Three weeks in-management questions.

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At this point, I'm willing to tentatively say the Advair 250 is working. The dose was raised just over a week ago, and now I've gotten through two workdays in a row without needing the inhaler. The pollen counts are still high, I'm still getting itchy, I'm occasionally still getting chest discomfort, but I haven't become seriously short of breath since Saturday. :bouncing::bouncing::bouncing:

I'm astounded. My only goal was to survive pollen season without getting worse, and now I've got almost textbook control. I'm SO glad I asked for a dose increase. My experience with my allergies is that, once triggered, they will not stop until the trigger is removed and my body is darned well ready to stop. I've had rashes that ignored Prednisone, for heaven's sake!

On the downside, I'm still spending most of my time away from pollen. I'm hoping to start allergy shots the next time I go to the doctor, because if I have to stay inside and take basket-o-drugs again next spring, that'll be a major disappointment.

But if the allergy shots can at least reduce my sensitivity to the point that it's medicines OR stay inside for a few months out of the year, rather than medicines AND stay inside, I can handle that. And of course, starting the medicines before pollen season begins should also make a big difference.
 
Just an FYI, my allergist won't start you on shots during your allergy season. With me, we had to wait till Noveraber to start to get past most of them - dust mites know no season! Not all allergists work this way, though some do.
 
Pulmonologist? Maybe. I'm hoping that won't be needed, being as it's quite clear my only trigger is pollen! I also need to find a family doctor, one who will trust me to manage my own allergies.

I know my asthma is not properly controlled. It hasn't been controlled for more than one day since this started. What I'm not sure about is whether it's reasonable to expect control any time this allergy season, or whether it's more of a hang on and survive kind of thing.

I got the allergy tests, and I definitely want allergy shots. That was my first thought when I realized what was happening, that obviously I need to have allergy shots.

My reflux got BETTER once I finished quitting PPI's. Better than it was while I was taking them, heck, it DEVELOPED while I was taking them for gastritis. The PPI's never did anything for the LPR type symptoms, and they just let my LES get lazy. I do have a hiatal hernia, but it's pretty mild. Lately I've been taking 300 mg Zantac every day, both to control reflux and in hopes of getting some antihistamine cross-activity.

I'm on the smallest dose of Advair twice a day. Maybe I need more.

I'm most definitely taking every possible precaution to avoid pollen in the house. And I'm avoiding the fruits that cross-react with pollens. I wake up feeling ok, I go outside, I wait for the bus, I ride the pollen filled bus, by the time I get to work I'm itching all over and my chest is tightening. Sometimes I wear a mask, but I don't like feeling like that much of a crazy person.

Maybe the doctor really doesn't understand how bad things are for me right now. Heck, he said I could exercise outside if I really wanted to! Which is why I spent two hours on Friday hauling stuff around outside (it needed doing, although maybe not by me,) which is why my chest hasn't felt good since. I think I really do need to call him and ask to increase meRAB.

Decongestants... Here's the thing. I don't get sinus problems with my allergies, not like most allergic people. I have a tiny tiny bit of congestion which is controlled 99% with one squirt of nasal spray every day and a half. It is not an annoyance to me at all, the only reason I use the spray is to keep postnasal drip out of the lungs and stomach.

My allergy symptoms are itching of the entire head, and asthma. That's all.
 
Okay, this could be kinda long, but I need to express my frustrations somehow.

I'm not real satisfied with how my treatment is going so far. I'm not sure if it's because my expectations are unreasonable, or because the treatment could be done better.

I've always had mild seasonal allergies, but it never seemed worth the effort to treat them. Then this month, my body decided that I need allergic asthma to make my life more interesting! It's a bad year for pollen, and despite antihistamines and Advair, I'm still having a bad time whenever I'm outside for more than a few minutes. And I take the bus to work, so "living in a bubble" isn't really an option.

Do antihistamines actually work for airborne allergens? Ever? It seems impossible, that taking one little pill could prevent your body from reacting to something it's being exposed to constantly. When I've had allergic rashes, I've thrown oceans of prednisone and benadryl and heaven knows what at them, and NOTHING will settle it down until the trigger is removed. Does anyone really have luck using antihistamines to fight POLLEN?

Plus, of course, I can't take Benadryl these days, and Benadryl is the gold standard. It not only makes me walk-into-walls drowsy, it causes me to have acid reflux. Acid in asthmatic lungs = BAD. So I switched to Zyrtec, and it seems to be helping a little, but it isn't enough. My face still itches all day long and I used the rescue inhaler 3 times today! (Most days are 0-2, I think 1 is my average. I should really be counting my doses better...)

