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Answers to Your Questions about Spring Allergies and Asthma
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Einstein Healthcare Network
11:14
Join us right here at 12:15 p.m. on May 16 for the live chat. There will be no audio or video, just answers to your questions. You can post questions beforehand or during the live chat by using the blue box below. We will provide a complete transcript as soon as the chat is over. See you May 16.
*** Wednesday, May 16 ***
Einstein Healthcare Network
12:07
Welcome, everybody. Dr. Huang is on the way. We'll get started in about 10 minutes.
12:14
Welcome everyone, thanks for joining us today. Let's start talk about asthma and what concern you today.
JP
12:14
I had childhood asthma. It resolved right around the time I turned 12. Can it come back in adulthood?
Einstein Healthcare Network
12:16
Hi JP, great question! Asthma can happen to anyone at any time of their life - in fact it affect up to 8-9% of our population (adult or child), and even if childhood asthma resolved (more common to boys than girls), it can still return later in adulthood - sometimes with different pattern, mechanisms and treatment need. It is important to also remind everyone to avoid smoking and keep up with age appropriate vaccine, including pneumonia and flu as smoking and infection can worsen airway health.
MargueriteRobinson
12:16
The stuffy nose clearing the mucus out of my thoart worsening at night. When does all this go away
Einstein Healthcare Network
12:17
Hi Marguerite, thanks for sharing. Sounds like you have significant post-nasal drip that can worsen at night due either to gravity (with allergy in nose, or throat/nose drip due to heart burn problem)
12:18
it would be worth checking if you have either of these problem.
Tara
12:18
Hello , I have allergies and asthma , my biggest problem is trying to control my asthma through those hot and humid days , that usual prevent me from enjoying the summer months, I do have a inhaler but its very difficult. Do you have any suggestions on how to make these days a little more enjoyable ?
Einstein Healthcare Network
12:21
Hi Tara, sounds like you have seasonal flaring of asthma - trigger is likely something in those seasons (sometimes mold after thunderstorm, other times may be either viral or or exercise or dust or pollens), it would be important to clarify the cause and do targeted treatment. Some people also benefit from using more controller asthma medicine (as against rescue inhaler like albuterol) during their allergy season, or better treating of nose/throat allergy during allergy season can help asthma/wheezing symptoms.

I would suggest we can collect more information with both breathing study, allergy and "asthma phenotype" collection to do more targeted treatment. Usually either asthma or pulmonary specialist can help you come to that answer (finding most precise medicine at lowest necessary daily dose)
Christina Ehlers
12:23
Hello, My 8 year old child has severe allergies to peanuts, tree nuts, eggs and animal dander (which ppt bronchospasms). She had positive skin allergy tests and has had adverse reactions to accidental consumption of small amount of peanut butter in a candy treat and a bite of cake containing eggs.  Both reactions were severe stomach ache for up to 3-4 hours and nausea and vomiting.  Since she was 2 years old, she had several episodes of bronchospasms & wheezing requiring ER visits and treatment with courses of oral prednisolone, albuterol nebs, and QVar.  The bronchospasms/wheezing were linked to animal dander from our 2 Golden Retrievers which we discovered after a couple of ER visits later.  We manage the animal dander allergy by vacuuming daily, mopping floors 2x/week and prn & brushing the dogs daily.  Asthma management is currently without daily meds and using albuterol MDI only prn.  The asthma & allergy specialist recommends getting a blood te
Continuing my questions Asthma & allergies for 8 year old with severe allergies to peanuts, tree nuts, eggs, & animal dander. 1. How helpful would it be to get a blood test for the allergy testing?  2. Is beclomethasone MDI still recommended for treatment of bronchospasm/wheezing episodes.  3. Is a gas fireplace preferred over wood burning fireplace?  4. Would you recommend anything else for this 8 year old?
Einstein Healthcare Network
12:26
Hi Christina, you raised many very good and inter-related food allergy. I'll try answer general related subjects without limited specifics to your case - as specific treatment should be directed at a doctor's visit to avoid bias and allow your doctor to ask directed/related questions, too.

