Rekan2,
ini saya punya cuplikan FAQ dari newsgroup misc.kids. Saya cuma cuplik yang
berhubungan dengan asthma dan alergi karena zat terhirup (inhalant).
Semoga berguna,
Rien.
-------
This FAQ is intended to answer frequently asked questions on allergies and asthma
in the misc.kids newsgroup. Though the comments are geared towards parents of
children, there is plenty of information for adults as well.
The information in this FAQ is the collected "net wisdom" of a number of folk. It
is not intended to replace medical advice. None of the contributors are medical
professionals. Most of us either have allergies/asthma or have relatives/children
with asthma/allergies, so this collection represents the experiences and
prejudices
of individuals. This is not a substitute for consulting your physician.
Collection maintained by: Eileen Kupstas Soo
([EMAIL PROTECTED])
This page last modified: April 8, 1997
Copyright 1996-7, Eileen Kupstas Soo. Use and copying of this information are
permitted as long as (1) no fees or compensation are charged for
use, copies or access to this information, and (2) this copyright
notice is included intact.
---------
1) What to look for to suspect allergies
Contributors:
Amy Uhrbach ([EMAIL PROTECTED])
Eileen Kupstas Soo ([EMAIL PROTECTED])
1.1 -cut-
1.2 Inhalants
The most common inhaled allergen is dust! More precisely, dust mites and their
wastes (every house has them, no matter how clean).
Other:
- mold
- pollen (ie. hayfever)
- animal dander (especially cats)
- chemicals
- perfumes
Most common symptoms:
- CLEAR runny nose and sneezing
- itchy or stuffed nose
- itchy, runny eyes
- lethargy
- asthma
Symptoms are generally worst in the early morning, for 2 reasons:
1. pollen counts are highest
2. you've been sleeping for hours in a room filled with dust
and/or mold
1.3 Asthma
On asthma: Not all people with asthma have allergies. Roughly 5% of the
population
lives with asthma.
A generally accepted definition of asthma is that it is a disease that is
charaterized by increased responsiveness of the trachea (windpipe) and bronchi
(main airway) to sometype of trigger that causes widespread narrowing of the
airways that changes in severity either as a result of treatment, or
spontaneously.
Acute asthma is what we generally refer to as an asthma attack. The bronchial
tubes
suddenly narrow, and the person is acutely short of breath, and (sometimes)
wheezes. An acute attack may require medical stabalization in a hospital setting;
unless special equipment, medication, and help is available in the home.
Chronic asthma produces symptoms on a frequent basis, in some cases almost
constantly. It is characterized by frequent symptoms, ranging from very mild
symptoms to full-blown acute attacks. Chronic asthma generally requires daily
medication, and may require the use of oral steroids, in addition to other
medications.
On doctor's: Allergists are not the only physicians who treat asthma.
Pulmonologists are also medically specialized
physicians who treat many people who have asthma.
Not all asthma is triggered by allergies. Not all allergies cause or develop into
asthma.
One main asthma trigger in children is illness. Typically a child has his first
attack 1-2 days after the onset of a respiratory illness.
Symptoms:
-wheezing (no wheeze may mean WORSE asthma, sometimes)
-elevated breathing rate (normal under 25 breaths per minute; over 40 is cause
for
calling doctor. Test your child's normal rate when well, so you can tell when
breathing is elevated. Remember: These numbers are just ballpark!
-coughing, especially early morning
-longer expiration than inspiration
-retraction
Asthma and reflux often co-occur, although it's not known what the relationship
is.
Attacks may build over days (as with illness-induced) or hit within seconds.
Generally, the more triggers present, the worse the attack.
In little kids, asthma is often misdiagnosed. Many little kids with recurrent
bronchial illness really have asthma. Of particular note is "cough variant"
asthma, in which the main symptom is coughing, especially early morning. My
allergist's rule is "If ventolin [an asthma medication] helps, it's asthma," no
matter what it's called.
1.4 -cut-
1.5 -cut-
1.6 -cut-
1.7 Views of allergies
There are a number of views about allergies. Most doctors agree that not all
allergies are "all or none"; you may be able to tolerate a certain amount of an
allergen without reacting. Once you exceed a certain amount, your body reacts.
