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Ask the Expert: How to Use Your Asthma and Allergy Medicines

    Join the Asthma and Allergy Foundation of America for an Ask the Expert Chat: How to Best Use Your Asthma and Allergy Medicines. The text-based chat will be hosted on our community on Wednesday, May 18, 2022 at 7pm ET/4pm PT. Join AAFA’s exclusive online community to participate in the chat.

    Our featured guest, John M. James, MD, is a board-certified allergist. He is a medical specialist and spokesperson for the Asthma and Allergy Foundation of America. He is also President of Food Allergy Consulting and Education Services, LLC. He has worked as a medical specialist in the field of allergy, asthma, and immunology for over 30 years. Dr. James received his bachelor’s degree from the University of Arkansas and his Doctor of Medicine degree from the University of Tennessee. Dr. James completed his allergy and immunology fellowship at Johns Hopkins Hospital in Baltimore, Maryland, and he is board certified by the American Board of Allergy and Immunology.

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Hello everyone and welcome to the chat! Please introduce yourself!
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.
Welcome Dr. James and thank you so much for taking the time to join us tonight and answer questions!
Hello everyone! Happy to have you here. My name is Moe and I work with the Asthma and Allergy Foundation of America staff. I will be helping in the chat to provide resources.
Thanks Moe for being here as well!
I'm Kathy P and I'm the VP of Community here at AAFA. I'll be helping to moderate the chat.
OK - so who has our first question?
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!
Hi Kylie and welcome!
If you have an "Add Image" button below the box you type in, that is how you can share an image.
Hello! My name is Melanie Carver and I'm the Chief Mission Officer for AAFA. I have a caller who called in their question that I will share after Kylie.
Sorry Kylie - do you mean can you take a screenshot of an answer to share?
Hello Everyone! My name is Elisa and I am the Manager of Corporate and Foundation Relations at AAFA. I'm also here as a Mom of a kiddo with food allergies.
Thanks for joining Elisa!
Yes Kathy. If there is an answer I would like to share/save may I screenshot it?
I have a question that was submitted privately-
"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?"
Yes, you are welcome to share the response! We will be picking the best questions and answers from tonight's chat to add to AAFA's Ask the Allergist knowledge base too!
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.
Great answer Dr. James! For more info on using spacers and holding chambers -
Here is a question I hear a lot: I accidentally left my inhaler in my car during the day when it was hot. Is it still okay to use? It was almost brand new, and I can’t refill the prescription again till the end of the month.
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.
Thank you for the answer Dr. James, for more info on inhaler storage safety -
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.
Shadowcat - here is AAFA's page on the different types of asthma treatments -
Thank you
Sometimes it can be confusing to know which inhaler to use when. Did your doctor give you an asthma action plan? This plan will tell you what your controller medicine is (if you have one) and what your quick-relief medicine is. It will also tell you when to take it and how much to take.
My LO's anaphylaxis plan explains when we should use an Epi-Pen, but I'm nervous about how to use it. What position should they be in when the epinephrine is injected? Should my child be lying down or is sitting, ok?
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!
Elisa - It's always best to follow your child’s anaphylaxis plan. If you have specific questions, follow up with the doctor - https://www.kidswithfoodallerg...-is-anaphylaxis.aspx
No my doctor has never given me an “asthma action plan”. None of my doctors have done that.
Hi Kylie LO = Little One.
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
I have practiced using an Epi-Pen on myself, but never on my child. They're 2.5. Is there a value in practicing in a safe setting with a child that young? I'd like to be prepared in an emergency, but I don't want to scare her.
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.
For Kylie and Shadownight - In addition to a asthma treatment resource Kathy provided above, we also have a detailed page about inhalers and how to use them here -
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.
Related to spacers and inhalers, we often get asked about nebulizers. How are nebulizers different from inhalers?
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.
Elisa - practicing with the training and your young child can be helpful for them to know what will happen in an emergency. We've had lots of parents on the community share how they role-play with their child about reporting symptoms and the steps for administering epinephrine by using the trainer.
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.
We have a caller who is asking: "It is grass allergy season. My legs break out in hives near my ankles when I'm in my yard. In general, is it best to use an anti-allergy skin cream or an oral antihistamine to help with hives?"
Thanks, Kathy and Dr. James. Those are very helpful suggestions. I'll do a role-play at our next visit with our allergist.
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.
That's a great question Melanie! This blog has information about choosing an antihistamine -
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?
What's the difference between an adult dose Epi-pen and the Epi-Pen Jr.? When do children normally switch from the child dose to the adult dose?
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?
Thank you Dr. James! This page has more information about allergic asthma and possible triggers -
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.
Great question, Kylie! I have a slightly different question on the timing of allergy meds. Zyrtec is super effective at providing allergy relief for me. But, it makes me drowsy. My sister recommended that I take it at night. Are there general recommendations on when to take OTC antihistamines?
Thank you Dr. James I appreciate the feed back.
CIS - seasonal pollen has gotten worse and you are not the only one experiencing an increase in symptoms. One reason is climate change -
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.
Kylie, here is some more information on the different kinds of allergy treatments -
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.
Thank you!
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.
Here is another question that was submitted: My child has a milk allergy but was prescribed a medicine that contains lactose. Is this safe to use?
Here is more information about using an epipen -
Thank you. One more question on Epi-Pens. How do you dispose of unused auto-injectors after their expiration date?
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.
Elisa - that's a great question and one we get asked a lot! Here is information about disposing of unused or expired medicines -
Here is more information about living with milk allergies - https://www.kidswithfoodallerg...ns/milk-allergy.aspx
For epinephrine devices, those can be great to practice with on something like an orange. The device feels a bit different from the trainer when the needle is deployed.
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!
My LO's anaphylaxis plan used to say to give Benadryl if she ate something with her allergy even if there were no symptoms. This time when the doctor filled out the form for daycare, that’s not on there. Should I add it to the form? Or just tell the director?
In the past, I've also donated expired devices to First Aid trainers including our local Girl Scout and Boy Scout troops for when they do First Aid training with scouts.
You can ask at the local school if the school nurse would like them to practice with staff too.
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, Kathy. I didn't know you could donate old auto-injectors.
For more information on allergy shots -
Thank you so much, Dr James and everyone for adding to this great conversation!
Thanks Moe!
Great questions everyone! Thanks for joining! Congrats to shadownight for being our raffle winner! Someone will contact you tomorrow!
Ohh… thank you.
Allergy shots are typically administered for 5 years, but this decision needs to be made by the physician and patient.
Thanks for the helpful information, everyone!
Thank you all! This was informative and helpful!
Thank you, this information really helps.
Thank you for joining everyone!
When and how often are nasal irrigation or use of neti pot recommended? Is daily use ok?
Still have more questions for our expert? You can submit your question through AAFA Ask the Allergy Service -
typically nasal saline irrigations are done once daily.
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