Question: Urticaria and antihistamines
I’ve was diagnosed with chronic urticaria over 3 months ago. My doctor prescribed Prednisone and anti-histamines when I first went to see her. Neither of them helped, but I continued with the anti-histamines. A few weeks later went to see a dermatologist who said continue with anti-histamines but increase the dosage and gave me an Epimax-cortisone mixed cream for my body. The wheals and itch were all over my body, and tend to move from arms to legs, to back to tummy at different stages. She suggested If I had any teeth problems to have them sorted out, I went to the dentist and all was good. After a lot of stress, a severe slump and feeling desperate, I went to my doctor and she put me on anti-depressants (Cilift) – which a little after a month kicked in and I’m definitely of stronger mind and communicating better again, but was still struggling with the rashes and severe itching. I also did a sample test for Helicobacter pylori which was negative.

In desperation I started doing my own research because they had both told me how difficult it was to treat and to find triggers and that allergy testing was not going to help with this. I did a lot of research and realised the link to histamine intolerance and the necessity for a low histamine diet, which I have been doing for almost a month now.

I carried on reading as much as I could including constantly coming back to your article on chronic urticaria on your website. I also read about the research of better results with histamine blocking if H1 anti-histamines aren’t working to combine with an H2 anti-histamine, which I started doing almost a week ago, to a noticeable difference. I then read about the difference in H2’s Cimetidine and Ranitidine and wanted to change to Ranitidine, and when I was talking to the pharmacist about it he told me about Rupatadine. He’s given me 10 tabs to try, but I’m very interested in continuing with them if they work.

My questions to you Dr. Morris: would you recommend Rupatadine and do I need a script to continue with them. Can they be taken with Ranitidine or any other anti-histamines (I read that they shouldn’t be taken with Cimetidine)? My last question is about montelukast, and whether that is an option for me if the urticaria doesn’t completely clear up?

Thank you for your informative website and the forum to ask questions.

Dr Morris replies

Thank you for your e-mail.
Yes, Rupatadine is a good option and can be combined with Ranitidine.
Montelukast would be an add on if you did not get adequate control of the
urticaria. I would double the dose of Rupatadine before adding Montelukast.

Desensitization Immunotherapy in South Africa.

 My Son is 21 years and has been struggling with Eczema since 2 years old.. lately he is shedding a huge amount of skin is very red and itchy.. the allergy clinic did a blood test and House dust mite was 83.3 and grass pollen 81.40 they recommended Staloral I applied for MCC approval but 10 months later we still don’t have the medication.

Dr Morris Replies

This is a very sad state-of-affairs in South Africa.  The Medicine Control Council (MCC) which regulates medication importation in South Africa has dragged it’s feet for 20 years with registering these life-changing vaccines. The one local company that imported Staloral has stopped due to the unreliability of MCC and customs, while the other company’s product has been withdrawn from the market. All-in-all its unacceptable and very disappointing as this treatment is now readily available in Europe, USA and Australia.

Misleading positive allergy test results

My 3 year old son has extremely high IgE levels (2200) and has tested positive
for peanuts, preservatives, food colouring, soy, wheat, milk and inhalants. He
has no symptoms of these allergies, except for a blocked/runny nose. I know the
peanuts must be avoided but is it really necessary to avoid the rest of these
food stuffs, considering he will be severely restricted and possibly lacking
vital nutrients to grow? He has not had any dairy or egg products in his diet
since he was 18 months old.

Dr Morris replies:

This is a very interesting question and a common problem. Children who have very
high non-specific Total IgE (which tends to occur if they have extensive eczema), flag up a
large number of “false positive” food allergy blood tests. This is a failing of the
immunoCAP allergy test system. As you say, your child has been diagnosed with all
these allergies/sensitivities on blood test alone, but can actually eat these
foods with no ill effect. Food allergies are unlikely to cause rhinitis. These
foods should not be avoided unless they cause obvious symptoms. Skin Prick
testing to food allergens is far more accurate in this scenario and less likely
to show up “false positive” results.

Anaphylaxis risk and treatments

On a recent visit to Germany, my children and I were allergy tested and diagnosed by a German immunologist with a genetic immune deficiency called Atopy.

While my first son (now 14yrs) suffers since he is born from atopic eczema and digestive problems, his diagnosis was much less severe than my second son’s (12yrs).

However, both children have a long history of health problems.