NOTE: this is not true of all allergens, especially peanuts and shellfish, which
may cause quick, life threatening reactions. For some allergens, any amount is
too
much!
Your doctor may use various metaphors when discussing allergies. Most have to do
with some threshold amount of allergens that a person can tolerate. Once this
amount is exceeded, allergic symptoms appear. ( One common term is "glass of
resistance" -- once the glass is full, you react). The amount of allergens
tolerated can depend on a number of things: stress levels, the particular
allergen,
the combination of allergens, illness, etc. As time goes on, an allergy sufferer
can determine just how much, if any, of what is ok. For food allergies, some
recommend a rotation diet in which various foods are eaten in
rotation so that no one food is ever eaten more than once in a three-to-five day
period. (The food juggling gets very complicated, but some find that the rotation
diet helps them. The best thing to do is read about it [see references section]
and
decide for yourself.)
2) Allergy treatment
Contributors:
Amy Uhrbach ([EMAIL PROTECTED])
Eileen Kupstas Soo ([EMAIL PROTECTED])
2.1 Doctors: see an allergist!
For both asthma and allergies, a doctor in general practice may not recognize
allergies. Some doctors do recognize and treat allergies while others do not. An
allergist (sometimes listed as "Allergies and Immunology") specializes in this
particular area and are up-to-date (we hope!) on treatments. As with any doctor,
it
is good to get recommendations from your doctor, friends, or professional
orgnizations. If you are not comfortable with one allergist, try another. For
children, there are allergists who specialize in pediatric allergies or advertise
that they treat children. Though any allergist can treat adults or children, it
sometimes helps to have one who definitely *likes* children and respects the
differences between adults and children.
ASTHMA: Pediatricians seem reluctant to use the term asthma. This bugs my
allergist (and me), because he feels it precludes proper treatment sometimes. If
you see any asthma symptoms and are poo-pooed by the pediatrician, see an
allergist! This seems most often the case with an allergic kid who coughs every
morning. I've heard MANY stories of pediatricians who, at most, tell parents to
use an antihistamine (worse, cold medicine; worst, don't worry). Then the child
ends up in acute distress in the hospital!
Allergists are most up to date on asthma treatment, which really matters.
Allergists can often pinpoint particular allergens to avoid, from testing or only
history! Allergists will tell you which environmental changes to make.
2.2 Tests
Blood tests can be done to look for elevated white blood cell counts, level of
particular antibodies, or for reactions with allergen extracts. Blood tests are
not 100% reliable and, to get good results, must be done by highly trained lab
technicians. Some doctors use these tests, while others prefer not to. The patient
will need to have blood drawn for this, which may be a drawback for testing
children.
"Scratch" test involves scratching the skin, then dropping liquid allergen on the
scratch. It's done on the arm or (for very small
children) the back. It seems to hurt a little, but may be scary to little ones.
[Ed. - it doesn't hurt much; it's just annoying.] Each
slate has up to 6 tests, plus positive (histamine) and negative controls.
Bumps/weals for a reaction appear immediately or several minutes later. The
patient
must remain in the office in case of severe reaction (rare).
A positive reaction is reliable, but a negative reaction may not be; that is, you
may be allergic but not react. Skin tests are more
reliable for airborne allergies than for foods.
Elimination diets are the only guaranteed way to determine food allergies. The
patient goes on a *very* restricted diet, composed only of foods that rarely cause
allergy problems. A new food is added each week. If the patient does not have any
allergic symptoms to the new food during that week, then it is not considered an
allergen. A new food can be added the next week. If the patient has a reaction to
the food, the food is considered an allergen and removed from the diet. The
patient
then goes back to the previous diet until all symptoms are gone for three days;
then a new food can be added. This is a very slow way to build up much of a varied
diet, but it is certain. In adding foods, you must be careful that it is only one
food that is being added. This means no processed foods (may have additives), no
pre-packaged foods (may have additives), no seasonings (except salt), etc. This
can
be very difficult to follow if you eat out for any meals. Generally safe,
non-allergenic foods usually include apricots, peaches, pears, beets, sweet
potato,
rice, distilled or spring water, cane sugar, salt, tapioca, olive oil, lamb and
chicken. (Not very exciting..) Your doctor may give a different list, based on
your
personal situation. It is fairly easy to put a young baby on an elimination diet,
but it gets harder as the child gets older. For very young children, this should
only be done under a doctor's supervision (unless the child is exclusively
breastfed) to insure a balanced diet.
