Here are some of our more frequently asked questions and topics of discussion. Should you have a question or concern that is not answered in the following information, please feel free to contact us. A member of our staff will be more than happy to assist you in whatever you may need.
- Should I see an Allergist or ENT?
- What medical conditions does an Allergist treat?
- Food allergies
- Bee stings
- Egg allergy and the flu vaccine
- Is it a cold, allergies or a sinus infection?
- Rescue inhalers
- What is a long-acting beta-agonist?
- Controller medications
- What are steroids?
- Considerations during pregnancy
Many patients see an ENT if they have problems such as nasal congestion, nasal stuffiness, sore throat or a post nasal drip. ENT physicians are surgeons, and you should consult with one if you have a structural problem in your nose or throat requiring surgery. However, most sinus and nasal problems do not need to be fixed surgically because they are either due to allergy, infection or just general nasal irritation. Board certified allergists have completed at least three years of training in pediatrics or internal medicine as well as 2 to 3years of training in the field of allergy. While many ENT physicians offer allergy testing and allergy shots, they generally have little or no formal training in allergy, immunology or asthma. Allergists do not perform surgery, but we have a lot of training and experience in determining what the cause of your nasal symptoms, and then treating your symptoms.
- Hay fever
- Sinus conditions including chronic sinusitis
- Food allergies
- Eczema and other types of skin rashes
- Drug allergies
- Bee sting allergy
During the last 10 to 20 years, there has been a significant increase in food allergies. The cause for this increase is unknown. While a food allergy can develop at any age, it is most likely to occur in infants and children. You should suspect a food allergy if your reaction begins within minutes to several hours after eating a food, and if the symptoms occur each time you eat the particular food.
Anyone who thinks that they might have a food allergy should be evaluated by an allergist.
Symptoms of a food allergy include:
- Itchy skin, especially around the mouth, lips, tongue and throat
- Swelling of the lips or tongue
- Hoarse voice
- Coughing, wheezing or shortness of breath
- Nasal congestion, sneezing
- Nausea, vomiting, cramps or diarrhea
- Light headedness (due to decreased blood pressure)
- Death can occur after a severe food allergy reaction
When a bee stings, it injects a poison called venom. If you are allergic to the bee, you might have generalized itching or swelling, difficulty breathing, swollen tongue, nausea, vomiting, cramps, diarrhea, dizziness, loss of consciousness, or drop in blood pressure. Death can occur.
You need to be evaluated by an allergist if you had any symptoms other than local irritation at the sting site. If skin testing shows that you are allergic, you should carry a special epinephrine kit with you at all times from early March until the ground is frozen (usually around Thanksgiving), and you should wear a medical alert bracelet. Allergy shots, made from pure bee venom may be recommended. These shots are very effective and provide complete protection for about 98% of people who receive them.
Since the flu vaccine is made using eggs, the vaccine often contains small amounts of egg protein, which may cause an allergic reaction in some egg-allergic persons. While most children and adults who have an egg allergy can get the flu vaccine, precautions may need to be taken. At this time we recommend that egg allergic patients be skin tested to the flu vaccine. If the test is negative, the patient may receive the full dose of the flu vaccine without any additional precautions, but if the test is positive, the vaccine will be given in several doses. This is usually done in the allergist’s office.
Colds usually last no more than one week, and are often associated with a fever, body aches and perhaps some nausea, vomiting or diarrhea.
Sinus infections frequently begin as a cold, but then the symptoms linger for weeks or months.
Allergies are rarely associated with body aches, fever or other symptoms. They may occur throughout the year or only at certain times of the year. Suspect an allergy if you always develop your nasal or chest symptoms at the same time each year, or if they always get worse at the same time each year.
Beta-agonist drugs (VENTOLIN, PROVENTIL, BRETHAIR, XOPINEX, ALBUTEROL) relax the smooth muscles surrounding the bronchial tubes and cause bronchodilation (opening the bronchial tubes). When used as an inhaler or in a nebulizer, these drugs begin to work within minutes, have few side effects and are effective for 4-6 hours. They are the drugs of choice to treat an asthma attack. They are also used frequently to prevent exercise-induced asthma. Since asthma is due to inflammation (irritation) of the bronchial tubes, most asthmatics should use an anti-inflammatory drug daily. Also, if you find that you are using the beta-agonist inhaler routinely, this usually indicates that your asthma is not well-controlled and you should see the doctor for further evaluation.
