What to Expect in a Pedia-allergologist visit?

[-;-maCooLet-;-]

^Hindi pa sis eh. Wala pa kasi binibigay na gamot Pedia niya. Iniinom ba yung Vandol?

[younis]

^nope sis... ointment yun. vitamin A + D lang, safe to use yan, walang steroids. ginagamit ko rin yan sa insect bites ng baby ko.

[leletmd]

@-;-maCooLet-;-:
CGH allergologists: Dr. Nenita Tiu and Dr. Rosa Ong
I suggest you ask your pedia for a formal referral as courtesy to her. Pwede naman magwork ang pedia and allergologist together to help manage your baby.
I am not sure if Dr. Sumpaico is maxicare accredited. Here are her clinic details:

United Doctors Medical Center
N. Ramirez Street cor. España Blvd.
Quezon City
Tel. no.  712-3276
Schedule: Tuesday & Thursday 10:00 am - 12:00 nn
                   Saturday 4:00 pm - 6:00 pm

Philippine Children's Medical Center
Quezon Avenue
Quezon City
Rm. 19 G/F
Tel. no. 924-6601 loc. 309
Schedule: Tuesday & Thursday 4:00 pm -6:00 pm
                    Saturday10:00 am - 12:00 nn

Medispecialist Medical Center
Rm. 5
2nd Floor
Rustan's Cubao
Araneta Center
Quezon City
Tel. no.: 911- 1850
Schedule: Monday & Wednesday 5:00 pm - 7:00 pm

From the pictures you posted, it doesn't look like clear cut atopic dermatitis. Pag atopic dermatitis kasi, more of rough red patches on the cheeks, forehead and chin. Not really butlig. Malinis ang nose and under the nose.  Did your pedia consider infantile acne or seborrheic dermatitis?
Anyway, it would be better to go to an allergologist for confirmation kasi iba pa rin yung makita mo ng malapitan compared to just seeing it from pictures.

@guiding star:
How do you feed your baby? If madalas kayo magfeed while the baby is lying down, may risk of developing ear infections. Hindi ba raw barado ang nose niya?

[guiding star]

^at night I feed him while his lying. and yes barado nose nya, its like he always have colds.

[leletmd]

^ I suggest not to feed him while lying down. That will predispose to nasal congestion (baradong ilong) and ear infection. The nasal congestion has to be treated in order for the ear infection to go away.

[katkat]

^dunno kung OT 'to doc lelet pero itatanong ko na rin po... But I'm now considering visiting an allergologist.

Kasi my kid just turned 3yrs old, pero ngayon lang siya nagka-allergy. Possible po ba 'to? 

She eats everything since nung baby pa siya - eggs, chicken, peanut butter etc. Wala naman reaction whatsoever. Until last week nag-vacation sila sa in-laws ko for almost a week, umuwi lang dahil sa allergy.

I forgot the medical term ni pedia, but this allergy daw is mag-start na maliliit na pantal all over the body (mukhang insect bite talaga), tapos nagdidikit sila then lumalaki. Of course itchy - arms, legs, neck, tummy, & back. Tapos sabi ni pedia, pag napabayaan pwede mamaga eyes, lips, & then throat - which is when isusugod na sa ER para bigyan ng steriods.

A kind of Urticaria po ba 'to doc (kita ko lang sa google image)?

[leletmd]

@katkat:
If pantal pantal, then it's possible that it is urticaria.
Urticaria can occur at any age. The most common cause of acute urticaria (pantal for a short period of time pa lang; less than 6 weeks in duration) is infection (usually viral infections of the upper respiratory tract) followed by food.
I suggest you consult na lang an allergologist for definitive diagnosis and para mapinpoint ang cause.

[katkat]

^doc lelet thank you.

doc, di po ba yung Benadryl tine-take as needed (parang paracetamol) tuwing magstart yung allergy?

Pedia prescribed Celestamine 5ml thrice a day for 5 days, & hypo allergenic diet for 2 weeks. Saka benadryl syrup every 6hrs pag maguumpisa pa lang daw allergy/pantal. Pero 5 days after ng HA diet, nagpantal ulit. Took Benadryl agad mix sa milk.

How do I know po when to stop giving Benadryl (prescribed every 6hrs)? kasi po after 2 dosages, 6-7hrs apart, nawala na yung pantal so di ko na pinainum the 3rd time. Tapos pag gabi bumabalik - inum ulit.  Actually almost 1 week na kami ganito pabalik-balik yung pantal.

[leletmd]

@katkat:
If it has been going on for 1 week then it's time to seek consult with an allergologist for better management.
Based on studies, anti-histamines have better effect if given routinely rather than on as needed basis.

[katkat]

^doc thank you. 

di na po natuloy check up kasi we observed na though nagpantal siya sa gabi, tiningnan namin kung dadami/kakalat without giving Benadryl. Turned out na di na po dumami & wala na rin pantal kinabukasan. This went on for a few nights. Now wala na po & balik normal na po diet niya.  Still observing though, pag bumalik po ulit will go to the pedia na.

[leletmd]

^ You're welcome. If the symptoms come back, have her checked up na.

[_heartbreaker_]

hi doc i just want to ask kung how much po ba ang pa allery test sa food kase po yung son ko nakapag pa allergy test na regarding sa environment like weeds, grass , dust mites etc. . Di ko po [textspeak!] mareach yung allergo niya out of town po eh, may idea po ba kayo kung how much para mapagipunan ko. Thanks!

