Allergies

Don’t eat that egg…You’re allergic to Ragweed…Huh??

/ Katie P. Tolley, RN, MSN, CPNP-PC / 4 Comments

Why in the world would I be telling you not to eat eggs if your allergic to Ragweed?? Concomitant Food Allergies.

Did you know there are certain foods that can make your environmental allergies worse? There are also foods that can worsen food allergies and food intolerance. These are called Concomitant or Synergistic Allergies. When certain environmental allergens are blooming (like ragweed for instance), eating these foods (such as eggs or milk) can make the allergy symptoms worse. Avoiding these foods during the blooming season is very helpful.

I wrote a post last week with basic allergy information, symptoms and treatment options, Springtime & Sneezes…You might have allergies if…. This post will help you recognize and treat your allergy symptoms.

You may not know what you are allergic to, and that is why allergy testing can be helpful!! Treating allergies isn’t easy, and knowing which allergens affect you can make developing a treatment plan easier. I remember calling my friend Kathy, RN/Allergy Specialist and asking her about Joshua’s allergies. She is my saving grace when it comes to Joshua and his allergies. (If you haven’t picked up on it yet, Joshua is definitely one of those kids that needs the entire village!) 😉 I have mentioned that Joshua has allergies, but has a negative RAST test. RAST testing is done via blood draw with lab testing to identify specific allergens.

There are many different panels that can be ordered depending on what part of the country you live in. Joshua was unable to do skin testing because he reacted to the control test that contained only saline. 😦 How his RAST test was negative alludes me… But, I say kids don’t read and follow the books. 😉 Also, we can’t test for every substance under the sun, it’s just not possible. Every April since this boy was 2 months old he has had a clear runny nose, that, my friends, is allergies!! No doubt about it. Some doctors will tell you that infants can’t have allergies. I beg to differ, I live with that clear runny nose, morning cough and sneezing each April, and have for 10 years now. Joshua eats a lot of apples, this high fiber food is actually necessary to help Joshua with another of his problems, but we can talk about why kids need fiber another day. 😉 So in April, when all the trees are blooming, Joshua avoids apples.

Keep in mind that allergy symptoms can be cough, congestion, clearing your throat, sniffles, runny nose, sore/scratchy throat, itchy/watery eyes, headache, skin rash, dry skin, eczema and asthma.

So, I wanted to share a list of specific foods that compound allergy symptoms. The following charts are provided by Online Allergy Center, and list what foods make specific allergies worse.

As you or your children sneeze and cough your way though this allergy season, I hope this information helps you Enjoy the Journey and beauty of Spring a little bit more! 😉

Proven Concomitant Foods:
Rhus Allergy (poison ivy, oak, sumac)… Pork, Black pepper
Ragweed… Egg, Milk, Mint
Iva ciliata… Wheat
Sage… Potato, Tomato, Tobacco (chewing or snuff)
Pigweed… Pork, Black pepper
Grass… Legumes: Beans, Peas, Soybean, Cottonseed (cooking fats)
Cedar… Beef, Yeasts (baker’s, brewer’s or malt)
Elm… Milk, Mint
Cottonwood… Lettuce
Oak… Egg, Apple
Pecan… Corn, Banana
Mesquite… Cane sugar, Orange
Dust… Oysters (seafood)
Molds… Monilia, T.O.E., Cheese, Mushrooms, Truffles
Cystic breast disease… Caffeine foods (thoephylline): Coffee, Tea, Cokes, Chocolate

Questionable Concomitant Foods (to be proven):

Dust… Nuts
Influenza Vaccine… Onion
Iva ciliata… Tea
Chenopods… Egg

Proven Synergistic Foods:

Corn… Banana
Beef… Baker’s yeast, Brewer’s yeast
Cane Sugar… Orange
Milk… Mint
Egg… Apple
Pork… Black Pepper

Questionable Synergistic Foods (to be proven):

Wheat… Tea
Pork… Chicken
Milk… Chocolate

Springtime & Sneezes…You might have allergies if…

/ Katie P. Tolley, RN, MSN, CPNP-PC / 6 Comments

AAAACCHHOOOO! Excuse me! We’re having a little problem with allergies already this spring, how about you?!? It’s Springtime and allergies are in full flare! I love Spring, it is my favorite season! The grass is so green, the flowers are so pretty and brilliant, the birdies are singing, the air is warming up, what’s not to like? Well, ok, yes, the pollen and allergens that travel up our nose as we begin to venture back outside.

