Expert: Marc Rubin, RPh Asthma Educator - 4/1/2009

Question
QUESTION: Hello. I am 30 years old. I live in East TN. As a child I had NO allergies. My allergies started in my 20's when I became allergic to my dog. (started with itchy bumps on neck, sneezing).

I am allergic to many types of animals (but strangely, cats do not bother me very much). I am pretty much in a small city and/or country environment regularly.

My allergies developed in my 20's. I take Allegra 180 as needed. Lately, the Allegra doesn't seem like it's enough. I still get really "sneezy" and runny nose, itchy nose, just sneezing a million times, itchy eyes, etc. when I am around animals. Even if I don't touch them...like on a farm or at a circus or in a barn, I start sneezing. If I DO pet them (took daughter to a petting zoo) I can get splotchy on my hands/forearms if I pet them lots.One or two touches doesn't give me a rash.

Well, lately I have started to cough,too. When I am around the animals I will first start with the sneezing, then coughing. It's not like a regular cough. I wheeze with it. I will cough a few times and then when I take a breath in I can hear the wheezing and also my husband heard it today.He was like "do you have a cold ?". I told him it was from the rabbits where I went downstairs to the garage to feed them. I didn't even TOUCH them.

I have an inhaler (Albuterol) from where I had bronchitis one time. I have had to use it a couple times for my allergies/coughing/wheezing and it works. I use it and pretty soon I am not wheezing and I am not coughing.

Could I have allergy related asthma ? I've never had asthma. Should I talk to my doctor about this ?

After I do the inhaler (2 puffs), the coughing will stop and the wheezing gets better. Nothing seems to help with the sneezing, though.

In my 20's I had to put the poor dog outside. The cat is now outside. I have 2 rabbits (my kids rabbits) in the garage that make me cough and sneeze. My daughter has started taking horseback lessons....I WANT to go into the barn with her, but every time I do....I start sneezing and coughing.

Ideas ? Things to tell my doctor ? Are there other meds out there that could help me more ?

I am so sad that I cannot even enjoy animals or etc.

I'm afraid that I may be getting asthma. Is it possible to just "get" asthma ?

Thanks,
Melissa

ANSWER: Hi Melissa,

It appears quite evident that you have developed asthma.

The majority of patients with asthma are those with allergy issues, and they can develop at any age ( I just recently developed an allergic eye condition which was brought on after a visit to my brother-in-laws home, containing 3 dogs and a cat. The reaction was so intense, I first developed a bacterial eye infection, then it evolved into a viral eye infection, and now I left with a condition called epiphora: chronically runny eyes...I've been thinking about going into acting in sad movies. Oh, btw, I'm 57)

What is happening is a reaction to the dander of these animals. Allergies are the result of an over-responsive reaction of our immune systems for foreign protein, the de4ad skin shed by cats, dogs, rabbits, horses, as well as pollens, molds, etc. This reaction causes a release of numerous chemicals which create inflammation in your sinuses and lungs, decreasing the flow of air in and out. It also results in an increase in mucus secretions in the sinuses and lungs also.

Treatment consists of a two-pronged approach: prevention and medication.
Prevention is the recognition of what triggers the symptoms, and avoiding them whenever possible, as in don't go near the horses, rabbits, etc. The medications help to bring your symptoms under control, and allow you to have a near-normal life. Near-normal meaning that you will now have a new awareness of what affects you, and if you must enter where those triggers exist, you need additional pre-treament with medication to minimize the effect.

With the degree of reaction you are having, I'd see an allergist for a proper workup and treatment approach. You can locate a board certified allergist by using this website: http://www.aaaai.org/physref/

Got to this website to download the "Asthma Control Test". This test is very helpful in monitoring how controlled your symptoms are. The doctor will appreciate it.
http://www.asthmacontrol.com/

For some beginning patient education, use this link: http://www.aaaai.org/patients.stm

Now, start taking your Allegra DAILY.

Once you have seen the doctor, get back to me, and I'll take you through the paces and answer any questions for all that you are about to learn.

Talk to you soon!
Sincerely,

Marc



---------- FOLLOW-UP ----------

QUESTION: Ok, thanks for all the info. My medical doctor seems to brush me off constantly. I had been having migraines and dizzyness and he brushed me off for a year. Went to a neurologist for a workup..and I "migraine spot". Yeah, I felt validated !

I will try to find an allergist.

In the mean time, is it OK to take the albuterol inhaler when I have a flare up ?

Thanks,Melissa

Answer
Hi Melissa,

Yes, use your albuterol as necessary, which should be 1-2 puffs every 4 hours as needed. Please note, if it is the newer HFA type of albuterol, you must clean the plastic mouthpiece weekly, since they tend to clog up. Just pull the metal canister out, rinse the mouthpiece under warm water for a few minutes, shake well, and allow to dry. Also, ALWAYS keep it with you, never leave it at home.

While you are searching for an allergist, start looking for a new doctor too. Your doctor apparently has a listening disability.

Dr. Richard Martin, pulmonologist at National Jewish Hospital in Denver (the top place in the country to go for lung disease) spoke last year at a major medical conference. His topic discussed the problem in medicine that has developed over the past few decades: doctors think that medicine is all about them. No....it is ALL about the PATIENT!

Talk to you soon!

Marc