I'm missing out on everything I love to do. I feel like a prisoner in my bedroom. I barely have the energy to get through the day at work, unless it's pouring rain, in which case I feel fantastic. My job performance is suffering, because doing my job well requires me to talk loudly and move energetically at the same time, which is obviously impossible when asthma is bugging me.

That's another thing. I feel so good whenever I'm away from pollen long enough for the lungs to settle down, I'm afraid to go outside. I went to yoga class at the gym, and I was the crazy person who said she'd leave if anyone opened one window on the other side of the room. I'm the nut wearing a face mask on the bus. The fit young woman who insists she can't walk six blocks across town. This is not the person I want to be. And, well, some days I'm just not coping well.

One voice says, "Look. This spring is a loss. Get through it without dying, winding up in the hospital, or getting fired, and then you can get allergy shots, and next spring you can start the treatments in advance, and things will be better."

The other voice says, "No, this isn't right. I should be able to get more out of treatment now."

The doctor seemed to think my asthma wasn't all that serious. Maybe he's right. (Of course, he did listen to my lungs on a rainy day.) I haven't at any point felt like I was in immediate danger of death, and I don't think I'm really wheezing. I just pant, and sigh, and sometimes cough.

I'm just not sure if my treatment is inadequate, or if I'm just being seduced by those drug aRAB that show people with asthma and allergies doing whatever they want.

I'll close with a little allergy humor. Over the past few weeks, I've noticed my laptop's speakers aren't as loud as they used to be. I turn the volume up all the way and sometimes still have trouble hearing. Initially I thought the speakers were failing.

After several days, I realized. It's my air filter. I'd gotten so used to the sound it puts out...
 
OK, first question - are you seeing a pulmonologist or allergist? If not, you need to. Have you had allergy testing recently? Are you considering injections? If not, you should. Allergy induced asthma can be tough to get under control because you dont normally medicate all the time. The first thing is to determine exactly what type of asthma you have and then treat the cause. This year has been awful for allergies due to all the rain. So, get them under control - whatever it takes - and then work on the asthma.

Keep us posted.
 
Diphenhydramine/generic Benadryl might be more effective than Zyrtec

Note that it can make you drowsy, especialy in the first few days.

Zaditen/Zaditor might be worth a try - it is a sort of "super-antihistamine" it would help the hayfever and the asthma, a prescription is required, so discuss with your doctor.
 
Just a thought about the hives on your face and head - are you taking any NSAIRAB? I delevoped an allergy to Aleve that manifested like this.
 
Jane,
I've been there where you are. This winter, I was at one doctor or another at least once or twice a week. (Those $35 co-pays certainly add up for someone who works for a non-profit.) I head to the pharmacy so often that a couple years ago when I called in a prescription without having my nuraber handy they didn't even ask me my name. They recognized my voice as I told them what I needed. When I asked if they need it, they told me who I was.

Have you had any luck with nasal antihistamines instead of the oral? I've had some success with Astelin. My ENT has also offered up Omnaris as well. I figured I'd stay with the Astelin as long as it was working.

You really do need to see about getting an asthma action plan next time you go in. I have a fairly recent post on asthma action plans if you haven't already read it.

Good luck with the Advair 250/50. Hopefully it can help get things under control and you can bump back down after that.
 
I love Benadryl. I adore it, I worship it, it's the only thing that's ever clearly helped my allergies, I personally believe all other antihistamines are cheap watered-down imitations or placebos.

I can't take it anymore, because, not only does it make me walk-into-walls drowsy, it gives me severe heartburn/reflux, which can set my lungs off. I can occasionally get away with one, but I really need to be taking multiple doses every single day, and I can't. So, I'm messing around with other stuff that might or might not be helping some. And also has side effects.

Maybe I can convince the doctor to give me a set of syringes so I can just inject myself with Benadryl every day and bypass my messed-up digestive system entirely. This sounRAB like a disturbingly good plan, but that might be because it's really late at night and I need sleep.

Zatiden isn't sold in the US, according to some very quick research. Allegra, hydroxyzine, and doxepin are on my list of things to test. I especially like the idea of doxepin, because I'm currently taking a tricyclic antidepressant, an H1 blocker, and an H2 blocker. It would be awfully convenient to get all three in one little pill. And the cheapness of decades-old generics is also attractive.

I guess I have to call him tomorrow and ask for more scripts. And go to CVS again. Have a chat with my new best friend the pharmacy tech.

