Patient portal
NNAC is excited to offer a new way to communicate with us online. The Patient Portal is a secure, web-based system that allows real time access to certain elements of your medical record including:
Most recent clinical summary which includes, your medications, allergies, care plan and test results.
Ask the nurses or receptionists a question.
Add or update your personal information.
Review existing appointments and statements.
This two-way messaging allows you to contact our office electronically, and also allows our office staff to communicate with you. There is no obligation to use this new system and we still remain available to you by phone during office hours. Using the portal will allow you to communicate with us at your convenience, 24/7, from any internet device. We will be activating certain portions of the portal at different times, so not all messaging may be available for immediate use. We do, however, recommend that you register as soon as you receive your invitation so that once all capabilities are activated, you will be able to use them immediately.
*Please note that this service is for non-urgent communication only*
When you connect to the portal, you are NOT connecting to our actual office computer system, but a secure web site hosted elsewhere. Only the limited information you see is stored on the portal, the actual records are maintained in our office.
In order to use the Patient Portal, you must first obtain a username and password. Our receptionists will be sending out an invitation via email for you to register for the portal. Please check with the front desk to make sure that we have a current email address on file. All instructions for your registration will be provided in the email as well as throughout registration process. If you are the guardian for a patient who is a minor, you will be given the same instructions. Once your child turns 18 years old, we will inactivate portal access under the parent and activate only upon instruction from the patient.
You will need to have a permanent email address that you check regularly. Private health information will not be sent to your email; instead the email will alert you that you have a new message posted on the patient portal. We want to keep your health information secure and confidential. Therefore, the system will lock you out with 3 failed attempts to enter the portal. Call our office to unlock your portal account.
Important Information About the Patient Portal:
Use is for non-emergency communication and requests.
The Portal is used for communication between appointments. The Portal does not replace your scheduled appointments.
The Portal is not checked on the weekends. It is only checked during regular business hours.
We will not send any private health information to your e-mail.
Documents and forms cannot be attached to the Portal messages.
Patient forms
Allergy drops
The medical term for “allergy drops” is Sublingual Immunotherapy or SLIT, for short. Allergy drops are a treatment for nasal, eye, and respiratory allergies, which is similar in its mechanism of action to traditional allergy injections.
However, instead of injections that have to be performed in a physician’s office, allergy drops are done at home through patients placing a few drops under the tongue each day, a process that takes only a few seconds. The drops have a slightly sweet taste, because they contain glycerin, and are found to be quite tolerable and even pleasant by most adults and children.
Allergy drops, like traditional allergy shots, contain extracts of allergens to which you are allergic (such as specific tree pollens, grass pollens, weed pollens, pet dander, dust mite extracts, etc.). The drops are tailored to your specific allergic sensitivities, based on the testing performed by your Allergist, just as would be done for allergy shots.
To learn more about Allergy Drops, click to read:
Allergy injections
Allergy injections—or allergen immunotherapy—immunize you against the things you are allergic to.
Allergen immunotherapy works in several ways, one of which is to direct your immune system to produce ever-increasing amounts of “blocking antibodies” that hamper a step in allergic reactions.
A course of allergen immunotherapy is begun with an extremely small dose of vaccine. The volume and concentration are then very gradually increased every several days, aiming for an effective “maintenance dosage” and the duration between the injections is gradually lengthened.
Tiny needles are used to give injections in the upper arm. The injections usually cause some mild redness and itching about the size of a quarter.
Allergy injection vaccines should be custom formulated for each patient, based upon individual patterns of skin test reactions and exposures. They can be safely continued during pregnancy.
Avoiding allergens
If you can completely avoid the things to which you are allergic, you cannot experience an allergic reaction. But completely avoiding your allergens is usually easier said than done.
For instance, if your lips swell and your throat itches when you eat shrimp, you probably choose to avoid it. And if you think you’re allergic to penicillin, you would tell your doctor to not prescribe it for you. But the things that cause most allergies are submicroscopic components of invisible inhaled particles, so they’re pretty hard to avoid.
There are multiple “partial avoidance” measures you can do to at least reduce, if not completely avoid, inhaled allergens. Partially avoiding or minimizing exposure to allergens might be as easy as not letting the dog in your bedroom, or wearing a special paper mask that filters out dust and pollens when gardening or sweeping out the garage.
