Allergy : what next

Text Box: Check List: Finished home work Used meds Kept diary Xray Sinus film Skin tests Options: Avoidance Medication DECISION POINT Adminstration Checked insurance coverage Allergy Injections Fast Usual  Bob Lanier M.D. v 6.20.05

 

Text Box: The skin tests for allergy are positive:   This means you have the genetic profile to be able to form defense antibodies to things other people ignore, such as pollen, molds, animal danders, and foods.   It’s NOT going to go away, but it does fluctuate over the years and according to season.  

 

What now:  You have only three choices in managing this problem- you can try and avoid exposures, you can treat this with medications, or you can try for a cure ( extended remission) with allergy injections.

 

Avoidance: If you are housedust sensitive, pillow and mattress casings will help.   Air Cleaners may be of some assistance, but the are pretty expensive.  If you wash the pollen from your HAIR before you retired for sleep – that can help.   Moving will help – for a short time only.

 

Medications:  The usual suggestions involve extended and consistent antihistamine use as the initial strategy.   We are pretty confident is this since antihistamines have been used since 1939.   Long term side effects are not an issue.  Short term side effect like drowsiness and memory loss have been reduced markedly with the newer non-sedating antihistamines like Allergra and Clarinex ( perhaps more potent than Claritin ) and the low sedating Zyrtec.  Many people think that older antihistamines such as Benadryl do not make them drowsy – but multiple studies show they affect driving and school performance.   The nasal spray antihistamines like Astellin may be covered from insurance more often and work very well without any likelihood of addiction.   Nasal steroid spays ( Nasonex, Rhinocort, Flonase, Nasacort) are likely more potent than antihistamines, and can be taken for long periods of time,  safely.   My own preference is to use the antihistamines as a foundation daily during a season, and add nasal steroid spays as a secondary agent to gain control.

 

How would you handle your car?  When trying to decide how to manage allergy long term, it’s sometimes useful to compare the medical illness with an automotive illness.  Let’s theorize that you have a car with a radiator that leaks.   You wouldn’t wait for steam to come from under the hood before putting water in it  ( but sometimes you will wait until allergy produces a sinus infection or asthma attack).   More likely you would maintain the car with regular check-ups and use the garden hose to keep going.   If the leak is minor, you might choose to  water it  “as needed”.   But it’s a daily ritual, or the car overheats, you instinctively know something has done before damage occurs. If you are ready to work on this problem ( whether allergy or automotive), you need some estimates.

 

Can you fix allergy?  Since allergy problems are in the genetic make-up,  it’s not possible at this stage of science to “fix” them like you would fix or replace a car radiator.   There is, however, a way to consistently put allergy in remission, sometimes for very extended periods (  15-20 years ) with Immunization or allergy shots.    Here are the costs involved: Time ( shots are weekly or every other week for an initial period of six months unless you rush  ) Out of pocket expenses-  The shots themselves cost 15-18.00 each, plus there is vaccine material costs.  It’s our experience that insurance consistently covers the cost of the vaccine, but often balks on covering the injection fee, requiring a “co-pay”.   But you will never be exposed to more expense that the cost of the shot.  Once at final  dilution ( we start small, dilute, and work stronger) we could stretch out the shots if you wish.   If we achieve goals of reducing allergy 50-90% over a two year period, and if that remission lasts 10+ years ( not everyone gets this) , this turns out to be a very good return on your investment when you consider the rising cost of drugs, x-rays and office visits.

 

What to do next:  we will give you a list of “CPT computer codes.   You call your insurance and assess coverage.  After computing the cost and inconvenience versus the prospect of long term remission – if you want to proceed, we will schedule the full set of skin tests after a pilot.   If we are going to try and clear this for you, we’ll need a bigger picture.   Once the skin tests are complete, we can discuss the type of allergy approach.

 

  A Rapid or RUSH technique can being you quickly up the build up phase and cut up to seven months off a two year program in the course of a single morning.   Standard approaches build up slowly over a six month period.  Make a list of questions – think about it.   There is never a rush with allergy shots.