I keep thinking that the pollen season will be over soon, or that the medications are finally working a bit more. Well, in just a couple more weeks I get a long-overdue vacation. At least then I won't have to stand outside waiting for a bus early in the morning.
 
You ladies totally rock. A few thoughts on how things are going:

1) Because it seems to me that I really should be on an oral antihistamine, I decided to see if I could make Zyrtec work for me. I take 20 mg all at once and pad my stomach well beforehand. I get a little pain, but it seems ok. However, I don't think it's helping! This is the 3rd day on 20, and I had yet another allergy attack this morning, after walking about half a mile at an easy pace.

2) My body hates albuterol. I think it triggers reflux. And headaches.

3) On the up side, I was a little angry yesterday that I'm on all these drugs and still feeling lousy. Then I realized something--I've been increasing my activity level as my body tolerates it. So I still feel bad, but I'm feeling bad while doing more of what I would normally do, as opposed to feeling bad while doing next to nothing other than work. Which probably means I'm getting better.

4) Also on the up side, I may have found an alternative to the bus. A couple of the ladies at work know what's going on, and they've started mothering me. One of them gave me a ride home today, because it's more or less on her way. This could make things a lot easier.

5) Nasal antihistamines? Haven't tried those, but they mainly work on nasal symptoms, right? I don't really have nasal symptoms, I just get itchy face and head. And then my chest tightens.

6) I will ask him about an action plan. I'm also trying to keep a symptom diary.
 
Seriously, I've never found a GP who knows much about allergies and asthma. It's just too much for most of them. And they all throw Advair at it and that's not always the best med. There are many others out there. I'm on Flovent and it works great for me.

As for the zyrtec, my allergist and my pharmacist both approve of 2 a day if I'm having a severe allergy attack (1 in the AM and 1 in the PM 12 hours apart). So you could certainly try that. It usually takes 2 days to get it under control when I do that.

Since my asthma is not allergy related (ended up with it after a bout with walking pneumonia), I can only take a guess at how to handle it. perhaps a hit of alubuterol before you leave the house to go to the bus? See, it's these sorts of things a pulmonologist can help you with.
 
I'm not seeing him again until the end of the month. Grass season doesn't really end until fall, but it's possible it will be winding down to the point that he'll be willing to schedule a start.

Or maybe he'll say it's OK to do it now. Or maybe he'll say wait until October.

Meanwhile, I should probably be talking to my insurance company to figure out coverage.
 
A Pulmonologist can also develop an asthma action plan for you. It is something everyone with asthma, no matter how severe, should have established to follow.
 
Nasal antihistamines work on regular allergies. Just better on nasal ones. But it's worth a try. And it can take several days for an antihistamine to "catch up" with the allergy. Kind of like when you had your foot surgery and tried to do without a pain med and then had to take 2 rounRAB or more before they helped? Not to mention that you are trying to get a handle on what's going on in the middle of the worst allergy season in years!
 
Tichou: Nope, no NSAIRAB. Happily, though, the shift from predominately tree pollen to more grass pollen has decreased the itching/hives and increased the sinus symptoms. I've noticed this in years past, too, that I get one set of allergy symptoms in spring and a different one later in the year--and I find the sinus symptoms much less annoying.

MountainReader: Yeah, that's about what I expected. Other triggers might crop up at some point, but in most people they don't, so for now just avoid pollen and maybe colRAB. Not that I generally make a habit of smoking tobacco or tending a coal fireplace anway. ;)

Believe it or not, I was wearing a mask for a while and quit because the material was irritating my face. Maybe I'll try to find a different brand.

Still, I made it through the worst at work, and I can work at home most of the time for the next few weeks, so that should help a LOT.
 
I've just started seeing an allergist since this fun began. He gave me the Advair. He also gave me a steroid nasal spray, which is almost completely unnecessary. (I'm using a little anyway, just enough to prevent any postnasal drip.)

He did testing, and I'm allergic to trees and very allergic to grass (and cats, but I don't even know any cats). He says we can talk about allergy shots the next time I see him. I'm thinking it will be necessary. It won't help this year, but it probably will next year.

I think the Zyrtec is helping, though it doesn't work for 24 hours. Maybe 18. Maybe I'll call the doctor tomorrow and ask for permission to take 20 mg instead of 10. I found some studies that say 20 mg is still quite safe and, for hives and asthma, works better than 10. (They also say 20 is no better than 10 for allergic rhinitis, that there's a ceiling effect)

You know, in past springs and summers, I've had weird rashes that started near my ears. I now think it might actually have been hay fever. Even now, my first allergy symptom is itching head (nose, ears, chin, forehead, scalp...