Allergy medications
Antihistamines are the most widely used medications to treat allergies. They block histamine’s attachment to cells, thereby lessening a lot of symptoms, but they have no direct effect on stuffiness.
New “second generation” antihistamines are mostly free of side effects, but you should always be aware of the possibility of drowsiness or slowed reaction time when you take antihistamines.
Oral decongestants
Although safe for many people, oral decongestants have the potential to adversely affect high blood pressure, heart conditions, diabetes, thyroid disorders, glaucoma, and prostate problems. They can also cause jitteriness, sleep disturbance, and palpitations.
Decongestant nasal sprays and drops
Patients are advised against using decongestant nasal sprays for longer than three consecutive days because they can cause “rebound congestion,” resulting in ever-worsening nasal stuffiness and dependency upon the medication. The anti-inflammatory steroid nasal sprays are largely free of side effects when used properly and can be very effective if used regularly. There is also an antihistamine spray that includes anti-inflammatory effects, and a nasal spray that has a drying effect that can be used to advantage for excessive runny nose.
Medications used to treat asthma
The most common prescription medications for day-to-day control are:
- Inhaled anti-inflammatory steroids are presently considered the first choice for patients who experience asthma symptoms more than twice a week. They do for the lungs what the nasal anti-inflammatory sprays do for the nose: they reduce inflammation – which is the underlying cause of allergic and asthmatic reactions – and they do so by working on the inner surface of the lungs, not deep within the body. If begun early enough, they can reverse tissue changes in the lungs known as “remodeling.”
- Bronchodilators dilate the bronchioles, or air passageways, by relaxing the strands of smooth muscle that constrict them. Although bronchodilators are mostly used by inhalation, oral and injectable forms are also available.
- There are other types of inhalers that can be helpful for some asthma patients.
- The most recently developed category of medications for the treatment of asthma is the anti-leukotrienes.
- Theophylline has been used to treat asthma for years but has been largely supplanted by newer medications.
Asthma exacerbations may require oral or intravenous steroids and/or injected epinephrine.
Steroids
Some patients are apprehensive about steroid side effects. But there is little reason to be overly concerned with the modern-day steroid sprays and inhalers being used for allergies and asthma. Some of the newer cortisone-type medications for hay fever and allergic asthma often bring about remarkable improvement and can be safe for long-term use.
Mast cell stabilizers
IgE allergic antibodies attach to the surface of “mast cells.” When the allergens corresponding to those antibodies are present, the allergens and IgE antibodies link up, initiating events inside the mast cell that culminate in the release of histamine and other chemicals that diffuse away and exert effects upon susceptible tissues. Mast cell stabilizers, available as inhalers for asthma, a nasal spray, and eye drops, decrease the amount of histamine and other “allergic mediator” chemicals liberated.
Avoiding allergens
If you can completely avoid the things to which you are allergic, you cannot experience an allergic reaction. But completely avoiding your allergens is usually easier said than done.
For instance, if your lips swell and your throat itches when you eat shrimp, you probably choose to avoid it. And if you think you’re allergic to penicillin, you would tell your doctor to not prescribe it for you. But the things that cause most allergies are submicroscopic components of invisible inhaled particles, so they’re pretty hard to avoid.
There are multiple “partial avoidance” measures you can do to at least reduce, if not completely avoid, inhaled allergens. Partially avoiding or minimizing exposure to allergens might be as easy as not letting the dog in your bedroom, or wearing a special paper mask that filters out dusts and pollens when gardening or sweeping out the garage.
Northern Nevada Allergenic Plants
Allergenic pollen is in the air throughout most of the year in northern Nevada, starting in February and persisting into November.
Sagebrush, which is Nevada’s state flower and which lends its scientific name—Artemisia—to the University of Nevada’s Yearbook, is responsible for many people’s hay fever and asthma symptoms, especially in the summer and fall.