Can you recognize the symptoms??? Some patients tell me they don’t have allergies,  they just have a cough.

  •  Well, if that cough is nagging you mostly at night and when you wake in the morning, you might have allergies.
  • If you wake up and have to clear your throat or blow your nose, you might have allergies.
  • If your child is coughing when they first wake up, it sounds a little wet, or a little hoarse, but then goes away in 30-45 minutes or so, they might have allergies.
  • If you sneeze, you might have allergies.  
  • If you have a sore, scratchy throat, but no fever, you might have allergies. (It is always a good idea to have a sore throat check out with your doctor or NP, if it’s strep, it has to be treated.)
  • If you have a clear runny nose that doesn’t get worse and doesn’t go away, you might have allergies.
  • If you have itchy, watery eyes, you might have allergies. 
  • If your child has asthma and is wheezing, it may be worsened by allergies.

There are many people that don’t think they have allergies, but they might…. ;-). Keep in mind that if you notice these symptoms year round, your allergies may be indoor and outdoor. The best way to determine if you have allergies is to see your primary care provide or an allergist. My allergy doc and his RN/Allergy Specialist wife, are a great resource for me! If you are local, email me and I will give you their contact info. They would be happy to help!

So, what can you do about your allergies so that you can enjoy the great outdoors???

  • If you don’t typically suffer from allergy problems, a netty pot can be a great way to help clean out those sinuses. I have friends that swear by their nasal rinses! You will want to microwave or boil the water before using the netti pot…of course, you should allow it to cool to room temperature before doing the rinse. 
  • Taking an antihistamine such as Claritin or Zyrtec can be helpful. I usually recommend Allegra if these first 2 aren’t helpful.
  • Nasal sprays such as Flonase or Nasonex can be quite helpful. They help to reduce the swelling and secretions caused by allergens.
  • Nasal sprays and oral medications can be a good combination therapy. If you’ve tried this without relief, I recommend seeing an allergist.
  • Eye drops such as Zatidor or Pataday can be helpful as well. Check with your health care provider to be sure this is the appropriate treatment for your family.
  • Wash your hair every night!! As we go though the day, all kinds of allergens sit on our hair. If we don’t wash them off, they are on the pillow. Laying on a pillow full of allergens all night is just as bad or even worse than being outside.
  • Keep your windows closed! The first thing I want to do when the weather warms up is open the windows. My husband runs behind me closing them all up again because he and Joshua have bad allergies. Keeping the windows closed keeps the allergens out!
  • Get rid of carpet and heavy drapes that hold dust and allergens. Hard floors and blinds are much easier to keep clean.
  • Buy hypoallergenic pillow and mattress covers. I am not even going to mention all the allergens (dust mites,etc) that can be trapped in pillows.
  • When you are cleaning the house, wet dust and wet mop. Sweeping and dry dusting just moves the dust around. Investing in a vacuum with a good HEPA filter to trap the allergens can be helpful also. Many vacuums just blow the dust right back out.
  • Immunotherapy: Allergy shots provide small exposure to specific allergens to help the immune system build up antibodies against the allergen. Immunotherapy works!
  • Don’t forget that Hydration can be helpful! If you learn nothing else from me, you will learn the importance of hydration (see The Importance of Hydration for more info on adequate hydration)
  • Treating allergies can be tricky, don’t try to do it all by yourself.

Please keep in mind that untreated allergies can cause increased problems for those with asthma and eczema. I see so many kids with eczema problems that are not on allergy medication, allergy medication may be key in controlling the eczema symptoms.

The secretions that come from inflamed nasal and sinus tissue can cause ear infections, sinus infections, and headaches. I have found that most people that suffer from allergies are allergic to grass and dust mites. So inside and outside, there is always exposure. These people should be on allergy medication year round.

