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Friday, March 27, 2015

Allergies making you miserable

(Shutterstock image)



In my last post, I talked about allergies vs colds. I also wanted to talk about how having allergies affects the body.

If you don't have allergies - lucky you! For the those of us with allergies, life can be VERY miserable. I tell people that allergies are like a cold - THAT NEVER ENDS! At least with a cold, you know it's only going to last for about a week. (Unless you have asthma, and then you can develop pneumonia....but I'll save that for another post.)

I get a runny nose - but unlike a cold - the runny nose can last all spring and into summer. We go through A LOT of tissues at our house. My favorite are Puffs with Lotion (that way we don't end up with a red nose!) I almost panicked when I was at the grocery store and they only had 3 boxes left. So I bought all of them. They're MINE - ALL MINE! (Insert crazy laugh....)

To quote an allergy medicine commercial, "I store tissues like a squirrel stores nuts."  Sad, but true.....

At our house, we can easily sneeze over 30 times a day. Sometimes, daughter Kitty will start to sneeze and we will count.......17, 18, 19 times in a row.

Other "fun" things that happen with allergies from WebMD are:

  • Watery and itchy eyes
  • Sinus infections
  • Irritated throat (from breathing through your mouth)
  • Snoring (yeah - try to get a good night's sleep while that is going on....)
  • Headaches
  • Wheezing
  • Coughing
It's hard to do well in school and work when all of that is happening. So...what to do?

WebMD lists several things you can do around the house. One thing they don't list is to shower before you go to bed. Asthma Doc tells us to make sure we shower before bed because you can have pollen in your hair and on your skin. If you go to sleep at night with pollen on your body, and roll around on your pillow, all of that pollen gets spread around. And you can wake up feeling even worse (and looking worse with a red nose and swollen eyes.)

WebMD also lists different ways you can treat allergies There are a LOT of options - from antihistamines, eye drops, nose sprays, to prescription leukotriene inhibitors (Singulair) and  mast cell inhibitors (nose sprays like Nasalcrom.) And let's not forget allergy shots (immunotherapy).

With all of those options, it's hard to know what is the best treatment plan. That's why we go to an allergy and asthma specialists. I like my primary care doctor, but for this, I need a specialist.
 
Talk to your doc and see what's right for you. Pardon me while I grab some tissues... 






15 comments:

  1. My mum wants me referred to an allergist for my asthma and hayfever. I'm on 125/25 Seretide 2 puffs twice a day as a yellow-zone medication and twice in the past six weeks I have tried to step back down and within 24 hours I've been really tight and breathless and coughing. My asthma has just got worse and worse over the past 8 months and I have had four rounds of Prednisolone as well as three rounds of antibiotics. I narrowly missed a fifth round of Pred because I refused to have it (and as a result ended up fighting for control for two weeks instead of one). I'm perfect with my meds and take them exactly when and how I am supposed to. Antihistamines just don't do it for me allergies-wise. I have a Mometasone nasal spray 50mcg 2 sprays each nostril twice a day and that helps my nasal symptoms but my entire body itches and comes out in what appear to be small hives, my eyes have those allergy shiners, I get flushed and lightheaded, I feel sick and of course it plays havoc with my asthma and the only thing that seems to have any effect in that regard is Benadryl Relief Plus, which is £7.99 a pack and lasts around a week! Hayfever season for my friends starts in July and ends with the summer holidays..for me it starts early March and ends somewhere around the end of October. I have allergy bedding, I shower about 4 times a day, change my covers and sheets every week, clean my room each week..I do everything I can OTC for my allergies and I'm spot on with my preventer but still things aren't in control.

    Is it right to ask my GP for an allergist referral?

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    Replies
    1. Hi Lizzi,

      So sorry you are having such a tough time!

      There come a point when it's best to see a specialist. It sounds like that would be your next step.

      Besides, allergy testing MUST be done in an allergist's office since there is a risk of anaphylaxis. In addition, if you do start allergy shots (immunotherapy) you also must have the injections in the doctor's office for the same reason.