If the original allergic reaction was moderate or worse, you must challenge test
when adding a suspected new food. That is, you start with a pea-sized piece. If
no reaction, on day 2 try a 3-pea-sized piece. No reaction, day 3 try a
9-pea-sized piece. Discuss this with your doctor. ALWAYS get instructions
beforehand (and medicine, if necessary) on what to do for a severe reaction. If
the original reaction was severe, your doctor will want to do this at his office
or
at the hospital.
2.3 Medications
OTC antihistamines - most are sedating but may overexcite kids or cause
hallucinations (in me, some do). For example, benadryl, brompheniramine.
Benadryl
is the drug of choice for an acute allergic attack because it is effective within
20 minutes, reaches maximum effectiveness at an hour, and wears off in 6 hours.
OTC decongestants - only help stuffy nose. May excite.
Other antihistamines such as seldane (12 hour) and hismanol (24 hour) - for adults
only! May or may not work. May have severe side effects - talk to your doctor.
Some, such as Guaifed, are available in dosages for children; your doctor will
have
to decide whether these are appropriate.
Sodium cromolyn (nasalcrom nosespray for allergies, intal by nebulizer or in-
haler
for asthma). Prevents mast cells from reacting, preventing allergic reactions.
Takes at least a week for enough to build up in body, so needs to be taken
regularly as preventative. Not useful for current symptoms. No known side
effects. Won't work for some people.
Steroid nasal sprays [beconase, rhinocort] also prevent and reduce inflammation,
but need several days of use before they are fully effective. They must be used
daily in order to remain effective. Great preventative! Often works better than
nasalcrom in adults.
Antihistamine eyedrops (optcon-a, vasocon-a) - immediate relief for 8 hours.
Works, but stings.
Bronchodilators [Ventolin, Bricanyl] - to open bronchial tubes for immediate
relief from attack. Nebulizer most effective in acute attacks, then turbuhaler
[not yet available in the US], then metred-dose inahlers and
dischalers/rotohalers. Oral preparations [syrups, tablets] are least effective,
requiring higher dosages to achieve the same effect as mDIs, and having generally
significant side effects [because of the oral route]. These can makes kids hyper,
grumpy; they make me shake. Great for occasional use. Most often used to treat
acture asthma flare-ups, although some asthmatics must take them daily in addition
to other medications. If you need to use bronchodilators more than twice a week ,
discuss with your doctor the use of an anti-inflammatory medication or other
appropriate medication (Ex. intal, steroid, or theophyline).
Epipen/AnaKit (epinephrine autoinjector) - an autoinjection (shot) most commonly
given for anaphylactic reactions. Carry this with you at all times if you've ever
had this severe a reaction!
Nebulizer vs. inhaler (puffer, MDI) for intal and ventolin: Some individuals have
poor reactions to [including having asthma attacks triggered by] the propellants
in
MDIs and cannot use them. Also, most children can't manage them until age 5,
though
some can manage at a younger age (some as early as 3). Children should use them
with a spacer.
The nebulizer is a machine which drives air through liquid medication to make mist
for a patient to breathe. Treatment takes 10-20 minutes. This is the most
effective delivery system. Adults use a mouthpiece. Kids use a mask; if they
refuse, you can blow the mist at them by mouthpiece.
Other alternatives to MDIs include rothalers and dischalers, which are powder
inhalers, and a turbuhaler [not yet available in the USA], which is a
breath-activated inhaler containing a very fine powder form of the drug.
Turbuhalers contain ONLY the pure drug; there are no propellants, preservatives or
other compounds present. Turbuhalers are more effective than MDIs, and some
Paediatric ERs have switched to using Turbuhalers in the place of mask treatments
for non-severe attacks. Turbuhalers should be available in the US within the next
year; both inhaled corticosteroids and bronchodilators are available in turbuhaler
form [e.g. Bricanyl and Pulmicort].
