Welcome to Asthma and Allergy Affiliates
Serving the North Shore community of Massachusetts since 1972
Board-Certified Specialists in the Care of Adult and Pediatric Asthma, Allergy and Immunology
Our patient-centered philosophy will ensure that you receive individualized care and attention
Our physicians specialize in the care of seasonal allergies, indoor allergies, food allergies, asthma, eczema, and other allergic conditions. Let us help you take control of your allergies and asthma today
Extensive array of services and programs to present a comprehensive and integrated diagnosis and treatment plan for you beginning from the moment you first step through our doors
Call for an Appointment Today
Information for Your First Visit
Please download and print the New Patient Form prior to your First Visit to make the registration process faster
The first visit usually takes approximately one hour. Depending on the complexity of your case, please allow up to two hours. Please arrive 15 minutes prior to your scheduled appointment time to complete the registration process. Be sure to have your insurance card and a photo identification with you. Co-pay or deductible are due at the time of visit.
Please do not take any antihistamines for the five days prior to your appointment (see list at right). Please continue to take all other prescribed medications including all asthma medications.
Your physician may decide to perform scratch tests and/or blood tests during the office visit to help diagnose the cause of your allergic or asthma problem. The skin testing is done in the privacy of the examination room with results available within 15 minutes. Blood tests are drawn in nearby medical centers with results typically available within one week.
Do Not Take Before any Skin Testing or Food Challenge Appointment
- Allegra (fexofenadine) for 5 days
- Astelin/Dymista (azelastine) for 2 days
- Atarax/Vistaril (hydroxyzine) for up to 8 days
- Benadryl (diphenhydramine) for 5 days
- Chlortrimeton (chlorpheneramine) for 6 days
- Clarinex (desloratidine) for 7 days
- Claritin (loratidine) for 5 days
- Periactin (cyproheptadine) for up to 11 days
- Xyzal (levocetirizine) for 5-7 days
- Zyrtec (cetirazine) for 5 days
- Eye drops: Alaway, Elestat, Optivar, Patanol, Pataday, Zaditor, Opcon-A for 3 days
- Antacids: Pepcid (famotidine), Zantac (ranitidine), Tagamet (cimetidine) for 2 days; Omeprazole is fine to take
- Motion-sickness/Nausea: Phenergan, Dramamine for 5 days
- Cold & Cough medicines: Delsym, Dimetapp, Drixoral, NyQuil, Robitussin, Triaminic, Tussionex for 7-10 days
- Sleep Aids: (e.g. Unisom) for 5-7 days
Do NOT stop the following without speaking to the prescribing physician
- Buproprion (Wellbutrin, Zyban), Eszopiclone (Lunesta), Trazadone (Desyrel), Zolpidem (Ambien) for 3 days
- Mirtazapine (Remeron), Quetiapine (Seroquel) for up to 7 days
- Clonazepam (Klonopin), Diazepam (Valium), Lorazepam (Ativan), Midazolam (Versed) for up to 7 days
- Amitryptyline (Elavil), Doxepin, Imipramine, Nortriptiline for up to 7 days
Continue to take all asthma medications as well as your regular prescriptions
Insurance & Methods of Payment
We accept all major insurance policies. You are responsible for co-payments, non-covered services, and deductibles. Payment is expected at the time of your visit. We accept cash, checks, VISA and Mastercard. We’ll work with you to set up a payment plan for any large balance. Please understand while our staff is knowledgeable about what most insurance policies generally cover, each policy is different so we cannot be responsible for making sure that your insurance will cover the services you need.
We encourage all of our patients to understand their financial responsibility. Please call the number on the back of your insurance card to find out if you have a copay, deductible or coinsurance. Also ensure that the doctor you’re scheduled with is in your insurance network. Our billing office is happy to help you with this process. Please call 978-745-3711 and ask for billing.
Glossary of Payment Terms:
- Copay: The amount you are required to pay at your visit.
- Deductible: The amount you pay for your treatment before insurance starts
to pay. This could be applied to allergy testing and breathing tests. - Coinsurance: Usually a percentage of your bill that you are responsible
to pay.
Meet Our Physicians
Dr. MacLean
Dr. Palumbo
Dr. Oren
Dr. Balekian
Dr. Ober
Palforzia for Peanut Allergy
PROs
- Protection from accidental ingestion of 1-3 peanuts
CONs
- Must be taken daily; for life
- Does not cure peanut allergy
- Epinephrine needed in 14% of kids taking peanut OIT in largest clinical study
- Intolerable GI side effects in 6.5% of kids
- Systematic review of all peanut OIT showed overall increased epinephrine use in those who were desensitized
- No evidence of change in quality of life, decreased ER visits, or deaths
Practical Avoidance
- Approximately 5% of foods with voluntary cautionary labels actually contain peanut
- <1% of those tolerating a 1.5mg test-dose were likely to react to products with voluntary cautionary labels.
For the past few years, researchers have tried to find new methods for helping kids and adults with food allergies avoid having severe allergic reactions. In January 2020, the FDA approved the first oral immunotherapy (OIT) for peanut. As of early February 2020, this product is not yet available to patients nor is there information on insurance coverage yet (listed price is $890 per month).
Peanut OIT allows those with an allergy to tolerate small amounts of peanut by introducing peanut slowly through a process called desensitization. The process starts in the office, beginning with 0.5mg of peanut protein (a peanut has approximately 100mg of protein). The dose is gradually increased (11 visits over 22 weeks) until the final 300mg dose is achieved (equivalent to about 3 peanuts). Once the patient successfully tolerates a 300mg dose, they must continue to take it every day to maintain this desensitized state. If the patient misses a certain number of doses, they will have to start the entire process over.
The final dose is felt to be protective of an accidental exposure of 1-3 peanuts. It does NOT allow kids to eat PB&Js, peanut M&Ms, or any other form of peanut or peanut butter. Patients must continue to carry an EpiPen.
The risks of peanut OIT include reactions to the medication itself that can occur either in the doctor’s office, or at home. Approximately 1 in 7 children undergoing peanut OIT required treatment with epinephrine for a reaction, and many of those reactions occurred outside of the doctor’s office. Another 1 in 15 developed intolerable gastrointestinal symptoms that required stopping the treatment.
A large meta-analysis of all peanut OIT studies done to date showed that peanut OIT led to increased cases of anaphylaxis and the need for epinephrine treatment. There was no improvement in quality of life among families in the studies. There were also no decreases in the need to go to the emergency room, and no change in deaths in the kids that took peanut OIT.
We Treat the Following Conditions and Offer these Services
- Food Allergy
- Asthma
- Seasonal Allergies
- Year-Round Allergies
- Sinusitis
- Nonallergic Rhinitis
- Allergic Conjunctivitis
- Drug or Vaccine Allergies
- Chronic Cough
- Eczema / Atopic Dermatitis
- Eosinophilic Esophagitis
- Anaphylaxis
- Contact Dermatitis
- Bee Sting Allergies
- Hives / Urticaria
- Angioedema / Swelling
- Primary Immunodeficiencies
- Latex Allergy
- Environmental Skin Testing
- Food Skin Testing
- Contact Dermatitis Patch Testing
- Spirometry
- Allergy Shots
- Allergen Immunotherapy
- Xolair Treatments
- Immunodeficiency Testing