Complex Allergy & Immunology
When the Infections Keep Coming Back
Difficult-to-treat infections, one course of antibiotics after another, and no clear answer — that pattern deserves an immune system evaluation, not another guess. Allergic conditions are immune system disorders, and diagnosing them is what a board-certified Allergist/Immunologist is trained to do.
The patient who has already been everywhere else
Some people arrive at our office with a thin folder and a simple problem. Others arrive with years of history: repeated sinus infections, pneumonia more than once, ear infections that never fully clear, courses of antibiotics that work for a few weeks and then stop working. They have seen a primary care doctor, maybe an ENT, maybe a pulmonologist. Every visit produced a prescription. No visit produced an explanation.
Dr. Mandel Sher founded Sher Allergy Specialists out of a deep desire to make people feel better — whether they suffer from straightforward allergies and asthma, or complex medical problems that are yet to be solved. That second group is the reason this page exists.
If an allergic or immune system evaluation is the next step because others’ efforts at diagnosing and treating have not worked, we would like to hear your story. Call our friendly Sher Allergy team at 727-397-8557.
Signs that an immune evaluation may be the missing step
Immune deficiency disorders may not be suspected until difficult-to-treat infections, recurrent pneumonia, ear infections or sinusitis, multiple courses of antibiotics to clear infections, or poor growth or weight loss become a concern. Those are the practice’s own published warning signs, and they are worth taking seriously in adults as well as children.
It is reasonable to ask for an allergy and immunology evaluation when you or your child notice:
- Multiple ear, sinus or lung infections in a single year
- Pneumonia more than once, or an infection that keeps recurring in the same place
- Infections that require several different antibiotics, or that return as soon as antibiotics stop
- Sinus disease that has not resolved despite medical treatment or surgery
- Breathing trouble, persistent cough or exercise intolerance that has been treated but never explained
- Poor growth or unexplained weight loss in a child alongside frequent infections
- Runny nose, watery eyes, itching, sneezing or coughing with no exposure to a viral illness
What a complex evaluation looks like here
The single most important factor in diagnosing allergy, asthma, chronic cough, sinus disorders and other allergy-related conditions — and in choosing the best-fit treatment — is a well-informed patient or patient advocate. So the visit starts with listening.
Our team will listen to your allergy story, thoroughly review your medical history, conduct a physical exam, and strive to do allergy testing and interpretation on the same day as your evaluation visit when possible. For a complicated case that has been open for years, having the history, the exam and the testing land in the same appointment is what finally lets the pieces line up. At Sher Allergy Specialists, your allergy skin tests are personally measured and read by a physician or physician assistant, with physician oversight and interpretation, rather than simply recorded by a technician or medical assistant for later review.
You will leave the initial evaluation visit with a diagnosis and treatment steps. If additional laboratory work is needed to characterize an immune problem, we will tell you what we are ordering and why before you leave.
- Allergy skin testing — scratch/prick, intradermal, and patch testing, usually completed at the first visit
- Blood testing — including celiac disease, food components (milk, peanut, tree nuts and egg), mast cell (allergic cell hypersensitivity), and alpha-gal (meat allergy)
- Nitric oxide (FeNO) — measures lung inflammation and identifies activity for asthma and eosinophilic bronchitis
- Spirometry — pulmonary function testing, compared against values predicted normal for your age, size and sex
- Rhinoscopy — a flexible fiberoptic look at the nose, throat and larynx to find what a standard exam cannot see
- Oral food challenge — when a food is suspected of driving symptoms and the picture is unclear
Why this belongs with an Allergist/Immunologist
All allergic reactions are the result of an immune system disorder. A trained and board-certified pediatric and adult Allergist/Immunologist is best qualified to safely perform and interpret allergy testing and manage allergy treatment — and is the specialist trained to recognize when the problem is the immune system itself rather than a run of bad luck.
Dr. Sher and Castro are double board-certified by the American Board of Allergy & Immunology and the American Board of Pediatrics. They both are on clinical faculty at Division of Allergy and Immunology at the University of South Florida located at Johns Hopkins All Children’s Hospital, teaching future allergist and immunologist, participating in clinical research and staying up to date on state of the art allergy and immunology clinical care.
Conditions we work up when infections keep returning
Immune Deficiency Disorders
Suspected when difficult-to-treat infections, recurrent pneumonia, ear infections or sinusitis, multiple courses of antibiotics, or poor growth or weight loss become a concern.