There are a many different foods that cause allergies as well. Many people suffer from food sensitivities vs. food allergies. I suffered from occasional stomach pain and Irritable Bowel Symptoms all my life, and finally found that I have food sensitives.  Food sensitives can present as stomach pain, bloating, vomiting, dry skin, eczema and other allergy symptoms.  Allergy testing, diagnosis, and treatment can be tricky. Just because the test is negative doesn’t mean you don’t have a sensitivity to that substance. I’ve talked to Kathy, RN my best allergy source at the office and we both agree that an negative allergy panel is not conclusive; there is no way to test for the millions of substances that are floating around in this world.

Well, I hope I’ve given you enough info to help you through the Spring. I talk more about food allergies and concomitant allergies in another post, Don’t eat that egg…You’re allergic to Ragweed.  Concomitant allergies are foods that will make allergies worse. One example is avoiding apples during the season when oak trees are blooming. Another is avoiding milk, egg, and mint if you have a ragweed allergy. So, as you can see, allergy testing can be helpful!

I think it’s time end this post and go wash my face and hands… My cat came and sat down next to me about 10 minutes ago, which usually doesn’t bother me, but I was petting him for a few minutes, and apparently touched my face, and now my eyes are all itchy and watering…. Still love my Jersey cat though! He’s a big, beautiful, black tom cat that will be 17 next month. He’s a sweety! Glad I didn’t know I had a cat allergy before I got him. Although, I had a sneaky suspicion when I got my Persian back in college and needed my inhaler every couple hours to breathe comfortably the first few days.  After I got used to her, things got better, I should have known then. I guess I did, but I love cats, and denial is a powerful defense mechanism! 😉

Please let me know if you have more questions about allergies, and I will do my best to help you Enjoy your parenting journey!

What’s that cough all about??

/ Katie P. Tolley, RN, MSN, CPNP-PC / 3 Comments

Hi all! I hope you are doing well, ’cause there are lots of sick kiddos out there.  I have been so busy in the office, I haven’t had time for a post, so this one is going to be full of info for you.

So many kids are coughing!  I’m sure you are nodding your head in agreement right now.  What I’m noticing is a common goal: Most parents just want the cough to go away!  Well, of course they do, so I…. it’s the same in my house.  Drew Elizabeth has been coughing on and off for months; but, that’s life in Kindergarten.   Joshua coughs and sneezes and clears his throat every morning, which has got to be disturbing to him, it is to the rest of us.

With all of this coughing going on the real question is WHY IS MY CHILD COUGHING?? 

A cough is the body’s way to protect itself.  The real goal for parents and pediatric providers is to determine what is causing the cough? Is it post nasal drip, congestion from a cold, asthma, croup, pneumonia??   Figuring out what is causing the cough is the first step in figuring out how to treat the cough.  Treating a cough with a cough suppressant is not a good idea, the cough is there for a reason.

If your child has a cold (upper respiratory infection or URI), the congestion may be causing the cough.  URI symptoms are cough, congestion, runny nose (clear or yellowish), low-grade fevers (<102F), decreased appetite, disturbed sleep and overall they feel kind of miserable. The congestion from a cold usually runs down the throat, causing the body to cough.  Coughing is the body’s defense mechanism to keep the congestion from travelling down to the lungs.  Colds are caused by viruses, rhinovirus, adenovirus, etc.

Some viruses cause Croup.  Croup is caused by inflammation of the airway and vocal cords during a URI.  This causes a “barky” sound that is SCARY the first time you hear it. I freaked out the first time Josh had croup, at 2am my first thought was asthma attack because he looked like he couldn’t breath and his eyes were as big as eggs! He looked terrified, which terrified me!  If this happens to you in the middle of the night, do the tried and true steamy shower trick. As soon as you can, take a trip to the doctor for a dose of steroids and that cough won’t sound so scary.

Antibiotics will not get rid of a virus, antibiotics kill bacteria, not viruses.  Viruses typically last 7-10 days, with symptoms worsening over the first 3-5 days.   The best way to treat the cough is by trying to dry up the congestion.  I usually recommend an antihistamine or decongestant to help.  Check with your medical provider to see if this is proper treatment advice for your child.

