Allergy Attacks? Fight Back: Lily Pien, MD

Last Editorial Review: 10/23/2003

By Lily Pien
WebMD Live Events Transcript

Spring has sprung! But if blooming flowers and trees make you sniffle and sneeze, read what with allergy and asthma expert Lily Pien, from The Cleveland Clinic, had to say about allergy and asthma treatments.

The opinions expressed herein are the guest's alone. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

Moderator: Welcome to WebMD Live, Dr. Pien.

Pien: Hello, and I'm happy to be here.

Member: My daughter has indoor and outdoor allergies, what is the medication you recommend for her? She is 14 and also has asthma. She has allergies to dust mites and pigweed and a few others. What do you recommend?

Pien: She would essentially be considered an adult and could use medications typically used by an adult. The non-sedating antihistamines are well tolerated and cause minimal drowsiness. Antihistamines are safe for people with allergic rhinitis and asthma. And nasal steroid sprays help control rhinitis symptoms, which can help prevent asthma flare-ups. Depending on severity of her asthma, intermittent rescue medication such as albuterol can be used. If her asthma symptoms occur on a daily basis, daily preventative asthma medication can be used.

Member: We have tried almost everything on the market, I mean over-the-counter. The doctors gave her nasal sprays, which dry her nose up too much. She also has been given albuterol for an inhaler. What I need to know is would a breathing treatment machine help her at all?

Pien: Breathing treatment machines, nebulizers, are primarily used for albuterol medication. There is also a steroid nebulizer solution available for preventative measures to treat asthma. If your daughter is having daily nasal and chest symptoms, I suggest a regular daily preventative medication for both her nasal and chest symptoms. Some examples are nasal steroid sprays, Singulair, and inhaled steroid medication for the chest as well.

Member: I am having problems with my eyes; they itch all the time and stay red, they also have a stringy white discharge coming from them. I thought it was my eye make-up, but it does it even when I don't wear it. I don't sneeze all the time but I do have sneezing fits, where I sneeze for 10 or 15 minutes non-stop.

Pien: Eye symptoms are a common manifestation of aeroallergen sensitivity. So I would suggest anyone with sneezing and eye itching and drainage to be skin tested to determine if there is a particular allergen to avoid. There are antihistamine eye drops available to decrease symptoms, and most of them are prescription.

Member: I think I'm allergic to salad; I can't eat a salad without having to "run " to the bathroom five minutes later because of diarrhea. I know it's the salad because it's been going on about a year. The funny thing is, I can eat lettuce without any problems. I don't eat salad much, but it's great if I'm constipated. Is this normal? What ingredients in it could I be allergic too?

Pien: True lettuce allergy is unusual. There are intolerances people can develop to foods and we all know vegetables are a high source of fiber. If you don't have any other symptoms besides diarrhea I would be cautious to say it is a true lettuce allergy. More typical signs of a true food allergy would include itching in the mouth, nasal congestion, hives, some chest tightness, as well as nausea, vomiting, and diarrhea. Some people have difficulties with preservatives used in vegetables such as sulfites, which may cause some adverse reactions to lettuce.

Member: What is the best way to stop the cough before it starts an asthma attack?

Pien: If you know you are going to be exposed to an irritant or allergen and there is no way to avoid the exposure, you can take albuterol one-half hour prior to the exposure. If the coughing occurs on a daily basis, an anti-inflammatory preventative asthma medication would be recommended.

Member: Does Allegra make you sleepy?

Pien: The second-generation antihistamines such as Allegra are not supposed to cross to the brain, so there should be minimal sedative effects with the medication. But everyone is different and some have complained of drowsiness with it.

Member: Is there an alternative to albuterol?

Pien: Yes, there is. There are other MDI's available such as Maxair, Alupent, and also a nebulized form of a bronchodilator called Xopenex.

Moderator: Are those just less popular than albuterol?

Pien: Albuterol is very specific for airway muscle. Some other medications have more cardiac side effects. So sometimes it's trial and error to see which medication works best for a patient.

Member: What is the best way to prevent itchy ears and throat problems?

Pien: An oral antihistamine is a good medication to treat generalized itching.

Member: I thought the Maxair was only to be used in case of emergency. Could this be used if you feel an attack starting?

Pien: Rescue medications are bronchodilators. Maxair is a rescue bronchodilator medication just like albuterol. All bronchodilators can be used to prevent asthma symptoms from occurring, such as half an hour before known allergen exposure or exercise.

Member: Is a scratchy and hoarse throat a part of asthma and what can be done for it?

Pien: Scratchy sore throat can be a sign of nasal allergies as well as asthma. Chronic postnasal drip from allergies or sinusitis can lead to a pretty raw, sore throat. A chronic mucus production in the chest from asthma can irritate the throat. To prevent symptoms of sore throat related to allergies and asthma, those two diseases need to be controlled. If the sore throat is persistent, throat cultures can be done to determine that it's not an infection.

Member: We are buying a new house. My daughter has asthma and I have acute asthma. We are having a problem with deciding which is better for my daughter: carpet, laminate flooring, or wood flooring?

Pien: Carpeting is not a good idea for those with allergies or asthma. It tends to retain allergens and cause prolonged symptoms, especially if there is a pet in the home. Laminate flooring is fine, though some may have a problem with fumes depending on the installation process. Wood floors are great, but they are expensive.

Member: Would the weather in Florida cause any difference in types of problems?

Pien: There are different allergens present in Florida or the South than seen in the Midwest. The high humidity in Florida has been known to increase mite and mold growth. In addition, the growing season is extended in Florida so the pollen season is extended as well.

Member: Do you build up a resistance to the medications over a period of time?

Pien: There has not been any well-documented medical study showing resistance to antihistamines or steroid medications. People can have some subsensitivity to bronchodilators.

