May is Allergy and Asthma Month in Central and West Counties
Published by Contra Costa Times
Posted on Wed., May 6, 2009
By Dr. Stephen Daniels
Although swine flu has captured the headlines, seasonal allergies and asthma are still much more common in doctors' offices so far this season.
The principle defining symptoms of the flu are a cough, fever and body ache. By contrast, most people with allergies or asthma don't have a fever or body ache, though they may have a cough. Allergies most commonly produce watery, itchy and swollen eyes and nose. Asthma causes wheezing, chest heaviness and shortness of breath, though sometimes the only symptom is a cough.
To check for a fever, in order to distinguish the flu from other illnesses, always use a thermometer. Even doctors and nurses cannot always detect a fever, or the lack of one, using their hand.
There are many treatments for allergies, so almost everyone will eventually find one that works. In my experience, the older over-the-counter combination of Sudafed (pseudoephedrine) during the day, and Benadry (diphenhydramine) at night can be as effective as prescription pills. If these don't work, then pills such as Claritin, Zyrtec and (prescription) Allegra might.
A particularly effective prescription combination in my experience is the steroid sprays for the nose (Nasarel, Flonase), and cromolyn drops for the eyes. The principle advantage of cromolyn for the eyes and nose is its lack of side effects. Cromolyn is not a steroid, and must be used 3-6 times a day.
Asthma occurs in the lungs, with or without allergies of the head. Mucus from allergies can drip down the back of the throat to the lungs, leading to asthma. Asthma can start and stop at any point in a person's life. Some get asthma only as a child; others have it most days of their lives. Most seem to get it in the spring (from grass and pollen) and when they get a cold or the flu. The flu is particularly dangerous for those prone to asthma.
Treatment for asthma usually starts with an albuterol (or albuterol-like) inhaler. But if needed more than 3-4 times per week, most doctors recommend patients use a preventative (controller) steroid inhaler, such as QVAR or Aerobid. Among the best controller treatments are the inhalers that combine a steroid with a long-acting albuterol-like medicine (Advair, Symbicort).
If a steroid inhaler doesn't control asthma, then pills such as Singulair and theophyline, and inhalers such as cromolyn and ipatroprium can be added.0 These are usually added one at a time, and continued based on their effectiveness and side effects.
Be sure to have enough asthma medicine on hand. Running out at night hoping you'll make it until the pharmacy opens in the morning can be dangerous.
Finally, there is the "shot." This refers to a short and/or long acting steroid shot, which can be used to control both asthma and allergies. For some, these shots seem magical: symptoms of allergy or asthma gone, and no apparent side effects. And in many cases they are right. But, short-term side effects can include fluid retention, stomach bleeding, depression or mania and increased blood sugar. Long-term side effects include osteoporosis, cataracts, increased infections and collapsed hip joints.
As with most treatments, it's best to start with the safest, and to reserve the potentially dangerous for when nothing safer has worked.
Dr. Daniels practices family medicine for Contra Costa Health Services, the county health department. Healthy Outlook is written by the professional staff of Contra Costa Health Services, the county health department. Send questions to series coordinator Dr. David Pepper at firstname.lastname@example.org. For more health information, go to www.cchealth.org.