Plants of Allergenic Importance in Northern Nevada aka stuff that makes us sneeze and itch!
| Alder (Alnus species) | Found in moist areas such as along streams and on lakeshores, alders in this area are slender trees with drooping pollen-bearing catkins about 3 inches long. Small cones, less than an inch long, emit winged seeds. They produce pollen in March through May, before their leaves appear. |
| Alfalfa (Medicago sativa) | A member of the legume family grown for horse and cattle fodder. We see many people with positive allergy skin tests to alfalfa, particularly those living in farm and ranch areas. Since it is perennial crop, there is no specific season of pollination. Wild alfalfa, common along roadsides, pollinates in mid-summer. |
| Arizona cypress (Cupressus arizonica) | A medium-size tree, the only cypress native to the Southwest. It is found on dry mountain slopes and canyon walls but can also do well when planted as a drought-tolerant ornamental and is used for windbreaks and erosion control. Pollinates in March and April. |
| Ash (Fraxinus species) | Members of the olive family, ash trees are not native to this area, but are used in landscaping. Their flowers appear before their leaves, and we find their pollen in March, April and May. By the way, the popular mountain ash tree is not related–it belongs to the rose family and is not an allergenic plant. |
| Aspen (Populus species) | Known for their brilliant yellow color in the fall at higher altitudes and their trembling leaves, the quaking aspen has drooping catkins up to 4 inches long. Closely related to cottonwoods and poplars, it is an early springtime pollinator. |
| Birch (Betula species) | Often graceful, birches pollinate in springtime. Abundant birch pollen in the Reno area is responsible for “nose woes” and other allergy symptoms from March through May. |
| Box elder (Acer negundo) | A close relative of the maples, this fast-growing tree common in the Midwest is sometimes used as a landscaping ornamental in this area. Largest amount of pollen dispersed in May. |
| Burning bush (Kochia scoparia) | This multi-branched compact weed that grows to about three feet high has aliases including Mexican fireweed and fireball. It turns a brilliant red in the fall and has been used as an ornamental hedge. Pollinates in late summer through fall. |
| Cocklebur (Xanthium species) | A member of the ragweed family, cocklebur is a coarse weed found in pastures, irrigation ditches, and marshy areas. Like the other weeds, highest pollen levels are in late summer and fall. |
| Clover (Melilotus species) | Clover, alfalfa, and broom are leguminous plants that cross-react allergenically, causing allergy symptoms when their pollen levels peak in the spring and summer. Sorry, but if you are one of the many people who are repulsed by broom’s audacious odor, it’s going to be just as sickeningly sweet after we fix your allergies. |
| Cottonwood (Populus species) | These trees’ “cotton” that fills the air in springtime actually causes less trouble than its invisible allergy-inducing pollen, which is prevalent in northern Nevada in March, April, and May. |
| Curly dock (Rumex crispus) | This slender weed, a member of the buckwheat family, is commonly seen in cultivated fields, along roadsides, and in ditchbanks. It grows to about four feet high and has crowds of small, dull yellow flowers. It pollinates from late spring through summer in this area. |
| Elm (Ulmus species) | Not native to the West, but commonly planted as a shade tree, elms are subject to pests and diseases, including a fungus known as Dutch elm disease, making them messy. Elms and junipers lead off our hay fever season, putting out troublesome pollen beginning in February. |
| Grasses (Gramineae family) | Widespread native and cultivated grasses are summertime pollinators that mostly cross-react allergenically, thus if you are allergic to one you are probably allergic to all grasses. If you have to cut the lawn, wear a “dust and pollen mask”. Hay fever and asthma symptoms can also be due to fungal spores whipped into the air by the mower. |
| Juniper (Juniperus species) | Widespread shrubs and trees occurring both naturally and as a hardy landscape plantings. Their potent pollen, so plentiful that it appears as smoke if you strike a branch, is abundant in northern Nevada from February into June, and is responsible for many allergy symptoms. |
| Linden (Tilia species) | Interestingly, the linden does not seem to be as allergenic in this country as it is in Europe. This may be due to the fact that it is more insect-pollinated here and more wind-pollinated in Europe. As with trees in general, linden pollinates in springtime. |
| Locust (Robinia species) | This is a drought-resistant eastern tree planted in the West along roadsides and on hillsides for erosion control. It adapts well to dry, hot conditions and will thrive in poor soil. A springtime pollinator. |
| Maple (Acer species) | Attractive landscape trees that contribute to many people’s nasal, sinus, eye, ear, and lung symptoms in our area in the springtime. The good news: even if you’re allergic to maple’s pollen, you can probably enjoy maple syrup without problems. We find maple pollen in northern Nevada from March through June, peaking in May. |
