What to Expect in a Pedia-allergologist visit?

[leletmd]

sweety_paige: it will depend on what type of allergy a person has.
For example, cow's milk allergy is usually outgrown by the time a child is 3 years of age. There are only about <5% who will have cow's milk allergy all their life.
Allergy to seafood and nuts are life long.
Atopic dermatitis usually gets better as the child enters puberty, but may later be replaced by asthma and allergic rhinitis. This is called the Allergic march.
Allergic rhinitis and asthma are life long diseases, so if a child develops these 2 diseases early on in life, it means that they will have it till they grow old. There will be times when they will be symptom free (when they are not exposed to their triggers) but once re-exposed to their triggers, allergic attacks occur.
It is not true that asthma is outgrown by the age of 7y.o. If the child's "asthma attacks" disappear at this point and never re-appear, it may mean that the child didn't have asthma in the first place. There are a lot of childhood infections that sounds like asthma and may become recurrent like asthma. Oftentimes, these conditions are misdiagnosed as asthma and these are actually the reason behind "asthma" disappearing by age 7, but in reality, the kid was never asthmatic.

[sweety_paige]

^Thanks Sis, will visit you one of these days.

[ms_guimba]

Thanks, sis leletmd for answering my question. I'll try to moisturize my daughter's skin. I also developed allergies to chicken and some seafood after I gave birth. Before allergic rhinitis lang. My husband had asthma until he was 12 and became more active.

[DV]

Thanks for the referrals, sis leletmd!

Another question (hahaha, sorry ang dami naming tanong, nakakalibre na ata kami ng consultation!  ): May vaccine din ba for babies ang atopic dermatitis  para hindi na ito mag-lead sa asthma or allergic rhinitis later on?

[leletmd]

You're welcome, sis DV, ms_guimba and sweety_paige! 
Unfortunately, there is no available allergy vaccine yet for atopic dermatitis.
AD has to be controlled properly. Otherwise, the rashes in the skin and the constant scratching may lead to further sensitization to different allergens, leading to the development of asthma and allergic rhinitis later on.
Allergy vaccines are recommended only for asthma, allergic rhinitis and in the US, also for bee stings and peanut allergy.

[younis]

@sis marose17, sis thanks ah.. sige i-check ko yung ni-pm mo na doctor. nag-e-error yung IE ko pag nagp-pm ako, tsambahan lang eh.

[marose17]

^ No problem. 

Dr. Abong is an excellent doctor too.  Malayo lang ang Asian Hospital sa house namin kaya I got Dr. De Vera for my kids.

[hana0928]

my daughter's pedia-allergologist prescribed Avamys (fluticasone furoate), nasal spray corticosteroid. no improvement kasi nung nag take siya ng Montelukast, she's been using avamys for almost 1 1/2 months, thank God kasi naiimproved na, medyo controlled na ang sneezing, runny nose at nalessen na ang pag kamot sa nose niya. According to the pedia, for 6 mos. daw gagamitin, nagworry lang ako kasi corticosteroid un, hindi naman kaya maover sa spray yung daughter ko? 

help naman mga sis, baka meron na din sa inyo nkagamit ng Avamys or any nasal spray corticosteroid. TIA! 

[marose17]

^ I suggest you research over the net about the effects of corticosteroids.  Marami kasing possible effects ang extended use of steroids and it depends on the form of steroid used.  Take a look also at the literature found in the med.  The effects and contraindications will be there.

[younis]

^tama ka sis.. the reason bakit umabot ng ganito katagal bago ako magdecide to bring my daughter sa allergologist (d ko pa nga nadadala eh), dahil na-a-alarm na ako, kasi walang remedy, dahil yung pedia nya would not recommend gamot, may mga steroids daw kasi ang mga ointment ngayon. and even if i bring my daughter to a derma, they would give ointments pa rin na may steroids. so ang reco lang nya is gamitan ng unscented soaps.

hopefully this saturday makapunta na kami, wala kasing clinic daw last saturday eh.

[marose17]

^ Are you going to Dr. De Vera?  Based on my observation, cautious ang approach niya.  Hindi rin siya basta magbibigay ng steroids unless na-exhaust na ang non-steroidal treatments.  She also explains the pros and cons of each treatment to give you a better chance to make an informed decision.

If kay Dr. Abong naman, conservative rin ang approach niya.  Feel free to raise your concerns din sa kanya.

[hana0928]

thanks sis marose17! ask ko na lang si pedia, wala kasi nakalagay sa literature kung up to how many months max. usage eh, but may nabasa ako up to 3 mos. lang daw maximum sa children below 6y.o. my tendency daw kasi n mag bleed [textspeak!] nose.