Sounds like your child is suffering "atopic march", food allergy are associated with increased odds of seasonal allergy, eczema and asthma.
12:27
Listen to our podcast interview about asthma with Dr. Huang.

http://einsteinperspectives.com/podcast-einstein-perspective-asthma/
12:31
For food allergy, one need to take careful history of reaction and test result, avoid those ones trigger reaction, there's now also component testing that can help determine risk before attempting food challenges.

To answer rest of your questions:
1) blood test is pretty good, only if you pick the right/relevant tests. It gives about 80-90% of answer to what skin test will tell you without causing local skin irritation beyond blood phlebotomy.
2) asthma control are divided into daily controlling medication and rescue medication. Additionally doctors usually device "action plan" that differs patient to patient (sometimes including pulse increase inhaled steroid for 2wks to help asthma control)
3) complete combustion of gas fireplace is preferred over fossil fuel with incomplete combustion - pollutent can release more irritant and damage to lung in long term. better ventilation will also help keeping air clean in house
4) I think your 8 yr old will need a asthma/allergist given problem set that follows him
Velma Wilson
12:31
I have food, drug and seasonal allergies all year long. I know my triggers for the food and drug allergies. Would you suggest that I get tested to find out what my triggers are for my daily reactions even though there is not much chance of an environmental change? By the way, I own a cat.
Einstein Healthcare Network
12:34
Hi Velma, thank you for the great question. I will use the opportunity to address the topic of pets owners. To answer your questions first, it would be important to clarify what allergies you have, as having animal allergy does not exclude you from other allergies like dust, and for both animal and dust allergy there are different environmental control strategies one can employ beside getting thinking you must get rid of pets.

Importantly, vacuuming of house and keep pets well cleaned do not completely eliminate dander, and animal dander are "sticky" and can stay allergen and persist for up to 9 months even if you get rid of the pets.
12:36
usually we suggest pet owners to:
1) reconsider getting pets and understand their risk, and potential treatment need/options before getting pets. Do testing before would help inform that decision.
2) if you already have pets, and do not want to get rid of them, keeping them and house clean is important. Other environmental intervention are: consider keep them outside your bedroom, and wear different cloth inside and outside bedroom, consider getting a air purifier in your bedroom (or use
12:37
HEPA filter in your air conditioner.
3) check your status to other allergies like dust, which has a different environmental control strategy. Dust like to grow on fluffy animals so is at increase risk to those with animal dander allergy
4) allergy treatments for either ear/nose/throat or asthma are available to help your control, your doctor will be able to help you
12:38
What do you know about spring allergies? Take this quiz.

http://einsteinperspectives.com/much-know-seasonal-allergies/
izellabee@yahoo.com
12:39
The medication I take has been ineffectual this year (OTC Rite Aid brand loratidine).  I have HBP and want to try another medication, but the Rite Aid pharmacist said I should ask my PCP.  Is there any ingredient in OTC allergy medication to avoid when you have HBP  that can be taken without medical consultation?
Einstein Healthcare Network
12:41
Hello Izellabee, great questions. Many people with seasonal/year-round allergies feel problems are "too small to see doctor", yet they are clearly too bothersome to allow you optimal daily function.

If you failed first line OTC treatment, which I will list below, or if you think problem has worsen beyond "mild allergy" - you should consider seeing family or allergy or ear/nose/throat specialist, for stepping up of your care.
12:43
General OTC treatment strategy for mild allergy (disclaimer, not specific to your care, we do encourage you, however, to clarify if this is really "allergy" with doctor, if you are not sure!)
1) take nasal steroid 2sprays every day from 2 wk before allergy season until end of allergy season. Children is 1spray. Example of Method as follow:

2) Then take either OTC allergy medicine eg. Allegra 180mg (fexofenadine), claritin (loratidine) or Zyrtec 10mg (cetirizine) daily as needed for itching and runny nose or congestion (or before go outside), children need to different dose.

No 1 and no 2 can do twice a day if very bad...

