Sunday, May 15, 2011

Q&A with Allergist!

We're in the midst of a crazy allergy season!  My poor older daughter is suffering pretty badly from it.  

Here are some commonly asked questions that I've posed to an Allergist/Immunologist.  Dr J has a private practice in Dallas, TX and is also a mom of a preschooler and a toddler.  Here is what she has to say:

*  At what point should my child be referred to see an allergist specialist?
 It depends. if there are food allergy concerns we can see very young (ie bad eczema)

Most kids don't start getting allergy symptoms, especially pollens, til about 3 yo, but those with more atopic family histories can have symptoms (dust mite, cat, dog) as young as 1 yo.  It depends on quality of life. if recurrent sinus/ear infections, bad asthma, then need to look at allergies as a trigger.

 *  How young do you typically start allergy shots?
Same thing, depends on severity of symptoms, quality of life, and maturity of the child.  I've started as young as 3 yo but that's because of fireant venom anaphylaxis, which are probably virtually nonexistent where you are. but with kids playing outdoors and high likelihood of exposure to fireant in Texas, then we can start that young.  Shots for environmentals is more rare, mainly because everyone wants to try meds first.  But if family loves their pets, then that's something to consider. Also, evidence shows that very atopic 3 yo who started shots did show a delay or reduction in severity of asthma developing, so that is often a decision maker for parents who suffered through allergies and asthma as young children and don't want their kids to go through that.  But "most" kids I have start around 7-8 yo, that's because they consciously know and can verbalize how tired they are of being sick, or they are now always on the football/soccer field, and want to keep playing.

 *  Typically how long does it take to complete treatment?
Evidence shows 3-5 years of allergy shots appear to help people for at least 10 years.  I usually tell people it's the closest to a "cure" we have.  There is still possibility of breakthrough symptoms when the pollen counts are high, but at least day to day quality of life is significantly improved.

 *  How soon can you expect the allergy shots to work?
Some as early as 4 months, I usually tell people let's try for a year, then you'll know when your typical allergy season comes around.  It works for about 90-95% of people who start allergy shots.

 *  I was treated with allergy shots before but I still need to take allergy
 medications.  Does this mean I need to go through another round of shots?
No, depends on severity of symptoms and complications.  if meds work and they are tired of the time commitment put into shots, then ok to just take meds.  But I always caution patients that allergy shots are effective for about 10 years, so yes, I see people in their 30s who recall childhood shots worked but now it's all coming back. Plus they may have received shots in another region of the US.

 *  What does it mean if all my allergy testing comes back normal but I still
 get allergy symptoms?
Could retest (ie skin testing, RAST testing). but their's 90-95% likelihood that negative means negative.  May need to look at nonallergic causes (ie irritants, wind) and especially chronic sinusitis.

*  Do you think brand name allergy medications work better than generic?
Not really.  That's depends upon the individual.