Since medical school, Dr. Denisa Ferastraoaru was attracted to the field of allergy and immunology because there is a combination of detective work and strong basic immunology knowledge involved in trying to figure out the triggers of different symptoms that people present with. 

Once she entered the field, she saw how environmental allergies were negatively affecting people’s quality of life and found it so rewarding to be able to alleviate their suffering. 

Fast forward 20 years, and there are now advanced and personalized treatments available for patients, and Dr. Ferastraoaru, an associate professor in the department of medicine (allergy & immunology), along with Dr. Nadeem Akbar, an associate professor in the department of otorhinolaryngology - head & neck surgery, co-lead the Montefiore Einstein Sinus and Allergy Center.

We spoke with Dr. Ferastraoaru about what the Center offers.

Tell us about the Montefiore Einstein Sinus and Allergy Center.

The Montefiore Einstein Sinus and Allergy Center is a combined allergy and ENT clinic where patients with chronic sinusitis with or without nasal polyps, allergic rhinitis, and other sinus conditions, can receive comprehensive care from both allergy specialists and otorhinolaryngologists in one office visit. This means that the patients coming to the Montefiore Einstein Sinus and Allergy Center will see both specialists on the same day.

Why was it created? Explain the need for it.

Many patients who have chronic nasal symptoms bounce around from specialist to specialist. They may first see an internist who refers them to an allergist who refers them to an ENT specialist, or the other way around, which may result in long wait times. Some of our patients also face difficulty taking days off from work. The Sinus and Allergy Center provides more efficient access for patients because they will be evaluated on the same day by both allergy/immunology and rhinology specialists.

What can patients expect during a first visit?

People with chronic nasal symptoms who come to the Sinus and Allergy Center for care benefit from our interdisciplinary approach. During the visit, they receive a full evaluation from an allergist and otorhinolaryngologist to determine the causes of their symptoms and discuss treatment options.

The allergist will conduct skin testing for any environmental allergies that could trigger chronic respiratory conditions. Based on the history, presentation, and physical exam, evaluation for an immunodeficiency or other associated medical conditions will be initiated, if needed. 

Rhinoscopy will be performed by the ENT physician to further evaluate the extent of the disease, the presence of nasal polyps, or other abnormalities exacerbating their chronic sinonasal symptoms.

Then the two specialists will discuss each case and formulate a personalized plan for a comprehensive medical and surgical management of these patients. 

How many patients have you treated at the Center?

We see patients once per month at our Center. To date we have seen about 300 patients.

What are some of the treatments for sinusitis?

There are different steps in treating sinusitis. Depending on the extent of the disease, we usually start with local medications, which are nasal sprays and saline washes. Based on the severity of the symptoms and how patients respond to the first step, sinus imaging might be needed to further help decide about the next treatment approaches. We discuss and offer our patients personalized treatments, such as allergen immunotherapy, also known as allergy shots, or different biologics targeting the chronic inflammation. For patients with severe sinus disease not responding to medical treatment, or in case of different anatomical abnormalities impairing the sinus drainage, our ENT colleagues discuss with the patients about different surgical treatments.

Is there a specific allergy season?

Many patients have worsening of their nasal symptoms during spring and fall, two seasons with high pollen counts. However, many of our patients have symptoms all year round because of exposure to perennial allergens such as dust, molds, pets, cockroach allergens, etc. Moreover, weather changes, exposure to different triggers at the workplace, or having other associated sinus conditions would also result in sinus symptoms throughout the year. Therefore, in patients with sinus symptoms, it is very important to get a comprehensive history, to perform a detailed exam including rhinoscopy, and to determine their environmental allergies through skin testing or blood work, in order to formulate an individualized treatment plan.

When should people seek medical care beyond over-the-counter remedies?

It’s always important to seek medical care when the symptoms are persistent and they are affecting the person’s quality of life. It is also important to have a correct diagnosis to offer a targeted treatment. Sometimes, there are other systemic conditions resulting in these symptoms, which, left undiagnosed or treated only by over-the-counter medications, will not be sufficient in providing adequate relief.