Allergic rhinitis?

[cece1126]

this is interesting, may ganito kasi ako baka mamana ni baby naku

[purpledheaven]

hi doc lelet, how would i know if my son's recurring cough is due to allergies or infection? he's 22 months and pansin ko madalas sya magkacough and colds almost every month. i'm confused kasi i can't pinpoint kung may asthma ba talaga son ko or may allergies or may infection na. sometimes kasi yung cough and colds accompanied by fever. sometimes naman it's not. madami na din akong pedia na naconsult and there are times na gumagaling sya with antibiotics and cough medicines na bigay ng ordinary pedia. pag naman sa pedia pulmo kami pumupunta binibigay montelukast, or pred 10 and asmalin nebules na pero di naman talaga nawawala yung ubo. yung wheezing lang talaga yung nawawala. pero biglang yung ubo bumabalik.yung colds niya pabalik balik din pero di naman sya nahihirapan huminga. yung ubo ang mas grabe pag may sipol na pag tumatagal. pero recently since nov. 7 nagtake sya montelukast(3 wks) and pred 10 (5 days) and allerkid (2 wks)kaso biglang may paubo ubo pa din. tapos biglang nilagnat na naman kanina after how many days na wala ng lagnat. im confused where to go kung sa pedia pulmo, allergologist or infectious disease specialist na? or talagang depende talaga sa pedia? what's your opinion on my son's condition. thanks so much!

[leletmd]

purpledheaven:
If infection, there's usually constitutional symptoms such as fever, irritability, body aches, etc. Cough and colds are present the whole day. There is usually a history of exposure to a family member with the same symptoms/infection.
If asthma, walang fever. Cough is episodic. It will occur only upon re-exposure to the offending allergen/s. There may be night time attacks, especially if dust mites ang offending allergen. There's also usually a personal (previous history of atopic dermatitis/skin asthma or allergic rhinitis) or a family history of allergic disorders. The patient responds well to beta agonist nebulization (salbutamol) or to oral steroids.
Good response to asthma meds is a clue to the diagnosis of asthma.

[purpledheaven]

thanks doc lelet

[delisyus]

hello doc lelet...

I just wanted to ask... does allergic rhinitis or asthma have a correlation with sleep apnea?

my niece kasi who starts sneezing when she plays in dusty places or when she just fluffs their bed and pillows now snores really loudly too. her parents suspect sleep apnea but haven't taken her to a doctor. i just wondered lang if may connection (increased risk ba ang allergic people) or baka kasi overweight lang din my niece. thanks!

[leletmd]

@delisyus:
Patients with Allergic rhinitis have an increased risk of developing sleep problems or disorders. Nasal congestion will cause narrowing of the airway that may lead to snoring or sleep apnea. In some patients, if you treat the nasal congestion, the snoring and sleep apnea goes away.
May effect kasi ang nasal steroids sa pag-decrease ng airway inflammation...
Aside from allergic rhinitis, your niece's weight is another risk factor...
If your niece suffers from chronic post nasal drip, there is a chance that her tonsils are also big due to chronic irritation so another risk factor yun...

[delisyus]

thanks so much doc... I will make hubby push his sister to bring our niece to the doctor na talaga!

[sky_butterfly17]

 hi doc lelet,

ask ko po kung ang montelukast is also use in treatment of AR? kala ko po kasi pang asama lang. thanks po

[leletmd]

^  Montelukast was first formulated as an anti - asthma drug, but due to its' anti - inflammatory steroid like effects (minus the side effects of steroids), it has also been shown to be effective against Allergic rhinitis and other allergic disorders.
We also use Montelukast as a second line medication for Urticaria. There are also studies exploring its' use as an add on medication for Atopic dermatitis or skin asthma.
May studies on giving it to infants with bronchiolitis for prevention of asthma development.
May studies na rin on prevention of upper respiratory tract infections, but not yet proven effective. Equivocal pa ang results.
Mabagal lang nga magtake effect ang montelukast kaya there is a need to give it for a longer period of time. Also, superior pa rin ang effect ng nasal steroids compared to montelukast.

