Anyone have experiences with allergy-induced and food-induced asthma?

[coldishfeet]

DD has experienced symptoms of seasonal allergies and food intolerances (mostly preservatives and additives) since she was around 4. These manifested as redness in the face, itchy throat, constant blocked nose.

She's 13 now and doesn't suffer with those symptons so much but for the past 2 or so years, she has had episodes of coughing at night which goes on all evening and stops her getting to sleep for an hour or so. After monitoring peak flow, a practice nurse prescribed a blue and brown inhaler for asthma.

DD put on lots of weight, the brown inhaler had no noticeable impact on the coughing. Anecdotally, others confirm her steroid inhaler caused them to gain weight although it's not found to be the case in medical evidence. I stopped the brown inhaler, reasonung her symptoms are mild, not everyday and we could use other preventative measures to help - specially as the brown inhaler seemed to have no impact.

We've come back from holiday where DD has eaten and drank all sorts and she's been suffering with the coughing and we realise that's probably the food I tolerances that used to make her face red now causing the coughing.

I don't know how to proceed. I don't want her on a steroid inhaler for asthma that's induced by specific triggers which aren't present even half of the days in the year. But the coughing can be disruptive and upsetting to her when it is there.

Is it just that she needs a stronger blue inhaler, so she can respond reactively? Her current blue one has little impact. Are there other things she can be prescribed? Could the asthma reactions get worse? Should I get her retested for allergies? She's only been deemed allergic to cats and dust mites but definitely has seasonal allergies too. Should she see a doctor or is a practice nurse who specialises in respiratory issues knowledgeable enough to prescribe adequately?

Thanks if you read this far.

You need to see a dietician who can help you work out what she’s allergic to.

There are things like montelukast (not sure if I’ve spelt that correctly!) that can help with allergy induced asthma.

However, I’m shocked that you stopped her brown inhaler without speaking to the doctor first (unless I’ve misunderstood). Even if her asthma is allergy induced it isn’t controlled and if you don’t know what’s setting it off she needs to be on some sort of preventer. The brown inhaler is actually one of the weakest preventers you can have (most people do better on something like Seretide).

Definitely go back to the GP / asthma nurse if your surgery has one and start from scratch again.

Sorry for some reason I focused on the food additives and that’s why I said dietician, but yes she needs a specialist to work out what she’s allergic to.

Coughing at night in particular is a sign that her asthma isn’t well controlled.

Thanks. Yes, it was probably not good to stop the brown inhaler without going back. It just seemed to do nothing and at that point her coughing appeared to be set off by winter seasonal allergies only so I planned to go back to see a hcp before October. Actually, part of the issue was delegating this to DH. He took her to see the practice nurse and got the inhalers and was not very thorough with exchange of information.

Do you think we should see the practice nurse again or a gp? Does she need a referral to someone or is it fully dealt with in primary care?

I have montelukast and inhalers for my allergy induced asthma.

The thing is that they need to be taken regularly for a while before the exposure to help.

They may reduce but not eliminate symptoms.

So if it's a seasonal allergy they need to be taken starting a couple of months before the trigger is due.

The blue inhaler didn't really do anything for my coughing, I think it's more for the type of sudden attack some people get, though I did take it 20 mins before the preventer one when symptoms were bad to make sure the preventer one could get in to do its job.

If the steroid inhaler alone doesn't alleviate the symptoms you need more treatment (montelukast, etc) not to just stop and live with it.

And yes, mine did just get worse and worse when left untreated, and gradually more and more things triggered it. You're more at risk if a severe attack if the 'usual symptoms' are uncontrolled.

I also take a daily antihistamine in days I'm exposed to my triggers.

My practice has a dedicated asthma nurse - probably best to see a GP if yours doesn't.

Thank you. She does take Antihistamines too. I've thought of asking for an Antihistamine Nasal spray as those are meant to work better for rhinitis type symptoms (which she does still get). She had the brown inhaler for 100 days.

Good to know about it getting worse if uncontrolled. No-one in the family has asthma.

My preventer inhaler is orange, I don't know if switching preventers could help but might be worth asking?

Just to put it out there, it may be cough variant asthma (also known as silent asthma) which is where there is no traditional wheezing. It’s the type I have and people don’t really understand it because they expect to see the dramatic gasping for breath and wheezing. Instead I cough a lot, often unable to finish a sentence for coughing when it’s very bad, and I have a lot of chest pain / tightness. I take Seretide 250 daily and that seems to keep it under control.

I wouldn't recommend the nasal spray as it can have long term unwanted effects on the nose.

If used properly, the brown inhaler should have a marked impact on the coughing. Use the blue first, wait a few minutes, then use the brown. The amount of steroid is minimal.

It's very important that your daughter learns everything she can about her condition, and that she learns to use the medications properly and effectively.

There will be an asthma specialist at your GP practice. I would also dare to say that only an asthmatic can properly understand asthma. When I was a kid, I got the old "it's psychosomatic" garble which is ignorant and dangerous. It's a lifelong, chronic condition, which can be well-controlled with modern medicines.

Thank you again for sharing your knowledge and experiences. Yes Fairylea - there is never any wheezing with DD and it is only in the past year that I learnt her coughing could be attributed to asthma. Thank you for giving me the terminology. I fear I have not taken it seriously enough and will go to her appointment instead of DH who tends to be far too blase about health issues.

Thanks for info about the antihistamine nasal spray. Is there a brand/type of antihistamine tablet which works better for you?