      You can experience anaphylaxis after allergy shots. That happened once to one of my sons, the doctors office was ready with epinephrine and a breathing treatment. They saved his life!

      There's no need to be miserable. It sounds like you have tried to manage this with a primary care doctor. But, specialists do have additional training and knowledge of other treatment medications and plans.

      It may be time to get a referral.

      I hope you can start to improve and not be miserable all summer!

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    2. My mum and I have an appointment to see the GP tomorrow morning. I was originally going to see my Asthma Nurse but I got rather upset the other day at my parents, saying rather irrationally that because they initially denied I had asthma (this was over a year ago when I had occasional breathlessness and tightness and my FEV was normal and the nurse said she didn't think I had asthma but she gave me Ventolin anyway) that when it started getting worse and I was using 15 puffs of Ventolin a day at least, they couldn't see it and that meant my treatment was delayed and that made my lungs worse so now my asthma is worse and I can't step down because they let it damage my lungs etc. etc….my parents didn't even know it was playing up, and how could they have known a year ago when I was so secretive about it? It was cruel of me but I was upset, because I sing and play ice hockey and I love them, but these things are being restricted by frequent chest infections and asthma which changes so soon after I stabilise it. My mum decided we would cancel my review with the nurse and make an appointment to see the doctor and request a referral to an allergist or an asthma specialist.

      Allergies-wise, it's hard to know what's going on. About 7 months ago, I was out in the park with my friend and we cut back through the trees and by the time we got out the other side, I was flushed and my eyes were glazed and puffy ('allergic shiners'), I felt faint and had a fluttering feeling in my chest, was wheezy (unusual for someone with CVA) and was itchy all over, even on my lips. My friend initially thought I was having an anaphylactic reaction to something but I wasn't swelling up and I wasn't in a life-threatening situation so it can't have been..but it is a strange presentation of 'hayfever'. When I had a Specific IgE panel a few months ago, it was clear for…everything. The only anomaly was a raised serum IgE, which was surprising: given how strongly and clearly I react to pollen, I would have expected at least one of the pollens to be elevated. I wondered if it might be non-IgE mediated but I have only heard that term used around anaphylactic food allergies (like your son's?) as it tends to be the non-IgE mediated ones that are more severe, and show up on skin-prick tests rather than blood tests. Is it possible that this is a more severe, non-IgE pollen allergy..?

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    3. It sounds very unusual. I would be interested to see what your asthma specialist says.

      Sorry you are having a tough time! :(

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    4. Doc wasn't on board with seeing a specialist until I have seen my asthma nurse but due to exams that won't be until 30th April!!

      Meanwhile, an acquaintance has suggested Mast Cell Activation Disorder/Systemic Mastocytosis as a reason why my 'hayfever' is severe and strange. I certainly fit the description really well so maybe I'll ask Asthma Nurse about that when I see her..

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    5. That's Thursday! Will your asthma nurse then send you to a specialist?

      We were lucky because our pediatrician knew that my son wasn't responding the way he should in the hospital with a case of pneumonia. So, the pediatrician called the asthma specialist to see us in the hospital.

      That was 15 years ago, and we have been going to him ever since then!

      Good luck, I hope you can get the help you need!

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    6. Sorry, mixed up my dates a bit; it was actually 29th!!

      I posted elsewhere about this but in short, she is trialling Montelukast for 3 weeks. If that works, we will try stepping steroid back down. If Montelukast doesn't work, or it works but I am still unable to step down my Seretide, then it's off to the hospital to see the specialist..

      I'm so glad that you're getting the right kind of care and maybe this is what I need but if I don't need to see a specialist then I'd rather not! The hospital is a fair distance away, clinic times are so inconvenient half the time..

      Mind you, they do serve really good curly fries there, and they have BBQ Saucers in the vending machines so...

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    7. I understand the frustration of trial and error. Over the years, we have had to try out different medications/dosages/delivery systems.

      Once my son was on the Advair disc and they had increased him to the maximum amount. Then the Advair inhaler came out, so the doctor switched him to the inhaler (he said it was a smaller particle, so it would get down deeper into the lungs.)

