Not at all-- feel free to quote the entire post there!! (or this one, for that matter)  I meant to post about it there yesterday, but got side-tracked before I could find it again.

My daughter's asthma has shifted slightly (worsened, actually, at least in frequency) in the past year or so.  We were aware that this could happen during adolescence, though obviously we aren't pleased about it.  She probably uses rescue meds 2-6 times a month even without illness or allergy being in the picture.

We are much better about checking peak flows as a result.  That's helpful in some respects, since we know what a 10% or 20% decrease in peak flows looks like, and she knows very well what it feels like. 

We also are quite aggressive about pre-medicating in any situation where an impairment is likely-- before exercise, before general anesthesia, etc.

So we have a sort of decision tree-- but not an "action plan" so to speak.  Not the way that we do with food allergy. 

But I have  lot clearer picture of when to transition from the one to the other now, and so I'm happy about that. 

Basically, the decision tree re: breathing problems of any kind is:

Possible allergen exposure?

Y/likely?  try ONE administration of albuterol-- and if it helps, observe, if not, proceed to allergy action plan-- aggressively.  Use Epi.

N/unlikely? try up to TWO administrations of albuterol (5-10 min apart), if impairment isn't significantly better, proceed to allergy action plan and watch carefully.  If impairment worsens, use EPI.

Other factors which change things slightly include:

a) ease of access to EMS (the more difficult, the more aggressive we'll want to be)
b) overall 'atopic' context-- that is, how reactive has she been recently, how much allergen load currently, etc.

Quote from: CMdeux on September 17, 2013, 11:53:51 PM
That's the pattern, basically-- that "regular" asthma responds to rescue meds pretty well, and allergy-driven asthma does not.

Do you mind if I link to this thread & put that quote in the protocol thread?  Not a problem if you'd rather I didn't.

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You didn't happen to ask him what he thinks about the idea of changes in general to the asthma plans of those also having FA?  Again, I completely understand if you kept the conversation strictly on your dd's specific situation.

When I was adding some stuff to the protocol thread, I realized it was a newbie who really got me thinking about this again.  Not everybody belongs to an allergy group, not everybody has read that AANMA ana article ... if this issue is not better addressed, I'm unfortunately pretty sure we will keep hearing of tragedies that could have been prevented ... although I hope that I am wrong on that last point. 

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ok, really - no more asthma talk from me in this thread! 

He is very nice.

And very smart and current on research, which is like-- well, it's like winning the lottery, frankly.

To further follow up on the asthma thing, because a post of Mac's reminded me.

Asthma that does not respond pretty much IMMEDIATELY to albuterol needs to be treated as anaphylaxis.

That's the pattern, basically-- that "regular" asthma responds to rescue meds pretty well, and allergy-driven asthma does not.

Interesting about the asthma stuff CM ... thanks for sharing!

You know, I haven't talked with our current pulmo about the asthma plan thing ... I told myself I'm going to about this.  He's smart, a little older, trust nobody (which on occasion has been amusing) & verify-everything-for-himself kind of guy  ... he might be able to convince me one way or the other (I can be a little hard to convince  )

Our asthma plan is good, and they did add something about FA & epi in there for me.  The 1st pulmo we saw there was excellent (but he was a follower of current protocols which of course I can't fault him for).  Last year, we switched to a closer location and thus our current dr.   I am getting more familiar with how things work at this place - they definitely have some friendly jabs amongst themselves regarding different approaches.

Will have to think about it.  If I do bring it up, I need to change my approach.

Anyway, dd is fortunate to have some very good doctors 

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BTW, that's so funny about the apple.  He seems very nice  .

Allergy appt today-- I  our allergist and nurses so much. 

Skin tests today-- but lengthy convo first re: what to test.  Allergist volunteered his lunch (fresh apple) for skin test, even.   

egg wheal is back up to 7X8, almond was ~4X4, and both apple and green bean were equivocal... but positive histamine barely did anything at all.  DD's skin obviously wasn't very reactive today.

We might try challenging almond.  Thinking it over.


Also discussed "what the heck does "possible ingestion" even MEAN in someone with MFA and low-threshold??"

His response was that this is HIGHLY individual-- but in DD's case, any time you have been where there's food, you have to keep it in mind in light of any sudden onset of ANY symptoms on the grading chart.  Anything airway that doesn't respond to albuterol within seconds, pretty much-- you have to figure-- epi.

Asthma as anaphylaxis:  again, any asthma that doesn't "fit" the usual pattern (for someone like my DD, who has pretty stable asthma) needs to be viewed with deep suspicion, and even moreso if she has been anywhere where there is food within the preceding hour or two.  I did laugh and remind him that this means anytime we've left the house.

 

Links I'm so happy you're having such a good experience. You deserve it!  Well, your kiddo does.

I think it's a great practice that our allergy group instructs patients to carry epinephrine for a year following a passed food challenge.

I love that they really include me in treatment decisions regarding my dd.

Although I am too shy to call her anything but Dr, I think it's so nice that she refers to herself by her first name.

I have to give credit to all of the allergists we have had that they have always made sure we had a Food Allergy Action Plan.

When I briefly talked about sesame labeling to one of our previous allergists, he told me that a small group of dedicated parents can make a huge difference.  (not bringing that subject up - just that what he said was really nice)

I love that when I brought an article to one of our allergists, he said it was "intriguing" and we had a discussion about it.

The staff at my sons allergy clinic hospital in london have been wonderful. Our latest weird allergy problem they admitted they had no idea if it was indeed a allergy problem or something completely different. However they reffered us to a immunologist 'higher up the food chain' to support us.

It took 8 months to get test results done,(   testing sent all over EU via nhs) with a group of doctors from three hosptials in the end, all confering with each other and concluding the next step. 

The consultant's secretary is a wonderful woman, who even sourced some seeds for our sons skin prick tests once, and I have rung her lots of times and she has supported us with sorting out  appointments for our son and now our daughter and her strange new symptoms.

this september is our sons last appointment as the pead allergy clinic, he has been their since he was 18 months old and is now 17. we have seen uk's top immunologists.
i am very grateful that we still have the NHS so that the only costs to us have been travel, and child care for other 3 children when they were younger.  we have been very lucky.

Our allergist has called us to follow up after a challenge or reaction in-office.

Those phone calls are often before 8AM or after 6PM; but we know that he and his staff both know us-- and care about my DD deeply.

I also really love that when he doesn't know the answer to something, he doesn't bluff or brush the question off.  He says that he isn't sure... and does research to find out if anyone else DOES know.

I love a doctor who can say "I don't know; let me see what I can find out."

I love Dr. Wood and his staff, particularly his nurse practioner.  They are warm, listen intently, and give sound advice. 

I thought it would be nice to start a thread about things we like/liked about our experiences with allergists/allergy departments.

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At our last food challenge, the nurse was so kind.  She also made a great point - she said they don't like to talk in front of the kids about "passing" or "failing" because it might make the kids feel bad if they do have a reaction.