Allergy Patient Basics
What questions should I ask my doctor after getting an allergy diagnosis?
I think you ought to ask the physician. What's available for medication? How often do I have to take it? How long do I have to take it? What are the side effects? Will this interfere with my other medications? What might I expect in terms of therapeutic response? How long should I wait to feel better before I see you again? What kind of follow up is necessary? Is there anything I should tell anybody else or should I involve my family in practicing better dust avoidance and environmental control? The questions are really quite reasonable but ask them because most of us are busy. The patients are busy, the physicians are busy, and "take a red pill twice a day and see how things play out" is not quite a good enough way to deal with a chronic ongoing allergic problem.
How soon will I start to feel better after taking allergy medication?
Depends on the allergy condition and depends on the medication. If you're having hay fever, an allergic reaction to the pollen out there, if you start taking your medication now, you can expect prompt relief. By that I mean within hours with antihistamines and decongestants, and within days with the inhaled nasal cortico steroids. If you have a more complex problem, if you have asthma, again, one would expect prompt relief, but the prompt relief would be measured in days to weeks rather than hours to days.
How often should I see my doctor after an allergy diagnosis?
It depends on the nature of the allergy and the severity and the seasonality and some other things that go on. Typically, if one sees a physician for a diagnosis and evaluation and started on medication for allergies, it would not be unreasonable to say, "I'd like to see you again in a few weeks or in the next three months." If the medication or the treatment is fine, good. If not, modification can be done at that time. I also tell patients, "Call me whenever you think and we'll handle some things over the phone if we can." If the patient is doing well on the return visit and several weeks or a month or two or three, then I'd typically say, "I'll see you about twice a year or more frequently if necessary." If a patient has a more severe medical problem, such as asthma and is taking a stronger medication with a potential for side affects, such as inhaled corticoid steroids, or other strong medications, then I say, "I think we should see each other initially in about three months and then probably two to three times a year, or whenever you think necessary. And, whenever you think necessary is when you're not comfortable with the way things are going."
Can I be cured of my allergies?
The advantage of immunotherapy or allergy injections are they are the one form of treatment that can promise a cure. In other words, down the road if they are exposed further, the body chemistry has changed and they are cured. However, we like to talk about control instead of cure. Cure is a tough thing in allergic disease. It is part of your genetic makeup and it can manifest itself later on down the road.
What do I do if I have an anaphylactic attack?
If you're allergic to shellfish and you accidentally ate some shellfish in a salad, and you find yourself tightening up, unable to swallow, unable to breathe, getting hives, getting itchy, getting scared, then two things: if you have an EpiPen, use it immediately, and then get to a medical facility. Get to an emergency room; get to a physician's office. Get there: have somebody drive you there, take a cab. Dial 911. An anaphylactic reaction is a potentially life-threatening reaction. It doesn't occur very often, but there are deaths that do occur because the patient has not been treated quickly, promptly, and because they thought, "Well, I'll be OK. I'll be OK." It's much better to be aggressively over-careful with anaphylaxis than almost anything else.
How do I choose the right doctor to treat my allergies?
It's important to have a good relationship with your physician if you can. By that I mean someone who you feel comfortable talking to, telling your story to without feeling the need to be defensive, somebody who makes you feel comfortable, and someone who has a level of competence. If you have an allergy, many of them can be treated, and should be treated, successfully and clearly by your family physician. On the other hand, an allergist is a physician who went to medical school, took a residency, or training, in either internal medicine or paediatrics, and then a fellowship in allergic disease. We're specifically trained in the diagnosis and treatment of allergic and immunologic diseases.
When should I see an allergy specialist?
Well, number one, you should see an allergy specialist if it's a diagnostic problem. If they think, "Well, I'm not sure. It may be an allergy, it may be this; it may be something else," then it may be useful to see an allergist. Another reason is when you need specific equipment that your family physician may not be able to provide; skin tests, pulmonary function tests, the R.A.S. test that we mentioned before. Another indication for a referral to a specialist is if there are complicating comorbidities, if you will. If in addition to allergic rhinitis, I'm getting recurrent ear infections. I'm getting sinusitis. I've got asthma. There seems to be more here than an allergy. An allergist or a specialist could help you to sort those things out. Another reason that one sees a specialist is if it's a medical/legal involvement; it may be helpful then. Some people will say, ever since I started working at the XYZ Corporation, I'm getting wheezing and rashes, and they say it's not an allergy. They say it's something in my life, and I know it's something there. That's the sort of a thing that an allergist may be able to help you with. However, the major time to see an allergist, or get a second opinion is if you're uncomfortable, or your physician is uncomfortable with the way things are going. We don't have to put up with discomfort. None of us know everything, but some of us need the opportunity to get a second opinion, because the first one just hasn't been reassuring enough, or we're not happy with it.
How effective are Hepa filters if I have allergies?
HEPA filters are effective in cleaning the dust out of the environment. They help some people enormously; they don't help other people at all. At a minimum, they make a house or the room less dusty; they make it cleaner. It helps you have a more pleasant place to live and to breathe. So my recommendation is that, if patients can afford them, put HEPA filters on their furnace and use them. There are no promises on whether they will cure your allergies or not. They are, again, helpful, but not a cure-all.
Will insurance cover my allergy care?
Generally, insurance, in this day and age, covers allergy care. Sometimes more, sometimes less. But if the insurance company initially said, "No, we're not going to pay for skin tests, or for this sort of thing," it's worth saying, "Wait, I'm a special case," or asking your physician to get involved. This is because often the insurance companies are not just trying to avoid the situation, rather they don't understand that this is a specific field with speciality areas and specialty problems, and they don't get it. Sometimes we can help the insurance companies get it. Push for your insurance coverage if you have allergic disease.
What resources are available to help me with my allergies?
Most states have a local allergy society. I know California does, I know Minnesota does. And if you just contact your county medical society and say, "Can you refer me to an allergy organization?" They will have the website or the phone number of all these things. It's easy to get information if you make the first phone call. If they don't put you on hold, but you get to talk to a real person, they can usually direct you to get a lot of information