[leletmd]

my daughter's pedia-allergologist prescribed Avamys (fluticasone furoate), nasal spray corticosteroid. no improvement kasi nung nag take siya ng Montelukast, she's been using avamys for almost 1 1/2 months, thank God kasi naiimproved na, medyo controlled na ang sneezing, runny nose at nalessen na ang pag kamot sa nose niya. According to the pedia, for 6 mos. daw gagamitin, nagworry lang ako kasi corticosteroid un, hindi naman kaya maover sa spray yung daughter ko? 

help naman mga sis, baka meron na din sa inyo nkagamit ng Avamys or any nasal spray corticosteroid. TIA! 

hana0928:
The Avamys should be tapered/decreased slowly before it is totally discontinued, otherwise, there is a chance of quick recurrence. The tapering of the dosage will depend on the response of your baby to the nasal spray.
Nosebleeds happen when it is used incorrectly, like when it is sprayed towards the nasal septum or the inner middle part of the nose. The nasal septum will get thinner and may develop small holes, which will cause the nosebleeds. The correct way of spraying it is to direct the nozzle towards the lateral part of the nostril (when you put it inside the nostril, aim it towards the ear).
I suggest you follow up with your pedia allergologist for proper guidance. Follow up is very important because there is a need to assess the response of your baby as well as to see if there is a need to taper/discontinue/change your baby's meds.

[hana0928]

thanks sis for the info. we will bring my daughter again for follow up on the 30th. sabi nga ni pedia wag ko daw i-stop yung avamys without her consent. buti na lang right yung way ko ng pag administer (tinuro ni pedia) natakot kasi ako bigla ng may nabasa ako na may chance mag bleed yung nose. now i know na what causes that.

thanks again sis. 

[ms_guimba]

I'm using Elica ointment on my baby. Does this have steroids? Anong okay na alternative for rashes?

[j3rz3y]

pinacheck up ko son ko sa ENT before kasi nagka ear infection sya then the doc told me due to allergic rhinitis daw kaya nagkaka-ear infection son ko so he prescribed AVAMYS for two weeks, yung first week 2x a day then yung 2nd week 1x na lang then stop na daw, everytime may symptoms lang yung son ng AR thats the only time daw mag spray, then after a couple of months na ganun i decided to bring my son sa pulmo-pedia kasi nagkaroon naman ng respiratory infection, the doc naman told me na di daw tama pag gamit nung spray dapat tuloy tuloy yun so na-confuse ako, pinatigil din nung pulmo yung montelukast (which my son is taking prior nung visit namin sa ENT) together nung avamys, and now madalas lalo sinusumpong AR ang anak ko haaayy dont know what to do na.

[leletmd]

^ I would have to agree with the pedia pulmo regarding the proper use of Avamys or any nasal steroid for that matter.
Nasal steroids take about 1 to 2 weeks to have full effect. If you discontinue it right away, then there is a high chance that you will be having symptoms within weeks or a month.
As I posted earlier, it should be decreased slowly before it is totally discontinued. For proper guidance, you may want to bring your child to a pedia allergologist.

ms_guimba:
Yes, sis, Elica is a mid potent corticosteroid. Thus, it should not be used for more than 3 weeks. Side effects include thinning of the skin and breakdown of collagen. You may ask your pedia or your allergologist if it is alright to shift to a calcineurin inhibitor (although they are quite expensive compared to topical steroids) or shift to a milder steroid with lesser side effects like hydrocortisone.

[hana0928]

sis leletmd: when i administered avamys sa daughter ko, she's lying down tapos naka tilt yung head nya, kaya lang kapag may sumpong nakaupo siya tapos i ask her to look down on the floor ten i'll spray the avamys. ok din ba kahit sitting down? when i asked her pedia ok lang daw. hindi kaya masayang lag yung gamot kasi baka after ispray eh tumulo agad? 

[ms_guimba]

sis leletmd, thank you for your reply. You know what? I tried your recommendation about putting some lotion on my kid's skin kasi baka cold urticaria. Mukhang wala siyang rashes after niyang maligo. Ang galing! Thank you so much. I am using my organic lotion, Peruvian Cacao Whipped Butter Cream from Cyleina. But you might have some recommendations on which moisturizers are great for kids.

[leletmd]

hana0928: it's ok to use the nasal spray while sitting down. That is how we advise our adult patients or older kids to use it: while sitting down with the head tilted down, insert nozzle inside the nostril and aim it towards the direction of the ear, then spray; inhale after to ensure proper absorption. Also, gargle with a saline solution after using the nasal spray.
Steroid nasal sprays have limited side effects as compared to their oral steroid counterparts but 2 of the common side effects are dry mouth and oral ulcers which usually happens when the spray goes down the throat, instead of towards the turbinates (lateral part of the nostril). That is why it is very important to have the patient gargle after use of the nasal spray.

ms_guimba: Good to hear that your daughter's skin condition has improved. Other good moisturizers are Cetaphil, Aveeno baby, Oilatum, Physiogel and Jergens ultra healing fragrance free moisturizer. Keep in mind that hiyangan din ang mga lotions and moisturizers so there is no telling which one will really work well for your kid. Just make sure that the moisturizer you use is fragrance free and hypoallergenic.

Happy to help