A trip to the allergologist

The weather has been erratic lately, and it has resulted in a lot of people sneezing, sniffling and coughing. Some self-medicate with over-the-counter medicines while others go to their doctors for relief. Most are prescribed over-the-counter medicines (decongestant, expectorant) and antibiotics. Some are prescribed antihistamines and nasal sprays. For some people, these will work and that will be the end of it.

However, in a country where at least 10 percent of the population suffer from allergic rhinitis and approximately 5.5 million people suffer from asthma, a general physician’s treatment scheme might not be enough and a specialist’s expertise in the form of an allergy doctor may be necessary.

hives

Sometimes, unexplained skin rashes or watery and puffed eyes (angioedema), or even a really exaggerated response to food and drugs may also warrant a follow-up with an allergologist/allergist.

What to expect

Depending on the gravity of your complaints, the allergologist will interview you about your medical history (yours and both sides of the family) and explore potential allergens with which you may have come in contact with (from your home, diet or work). He or she will also most likely check your ears, nose and throat and listen to your lungs to rule out viral infections. In cases of skin complaints, the allergologist will also probably take a closer look at your hives, rashes or skin.

The allergologist will offer a possible diagnosis based on your symptoms and the interview, and will prescribe relief medications. Depending on your complaint, an allergologist may offer a regimen of sprays/puffs, creams, antihistamines and other drugs (with or without steroids). He may also prescribe preventive medications (like montelukast for asthma and allergic rhinitis) and drugs to reduce the intensity of your allergy.

The doctor will insist on a follow-up consultation which you should keep. Depending on your response to the initial treatment regimen and the degree to which your allergies are affecting your quality of life, he or she will then offer you other options: a more aggressive treatment regimen, desensitization injections, Gamma globulin shots (to boost immune response), and allergy testing (usually skin testing). Depending on the outcome of allergy testing, whether you got better from the previous treatment regimen/s or not and the severity of your allergies, an allergologist may recommend allergen immunotherapy (allergy shots) which can last between six and eight months.

An allergologist is also most likely to recommend changes in your diet, if only for a time, as well as with products you use and other habits you may have.

Costs to expect

Average consultation fees range from P400 to P1000, depending on who you go to and where you go. The cost for skin testing can also range from P1,500 to P25,000 depending on how many allergens are tested on you, and what method is used. The cost of antihistamines can range from P10 to P50 per pill, while the cost of allergy shots will depend on how many allergens need to be given.

What to watch out for

I have had the misfortune of going to a pediatric allergologist who said my son’s symptom (dark circles under watery eyes) will progress into asthma for sure, only because I told her my husband’s family has a history of asthma. She never asked me what my son ate and did before exhibiting the symptom. She didn’t even ask me if my son was bothered by it (he was not, only I was). She never even once touched my son to look into his eyes, or throat or check his lungs. She did not even ask me what my son’s milk was. She did charge me for Cetaphil and Physiogel products though and was more enthusiastic about how she offers the latest allergy skin testing which won’t hurt my child. It would, however, cost us P25,000. Needless to say, I did not return. And my son hasn’t had an allergic episode since.

Indeed, just like with regular doctors, not all allergologists are created the same. So, although most patients who go to an allergologist require immediate relief, make sure to still ask your doctor for options. A decent one will warn you if something he prescribes will be expensive, and will even explain why he’s prescribing the expensive one. A decent one should not even prescribe products that you can only get from him, even if pharma companies are allowing him to sell them at a cheaper price. And most definitely, he should not be just recommending these products to you, like what happened to us, even if these products work.

In pediatric cases, an allergologist should not be recommending that breastfeeding mothers stop breastfeeding, no matter the age of the baby. Instead, the doctor should explore if the mother’s diet could be triggering the allergies. Definitely, no allergologist should also be pushing specific formula brands to a breastfeeding mother.

Skin testing is also not NECESSARY for every allergic person though it is recommended for those with severe cases of asthma, allergic rhinitis, atopic dermatitis/skin asthma/eczema, and food allergies.

If dissatisfied with the way your condition is being handled or how the doctor treats you, better seek a second opinion, especially before agreeing to more aggressive treatment procedures.

What to prepare

Although specific allergies are not hereditary, the tendency to develop allergies is. But there are things you can do, despite your strong allergy history, to minimize or delay the need for an allergologist.

Observe clean living. Eat healthy. Avoid junk, instant and fast food for their preservatives. Don’t smoke. Clean and air your house regularly. Change your beddings, curtains, rugs etc. regularly. Eliminate or wash often things that can accumulate dust (plants, stuffed toys, throw pillows, carpets, etc.) to avoid house dust mites.

