Hello everyone. My names is Dr. John James. I am an allergy specialist in Fort Collins, CO. I am a consultant and I work with the Asthma and Allergy Foundation of America.

Hello everyone! My name is Kylie. I have a quick question before the questions and answers. Are screenshots of answered questions allowed? Thank you all!

Yes Kathy. If there is an answer I would like to share/save may I screenshot it?

Great thank you!

I know it’s best to use MDI (press-and-breathe) inhalers with a spacer. One of my kids lost their spacer from his emergency pack. I put their one from home in their emergency pack. Can they just share one between the two of them at home? Or how do I get a new one? The best recommendation to follow here is to not share spacer devices among different people. The spacer device should remain with the patient it was prescribed for and should not be shared. If a MDI inhaler is needed and a spacer device is not immediately available, the MDI can be used as directed without a spacer. The spacer device should be cleaned once a week. If you need a new spacer device, you should talk to your healthcare provider who can prescribe a new one.

Do not keep your asthma medications, such as inhalers, in places that become too hot, such as the glove compartment or trunk of your car. The temperature in a car can rise to 160 degrees in the summer months, which may have an adverse effect on the potency of the inhaler. In fact, Albuterol inhalers for asthma can explode when stored in temperatures above 120 degrees. At high temperatures, the inhaler delivers less medicine than at room temperature. If you did leave your inhaler in your car on a hot day, it would be recommended that you replace it with a new inhaler. The pharmacy should be able to help with this refill even if it is not due for refill; make sure to inform them of this issue. The pharmacy can call your healthcare provider’s office for a new prescription if needed.

I’m very confused about using my inhalers. My doctor has told me to use them every day to control my Asthma but when I do research and reading it seems the inhalers should only be used for “distress” situations. I was wondering if you could shed some light on the use of the puffers/inhalers.

Great question. There are two types of asthma inhalers. There are controller inhalers that typically are used on a daily basis and there are quick relief asthma inhalers that are used for relief of acute symptoms.

Thank you

Hi! So one thing that took me MANY years to understand is the value of using a spacer. I have multiple friends with asthma that I have tried to convince to use a spacer. Is there a "short" answer you could give as to why using a spacer is beneficial? I always just have to say, "I don't know it just does make a difference."

First, if someone is having an anaphylactic reaction the best position to place them in is flat on the floor, ground or exam table in the supine position (on the back facing upward) with knees bent. This position promotes good blood flow back to the heart which can improve blood pressure. Standing can make anaphylaxis worse by causing blood pressure to drop. This position also aids in holding patients, especially infants and children, very still while epinephrine is injected into the lateral aspect of the thigh. In addition, laying down in the supine position can help to prevent vaso-vagal reactions, fainting or passing out. Second, epinephrine can be injected in any position, laying down, sitting up or standing, but the supine position mentioned above is ideal. The key message is that epinephrine is the most important emergency treatment for anaphylaxis. It needs to be given early if anaphylaxis is suspected. It is important to not delay the administration of epinephrine if it is warranted.

Hi Elisa may I ask what LO means? Sorry if that is a silly question!

No my doctor has never given me an “asthma action plan”. None of my doctors have done that.

You should ask your doctor about a written asthma action plan. These are very useful and effective in managing asthma symptoms. Specific medications are listed, when to use, how much and when to contact the doctors office for further advice.

I too am wondering about the spacers. For years I didn’t know that it was a must use with puffers. Until now I didn’t know it was something my doctor could give me a prescription for. I’ve been struggling on my own to find them. (Thanks for sharing that I can ask my Doctor for it.)

Thank you John James

For Kylie, Spacers are very useful in helping deliver asthma medications into the lungs, it helps coordinate the patient using the inhaler and it helps to prevent side effects to the medications such as thrush.

Thank you!

Thank you

I’m told to rinse my mouth after using my orange inhaler (Alvesco). I don’t understand the reason why… would you be able to explaine?

Elisa, The best approach to practicing with an infant or young child is to use the trainer devices that come with the prescriptions. This should be done with the staff in the office first so the process can be observed and feedback can be given. Then periodically practice at home with trainer.

The delivery of asthma medications by the inhaler route or with a nebulizer can be equally effective if they are used properly and as directed. In other words, the delivery of asthma medications by a nebulizer is not necessarily better than delivery of medications by an inhaler. A nebulizer machine turns liquid asthma medicine into a mist, which is breathed into the lungs using a mouthpiece or mask. Nebulizers are relatively easy to use with proper instruction. If used properly and as directed, asthma medications delivered by inhalers and/or nebulizers can be equally effective in managing asthma symptoms.

Shadownight, It is very important to rinse out the mouth after using inhalers that contain corticosteroids. Alvesco does contain a corticosteroid. This will prevent irritation and inflammaiton in the mouth and help to prevent the development of thrush which is a fungal infection that can occur with the use of these types of inhalers.

