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Asthma secondary to allergy.

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Dear Doctor

Please note that I have been feeling some asthma related issues, mainly being:

1. lots of sneezing
2. occassional bad cough (mostly in the evening)
3. watery eyes (in the evening)
4. chest pain (moves around in the upper part of chest, feels like spasm)

This has been situation over last few months. I have taken some allergy medicine and one doctor advised me an inhaler and nasal spray a couple of months back.

Last week I consulted an ENT specialist, who prescribed me again allergy medicine and nasal spray and took blood sample for testing. He told me this is common allergy and would go away when weather will change.

The result was fine except eosinophils which was at level 10 compared to normal level of 6-7. The doctor asked me to have a second opinion from a lungs specialist to be on the safe side. I have not yet consulted with lung specialist but I have been worried after reading online comments that high eosinophils can lead to heart failure also.

Can you please advise what should be my course of action? I am 35 years old, living in United Arab Emirates with desk job

Category: Pulmonologist

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Category: Allergy and Immunologist
Dr. Jacob George Pulinilkunnathil is online now

Expert:  Dr. Jacob George Pulinilkunnathil replied 4 Days.

Dear patient,
Regards from the DoctorSpring team.
You are suffering from a constellation of symptoms, all due to a common problem of allergy.
Allergic to what is a specific question, and often no specific answer can be made. However if you are able to find out a precipitating factor for allergy like specific food, office dust, molds in wall, air freshener in car- it might be something so obvious but overlooked, or just dust, which cant be avoided.
The symptoms of asthma and allergy, are so silly that is usually ignored. However, once a symptom develops, it can be trouble some. So everyone usually treats it. and when we treat, we should manage nasal symptoms, control it well so that the eye problems and respiratory problems are well controlled.

I would suggest nasal corticosteroid spray - to be continued, anti allergic tablets like monteleukast as a to tide over the crisis ( for a period of 3 - 5 days) and a steroid inhaler that has to be used for 3 months and then tapered.
The quality of life can change dramatically once symptoms are controlled, and also the fear of complications can be alleviated.
I would suggest you follow up with a pulmonologist

Feel free to follow up with any queries.

Patient replied :

Dear Dr.
Thank you for your response, can you please advise whether eosinophils level of 10 is of any concern? What is the frequency of testing this?
Generally I understand that steriods do more bad than good, so should we consider some alternative medication in case doctor suggests steriod inhaler?
Kindly apologize if I am being unreasonable but can you advise why should I consult pulmonologist if you believe it is allergy only?
Do you think this is seasonal only?

Thank you for your time. Hoping for a swift response.

Expert:  Dr. Jacob George Pulinilkunnathil replied 3 Days.

Dear patient,
I can understand your apprehensions and also understand the doubts that may cross your mind.
Yes, it is allergy only, affecting the lungs, upper airway(nose and sinus) and eyes.
Treatment of allergy is steroids. To avoid complications of steroids, you should take it in the minimum possible dose at minimum possible therapeutic frequency.
The side effects of dose of steroids given in sprays or inhalers are negligible because of the miniscule doses. They are given in micrograms than milli grams and they have been followed up sufficiently to boldly say that when used properly and under good guidance, they do not produce any side effects.
Yes, it is only allergy now and if untreated, it will progress to disease. I want to arrest that progression of allergic symptoms to a disabling disease, hence I will advise treatment.
Treatment should be preferably done under the guidance of a doctor who will be adjusting the dose of medicines according to your need. So i recommend a pulmonologist who will be able to treat the nasal and lung symptoms.
Eosinophils are a marker of inflammation, and once adequately treated, they come down. Hence you may check it once in 6 months or when there is a flare of symptoms.
This allergy if untreated can progress to asthma and an acute attack of asthma can be disturbing. You already have symptoms of a reactive air way disease, which if left untreated can progress.
Anti leukotrienee antagonists, Anti IgE therapy etc are tried but both are neither cost effective or rather as effective as inhaled steroids.
I hope I have clarified your doubts. Please do feel free to ask if I am not clear
DR Jacob George P

Dr. Jacob George Pulinilkunnathil
Category: Allergy and Immunologist
Residency, Post Graduation: MD, Respiratory Medicine, J L N Medical College, Ajmer, Rajasthan (2012).
Medical School, Internship: MBBS, Government Medical College, Kottayam, 2001-07 
Indian Diploma in Critical Care Medicine (IDCCM) - Medical Trust Hospital, 2013-2014.
Dr. Jacob George Pulinilkunnathil and 4 other Medical Specialists are ready to help you

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