Sinusitis & Nasal Polyps
Sinuses that do not drain mucus properly produce bacterial or viral infection, tooth pain and front headache. Chronic sinusitis is associated with allergic rhinitis or asthma and can cause persistent postnasal drip and chronic cough. We treat sinusitis, nasal polyps, and recurrent or chronic infection.
Eosinophilic Disorders
Increased levels of eosinophils — the white blood cells that fight parasites and drive allergic reactions — in one or more places in the respiratory and digestive tracts. Sher Allergy diagnoses and treats all eosinophilic disorders.
Asthma That Is Not Behaving
We identify and treat the primary cause of airway inflammation, not just the symptoms, across allergic, cough-variant, eosinophilic, exercise-induced and occupational asthma.
Chronic Cough & Throat Clearing
A cough that has outlasted every explanation is a medical condition in its own right. Sher Allergy patients can be seen in our specialized Center for Cough clinic.
Drug Allergy
Repeated antibiotic courses raise the question of drug allergy. Through allergy testing you may find out that you are no longer allergic to certain drugs, such as penicillin — which can reopen treatment options that were closed to you.
The Pinellas County context
Living on Florida’s Gulf coast makes a recurring-infection story harder to untangle. Warm, humid air supports year-round mold and keeps dust mites — which love the heat and humidity of Florida — active in carpets, mattresses, pillows and upholstered furniture every month of the year. Oak and other tree pollen arrive in late winter into late spring. Add in family cats and dogs, that can cause respiratory allergies, and there is rarely a clean baseline where symptoms stop entirely.
For patients in the beach communities, offshore red tide blooms add a documented respiratory irritant to the mix on certain wind days. None of that causes an immune deficiency — but all of it can mask one, because there is always an environmental explanation available for one more bad month. Sorting the environmental from the immune is exactly the work of an allergy and immunology evaluation.
We work with your other doctors, not around them
After your initial visit, your Sher Allergy allergist will send a letter to your primary care or referring doctor to facilitate the care coordination that is integral to your health and wellbeing. Complex patients usually have several physicians involved, and the answer often only becomes obvious when the allergy and immunology findings are added to what everyone else already knows.
Our team will regularly communicate with your other doctors, and an Allergist is available 24/7 every day in case of emergency. Referring physicians are welcome to call the office directly.
Questions patients ask about recurrent infections and immune testing
How many infections a year is too many?
There is no single magic number, but the practice’s own guidance points to multiple ear, sinus or lung infections in a year, infections that need several different antibiotics, or recurrent pneumonia. If you find yourself explaining your infection history by counting rather than remembering, an evaluation is reasonable.
I have already seen an ENT and had sinus surgery. Is there anything left to look at?
Often, yes. Chronic sinusitis is associated with allergic rhinitis and asthma, and sinus disease that returns after structural treatment raises the question of what is driving the inflammation in the first place — allergy, an eosinophilic process, or an underlying immune problem. Rhinoscopy, allergy testing and lung inflammation testing address a different set of questions than a structural evaluation does.
Are immune problems only diagnosed in children?
No. Immune deficiency disorders may not be suspected until difficult-to-treat infections, recurrent pneumonia, ear infections or sinusitis, or multiple courses of antibiotics become a concern — and that pattern can surface at any age. Sher Allergy Specialists is a pediatric and adult practice, so children, teenagers and adults are all evaluated here.
Will testing happen at my first appointment?
We strive to do allergy testing and interpretation on the same day as your evaluation visit when possible, and allergy skin tests can usually be completed during the initial visit. Certain medications need to be stopped beforehand so they do not interfere with test results, so ask our office team for the Allergy Testing Dos and Don’ts when you schedule.
Do I need a referral from my primary care doctor?
Many patients come to us directly and many are referred by their physicians; either is welcome. Some insurance plans require a referral for a specialist visit, so call our office team at 727-397-8557 and they will check your plan’s requirements when they verify your eligibility and benefits before the visit.
What happens if the evaluation finds something outside allergy and immunology?
You leave the initial evaluation with a diagnosis and treatment steps, and your allergist writes to your primary care or referring doctor. If the picture points somewhere else, that is a useful result too — it closes a door that has been open for years and gets the right specialist involved rather than another round of antibiotics.
Bring us the case nobody has solved
If an allergic or immune system evaluation is the next step when others’ efforts at diagnosing and treating have failed, call our friendly Sher Allergy team. Telehealth virtual visits are available for patients throughout Florida.
Largo Professional Center
11200 Seminole Blvd #310
Largo, FL 33778
Monday 8:00-5:00
Tuesday 9:00-6:00
Wednesday 8:00-5:00
Thursday 8:00-5:00
Friday 8:00-12:00