patients have a significant improvement with immunotherapy.

As noted previously, the important allergens for each patient are identified by the clinical history of symptoms and the allergy skin tests. In Canada, the most common allergens are dust mites, pets, pollens and molds. All of these allergens can be used in allergen immunotherapy. There are properly performed studies proving that these allergens are all useful for immunotherapy. Furthermore, we now have available standardized allergens for dust mites, cat, grass and ragweed available for patients in Canada. "Standardized" refers to the idea that these allergens are manufactured and tested so that their potency can be more accurately predicted. This has led to more effective immunotherapy that is easier to prescribe by allergists.

If the patient’s symptoms are not controlled by medical therapy, the allergist may prescribe the allergen immunotherapy. Generally, we try to include a maximum of three allergens per vial of serum. For example, we may mix dust mites with ragweed into one vial if a patient is allergic to both of them. Often, we must use two vials of allergy serum because a patient is allergic to several important allergens. Also, some allergens should not be mixed with some other allergens because some allergens can impact the potency of other allergens. Each vial is produced at a full strength concentration. Then that vial is further diluted into weaker vials that are 1/10 strength, 1/100 strength and 1/1000 strength compared to the full strength vial. The patient will receive gradually increasing volumes from the weakest strength vial up to the strongest strength vial. Ultimately, the patient will reach a maintenance volume from the strongest vial of allergen immunotherapy. The increasing doses are given once or twice per week by injection into the arm(s). When the maintenance dose is achieved, then the interval is gradually increased to once per month. Then the maintenance dose is given every month on a year-round basis. Usually, patients have clinical improvement in their symptoms within 6 to 12 months. Private and even provincial drug plans usually cover the cost of the immunotherapy extracts. The injections and medical care associated with them are paid for by public health coverage.

Unfortunately, there are some drawbacks to allergen immunotherapy. For example the length of time to increase the dosing of immunotherapy is usually about six months. Then, the patient stays on the monthly injections for approximately 5 years. One can see that there is a big time commitment to this treatment. Also, there is a risk of allergic reactions to the injections. Occasionally, these reactions can be life-threatening anaphylactic ones. Therefore, patients must wait 30 minutes after each injection in the physician's office. A physician must be present for all allergy injections. As well, generally patients with poorly controlled asthma or patients on beta-blocker medications should not receive allergy injections because of an increased risk of anaphylaxis.

In summary, allergen immunotherapy is a proven treatment in allergic conditions such as allergic rhinitis and asthma that can have a true disease modifying effect. Occasionally, we even are able to "cure" allergic rhinitis or asthma. It is a great option for patients who have not improved with standard medical therapies or who do not wish to stay on medical treatments indefinitely. Finally, a qualified allergist should prescribe immunotherapy and a physician must be present for each injection.


  1. Allergen immunotherapy is the only treatment available that treats underlying allergies.
  1. There may be long-term benefits of receiving immunotherapy even after it is stopped.
  2. The injections must be given once or twice per week to increase dose then the interval is increased to every month. Generally, the immunotherapy is given for 5 years.
  3. There is a small risk of allergic reactions to the immunotherapy. Therefore you must wait 30 minutes after every shot.

Practical Guide for Allergy and Immunology in Canada (Medical Resource)

  • Medical Papers on Specific topics in Allergy and Immunology
    General Allergy/Asthma Websites
  • Allergy Asthma and Immunology Society of Ontario
  • Allergy Asthma Information Association
  • American Academy of Allergy Asthma and Immunology
  • Canadian Society of Allergy and Clinical Immunology


  • Canadian Network for Respiratory Care

    Food Allergy and Anaphylaxis

  • Allergy Asthma Information Association
  • Food Allergy and Anaphylaxis Network
  • Canadian Government Food Information

    Airborne allergens are protein particles that can cause asthma, rhinitis and atopic dermatitis. It is important to avoid the allergens that cause allergic symptoms. Avoidance may result in the complete disappearance of symptoms. People should keep their allergies in mind when choosing their environment. In this write up, we will suggest some measures to avoid common allergens.

    1.Animals: The ideal method for avoidance of animal allergens is to remove the pet from the home. Symptoms caused by pets can be so long-lasting that it is not apparent to the individual that the pet is responsible for the allergy symptoms until he or she has been away from the pet for a long period of time. It takes months to get the animal proteins to clear from the environment. If the pets cannot be removed, then the pets should be kept out of the bedroom, carpet should be removed from the bedroom, a HEPA filter should be present in the bedroom and the pet should be washed regularly. Please note that these measures are not as effective as removing the pet.

