Question:
We've just been to the allergists and I'm baffled by what I've just been
told.
My 6 year old has had a cough/post nasal drip that has come and gone
since she was 4, but it first started right after she got back to back
colds in preschool in November 1997. In Spring of 1998 we went to the
pediatrician who could see no obvious acute sinus infection and so, on
the basis of family history (mine) and the clear watery nasal
secretions, that allergies were the cause. Probably dust mites, molds
and springtime pollens, since it was spring when I took her in (forget
that this has been going on since November, pollens were in there). We
were given Claritin and Flonase and sent on our way.
The Claritin did nothing, the Flonase has minimal effect since she was
never that congested, but rather, it was the chronic coughing that was
the problem. I did the usual anti-dust mite thing to "de-dustify" the
room and her bedding that are recommended, to some small effect.
On return to the doctors, she was given Zyrtec to replace the Claritin
and we were admonished to continue with the Flonase even though it was
uncomfortable to give, and didn't seem to be helping a whole lot. She
also had a sinus x-ray at my insistance because I thought the allergy
diagnosis was based more on family history than anything else. It was an
easy out. The x-ray came back negative for sinus infection.
At the end of May, we went to visit the grandparents in a different
state, and the whole thing cleared up. Period. No sniffles, no coughing,
nothing. It never returned upon arriving home and stayed fine until next
fall.
This past October the same thing happened again, just as it had in
November. She caught her first cold of the season and the "cold"
lingered with chronic coughing and runny nose until we trooped back to
the doctors in February. She was treated for bronchitis because the
doctor thought she heard a wheeze. She got antibiotics and a Proventil
inhaler. After running the course of treatment, the cough and runny nose
were still there. At this point, a referral to an allergist was made
(we're in an HMO).
Two weeks before we made it to the allergists, my daughter came down
with a 24 hour stomach flu and did not eat anything for the entire day,
and liquids were limited to ginger ale and cola. She may have felt awful
but she stopped coughing completely and her runny nose dried up. So did
the minimal stuffiness.
I decided to use this as an opportunity to see if a food allergy was the
problem and eliminated milk from her diet because it was one thing she
consumed a lot of and it is a known allergic food in children.
The difference was remarkable. She coughed only once an hour instead of
every half minute or less (I kid you not) and it was dry instead of
phlemmy. She has been off milk and milk products for two weeks and the
difference in the quality of her life is remarkable. She still coughs
once in a while, but you wouldn't even notice it, as compared to the
horrible frequency of before.
Problem is, I told all this to the allergist who promptly ignored
everything I said (except for commenting on the dust mite treatments I
had started) and proceeded to test her for 60 common allergies including
pets, pollens, molds, foods and dust mites. All 60 came back negative.
Then she decided to immediately test for 9 popular allergens
(subcutaneously) for this area (Virginia) including cats, dogs, 2 for
dust mites, and 4 popular pollens for this time of year. All came back
negative except one of the dust mites injection sites came back as a
very mild positive, according to the doctor. They had to struggle to
measure the diameter of the wheal.
Here's the rub: the allergist has decided that the dust mites are the
great enemy, and told me to finish the dust mites treatments with a
carpet dust mite killer, continue to "de-dustify" the room and as I
already have a Honeywell HEPA filter in her room at least I don't need
to do that. I'm supposed to give her Zyrtec and Flonase every day so we
can get this "under control". When I continued to mention that she was
almost symptomless since being taken off dairy, I was reminded that the
prick test showed she was not allergic to milk and that false positives
were more likely than false negatives BUT since she seems to feel better
without milk, I can continue to keep her off it until the followup visit
in four weeks. Oh, and here's the kicker, after she sees how she's
doing at the followup visit, she wants to start her on shots immediately
after since dust mites are a year-round irritant for my daughter.
I mean, I feel like I've just returned from the Twilight Zone and I'm
also really PO'd. I was assured that she was an excellent allergist (but
not a pediatric allergist, I later found out) who is used by my HMO, but
she is not limited to HMO work, taking "regular" non-HMO insurers as
well. She asked about the sinus x-ray (which my pediatrician had scoffed
at but did anyway because I was raising such a fuss) and mentioned how
chronic sinus infections could be symptomless in children except for a
drip. But starting shots for a mild positive reaction to dust mites? And
she's not even coughing right now in the middle of the traditional "dust
mite season"!
