About Allergy and Immunology

The American Board of Allergy and Immunology is a conjoint Board of Internal Medicine and Pediatrics, therefore we see people of all ages from weeks old to many years. The specialty of Allergy and Immunology involves the diagnosis and treatment of allergic (atopic) diseases and diseases of the immune system. These include allergic rhinitis (hay fever), sinus infections or sinusitis, asthma, eczema (atopic dermatitis), food allergy, drug reactions, acute and chronic hives, insect sting reactions, severe allergic reactions (anaphylaxis) and eye symptoms related to allergy, Immune system problems include recurrent or unusual infections associated with depressed immunity, and certain autoimmune diseases.

Hay fever and asthma...these are considered allergic diseases of the respiratory tract, and are the most common referrals we see. These are often due to allergens in the air (inhalants) and skin testing to inhalants is almost always done in these patients. Older patients may remember allergy work-ups as being painful and extensive multi-day procedures. This is not the case anymore. We usually test for about 20-30 allergens done on the arms and it takes about 15 minutes. There are no needles or shots involved. Antihistamines can interfere with our testing, so it is important that patients come into the office without having taken antihistamines for 4-5 days prior to the visit.  These include Zyrtec (ceterizine), Benadryl (diphenhydramine), Claritin (loratidine), Allegra (fexofenidine), stomach medications such as Pepcid (famotidine), Zantac ( ranitidine), Tagamet (cimetidine), and even some anti-depressants such as Sinequan (doxepin). New patient visits for these symptoms typically last about a half an hour including skin testing.

Eczema and Hives...Eczema is a chronic skin inflammation that is itchy, red, and scaly. If you close your eyes and run your hand over the rash it will feel rough. These spots will usually last for days to weeks in the same place. Eczema is common in allergic infants and we call this atopic dermatitis. Food allergy is very common as a cause of atopic dermatitis in children, therefore skin testing may be necessary to figure this out. In kids, we use a plastic multitest device that causes no pain and allows us to test 10 different allergens. If you are seeing us for this problem, avoiding antihistamines is important prior to the test as we mentioned above.

Hives (urticaria) is a transient rash that comes and goes very quickly, usually within a day or so in one place. If you run your hand over it, you may not feel anything. Sometimes, it is associated with severe swelling of the lips, eyes, hands, or feet (angioedema). Acute hives last less than a month or two and are often due to a preceding viral illness...especially in children. Chronic hives come and go over a few months or even years. Although we know that allergic reactions can produce hives, the reverse is not true. Most patients with chronic hives do not have allergy. Therefore, we rarely skin test patients with chronic hives, rather blood tests may be ordered to rule out illnesses that can cause hives.

Sinusitis...chronic or frequent sinus infections is a common and stubborn problem. The allergist's job in these cases is to assess patients for risk factors. Allergy is a major risk factor for chronic sinusitis, so skin testing will usually be done, especially for indoor allergens such as house dust mites and animal dander. In addition, some patients with chronic sinusitis may have a low level of infection fighting antibodies, and blood tests may be required to diagnose this condition.

Immunology...the immunology portion of our specialty involves the assessment of immune system function. Deficiency of immune function can cause a host of diseases, we mentioned chronic sinusitis above. In severe forms, immunodeficiency leads to "bubble babies", but mild forms are much more common. Any patient who has had numerous infections, such as sinusitis or pneumonia, or has had unusual infections, needs an immunodeficiency evaluation done by blood test. Conversely, there are many diseases in which the immune system is too active, or active in a mis-directed way. These include autoimmune disorders. All of these would be tested by blood test.

About the Staff

Dr. W. Donald Cooke MD is a graduate of the University of New Mexico School of Medicine, and completed fellowship training in allergy and immunology at the State University of New York in Stony Brook NY in 1991. Dr. Cooke did basic research in clinical immunology as well as patient care at the Guthrie Clinic in Sayre PA before moving to Durango in 1995. He is now doing clinical work in pediatric and adult allergy, asthma and clinical immunology.

Wendy Craig MA trained as a medical assistant at the Mayo Clinic in Rochester MN and joined Dr. Cooke in 1995. Wendy runs the immunotherapy (allergy shot) clinic and has 23 years of experience in allergy care.

Heather Cannon RN joined Dr. Cooke in April of 2016. Heather has lived in the area for 30 years and grew up in Mancos. She did training at Pueblo Community College and worked at Southwest Memorial hospital in Cortez prior to joining our staff.

Patti Else joined the practice as our front office person in 2013. Patti has been in Durango since 1991 and has years of experience in the medical field. 

Cindy Yeager RN was our office nurse in the late 1990s and moved away for some years. She is a Durango native and moved back home in 2017. She now works with us again as office nurse.

Kimberly Pappas CNP was also part of our office staff in the late 1990s. She then did advanced practice training and rejoins our office part-time as a Nurse Practictioner. Kim will be covering the allergy shot clinic when Dr Cooke is away, and seeing adult patients in follow up.