[Allergy & Asthma Corner]

This is a question every asthma patient should be able to answer.

Once a controller medication has been prescribed for treatment of persistent asthma, evaluation of control should follow. There are three categories of control published in the NIH revised Asthma Guidelines:

-Well Controlled  

-Not Well Controlled 

-Very Poorly Controlled

People with well controlled asthma:

1) Have asthma symptoms (cough, wheeze shortness of breath and chest tightness) less than 3x/week

2) Need their reliever inhaler (albuterol) less than 3x/week

3) Awaken from sleep because of asthma symptoms less than 3x/week

4) Do not have limitations because of asthma symptoms at work, home or school

5) Have normal pulmonary function (PFR >80% personal best or FEV1 >80%)

6) Have and Asthma Control Test (ACT) score of 20 or higher

7) Have not had more than 1 asthma attack (episode of asthma requiring a nebulizer treatment, oral steroid, unscheduled doctor visit or trip to an Emergency Department or Urgent Care Center) in the last 12 months

Do you know what your ACT score is?

Click this hyperlink to take the test.

Good asthma control is a primary goal of asthma management.

If any one of the above 7 levels of measure, of asthma control are not met, your asthma is not well controlled.

You should discuss how to achieve better control with your doctor or specialist (allergist or lung specialist).

Review my posting on: Asthma Checklist.

Going hiking, camping or on a picnic in the preserves soon?

You may want to review my latest posting about Poison Ivy (Be Prepared!!)

Click on this link: Poison Ivy: "Leafs of Three Leave Them Be!"

Much to choose from OTC but read labels and exercise caution with nasal sprays.

More than 40 million people in America have allergic nasal symptoms. Many have turned to over the counter (OTC) medications to treat their allergy symptoms. Allergy medications have escalated in costs and are becoming less available by prescription. I recently posted comments on how to reduce costs associated with OTC antihistamines. Intranasal steroids are important for managing moderate to severe allergic rhinitis and may be used down to 2 years of age (depending on the brand of nasal spray). They are only available by prescription. What are you getting when you turn to an OTC nasal spray for your allergy symptoms?

The major OTC nasal sprays include:
Nasal saline rinses are much safer than the nasal decongestant sprays.

Topical Nasal Decongestant (TND)- Very quick acting but may be addictive if used more than 3-5 days at a time. Are you taking a nasal spray that within seconds to minutes opens your nose up (almost instant gratification)? There is much more you should read about by clicking this link: Beware of the Topical Nasal Decongestant Sprays

Nasal Saline: (Ocean Spray, Ayr and others)- Nasal saline is salt water of similar consistency to body fluids. I previously discussed methods on moisturizing vs. irrigating the nasal passages. This has very little risk but is not effective alone, in treating seasonal or perennial allergic rhinitis. When a comprehensive program of environmental controls, avoidance, medication and nasal rinsing is followed, successful management is often achievable.

Nasalcrom (Cromolyn)- Previously only available by prescription, Nasalcrom is now OTC. It must be sprayed in the nose three or more times daily to be effective. Best results are achieved when the sprays are begun well before (about 2 weeks before) the allergy season starts. It is most effective for seasonal allergy. Children tend to have a better response compared to adults. Nasal steroid sprays are more effective overall.

Alternative (Holistic) Nasal Sprays- There is an endless number of such nasal sprays and drops which frankly have very little clinical research to support their use in allergic nasal conditions. Safety data tends to be lacking on many of them. I do not recommend them to my patients. I point out (to my patients) that people that have allergic problems may be more at risk of developing an allergic reaction to various herbs associated with some of the available allergy remedies in health food stores.

Have other comments?

Am I missing something that should be on the above list?

Let me know: AllergyQA@aol.com

Showering of Cottonwood Seedlings

The long cold winter has turned into a cool spring replete with temperature swings and requisite tree and grass pollens. This is the time of year people in the Midwest begin to complain about those cottonwood seedlings that infiltrate the air where trees are plentiful. Many allergy sufferers think those cotton-like floaters are their nemesis but they would be wrong.

The cottonwood tree which molts these seedlings every summer actually pollinates two months before the seedlings erupt. The floating seedlings have no impact at all on people allergic to cottonwood tree pollen.

On the other hand, cottonwood seedlings tend be prevalent in the air when grass pollen season is well under way. Grass and tree pollens are microscopic and therefore not visible to the naked eye. The cottonwood seedlings are too large to gain access to the nasal lining where allergic stimulation can take place.

So What Makes Your Nose Go Crazy When Those Seedlings are Swirling Around?

The most likely culprit is grass pollen. Trees that pollinate in May and June may also contribute to allergy symptoms this time of year (in the Midwest: Oak tree). Mold spores may also play a role in triggering typical hayfever symptoms when the cottonwood seedlings are out.

Last June (2007) I reviewed several steps you can take to get through your outdoor allergy season. Remember (Chicagoans) how annoying the Cicadas were this time last year?

New allergy medications have become available over the counter and by prescription. VeraMyst and Omnaris are relatively new nasal steroid sprays that have given more depth to the management of nasal allergy. Xyzal became available last year and has likely raised the bar for new generation, long-acting, oral antihistamines. The new generation antihistamines have little to no side effects of sedation and fatigue.

Astelin, a prescription nasal spray that has been around for more than 10 years, and is indicated for allergic nasal problems as well as non-allergic irritant rhinitis, has a new rival, Patanase nasal spray(prescription only). I have not yet collected feedback from my patients on Patanase but this should be forthcoming.

If you have nasal congestion, drainage, sneezing or just feel like you have a cold that won't quit, that fails to respond to allergy medications, an allergy work-up should be considered. A board certified allergist is trained to take a thorough symptom, family and environmental history, perform a focused physical exam and do allergy testing to define the trigger factors. A comprehensive treatment plan that involves orienting the patient/family to trigger factors and how to avoid them, and taking selected medications is established. Sometimes allergy shots are discussed depending on the level of response to allergy medications and environmental controls.

Comments or questions about any of this?

Email me at: AllergyQA@aol.com