      It can be hard taking the wait-and-see approach. But we have had to do it for all of us. There are national guidelines for medication dosages and when to step up/step down treatment.

      But everyone seems to respond differently to medication. My daughter and two sons and I are all on different treatment plans.

      Good luck!

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    8. Well I have nothing but praise for Montelukast. Last time I had ice hockey and the past couple of times I've been to the rink I have been totally fine. I've had more stamina and less reliever :D no cough of tightness...ahh, sweet joy!

      I'll probably get a lecture about why I should follow my treatment plan all the way through but I decided to trial stepping down myself because I knew exactly HOW I was supposed to step down and the Montelukast was working well so I stepped down to Seretide 50/25 two puffs twice a day. That lasted about 12 hours before I stepped back up again. Last night I stepped down to one puff of 50/25 and one of 125/25 and managed for about 24 hours but now I'm back on 125/25.

      I just figured that it's easier for me and for my asthma nurse if I can go in on Wednesday and say "well I've tried both stepping-down options and neither worked out for me but the Montelukast is doing its job and I'm doing fine on that and the Seretide 125/25"...I go to college (16-18) in Preston, an hour away from where I live, and I'm either there or travelling there between 7:00am and 5:15pm every day so it's just not convenient for me to be going to the surgery so often, so if I can shorten the trial-and-error time myself, I'm making less trips to the nurse, and I'm more in control. Besides, it's not like I'm trialling things which take a while to build up. If the lower-dose Seretides were going to work, they would have worked then, so I'm saving myself time as well as the nurse.

      One thing I like about the nurse rather than having to see the GP is that you get a scheduled half hour with the nurse, so you have time to slow down, talk to the nurse, show inhaler technique and peak flow charts and all that, explain what's working and what isn't, and ask questions in general. With the GP, you only really have time to say what the immediate problem is and get that checked out and then you go, so...

      I'm worried that I haven't been able to step down though, because that might mean she will refer me to a specialist..*sigh*

      Yes, I've heard that too, and that Beclomethasone has bigger particles. It makes sense, as the Beclomethasone molecules are larger than the fluticasone ones, but it's interesting. The thought is that a similar concept applies when it comes to why E-cig vapour affects me so badly: the vapour contains much much smaller particles than cigarette smoke so it gets deeper into my lungs quicker so instead of my bronchi constricting, it's my bronchioles constricting first...weird! I don't know anyone else whose asthma is affected by them....

      Probably the thing more annoying than trial and error is people who think that no-one's asthma can be 'that bad'..someone I know with mild asthma just takes low-dose Clenil during winter and a reliever very rarely and thinks that it's totally unnecessary for me to be taking a steroid, LABA, LTRA and a reliever, and to have antibiotics and Prednisolone when I have a cold, and to take my peak flow twice a day...I just don't think she understands that not everyone has 'typical' asthma. (On a tangent, I'm just coming out of a throat infection which made me a bit chesty, and I managed all that without pred or antibiotics, just upping my preventer and doing 4 puffs 4x a day through the spacer of Salbutamol so..I'm happy about that!)

      Gosh, it's nice to talk to someone who actually knows that asthma isn't as cut-and-dried as people think.

      Well, we'll see how things go on Wednesday...

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    9. Asthma can be very difficult to treat, since everyone is different.

      I LOVE our specialist, who we have been seeing for 15 years. He takes the time to talk to all of the kids about asthma symptoms - and life in general.

      I always wait for Asthma Doc to step up or step down treatment for all of us.

      Many of the medications take time to be effective, so yes, I would recommend not doing it yourself.

      I don't know what the British guidelines are, but there are very specific guidelines in American for stepping up/stepping down medications.

      Since my doctor has the medical degree, I let him do it.

      I am careful to track symptoms and let him know what I feel is or isn't working.

      It's great to work as a team with your doctor or nurse!

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    10. In the UK we probably follow the same step-up/step-down guidelines. There are clever little visual diagrams detailing each 'Step' and the treatment one would be on at that step, and even what it is classified as.