These are usually mild: anxiety, muscle tremors, increased heart rate. These side effects can often be avoided by decreasing the dose or switching to a different brand. There have been several reports associating regular usage (as opposed to as-needed usage) of these drugs to a worsening of asthma. The reasons for this remain unclear.
What should you do?
You should not stop using your beta-agonist inhaler, but you should periodically review your need for this medication with your doctor.
SEREVENT (Salmeterol), FORADIL (Formoterol): These are also bronchodilators, but are unlike the other beta-agonist drugs. Serevent can take 30 minutes for it to work, and lasts for up to 12 hours. Foradil also works for 12 hours, but begins to work within 15 minutes. YOU SHOULD NEVER USE THESE DRUGS AS A RESCUE MEDICATION DURING AN ASTHMA ATTACK! AND NEVER USE THEM AS RESCUE INHALERS.
Almost all asthmatics, except those with very mild asthma, should use an anti-inflammatory medication daily. If you use these drugs daily, you will generally control your asthma better and be able to decrease your usage of the beta-agonist drugs. Since these drugs do not relax the bronchial tubes, you still need to have a beta-agonist drug available to use when needed. There are two classes of anti-inflammatory inhalers and corticosteroids. Leukotriene inhibitors generally do not control asthma as well as the coritocsteroid inhalers.
INHALED CORTICOSTEROIDS ("steroids"):
Some examples are Aerobid, Azmanex, Qvar, Flovent, and Alvesco. The drugs are the preferred method to treat your asthma because they are among the most effective and powerful drugs to treat asthma. Side effects: thrush ( a fungus infection in the mouth which is rare if you rinse your mouth after using the inhaler), hoarse voice, mild cough immediately after using the inhaler. High dose inhaled steroids are used for many severe asthmatics and may cause additional side effects, but these are generally fewer and less severe than when taking the drug as a pill.
Advair and Symbicort are special types of controller medications (see below).
Advair is a combination of a steroid (Flovent) and a long-acting beta-agonist (Serevent- see above). Never use more than one inhallation twice daily.
Similar to Advair, except that some relief can be felt within 3 to 15 minutes after it is used. Do not use more than 2 inhalations twice daily.
LEUKOTRIENE INHIBITORS (monteleukast, zafirleukast, zileuton):
All are alternatives to inhaled steroids, but they are not the preferred medications.
Points to remember:
- No drug is 100% safe
- Use a beta-agonist when necessary to control acute symptoms
- Use a beta-agonist (rescue inhaler) when needed to control asthma symptoms
- If you have any asthma symptoms more than twice each week, you should usually use an inhaled anti-inflammatory drug
- Signs of unstable asthma include frequent flare-ups or frequent usage of a beta-agonist inhaler
- Almost all asthmatics (even infants!) who have asthma should be using an anti-inflammatory medication
Everyone makes steroids, which are essential for maintaining health. There are two groups of steroids: anabolic steroids, which have been abused by athletes, and corticosteroids. In this article, the term steroids will refer only to corticosteroids.
THE HISTORY OF STEROIDS:
Steroids were first used in the late 1940s. Physicians thought that they had found a miracle cure for asthma and other diseases until patients began to develop significant side effects. Because of these side effects, many physicians and patients developed a steroid phobia (fear of steroids). However, we now know a good deal about these medications, and the side effects can frequently be avoided or minimized if the steroids are used carefully.
TYPES OF STEROIDS:
Steroids may be injected, inhaled into the lungs or nose, taken by mouth or used on the skin. The oral and injected steroids are powerful and act quickly, but side effects are also more frequent. We prefer to use inhaled steroids to treat asthma or severe nasal symptoms because the drug is delivered to the lungs or nose and in small amounts. Since inhaled steroids are much safer, they are suitable for long-term usage.
HOW STEROIDS WORK:
Steroids are powerful anti-inflammatory drugs used to treat inflammation (irritation) of the skin, joints, and airway.