Thank you. I knew it was important, I just didn’t understand the why part. I appreciate the details.

Hi, I’m Chris. I have noticed over recent years a sensitivity to scents (chest tightness) such as perfumes and scented soaps and lotions. The chest tightness can occur too if I’m having nasal congestion but after I take an antihistamine oral or spray, it goes away. Is this a sign of allergies or asthma?

Good question Chris, I experience that too.

In regard to the hive question, the hives could be occuring from direct exposure to grass pollen on the skin. You could use an antiallergy skin cream like OTC hydrocortisone as directed first. If symptoms persist or worsen, an oral antihistamine like cetirizine or Zyrtec would be of use. Use as directed.

Is cool mist something that can help with asthma / allergies? I’ve been looking at the “MyPurMist” device but I’m not sure about it.

I take a daily allergy medication. I am struggling with when to take it. I seem to have horrible allergies early in the morning and again in the evening as the sun sets. I have pretty bad seasonal allergies but it seems like I cannot get relief during the transition time between environmental allergies. I have only been prescribed one-a-day meds for allergies. Does something exist that is more than once a day to combat my morning and evening allergies?

strong odors and scents can be a very strong aggravating trigger for rhinitis and/or asthma. This is usually not an allergen but an irritant. These irritants can definitely trigger nasal congestion, runny nose, cough, and asthma symptoms.

I never knew hydrocortisone could help hives and skin allergies like that. Is that a prevention measure I could take?

I have gotten allergy shots for many years (immunology). This season allergies have been very bad. I got an anaphylactic reaction before and was treated with prednisone and antihistamines. I was told by my allergist’s office that it was ok to take an antihistamine daily. Is that true? I usually only take one before getting a shot, but function so much better when I take the antihistamine more regularly, especially in a dusty environment. I’m highly allergic to dust.

Cool mist can benefit asthma and allergy symptoms but it is best to have humidily associated with the mist. Do not use cold, dry air, which can be a trigger for asthma symptoms.

Thank you Dr. James I appreciate the feed back.

Kylie, most allergy medications are given once a day, but if symptoms are moderate to severe, some antihistamines can be given twice a day, such as loratadine. The dose is well tolerated without side effects. you could also give an antihistamine in the mornind and use a topical nasal steroid spray in the evening. Another allergy med that could be used in the evening is Monteleukast.

Antihistamines can be taken in the morning or evening. This does in part depend on when your symptoms are the worse. Taking zyrtec at night is fine if this works best for you. This decision is flexible and can be tailored to your symptoms and clinical course.

CIS, good question. Yes, you can certainly take you antihistamine on a daily basis when you are receiving your allergy shots if you need better daily control of your allergy symptoms. This will not effect your response to the allergy shots.

This is a great question. The regular EpiPen does contain 0.3 mg of epinephrine and the EpiPen Jr contains 0.15 mg of epinephrine. The package insert says the EpiPen (0.3 mg) is generally prescribed for patients 66 pounds or above. Reliable, published studies have shown that for a 25 kg (55 lbs) child, the 0.15 mg autoinjector delivers only 60 percent of the ideal dose, while the 0.3 mg autoinjector delivers 120 percent of the ideal dose. Therefore, national guidelines for the management of anaphylaxis in children recommend that the switch from the 0.15 mg to 0.3 mg epinephrine autoinjector device should occur when the patient weighs approximately 55 pounds or above. Finally, you can wait until the current EpiPen Jr expires next month and then move up to the new EpiPen prescription.

Lactose can be contaminated with cow milk proteins and lactose can be found in certain medicines such as dry powder inhalers used to treat asthma. Therefore, patients with cow milk allergy need to avoid these inhalers because they could experience an allergic reaction when using them. Ask your healthcare provider to switch your child to a different inhaler such as a metered-dose inhaler, which does not contain lactose. Other medications can contain lactose such as antibiotics, antihistamines and pain medications. Check the ingredients carefully and ask your pharmacist to identify if lactose is an ingredient present in the medication.

How do you rationalize if getting an allergy shot would be good for the patient? Is there a test done to see if you qualify to get allergy shots? Im interested in asking about trying them!

Once a patient starts allergy shots is there an ending period? Like 5 years? Or is it longer term?

The recommendation for starting allergy shots is typically made if a patient is having persistent allergy with or without asthma symptoms despite the use of nasal saline irrigations, antihistamines, topical nasal steroids and other common therapies. Some patients cannot tolerate allergy meds due to side effects and they may be a candidate for allergy shots.

Thank you!

Thanks Moe!

Ohh… thank you.

Allergy shots are typically administered for 5 years, but this decision needs to be made by the physician and patient.

Thank you all! This was informative and helpful!

Thank you, this information really helps.

When and how often are nasal irrigation or use of neti pot recommended? Is daily use ok?

typically nasal saline irrigations are done once daily.