Here I go again

[Amy2]

A few days ago, I started with head cold symptoms and by Friday evening, I was feeling pretty crummy.  My primary and pulmonologist's offices are closed on the weekend.  I didn't feel that my symptoms warranted a call to their emergency service so I went to a walk in "urgent care" center near me on Saturday.  The doctor heard wheezing and my peek flow was down to 250 but pulse ox was decent and despite the wheezing, I was moving air pretty well.  I was told that I had a sinus infection and was in bronchiospasm.  I called the pulmonologist today and they got me in.  I had allergy testing (through blood work) three weeks ago.  The pulmonologist said that the results of the bloodwork were consistent with an allergic reaction but no specific allergy was identified.  The doctor felt that my lungs being in bronchiospam (asthma) could have caused this positive allergy test result without identifying any specific allergens.

Is it possible for a flare up to cause the test to be positive for an allergic reaction?

Today, the doctor did not hear wheezing but when I took a deep breath in, it triggered coughing.  In addition to my current advair, singular, xyzal and nasocort.  The doctor added in a short burst of prednisone (medrol pack)  and then wants me to start asthmanex when the medrol pack is finished to break the bronchiospasm cycle.  She wants to see me in two weeks.

Does that sound like a lot of medications?

I have found that upper repsiratory stuff and viruses have triggered bronchiospasms, wheezing, coughing etc for years. My primary recently referred me to the pulmonologist and this is the second time I saw her.  I am kind of new to all of this.

[Amy2]

I had a skin test when I was about 11.  That test showed a reaction to maple and mold.  A repeat test about age 40 showed no reaction.  The most recent test was not a skin test, but one in which they drew blood and tested it for allergies. That is the one that the pulmonologist said indicated a reaction, but no specific trigger was identified by the test.  Could an exposure to a virus- sinus infection cause this reaction for the blood test.  I still have tons of post nasal drip and a cough/sore throat.  I am moving air well, have minimal wheezing and slightly decrease breath sounds in the lower portion of the right side.  So far, my asthma seems to be reasonably well controlled despite being in the middle of an infection.  I saw my primary doctor today who felt that I am on too many different types of decongestants and my nasal cavity was very dry which could contribute to my persistent sore throat. I am finishing the medrol pack, antibiotics, continuing with advair and singular and taking one decongestant.  My primary doctor feels that both advair and asthmamex combined is not necessary considering that my lungs do sound pretty good considering the amount of post nasal drip that is still occurring.

It was interesting, buy we do know the pharmacist who fills our prescriptions.  He told my husband that he feels the doctor from the walk in office tends to over prescribe medications.  That is the one that added the extra decongestants which have dried me out so. Pharmacists definitely are aware of prescribing habits of local doctors.

What do you do when you have differing opinions?

[National Jewish Health]

You ask, “Is it possible for a flare up to cause the test to be positive for an allergic reaction?”  It is more likely that the test is positive because that allergen is involved in the airway inflammatory response, which resulted in bronchospasm.

The important thing, in the circumstance of multiple positive skin tests, is to seek a correlation between one of the positive reactions and your real-life, environmental exposure to that allergen.

Your doctor’s medicine recommendations are sound.  The principle involved is to gain control of the airway inflammation with the Medrol® (methylprednisolone) and then maintain it with one or more inhaled steroids.  Asmanex® Twisthaler® 220 mcg (mometasone furoate inhalation powder) is an effective inhaled steroid.  Using it with the Advair® HFA (fluticasone propionate and salmeterol) Inhalation Aerosol is the equivalent of at least doubling your inhaled steroid, so as to better maintain the state of reduced inflammation, accomplished with the Medrol® (methylprednisolone).

A question to be asked is whether immunotherapy such as allergy shots or sublingual immunotherapy (SLIT) might help with your asthma control.  You may want to request a board certified allergist’s opinion on this, as well as the pulmonologist’s opinion.

Finally, if with all this medicine and immunotherapy, your asthma remains sub-optimally controlled, you might be a candidate for the administration of a monoclonal antibody called Xolair® (omalizumab).  You should also discuss this with both specialists.

Good luck.