SIDE EFFECTS OF INHALED STEROIDS:
If you develop a BLOODY NOSE while using nasal steroids, stop the medication for several days and then restart it. If the bloody nose reoccurs, call the doctor. THRUSH (a fungus infection in the mouth) and HOARSENESS are common when taking inhaled steroids for asthma, but can usually be avoided by using a spacer device and rinsing your mouth after using the inhaler. If you are taking very high doses of inhaled steroids, you may develop some of the same symptoms noted when taking oral steroids (see below).
For many years there has been a concern that children using inhaled steroids might not reach there full adult height. However, a study published by The New England Journal of Medicine on October 12, 2000 (Effect of long-term treatment with budesonide on adult height in children with asthma) followed children who took an inhaled steroid (budesonide) for up to thirteen years. The final adult height was less than one inch from their predicted adult height although some of the children reached their adult height later than others. The conclusion of the article was that the drug decreased the rate of growth but not the final adult height in most children. Keep in mind that poorly controlled asthma also will cause a decrease in a child's growth.
SIDE EFFECTS OF ORAL STEROIDS:
Mild, temporary side effects are common: increased appetite, mood swings, water retention, weight gain, acne flare-ups, muscle cramps (possibly due to loss of potassium, so drink orange juice or eat bananas), menstrual irregularities and heartburn (take the steroid with meals or use an antacid). Serious side effects can occur in patients who have diabetes, mental illness, high blood pressure or infections such as tuberculosis. Long-term usage of oral steroids can cause many side effects, including osteoporosis, cataracts, high blood pressure, diabetes, poor wound healing and in children, decreased growth and hip problems. Most of the more serious side effects can be avoided or minimized if the oral steroids are used for only a short period of time (usually less than two weeks) or taken every other day. If you notice symptoms other than the mild symptoms listed above, the steroid may need to be stopped, but NEVER STOP ORAL STEROIDS BEFORE SPEAKING WITH DOCTOR.
Steroids can be a lifesaving medication, but like all other medications, they should be used carefully and exactly as prescribed.
As a general rule, no allergy or asthma medications should be stopped until after you consult with your allergist or pulmonologist, because the risks associated with having an asthma attack during pregnancy generally are far greater than the risks of taking the medications. In addition, the pregnant woman should try to avoid her known asthma triggers (such as exposure to smoke).
Even when not pregnant, these medications should be used only occasionally, rather than on a daily basis. Studies have generally shown no significant effects on the baby from any of these inhalers when used during pregnancy.
LONG-ACTING BETA-AGONISTS (salmeterol, formoterol):
Limited data in humans has not shown any significant adverse effects during pregnancy. Either one can be added to an inhaled steroid if asthma is not well-controlled.
There is limited information on animals and humans, but studies shows no significant adverse effects. However, ipatropium should only be used during pregnancy if the short-acting beta-agonists are ineffective during an acute asthma attack.
Inhaled steroids are considered to be the first line of medications for asthma treatment in patients of all ages, as well as during pregnancy. Since most studies have been done using budesonide, this should probably be the drug of first choice. However, as a class of drugs, they are all safe and it would be reasonable to continue any of the other corticosteroids if a woman's asthma is well-controlled on that drug prior to her pregnancy.
ORAL CORTICOSTEROIDS (prednisone, prednisolone):
Although there have been several studies showing some risks, these medications should still be used to control life-threatening situations, or when there are not safer alternative medications. The risk to the fetus during a serious asthma attack is probably significantly greater than the risks of using an oral steroid.
MONTELUKAST, ZAFIRLUKAST, ZILEUTON):
Zileuton should not be used during pregnancy. Although zafirlukast and montelukast are safe during pregnancy and are alternatives to inhaled steroids, they are not the preferred medications.
Loratidine and cetirizine can be used if needed. At this time, fexofenidine (Allegra) and desloratidine (Clarinex) should be avoided.
ORAL DECONGESTANTS (pseudoephedrine):
Until further studies are available, it would be wise to avoid the decongestants during the first trimester, due to the occurrence of a rare birth defect (gastroschisis).
ALLERGY SHOTS: While it is not recommended that allergy shots be started during pregnancy, continuing the shots during pregnancy is safe. However, this should be carefully discussed with your allergist.