Breastfeed. Even if a baby’s allergy may be triggered by something from the mother’s diet, breast milk is still a safer milk for infants than formula.

Use heat. Iron clothes, beddings and pillow cases regularly. For babies with sensitive skin, use hot water for the last rinse of their clothes. Make sure your air-conditioning is not that cold and used 24/7. At the first sign of sniffles, start steam inhalation. You can also burn aromatherapy oils to relieve allergy symptoms at no side effects. Use a humidifier if you have the A/C turned on all the time.

Avoid using baby powder as they may irritate lungs, or use talc-free ones and only put on places where they’re needed, and not all over the body.

Invest on gentle and hypoallergenic wash like Cetaphil and Aveeno for newborn or really sensitive skin. Other popular and trusted products include Physiogel, Oilatum and Dove unscented. You can also use organic, hypoallergenic soaps like By Nature Handmade Soaps. These products may be more expensive but infants don’t need much of these products anyway.

Minimize or space out intake of highly-allergenic foods. Eight foods account for 90 percent of all food-allergic reactions so note or avoid them (milk, egg, peanut, tree nuts, fish, shellfish, soy and wheat) when you suspect food allergy.

Take probiotics. Pregnant moms are also encouraged to start taking probiotics two weeks before their due date and to continue taking them for six months as they breastfeed to decrease incidence of atopic diseases in their babies. The probiotics coupled with breastfeeding help shift the immune pathway away from the allergic pathway. Consult your obstetrician or paediatrician on which ones you can take and give to your child.

Avoid antibiotic use in early life as it increases likelihood of childhood asthma. Prevent usual ailments like coughs and colds from worsening and always ask your doctor if antibiotics are necessary or can be delayed.

It would be very helpful to have your medical records with you when you go to any doctor. If it’s your child you’re bringing, bring the baby book with you as well as your main pediatrician’s referral letter, if available. Take note of your complaints, when it first manifested, and what you have already done for it. If you have had similar attacks before, also try to remember what has been prescribed to you and whether or not they worked. Take note of the usual antihistamines you take, if you’ve already taken any, and how many.

Also be sure to mention any particular allergen you were exposed to, or habits you might have (or people around you have) that may be triggering your allergies.

Remember that the more critical information you provide, the more informed diagnosis and treatment your doctor can make.

When to go

You do not go to an allergologist when your eyes have swollen shut in a span of minutes and you are finding it hard to breathe (signs of anaphylaxis). You go to the Emergency Room then and follow up with a consultation with an allergologist after.

You also see an allergologist when colds and coughs have been persistent for weeks and you are unresponsive to medications. It is also better to see an allergologist when your symptoms only happen during, or are aggravated by, certain times, weather changes and extreme temperature. Also see an allergologist when your symptoms are already affecting your quality of life, resulting in absences from school or work, or are already resulting in complications.

It may also be wise for people with strong allergic histories to see their allergologist before major surgeries to consult, or test, for drug allergies.

Where to go

The Philippine Society of Allergy, Asthma and Immunology Inc. (PSAAI) has a list of the country’s allergologists with clinic schedules. One can also ask for referrals from trusted friends and relatives, e-groups, or message boards and know beforehand whether a doctor accepts patients enrolled in HMOs or not. Of course, highly recommended ones may either involve higher fees or a longer waiting time, and they may not exactly hold clinics in a place convenient to you.

For cheaper skin testing, you may also opt to request your allergologist to have yours done at the Allergy section of the Out-Patient Department of UP-PGH Medical Center where it will cost about half of what it would in private clinics. Just call their Allergy and Asthma Clinic 5548400 (local 3071) for operating hours and more details.

For additional support, PSAAI has also established an Allergy Club to help sufferers and their families. Just ask your allergologist for the nearest one you can join.

One last note on consulting allergologists, especially those working on pediatric cases: though relief is always our foremost agenda, it is better to work with one whose approach is conservative. You don’t want to subject your child to a full panel allergen skin test, no matter how painless it might be, when all he needed was a seven-day antihistamine use, and maybe a change of soap. Sometimes, you may also just need Gamma globulin shots like I did, when wedding stress was compromising my immune system, and not several months of antihistamine use.

Photos by author. Some Rights Reserved.

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Mec Arevalo is a serial blogger, stay-at-home Mom, breastfeeding peer counselor for L.A.T.C.H. Inc. and volunteer counselor/facilitator for FAD Inc. Aside from being an intentional parent and preparing their family for homeschooling, she does what she can for her advocacies: breastfeeding, children-in-conflict with the law (CICL), HIV/AIDS Awareness and sign language. She relaxes by Plurking and digiscrapping.

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