Although I kept stressing that she wasn't wheezing, she insisted that I
purchase a airflow meter to test her twice a day during the worst of the
coughing. So now we're back to the Zyrtec which I never found to be of
much help, and now Flonase (for a nose that isn't running or congested)
for an entire month until oudr return visit. And then she's going to
start her on shots. This is ridiculous.
Have any of you had any experiences like this and what did you do?
(Remember I'm still hindered by needing to clear things with an HMO, but
which is a "not bad" one as national reviews go).
Help.
Answer:
My physician, as well as reasearch I have read on the matter,
all agree that allergy skin tests have somewhere around a 50/50 chance
of being right, with false negatives [it says you are not allergic,
but you are] having a bigger chance of occurring than false positives
[it says you are allergic but you aren't, even very mildly].
I had one skin test when they were testing to see if I was allergic to
penicillins or not [this is important to know, and the drug I reacted
to that caused the question was a cephalosporin, which apparently has
a high cross-allergy with penicillins]. I had the test about 6 weeks
after the cephalosporin 'adventure'. WHen they do a skin test, one of
the things they use as a control is a small amount os histamine --
which EVERYONE should react to, allergic or not -- it combined with a
non-reaction to the non-histamine control is how they know that the
test is at least somewhat reliable [i.e. you at least rect to
histamine, which everyone should, and you don't react to the
non-histamine control, which nobody should]. Well, I did NOT react
the the histamine control AT ALL, hence the entire test was a void
test. My physician [not the allergist -- the allergist was the same
jerk who wanted me to bring in a tuna sandwich to eat in his office to
prove that I was allergic to tuna!!] said my body was probably
reacting so much to other allergens that it just didn't care about a
little bit more histamine disturbing it -- whether this is true or
not, who knows, but at the time my allergies *were* already bad, adn
the cephalosporins 6 weeks earlier had not helped matters :)
To diagnose my food allergies [which didn't show up on skin tests, and
I don't even bother getting the skin tests done anymore, as it is a
collossal waste of time for me], I kept a diary of everything I ate
and all my symptoms and medication usage for about 3 months. My Mom
[a veteran of food allergies herself] and I went through food diary
and identified a list of foods [bread/pasta (hence wheat, yeast),
milk/ice cream/cheese (hence dairy products), peanut butter, citrus
products, tomatoes, chocolate, and I think a couple other things] that
distinctly and repeatedly coincided with being eaten in a short
timeframe [upto say an hour or so] before I had asthma symptoms [we
were most concerned with asthma at the time, as mine was out of
control]. We presented this list to my allergist at the time [who has
to be one of the more incompetent MD's I have dealt with], and once
presented with our findings she agreed that I should cut them out of
my diet and see if things got better -- something my Mom and I had
already decided to do. So, I had nothing from that list for a couple
years. Yes there was the occasional "cheat" [uninentional/unknowing
until later and intentional], but each time, especially with wheat and
dairy products, I would get sick. AFter a couple years I began to add
in some of the foods, like citrus products and tomato products, and
did so without prblems [who knows if I was actually allergic to them
or not, or if they just happened to coincidentally be implicated].
Everything but the wheat, dairy, and chocolate was successfully added
back into my diet over a period of a few years. Other things got
added to the banned list as I ID'd them as allergy cuplrits. Now I am
at the point where there is an entire group of foods I cannot have due
to a fatal/life-threatening allergy to enough of the items within the
group to say it isn't worth having anything in the group :) I am also
allergic to wheat and dairy products, but some forms of them are worse
than others, and I do have some tolerance for each most of the time.
I find the worse my allergies are on any given day, the less tolerance
I have for either substance. So milk and wheat are cautiosly back
into my diet, but I am still allergic to them.
So, allergy skin tests are not as reliable as some would like you to
believe :) For food allergy identification, the elimination diet is
the way to go [though keeping a food diary like I did can give you a
starting point]. For other allergens, I find that I can usually
figure out what the cause is. Ok, not always specifically... For
example, this past Tuesday *something* outside [everything is blooming
around here] reached a level in the air where I am reacting
allergically to it. I have no clue what it is, but it is presumably
something that is blooming. Does it really matter which specific tree
or flower or whatever it is? Not to me -- all I know is that there is
something that came out and I am reacting to it and I want the
symptoms to go away! It isn't something I can remove from my
environment, so knowing exactly what it is is not going to help me, at
leastnot right now...