    2.Dust Mites: Dust mite are microscopic creatures that live in the pillow, mattress, bedding and carpets in the bedroom. Dust mites eat skin flakes that fall off the body and get water from the ambient air. The allergens from dust mites are from the fecal particles. If you must do the house cleaning, dust-proof Respro™ masks are helpful. The following measures should be completed to avoid dust mites:
    a.Hardwood or linoleum are superior to carpet.
    b.Mattresses and box springs should be completely encased mite proof covers. Plastic covers can be used on the box spring. Special mattress covers can be purchased at Belgage Pharmacy (525 Belmont Ave. W. Kitchener, 576-2900), Medigas (334 Manitou Drive, Kitchener, 893-3250) or in Stratford at Horizon Prohealth (342 Erie Street Suite 114 in Jenny Trout Centre, 272-0202) or in London at Western ProResp (699 Wilkins St. #43, 519-686-6212).
    c.Pillows and comforters must be machine washable or encased in mite proof covers. All of the bedding should be washed monthly in hot (greater than 55°C ) water.*If there are children in the house caution must be used. as these temperatures can cause burns.
    d.Relative humidity above 50% promotes dust mite growth. The ideal humidity is 30 — 40%.

    3.Pollens: Pollens from plants that are fertilized by wind-borne pollen can cause allergies. The common pollens in southern Ontario are from trees, grasses and ragweed. Trees pollinate from about April 15 — June 10. Grasses from about May 1 – July 31. Ragweed from August 15 to frost. It is impossible to completely avoid pollens. The best way to avoid pollens is to live and work in an air-conditioned environment. Air-conditioning is effective if all windows in the home are kept closed all season.

    4.Moulds: Moulds are outdoors from spring to fall. Keeping windows closed and air conditioning on will decrease exposure to outdoor moulds. Moulds grow frequently in the soil of house plants. It is best to remove any plants that are suspect. Clean humidifiers carefully, at least once monthly. A little bleach in the water helps inhibit mould growth. Mould can be found in bathrooms in the shower area and once again bleach is helpful in removing it. If the basement is humid or you suspect mould is present a dehumidifier may decrease mould.

    Air Cleaners: Indoor air can be improved by some air cleaners. One must be aware that manufacturers claims often exceed the real improvement. The most efficient filters are 1. Electronic air-cleaner 2. 3M Filtrete ™ filter 3. HEPA (High Efficiency Particle Absorption) type.

    Humidifiers. The ideal humidity is 30 — 40%. Humidity is measured with a hygrometer. Humidifiers should be cleaned with diluted bleach to prevent mould growth.

    Duct Cleaning: Dust mites do not live in ducts. Cleaning is recommended when you first move into a house. It is not necessary otherwise. Time and money are better spent on other avoidance measures.

    Vacuums: In general vacuums are designed to pick up visible rather than invisible or allergic dust. Many vacuum manufacturers claims are not true. Removing carpet works better then any vacuum for dust mite allergic people. The best vacuum style is a central vacuum system venting to the garage or outdoors.

    Smoke: Smoking can cause allergy like symptoms in smokers and people exposed to "second-hand smoke". No one should smoke in the house at all. Allergic people should not smoke!

    Patient Information for the First Visit to Our Clinic

    Dr. Kim’s office is located in the Belgage Medical Arts Building in Kitchener at 525 Belmont Ave. West Suite 205. There is paid parking at the building. If you have been referred to one of Dr. Kim’s clinics outside of Kitchener please contact that clinic for specific directions.

    The following information is important for your first visit to our clinic:

    You should plan your schedule to allow approximately one hour for your first visit.

    Medications containing antihistamines should be stopped for 5 days prior to the first visit. DO NOT stop any other medications including nasal sprays or asthma medications. If you cannot stop the antihistamines for 5 days please stay on the antihistamines.

    If you have been on allergy shots, please bring in the serum and your dosing schedule.

    There have been advances in the methods for allergy testing. The testing involves placing drops on the arms and touching each drop with an allergy tester.

    Testing for insect stings, antibiotics and other medications may involve injections of small amounts of the allergens.

    If you are referred to the clinic for latex or antibiotic testing please contact the office to be sure your appointment is scheduled for the appropriate date.

    For patients under 16 years of age, we request that an adult accompany them for the visit.

    Please contact our office if you have any questions. We look forward to seeing you.

    Dr. Kim’s office is located in the Belgage Medical Arts Building in Kitchener at 525 Belmont Ave. West Suite 205. There is paid parking at the building. If you have been referred to one of Dr. Kim’s clinics outside of Kitchener please contact that hospital’s clinic for specific directions.

    Belgage Medical Arts Centre
    525 Belmont Ave. West Suite 205
    Kitchener, Ontario N2M 5E2

    Tel: (519) 745-9525
    Fax: (519) 745-9501

    Dr. Kim also has clinics in Stratford, Seaforth and London. To contact these clinics directly please call:

    Stratford 519-272-8210 ext. 2415
    Clinton 519-482-3440 ext. 6275
    London 519-685-8277


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