      I'm one of those 'good asthmatics' (as opposed to my best friend, a self-titled 'lazy asthmatic' who lets all her meds slide when she's busy…!) so I follow treatment through and I track my peak flow and symptoms - not obsessively, but daily - and my nurse always comments on how well-prepared I am for each review! I guess I just want to find the right balance of the right meds which do the right job for as long as possible…

      It does tend to feel like I can never just go in and say "you know what, it's all going great and I'm totally fine". I mean, something will always have worked out (Montelukast this time, three cheers to the pink squares) but for instance I found out the not-so-nice way on Sunday that I have a Type 1 Latex allergy, which is basically the same as a typical peanut or tree nut allergy although swelling of the face only occurs usually if the Offending Latex Product has been in contact with the face, or if the particles are airborne. Biologically, it is the same. I didn't go into life-threatening anaphylaxis (although with it being a Type 1 allergy, that could happen the next time, or it could never happen…) but I am still almost entirely covered in hives, and both of my hands and feet swelled up, as well as nausea, wheezing, breathlessness and some light-headedness. I saw the doctor the following day, and he confirmed that it was almost certainly a T1 reaction to the latex, but he said that he wouldn't recommend skin-prick tests or blood allergy tests because it wasn't a food allergen which is contradictory to everything I have read in multiple medical journals about latex allergies, I'm not entirely sure I trust his opinion when it comes to asthma and allergies, as he said he 'doesn't believe in stepping up steroid inhalers' when someone's asthma gets bad…despite that being the confirmed best option by scientists, researchers, respiratory therapists, asthma specialists and other medical personnel to name but a few, as well as studies to prove that the best results come from that, and my own personal action plan which tells me very specifically to do that! I ignored him on that front, and as I have my review tomorrow I will elicit a second opinion from my Asthma Nurse.

      Maybe I'm overreacting? I don't know. But personally I would have thought it would be best to confirm the allergy even if just by a simple blood test, and to have some sort of plan in place for future reactions. Also, I read on more than a couple of sites about Latex allergies that if you have experienced wheezing during a reaction to Latex then it may well be the best thing to carry emergency medicine with you in case of a severe reaction. I also wonder if, as leukotrienes are released and enhance symptoms of an allergic reaction (especially the respiratory symptoms), my reaction would have been more serious then had I not already been taking an LTRA?

      I know I should wait with stepping up or down, but when it comes to Seretide, it's either going to work when I step down, or it isn't going to work full stop. So when stepping down from 125/25 to 50/25, within less than 24 hours I was very tight-chested, coughing and breathless - this happened on all of the three occasions I tried to do this - and I don't think that that would have changed if I had stayed on that lower dose any longer.

      I'm not a respiratory expert (although fingers crossed, if these AS exams go well I'm one step closer) but some things just make more sense. And of course, if I were to change over to another type of combination inhaler for whatever reason then I would give it the full window to work in before deciding whether it is or isn't working :-)

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    11. P.S. just to clarify, as on re-reading that I sound like I spend my life trawling medical journals to find out about things, that I do not spend all my time doing that, but I do take an avid interest in medical research as that is a career path I really want to pursue. Also, due to this scientifically-minded inquisitiveness I have, when I get a medication or an illness or something I like to know what is actually happening. It's all well and good to tell a newly-diagnosed asthmatic that 'your airways tighten up and fill up with mucus' but for me, that's not enough and the actual biochemistry and pathogenesis of diseases and medications is what I really want to know.

      TL;DR: not crazy, just curious

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    12. No worries, it's important to read up on any illness or disease so you know what the signs and symptoms and can help your doctor figure out the best treatment plan

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    13. I agree, although I sometimes worry about mentioning a possibility I have read about for fear of looking like I spend my free time looking up medications and things..occasionally I'll have heard of a medication but I'll feign ignorance just so that I don't appear to have researched the life out of it!

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  2. Hello…..
    Very nice post…….
    If you know about asthma treatment

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