Which would mean my hay fever has been a nontrivial problem for longer than I thought. Interesting.
 
Hayfever really bad this year. Felt as though I had flu the other day. Have upped piriton to 2tabs 3x day and feel better, although use of salbutamol has increased five-fold!
 
Well, today was 4 weeks since this started, and I am still alive. I spent the long weekend with my parents, gave my husband a break from the Jane Zone, which was mostly good.

I've lost 5 or 6 pounRAB this month due to frequent asthma symptoms and lack of appetite. I think my weight before was ideal health-wise, my current weight is still in the green but toward the low end. My mom spent the entire time trying to stuff me with food!

I think the increased doses of Advair and Zyrtec may be working to some extent. I'm still having symptoms, but it seems to take more time outside to provoke them. Saturday I was outside for over 2 hours before I had an asthma attack. I get itchy welts on my face, but they go away. No major rash, like I had in a couple recent summers. Baby steps, but still forwarRAB.

Mentally, some days are better than others. I've missed a lot this month, two camping trips, several picnics and barbecues, and any nuraber of hours I might have spent walking outside. I really did expect that either pollen would end by now or medication would be more effective. The almanacs tell me that grass season runs until the end of July in my area, and I've actually experienced mild symptoms in late August, but my (local) allergy doctor says the worst is usually over long before that.

Some of the things people say, trying to be helpful, can really grind my gears. These are the slightly nasty responses I'd like to give:

1) "Sudafed is a great antihistamine, it works wonders for my allergies."

I'm soooo happy for you, but it isn't an antihistamine, and it doesn't treat any of the allergy symptoms I have.

2) "Are you feeling better?"

I know you want to hear that I'm fine. And I'm a little better than I was, but seriously, is is winter yet? Then no, I still feel lousy.

3) And after I explain why I can't do as we planned this weekend, "Wait and see, maybe you'll feel better Friday."

See #2. I'm trying to be RESPONSIBLE and tell you now.
 
Still alive, still not perfect but well enough. Still waiting for Godot to arrive with a break in the pollen season.

One more question, not sure if anyone here can say for sure. (Sorry I keep bothering you guys, I'm just a little stressed over all this!)

It appears that pollen is my only trigger. I know that exercise and cold air are both fine. How likely is it that I will experience symptoms outside of pollen season? How likely is it that colRAB and whatnot will cause more problems now? Thus far in my life, I've had very few chest colRAB and (as far as I remeraber) none bad enough to require medical treatment.

I already use careful handwashing to minimize sick days at work, and I try to get a flu shot every year. I suppose I'll put more effort into getting one early this fall.
 
Well, today has both good news and bad news.

The good news is that my allergist's office is amazing. I called this morning and said I was still having a lot of chest symptoms and wanted to increase my meRAB. I also said my voicemail was private, in case I missed the return call.

As it happened, I did miss the call, but it was ok. They called in a script for the Advair 250 and I have the stuff right now.

Given past experience with calling doctor's offices, this is a miracle. I totally lucked out with my choice of allergist.

Bad news is, I tried an extra Zyrtec last night and then another one this morning, and it made me drowsy to the point I was having trouble carrying on a normal conversation. Worse, the Zyrtec is apparently irritating my stomach, too. And given that I have acid reflux and erosive gastritis, irritating my stomach is dangerous.

(I have fibromyalgia that I have to manage with topical pain treatments and a little Pamelor only, that's how drug-sensitive my stomach is these days. And it wasn't any easier when I was on prilosec, not once I'd become dependent, anyway.)

So, benadryl has bad side effects, zyrtec has bad side effects, claritin does nothing. Grrr.

The biggest time I'm bothered by asthma is at work, and today I did try taking the albuterol right before starting the demanding part of my job, instead of waiting until it became absolutely necessary. It seemed to work better. I am getting better at figuring out when I really need the inhaler and when I should wait and see.

Titchou, the stories I could tell about family doctors and allergies... That's why I got used to handling my skin allergies without bothering a doctor, because I knew so much more than they did and got tired of arguing with them about why ANTIBIOTICS were completely inappropriate for someone with an allergic rash and a history of multiple antibiotic allergies. I suppose I could have tried a specialist, but I was never able to get an appointment in a timely manner when I was having a problem. All I really want from a GP is for her to accept what I tell her about my conditions and not try to mess up treatment that's working.

MountainReader, you're no doubt right. I'm just tired of dealing with this. It seems like I'm at the doctor or in the drugstore every single day. Went to the drugstore today to pick up my script and I was all, "Hi, it's me again! I just love you guys that much!"
 
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