[leletmd]

^ Sorry, but it would be best for you to wait for your allergologist and ask her na lang regarding the price. It varies kasi depending on how many allergens are tested and saan ang supplier ng allergens (hindi kasi pare-pareho ang number of allergens and suppliers). Baka mamaya iba ang price niya kasi iba ang supplier niya and iba ang number of allergens niya.

[DV]

Doc Lelet, my daughter has atopic dermatitis according to her dermatologist. Pag nagpa-check-up po ba sa allergist, siguradong nag-re-recommend agad ng allergy tests? How painful po ang tests na ito? I'm wondering kung meron pang non- or less-invasive/painful methods of determining my daughter's AD trigger?

[myleia27]

hi doc, makiki consult na rin po. my daughter kasi has acute urticaria. napansin ko na ito when may change of temperature. Sinugod ko siya sa ER and ni recommend nila na medicine is Zyrtec drops. So bumili ako. When I finally got an allergologist rin sa same hospital kinabukasan, she shook her head when she saw na Zyrtec ang ni recommend ng ER doctors. Pinapalitan nya abruptly ng Iterax syrup. Napansin ko magkaiba ang generic name ng 2 gamot. Since kakabili ko pa lang ng Zyrtec parang nag aalangan ako bumili ng Iterax dahil gusto ko paubos muna yung unang gamot kasi sayang naman at hindi rin biro yung price nya for a small bottle. Ask ko lang po kung if you have insights why pina change ng allergologist agad yung gamot nya. Hindi ko na lang po mention kung sino yung pedia-allergologist na nakita namin. Hindi ko na rin po natanong dahil na intimidate ako sa kanya, noon nasa clinic kasi kami nya eh feeling ko sinesermonan nya ako at may instance pa na talagang sinungitan at tinarayan nya yung medical secretary niya. Balak ko pa naman na mag switch na permanently sa pedia allergologist para 1 doctor na lang daughter ko.  Thanks in advance po.

[Mai]

Dra.lelet: is there a staple set of foods na surely allergenic for those with skin asthma? Or it really varies? para ma avoid ko habang di pa ko prepared magpa skin test.
My 3yr oldgirl has skin asthma (as told by our pedia), as in the back of her knees, legs, forearm, inner forearm nagkakati, nagbabalat and after scratching magsusugat na.
Ang skin asthma ba, should be handled by an allergologist or a dermatologist? Thank you dra.lelet.

[leletmd]

@DV:
When you consult an allergologist, most likely there will be history taking, physical examination as well as explanation of findings and recommendations. Part of the recommendation is to do a skin prick test to determine what the exact triggers are. As to if this would be performed on the first visit pa lang would be the call of your allergologist and would depend also on what meds your daughter is currently taking. Patients have to be off anti-histamines for at least 1 week before a skin prick test can be performed since the test results may just come out negative if the patient is still taking anti-histamines.
The skin prick test is actually the least invasive of the tests and the most specific compared to having a blood test done (RAST, Phadiatop, etc.) It is not painful. Sure, they might be a little sting when the skin is pricked, but it is generally tolerable naman. It will make the skin very itchy and it is more often the itch that make the patients uncomfortable pero generally tolerable din naman.
Depending on how cooperative the patient is, the test can be performed in 15 to 30 minutes with the results read after 15 minutes of allergen application. Tapos, the allergologist will explain the results na.

@myleia27:
Pasensya na but it will be unethical for me to comment on why your allergologist's management was like that.
Although parehong anti-histamines ang Iterax at Zyrtec, magkaiba ng generation sila. Iterax is a short acting anti-histamine and is an older generation anti-histamine while Zyrtec is a newer generation anti-histamine and is a longer acting anti-histamine.

@Mia:
There is no such thing as a hypoallergenic diet. Lahat ng food may potential to cause allergies depending on how our immune system will react to it. Better to do a food diary, chart what food is the possible trigger and do an elimination diet based on that.
If there is a possible food trigger, pwede to do skin test to food and eliminate also based on the results of the skin test with correlation sa history ng patient.
If skin asthma, you'd have to consider also na baka hindi lang food ang trigger. Skin asthma may have both allergic and non - allergic triggers. Allergic triggers include food and inhalant allergens such as house dust mites while non allergic triggers include hot temp, sweating, stress, irritants such as perfume and fabric conditioners.
Both dermatologists and allergologists can handle skin asthma. The difference lies in that allergologists have the capacity and training to detect the specific triggers (pasensya na if I sound biased)...

[myleia27]

thank you po doc. at least na enlighten ako about sa medicines na pinapa take sa daughter ko. I guess I'll stick with Zyrtec drops muna and let her finish it since prescribed rin naman siya. I'm going to look for another allergologist kasi sa totoo lang, uncomfortable ako sa naging 1st session namin. right now, I'm jotting down food she's taking and her possible interactions with dusts, pollen, plants etc para ready na sa next doctor. I highly doubt it's food kasi before naman lahat nakakain nya w/o having rashes.

[leletmd]

^ Contrary to popular belief, hindi food ang most common cause ng acute urticaria in children.
It is actually viral infections of the upper respiratory tract that is the most common cause of acute urticaria for children, which is why we also ask about recent bout of infections and may ask for some laboratory exams when we try to determine the cause of urticaria.

[cheskacruz]

I also take notes of the food kinakain nila and possible factors kapag inaatake when I'm with the kids - sad minsan nga lang nakakalimutan ng yaya kapag nasa office ako.