Don't Let Allergies and Asthma Ruin Your Summer
By Marge Dwyer
Beth Israel Deaconess Medical Center Correspondent
Until this summer, the warm weather months meant more than just vacations, ballgames and cookouts at David Shein's Boston area home. It meant stocking up on tissue boxes, cranking up the air conditioner and turning on the air filtering machines. Along with the traditional activities came an unwanted guest -respiratory allergies.
"My head was clogged and my eyes were swollen. I had headaches and coughed all the time. Last year I was taking five medicines including inhalers," says Jared, David's ten year old son, who has experienced severe allergic respiratory symptoms, asthma and food allergies since age three. Allergies often caused him to miss school, skip recess and feel so poorly he could not do his homework.
"One day our class went to the library and I could not even look for a book because I felt so bad," he recalls.
But this summer is different. After being treated by
Dr. Daniel Steinberg an allergy/immunology specialist at Boston's Beth Israel Deaconess Medical Center who also sees families at the
Allergy and Asthma Center of Massachusetts, Shein and his family are enjoying a more active lifestyle than ever before.
"Allergic conditions may present in different forms from infancy, through childhood, into adulthood," explains Dr. Steinberg. "The infant with food allergy and eczema can evolve into the toddler with ear trouble and the adult with chronic sinusitis. The elementary school student with chronic cough can evolve into the exercising adolescent or adult with asthma. Connecting the patient's history, specific triggers and symptoms to a customized action plan is central to achieving the desired outcome."
Proper Diagnosis is Key
The Sheins couldn't agree more on the importance of seeing an allergy/immunology specialist to identify allergy triggers and determine which of the many available prescription and over-the-counter medications, nasal sprays and inhalers might help.
After an initial consultation with Dr. Steinberg, which included a detailed medical history, testing to identify Jared's allergy triggers, and a review of his previous medications, the decision was made to start Jared on an immunotherapy program (allergy injections) to desensitize him to several offending allergens.
"It was like a detective story," says Shein. "Once we identified his triggers, we were able to put in place a program to manage his triggers and symptoms for the long term."
Allergic reactions occur when the body's immune system reacts to foreign substances called allergens. These reactions can range in intensity from mildly bothersome to life threatening, and may be episodic or chronic. It is estimated that allergic conditions affect approximately 1 in 5 Americans.
Among the more serious allergic conditions is asthma, a chronic condition in which narrowed, inflamed airways cause shortness of breath, wheezing or coughing. A similar reaction can occur in allergic rhinitis (hay fever) which can mimic flu-like symptoms when the nasal membranes become inflamed following exposure to allergens and irritants such as pollen, dust mites, molds, animal dander, tobacco smoke, air pollution and odors. If these respiratory conditions are chronic, they can lead to persistent or acute symptoms of shortness of breath, cough, ear problems, sinusitis, headache, nasal and eye irritation. Regionally, Massachusetts and New England have some of the highest asthma prevalence rates in the country.
A Family Affair
Because allergies often run in families, Dr. Steinberg and other allergy/immunology specialists often treat members of the same family. "A significant percentage of children with allergic or asthmatic parents will eventually develop allergic symptoms", says Dr. Steinberg, who previously served as President of the Massachusetts Allergy & Asthma Society and currently serves as Chairman of the Federation of Regional, State & Local Allergy Societies of the American Academy of Allergy Asthma & Immunology.
After his first season on immunotherapy, Jared says that he feels much better and requires minimal medications this year. "I'm playing baseball this summer and can concentrate on what the coach is saying," he explains.
With Jared feeling so much better, his dad decided to see what could be done for his own symptoms. Like Jared, Shein had suffered from asthma and other related allergic respiratory symptoms since childhood, occasionally requiring emergency treatment. Prior to focusing his treatment Shein recalls I coped with it for years by, taking over-the-counter antihistamines, carrying tissues and keeping a rescue inhaler on hand,".
After an initial consultation, it was noted that while Shein's allergy triggers were similar to his son's, his symptoms could be managed effectively with medications or inhalers during the peak allergy season.
"I didn't even realize I was having symptoms. Now I'm feeling a lot better," Shein says. "I ride my bike to work three days a week. After using the inhaler, I can ride longer and exercise harder."
In addition to avoiding exposure to substances that trigger allergies, a customized allergy treatment plan may include oral medications, inhalers and/or desensitization (immunotherapy). Some of the medication options include:
Nasal sprays and inhaled steroid sprays: Several spray medications are available to control respiratory allergies. Nasal/inhaled corticosteroids that reduce inflammation may take several days before taking full effect. Examples include fluticasone (Flonase/Flovent), budesonide (Rhinocort/Pulmicort), mometasone (Nasonex/Asmanex) and triamcinolone (Nasacort AQ/Azmacort). Other medications such as cromolyn sodium (Nasalcrom/Intal), azelastine (Astelin) and ipratroprium (Atrovent) can be helpful for certain patients depending on their specific triggers.
Antihistamines: Used for over 50 years to reduce the release of histamine in the nose (allergic rhinitis), skin (hives) and elsewhere. Several antihistamines are available without prescription. Newer second-generation antihistamines, such as loratadine (Claritin and Alavert), fexofenadine (Allegra) and cetirizine (Zyrtec) are less likely to cause drowsiness. Other antihistamines available over-the-counter including diphenhydramine (Benadryl) and chlorpheniramine (Chlor-Trimeton) are effective alternatives for many but may cause sedation.
Decongestants: Available over-the counter these oral and nasal medications include pseudoephedrine (Sudafed), phenylephrine (Neo-Synephrine) and oxymetazoline (Afrin). These nasal sprays are for short term use, since extended use can aggravate nasal congestion. People with high blood pressure, cardiac issues or prostate problems should use these medications in consultation with their physician.
Leukotriene modifiers: An alternative to inhaled steroids as controller therapy for some milder cases, montelukast (Singulair) blocks the action of immune mediators called leukotrienes that cause the inflammation and production of mucus which contribute to respiratory symptoms.
As Shein says, "With so many treatments available - there's no reason to not to get tested, get treated and get better."
To schedule a consultation with the Allergy/Immunology experts at Beth Israel Deaconess Medical Center, call 1-800-667-5356.
Above content provided by Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.
Posted June 2009