Specific treatment options should be discussed with your primary care provider (PCP).  Children that do not start improving within a week should be evaluated for ear infections, pneumonia or other complications.  Children with symptoms that get bad quickly should be evaluated sooner.   Infants with lots of congestion and runny nose should also be evaluated sooner.  Babies are at higher risk for complications from viruses that older children and adults can easily fight off.

Pneumonia, a lower respiratory infection, can be a serious complication from ongoing cough and congestion. Children that have pneumonia will often present with symptoms other than cough, but not always.   These children will typically have little energy, and tire more easily when playing. Children with pneumonia will often have difficulty taking a deep breath, or doing so may be painful and will cause lots of coughing. These children are often compensating by doing lots of shallow breathing, and their breathing may be faster than usual.  Keep in mind fevers can also cause fast breathing and rapid heart rate. Children with pneumonia will often run a fever, but not always.  Another red flag with pneumonia is a cough that went away, or you thought it went away… The cough that is wet, thick and sounds bad, and then just disappears, may be a sign that there is fluid in the lungs that is inhibiting the child’s cough.  These children often look sick and have little energy, but again, not always.  If your child has a cough for more than a week that doesn’t get any better, but continues to linger, please have your child evaluated.  Children of all ages get pneumonia. I’ve treated just as many teens with pneumonia as younger children this winter.

Vaccinate against Pneumonia: You can help protect your children under the age of 5 years old with a vaccine.  Please check with your doctor to be sure that your child has had all of their pneumonia vaccines; this vaccine protects against 13 different organisms that cause pneumonia.  Children over the age of 2 years old with asthma or other chronic health conditions should consult with their doctor to see if they should have an additional pneumonia vaccine that is for people of all ages; this vaccine protects against 23 different causes.

Coughing can be a symptom of asthma.    Children with asthma will cough because of inflammation and secretions in the airway.  Children with asthma may not look like they are having difficulties breathing because they will breath more shallow to compensate.    Frequently, parents and children do not even realize this is happening.  I treated a little girl (8 yrs old) yesterday for asthma that was flaring because she has a cold.  The child’s symptoms were cough and congestion.  When I evaluated her, I discovered she was moving very little air in her lungs, but didn’t look bad at all.  Mom had not realize she needed her asthma treatments because her symptoms were so mild.  After giving her a nebulizer treatment in the office, she was able to move air in and out of her lungs more easily.   URI’s frequently cause children with asthma to have increased breathing problems.  Even if the child has not needed daily treatment in the past, they may while they have a URI.  Without a proper physical assessment, it is not possible to determine if a child is coughing because of asthma.  Please consult your provider to create an Asthma Care Plan for your child.  This plan should include treatment for mild, moderate, and severe asthma symptoms.  Asthma symptoms are often exacerbated by allergies, this should be addressed by your provider. Children cannot be diagnosed with asthma with one visit or one incidence of breathing difficulties.  Asthma is a diagnosis of chronic/ongoing incidence. 

If a child has allergies, they usually have a nighttime cough, but this cough goes away during the day.  These children will often cough, sneeze, and clear their throat for a while in the mornings.  Yes, this does sound like Joshua.  Zyrtec is often helpful for him, but at almost 10 years old, I let him chose if he is going to take it.  Recently, he has chosen no; so, the morning sneezing continues.  As April approaches  his allergy symptoms will get worse, and I will strongly encourage 😉 him to take his Zyrtec every night.  Joshua’s allergies are tricky to say the least, but that’s for another day.  If you think your child has allergies, check with your doctor to see if your child displays other silent allergy symptoms.  Allergy medication can be helpful, but you should always consult with your pediatric provider before starting a chronic medication.  I’ll talk about allergies in a future post, the season is not too far off.

I enjoy sharing my advice, and encourage you to consult with your pediatric care provider about all of your child’s healthcare needs and concerns.  Think of your Doc, PA, or NP as your partner in parenting and caring for your child. That is what I hope I am for all the families that I work with.  The journey is a challenging one, the more we stick together, the better parents we can be!

I hope you enjoy the journey, even with the coughs and runny noses! 😉