3) eye drop like zaditor as needed

4) nasal saline irrigation 1-2x/day, is also very helpful after coming into house or when congestion is bad , example of method as follow:
Maureen
12:43
Why do I have allergies at age 50 and never before in my life?
Einstein Healthcare Network
12:45
Hi Maureen, good question. It is important to recognize that allergy (as is asthma or eczema) can occur any time in people's life. I have worked and lived in Asia, Africa and UK before coming to US in 2011, and I only developed seasona allergy 4 years after moved around all these years and seeing allergens across the world.
It would be important to find out what you are allergic to, or have a pragmatic method to avoid trigger and treat symptoms - please talk to your doctor.
Marie
12:46
Does taking local honey daily help alleviate allergy issues?
Einstein Healthcare Network
12:49
Hi Marie, I really like this question. I hear so many people asking this one. While it is difficult to study food/supplement in general in a controlled fashion (compared to "double blind, randomised trials"). I would however, point you to a reputable source of research publication called Cochrane database, where people aggregate similar studies into "metaanalysis" to help increase power of questions that small studies failed to answer.

your question was answered at this meta-analysis: http://www.cochrane.org/CD007094/ARI_honey-acute-cough-children

In summary, honey is similar to cough suppressant in its strength. However - be careful of its calories and dental hygiene when you use it, and if it is not controlling you enough, talk to a doctor to better help your problems.
Ellen
12:49
With this season being so bad, what is the best way to keep a severe allergy attack from happening, when you are a teacher, and have to be outside with your students? Already taking asthma meds and inhaler. I save the rescue inhaler for extreme breathing problems. Also have an epipen.
Einstein Healthcare Network
12:52
Hi Ellen, Great questions - I feel for you. As I answered earlier to Tara and Izellabee - you may need 2 important approach to your asthma and allergy:
1) studies have shown poorly controlled and active seasonal allergy can worsen asthma control, so stepping up the game on seasonal allergy is important. Also nasal irrigation after coming from outdoor that I mentioned above may be of additional help coming indoor from outside/allergen exposure
2) you may need seasonal escalation of asthma treatment.
Mike
12:53
I have high blood pressure. Any issue taking Over-the-Counter medications for allergies or asthma?
Einstein Healthcare Network
12:54
Great question, Mike. Generally I'd suggest you avoid sudafed, any product with "D", avoid oral steroid and afrin-like nasal sprays - these medicine either cause increased BP either due to hormone or vaso-constriction mechanisms.
Mike
12:54
Can you tell me anything about some of the newer drugs for controlling asthma? And do I need a specialist to help me treat my asthma with those drugs?
Einstein Healthcare Network
12:55
great question, Mike, to continue above, I should also say, sometimes short term oral steroid may be necessary for acute asthma flares. I will answer your question below now
12:58
New asthma medicine are coming out, and in fact it is a very exciting time for asthma precision medicine. Guideline like EPR-3 and GINA have updated their recommendations now to include: biologic asthma medicine (like omalizumab, mepolizumab, benralizumab, reslizumab etc) in addition to traditional inhaled controllers (typically inhaled steroid, oral singulair/montelukast pill and combined inhaled steroid inhaler with bronchodilaters) - these inhalers are still important, and when problems are not controlled by inhalers or controllers, we now offer specific tests to detect your "asthma phenotype" and then device the most targeted treatment to your asthma mechanisms
You should talk to either a asthma specialist or pulmonologist for these discussion!
Linda Lostracco
12:58
is there a way to get this info afterwards?  I am unable to join due to Joint Commission but very interested in the information.  Thank you in advance.  Linda
Einstein Healthcare Network
1:00
Linda, a transcript of this chat will appear in this space as soon as the chat ends.
Dixie
1:02
What is eosinophilic asthma? How is it treated?
Einstein Healthcare Network
1:03
Hi Dixie, eosinophilic asthma is one of asthma phenotype that I briefly mentioned. Eosinophil is a type of allergy cells active in asthma inflammation of airway. They usually respond to inhaled or systemic steroid, and new asthma biologic treatment such as anti-IL5 (eg. mepolizumab, benralizumab, reslizumab). Please talk to your doctor to choose best treatment for the problem.
Sarah
1:04
My son is incredibly active. Never walks when he can run. :-) He has had exercise-induced asthma attacks. What can we do to prevent them? Are there warning signs?
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