2.4 Desensitization (injections)
One treatment for inhalant allergies is desensitization. This is not available
for
food allergies.
In desentization treatment, the patient is injected with small, dilute extracts of
the inhalant allergens. The dosage is gradually
built up, until the body is less sensitive to the allergen. This is a slow
process,
involving months to years for a complete treatment, though there is benefit even
after a few months for many. Initially, the patient receives two shots per week.
This is reduced to one shot a week, then one every other week over time. The
initial treatment, however, involves visits to the doctor (or a medical place that
will do the injections) rather regularly. The actual time to get the injection is
about 20 minutes -- the injection is quick, but the patient is usually asked to
wait in the office for about 20 minutes to see if a reaction develops. These
reactions occur in a small percentage of patients but they need to be treated
promptly.
Desentization can also be used for insect sting allergies. Your doctor will know
whether this is an appropriate treatment in your
particular case.
2.5 Avoidance and environmental changes
For most allergies and asthma, the best treatment is to avoid the allergen. This
is
easier for foods and more difficult for inhalant
allergens.
For food allergies, a number of books have been written with recipes and advice.
The list of resources below give some ideas.
Altering the diet to exclude certain foods can be easy if the food is relatively
uncommon or is easy to spot. For example, shellfish, melons, citrus, and bell
peppers are usually easy to spot and avoid.
Foods like eggs, wheat, corn, peanuts and milk are harder to spot as they may be
hidden ingredients in a number of foods. Many recipes are available that are easy,
tasty, and avoid the allergen. Although some change in diet is inevitable, it is
not a death sentence; most people do not have to cut out social events or change
their lives radically.
For inhalant allergies, avoidance requires more work. For seasonal allergens
(pollens), try to stay indoors as much as possible
and avoid going out during peak pollen times ( usually early mornings). Filter
masks are available to prevent breathing in
allergens if you must be out. For year-round and household allergens (mold, dust,
dander), the best approach is minimizing places for the stuff to gather. Patients
are usually advised to remove curtains, carpets, and unnecessary clutter. If
anything is left :-), make sure it is easily washable and wash it frequently.
Vacuum often; once a day is recommended by some. Make sure allergy-prone people
(especially asthma sufferers) are out of the house before any painting, waxing, or
other heavy-duty fume- producing activity occurs. Air filtering systems are
available for individual rooms and as whole-house systems. (See resources
section).
Furry pets are a big source of dander, so it is best not to have pets or, next
best, keep them outside. Absolutely keep pets out of bedrooms at all times.
Tobacco
smoke is irritating to many allergic people, so this should also be eliminated or
kept outside.
2.5.1) From: Susan Fiedler ([EMAIL PROTECTED])
My son and I have asthma and allergies, these ideas have helped us
tremendously.
=====================
Cleaning the Home Environment:
Invest in an electrostatic filter (plastic frame $27.00, metal frame $60.00 up to
$100.00) if you have a heating system that accepts changeable filters. It saves on
the throwaway filters, trips to the doctor, allergy medications and misery for
several months a year. But you MUST wash it out once a month to clean the pollen
and keep your pump working at top efficiency.
It may pay to have your air circulation ducts professionally cleaned, to get out
old dirt, pollen, pet dander. Use the phone book, call heating/cooling specialists
for recommendations. This may be especially useful if you are moving into a used
house.
If you take prescription allergy medications like Seldane (.92 each pill) take
that
when you need to be awake, but take a cheaper, over the counter medicine at night
(if it has the effect of making you drowsy, not irritable). Suggested by my
pharmacist.
Suggested by my doctor: During the allergy season buy one bottle of nasal saline
spray and then make the refill solution yourself. By spraying the nasal passages,
you rinse out the irritating pollens. This can cut down on the need for medication
and overall discomfort. But you must remember to do it after every time you go
outside. The refill is just one teaspoon of salt into 1-2 ounces of water, stirred
until dissolved.
If you have forced air vents, put cheesecloth or air conditioner filter in each
one. Keeps dirt from the vents and air system from entering the house.
--
O
_/)(\_ |~ Salam,
/~~\ o' |~ Rien.
/_ _\ o'
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