Member: I'm very allergic to pollen. In the spring my eyes water, itch, and get red with a burning sensation. I take Claritin twice a day, use Ventolin inhaler as needed, and also use eye drops and Flonase as needed. Is there anything else that can help me, other than being a hermit?

Pien: There are different antihistamines you can try that may be more effective. Singulair is an anti-asthma medication that is preventative and may be better than Ventolin. And you could consider allergy shots, too.

Member: Can hives and swelling of the lips or eyes be associated with asthma? Also, would Allegra or Zyrtec be sufficient to control the swelling? And is it safe if you have osteoporosis?

Pien: Hives and angioedema [swelling] are not always associated with asthma. Antihistamines are good preventative medications to control hives and swelling. Antihistamines do not cause osteoporosis.

Member: My husband has very bad asthma. He is using Advair but there are times he has to use albuterol as a backup. Is there another inhaler that is stronger?

Pien: There are three doses available for Advair. If your husband is using albuterol more than three to four times per week, he may need the highest dose of Advair available. Singulair is sometimes added to Advair therapy to get a decrease in symptoms.

Member: Which antihistamines are the best?

Pien: Whichever ones work! Zyrtec has been demonstrated to decrease histamine skin reactions the most. However, about 14% of patients taking Zyrtec experience drowsiness.

Member: I had asthma as a child. It disappeared at age 13, and then came back when I was 65. Is this common?

Pien: It is not unusual to have a recurrence of asthma. It is thought that the underlying hyperactivity of the airways persists throughout the lifetime.

Member: Once you are diagnosed with asthma can you expect to have it the rest of your life?

Pien: Asthma can go into remission for several years. Some do have increased symptoms after age 40.

Moderator: If you are going to suffer from asthma, is it going to hit early in life?

Pien: It can strike at any point. We have some individuals who present with adult-onset asthma. Sometimes asthma is not diagnosed for many years and is diagnosed as bronchitis.

Member: My husband has allergies and asthma. He claims that he cannot help with household chores because the dust would set off an asthma attack. I bought a vacuum cleaner with a HEPA filter that is supposed to prevent the dust from getting back into the air. Can he run it without putting himself in danger of an asthma attack? I need help around here!

Pien: I generally advise patients with asthma to avoid exposure to allergens that would set off symptoms. If your husband wants to help, he could consider wearing a mask and taking his medications preventively [beforehand].

Member: What role does stress play in asthma attacks? My husband's doctor has him on Paxil to control his stress.

Pien: Stress has been known to exacerbate asthma. Patients with asthma frequently get anxious with attacks and that causes exaggerated symptoms. Patients with asthma have also been known to be depressed due to the disease. Emotional health is important in controlling all illnesses.

Member: Is asthma commonly associated with menopause, and can HRT [hormone replacement therapy] help or make symptoms worsen?

Pien: That's not very well studied. Some women have noted increase in asthma symptoms pre-menstrually, so there's not that much known about asthma and menopause.

Member: Is it possible to control allergy symptoms without medication?

Pien: Avoidance measures can be very effective. Exercise, decrease in weight, and change in diet have been shown to have beneficial effects in decreasing asthma symptoms.

Moderator: What kinds of foods are known asthma triggers?

Pien: Those containing sulfites.

Member: I have mold allergies. How can I test for mold in my air in my home? We had a flood in the basement four years ago. Everything was either removed or cleaned up, but that is when my problems started, what else can I do?

Pien: There are some environmental companies that will measure mold counts both inside and outside of the home. And they can provide control measures to decrease mold growth, primarily with the use of a dehumidifier.

Member: I've had a runny nose off and on for the last two years. After seeing three ENTs on different occasions, they all think it's my two dogs. I have been on nasal spray for some time, but I still get attacks almost every month! What should I do?

Pien: You can use antihistamines and nasal sprays daily to prevent attacks of nasal drainage. If you are allergic to the dogs, avoidance is best.

Member: I have seasonal and perennial allergies, asthma. I take Singulair, Flonase, and Flovent to control symptoms. I started shots in mid-January. Since I added the Singulair last fall, until this week I have not had the intermittent ear ringing and ear fullness that drives me batty at night. If I stay inside completely, it's much less a problem. I do wear a hat to keep spores and pollen out of my hair. Now, with a mild winter, no snow cover, and warm, windy days, the ear stuff is once again keeping me up at night. I use two snorts of Flonase in the morning. Would I get better control with one in the morning and one in the evening (each nostril)? Would Allegra help? I've tried all the others, which had various side effects or no effect. Also, when I'm congested, I snore and keep hubby awake. Sudafed before bed helps that, but at age 50, starting to get elevated systolic readings. How long before I begin to see help from shots?


Allergies can best be described as: See Answer

Pien: Allergy shots appear to be beneficial at higher doses so when you hit the maintenance dose, you should expect to have some benefit. So by the end of the first year, allergy shots should be beneficial. Flonase can be taken one squirt twice per day to provide some nighttime coverage. The maximum dose is two squirts per day.

Member: I'm a 58 year old man. I'm having allergic reactions to something. Mainly mid-afternoon, I experience hives on the back of neck, around the belt area, and tightness in my throat. Benadryl sometimes takes care of the problem, but I am concerned that it may be getting worse. What should I do?

Pien: If the hives have occurred for more than six weeks, they would be considered chronic, and the most common cause of chronic hives are idiopathic. This means the cause is generally something internal, not an external allergen.

Moderator: Unfortunately, we are out of time. Thanks for joining us, members, and thanks to Lily Pien, MD, for being our guest. Sorry we couldn't get to all of your great questions. For more allergy information and advice, be sure to visit the new Allergy Center and the allergy message boards here at WebMD. Be well and goodbye!

Pien: Thank you for chatting with me today.

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