| Mulberry (Morus alba) | Fruitless varieties are prodigious springtime pollen producers that tolerate heat and alkaline soil. The paper mulberry was originally planted in the South to develop a silkworm industry. Two wonderful specimens with large rose-lavender flowers in late spring and early summer can be seen at the north end of Virginia Lake. |
| Oak (Quercus species) | Pin oak has become a popular landscape tree in our community. Its clean good looks and tenacious leaves are appreciated by many, but its allergy-causing pollen by few. A late spring pollinator. |
| Pigweed (Amaranthus family) | Plants of the pigweed (Amaranthus) and goosefoot (Chenopodium) families grow aggressively in cultivated or otherwise disturbed soil. Names of some, like “rough redroot pigweed,” aptly describe them. Their abundant pollens are responsible for a variety of airway symptoms during late summer and into autumn. |
| Pine (Pinus species) | Although pines are widespread and their waxy, yellow pollen is notorious for coating windshields and forming a scum on water, allergy skin testing often reveals that symptoms during the many months of pine pollination are actually due to other plants that pollinate at the same time. Its extensive pollination period in our area lasts from March into late fall. |
| Plantain (Plantago species) | Common weeds in lawns, meadows, and waste lands. Less than a foot tall, English plantain (Plantago lanceolata) survives heavy traffic. Heaviest pollination is during summertime. Psyllium seed from a related plant is used as a laxative and can produce adverse symptoms in patients allergic to plantain. |
| Poplar (Populus species) | The lombardy poplar is a rapidly growing columnar tree native to Italy that is used to good decorative advantage along driveways and as a windbreak. It does well in cold, dry climates. Pollinates March through May in our area. |
| Privet (Ligustrum species) | A member of the olive family, privet is mostly used as an evergreen hedge. The flowers draw bees (which can be minimized by clipping the hedges, eliminating most of the flower-bearing branches). Some people find the fragrance annoying. A spring pollinator. |
| Rabbitbrush (Chrysothamnus naseosum) | This first cousin to ragweed is golden yellow in the summer and fall. Handsome for a high desert weed, its scientific name tells you how much its allergy-causing properties are admired. Pollinates summer into early autumn. |
| Ragweed (Ambrosia species) | Despite a scientific name that means food of the gods, North America’s 17 species of ragweed don’t have many friends. Much more of a problem east of the Mississippi–where giant ragweed (Ambrosia trifida) can grow to 12 feet–than in our area, different species of ragweed can found in all states and some can put out pollen when only inches in height. Typically pollinates mid-summer into September. |
| Russian olive (Elaeagnus angustifolia) | Rapidly growing tough little trees with thorny dark branches that tolerate heat and wind and need little attention. Small greenish-yellow flowers give rise to fruit that look like small olives. The silverberry (E. commutata) is a close cousin. Springtime pollinators. |
| Russian thistle (Salsola kali) | More commonly known as “tumbleweed,” this and sagebrush are hallmarks of the western deserts. If you’ve got allergy problems in the fall and you’re not allergic to tumbleweed you’re not from the West. |
| Sagebrush (Artemisia species) | Nevada’s state flower, it pollinates in summer through late autumn and causes chukar hunters as well as home bodies to sneeze, wheeze, and rub their eyes. A plume of greenish flowers the same color as the leaves grows out of the top of each stem. |
| Salt cedar/Tamarisk (Tamarix ramosissima) | A small tree introduced into the Southwest in the early 20th century, it does well along water courses, where it is often found growing with cottonwoods. Pollinates March through August. |
| Sycamore (Platanus species) | The “plane tree” is popular as an ornamental. It has leaves that look like enormous maple leaves and golf ball-sized green fruits that turn yellow-brown as they mature. Pollinates springtime into early summer. |
| Willow (Salix species) | Although Salix gave us acytl-SALI-cylic acid, or aspirin, this attractive native with catkins that turn fuzzy and spread seeds in the wind and its pretty cultivated cousins can be just one more headache for the allergy sufferer. Pollinates in the spring. |
Miscellaneous Desert Plants
The following shrubs might add to allergy problems in Northern Nevada but there is currently insufficient data to be certain of their allergenic importance:
| Bitterbrush, deerbrush, horsebrush | Shrubs in sagebrush deserts usually about twice the size of sagebrush. Small yellow flowers appear for about two weeks in June or July, depending on temperature and precipitation. |
| Desert peach | A pretty shrub of the rose family. Pink flowers precede little pink and green fruits that look like tiny peaches. Being insect pollinated, it is probably not responsible for many allergy problems. |
| Ephedra (“Mormon tea”) | Looks like broom. Clusters of small golden-yellow flowers at the ends of stems. |