[snowyice]

@ leletmd hi!  I hope you can help me with my son, he got a severe allergic rhinitis as for me kasi parang whole year round siyang hindi nakakahinga ng maayos.  Everytime he is about to sleep he would say I can't breathe. And mabilis siyang magkasipon as in maambunan lang ayan na.  Our ENT doctor told me give him a Nasal Steroid Avamys is the brand name and told me not to worry dahil sa ilong lang daw yun wala daw side effect, but one of my friend told me may side effect pa rin daw kasi ginamit daw niya yun dati and humaba daw yung arms niya I don't know if I understand her correctly. Honestly,  I see a good result with the steriod dahil hindi na masyadong kinakalikot ng anak ko yung ilong unlike before na default place ng finger niya e sa nose. About sa Montelukast binigay din yan ng pedia niya and  suki na kami ng Mercury Drug jan.  I just want to know should I not worry about the side effect of Avamys and how long ba pwede gamitin yun?  Ang sabi ng ENT 2weeks tapos 2 weeks pahinga tapos 2 weeks ulit then 2 weeks pahinga ulit and so on.... pwede ba siya gamitin ng matagal?

[hunny_ally]

My son takes nasal steroids (nasonex) and usually 5-7 days Lang Nya gamit yun. Then we just use setrimar daily to clean his nose.

Montelukast, like what doc lelet said, is slow acting. My son has been taking this since September non-stop. Sabi ng pedia ng kid ko she had patients daw who are taking this for as long as 2-3years straight.

[marose17]

@snowyice, how long has your friend been spraying Avamys?  I've been spraying Avamys non-stop also since September.

@Ally, same with me and my kids, pagtuntong ng -ber months, naka-Montelukast na kaming 3.  We stop taking around March because our symptoms go away usually around summer.

[hunny_ally]

^M started using it when he was 3mos. Initially for 3mos Lang, but when we stopped it, he developed pneumonia for the 2nd time. But when he had his 3rd bout after removing him again for montelukast, he had his 3rd bout. Kaya sabi ni pedia (actually both his primary and immunologist) we just continuously give him that. 6mos na siyang tuloy tuloy on montelukast.

[sky_butterfly17]

wala naman bang bad effect for long time taking of montelukast?

[hunny_ally]

According to the 2 pedias my son is seeing wala naman. Your thoughts on this doc lelet?

[leletmd]

^ Agree with your pedias, especially with your Immuno. Montelukast may be taken for a long period of time, without serious adverse reactions. It is considered a steroid sparer because, it is able to do what a steroid does without having the serious adverse reactions.

@snowyice:
How old is your son? If he has year round symptoms, then, at the risk of sounding biased, I strongly suggest that you bring him to an Allergologist for management of his symptoms so that his specific allergens may be identified.
As to the nasal steroids, it is considered a topical steroid. Side effects include dryness of the mouth and mouth sores. There may be thinning of the nasal septum and epistaxis (nose bleeds) if it is not used properly. It does not have the same adverse reactions associated with long term use of oral steroids kaya, just like inhaled steroids, nasal steroids may also be given for a long period of time.
If we follow the ARIA protocol (Allergic Rhinitis and its' impact on Asthma protocol), nasal steroids should be given for at least 2 to 3 months, on a tapering dose. That means after 2 to 4 weeks use, we ask the patient to follow up, re-assess and either maintain, increase or decrease the dose, depending on our assessment. That is why follow ups are very important when a patient is taking maintenance meds.

[snowyice]

^he is 6 going 7. nabanggit na nga ng doctor na magpa chk up kami sa allergoligist. I will have him scheduled once the symptoms are back nawala kasi sa Avamys. Ask ko lang po we will going to hk next week and medyo malamig ang temp sa hk around 12-18 should I bring his neb kit? Malaki ba ang possibility na magka asthma siya due to change of temp? Thanks!

[marose17]

^ We went last December and we brought our nebulizer just to be on the safe side.  Good thing hindi naman namin kinailangan.

[snowyice]

^thats good to hear. Ang bigat niya kasi eh

[marose17]

^ Oo nga eh but just imagine if magka-asthma attack ang anak mo in Hong Kong.  It is not easy to get a prescription there and magastos magpa-ER, not to mention hindi tayo familiar sa protocol nila sa hospitals there.