My third son (11yrs) has always seemed much healthier than his brothers, but as I know now, he certainly carries the defective gene.

We have long known that our children have certain food intolerances and react with eczema/itchy skin, diarrhoea, stomach cramps, or breathing difficulties when exposed to these substances. However, only know do we have an idea of the full picture and what this might mean for my children’s life.

Regarding my second son we were told that he could react any time with an anaphylactic shock due to a possible allergic cross reaction. Therefore, we have been advised to get him an emergency allergy kit with tablets (comprising of an Antihistamine, Cortisone, and Adrenalin) which is readily available in Europe and that he must carry a note with him at all times with the international recognized codes from the WHO.

Unfortunately, when I enquired at a local pharmacy, I was told that they are only aware of the “Epi-Pen” which we were advised not to get by the immunologist.

We were also told that allergy testing in this case would be of not much help, as especially my second son might be fine with some potential allergen today but could potentially have an anaphylactic shock reaction tomorrow. Do you agree with this?

My sons have been treated by the immunologist with medication derived from their own blood but he told us this was only the first step and strongly advised we should continue this treatment with an immunologist in CT.

 

Dr Morris replies

Welcome back H…..

The German immunologist seems to have given you a lot of misleading or incorrect information. Although allergies tend to occur in allergy prone families, there is no single “defective Gene”. Allergies occur consistently and do not occur one day and then not the next and allergy testing is the most important parameter for assessing allergies.  You probably need to make an appointment and bring copies of any blood or other tests done so that we can this “sift” though the information and “misinformation” you have been given so far.  Any treatments derived from a person’s own blood sounds very suspicious (such as AllergoStop now available in SA). The Epipen adrenalin autoinjector is the most effective treatment for severe allergies and anaphylaxis.

 

Allergic and non-allergic rhinitis

Hi Dr. Morris. I am a 28 year old male and I have been struggling with a permanent post nasal drip for about 5 years now. I am pretty sure I have tried everything to get it under control but still no luck. At first my doctor had me take Allecet but I stopped using it after a few months as I couldn’t see any change. I then went on Cortisone shots for a few months but still nothing. Then I had sinus surgery & I am pretty sure it is worse after that. I then finally went for an allergy test and it concluded that I am allergic to Tree Pollen, Grass Pollen, Maze Pollen, Weads etc. Once again I was on Allect for about 7 months but still no luck. At the same time I used Flonase Nasal Spray but it just thickend the mucus even more. Over the years I have tried numerous other sprays (Flixonase etc) and methods (from Scio treatment to Homopathic medecine etc.) but cannot get any relief. My biggest issue is that I have a permanent sore throat and it is affecting my professional & personal life. I also get sinus infections quite regularly. I have spend thousands of Rands over the years without success. Is there anything else I can do? Am I looking at the wrong treatments? Should I move to where there   are no trees etc.? Many thanks Doctor, any suggestions etc. will be highly appreciated.

Dr Morris Answers.

Hi R….

You appear to have quite a problem and I wonder if treatments have focussed on an allergy cause too heavily. Many people may test positive to pollen allergies, but their symptoms may not necessarily be related to that allergy. It sounds like you have chronic rhinitis and sinusitis with over production of mucus, sinus congestion and a post nasal drip all year around. We call this condition Vasomotor Rhinitis and it responds well to a nasal spray called Ipvent (Ipratropium bromide) .  If the tree pollen was the main allergy for your rhinitis, then you would only have symptoms in September each year, while grass pollen would make you symptomatic from October through to February and Weed pollen in late Summer and you would get symptom relief in winter. Steroidal nasal sprays such as Flonase, Allercet and antihistamine’s would only  help allergic rhinitis and the cortisone shots (not a good idea as they can lead to thinning of your bones, diabetes and even high blood pressure) would not help Vasomotor Rhinitis.  You need a full allergy assessment and a trial of Ipvent nasal spray.

Big cats and small cat allergies

Question from Gaithersburg, Maryland, USA:

To celebrate my 70th birthday I wanted to attend a 2-week visit to the Lion Park outside Johannesburg working with lion cubs. My problem: wife is allergic to domesticated cats and dogs. Do African lions present the same allergy reactions?

Dr. Morris answers:

Yes, unfortunately African lions do carry the same Fel d 1 allergen on their skin and in their saliva, so your wife should avoid close or direct contact, petting and stroking the lion cubs. The cubs also tend to release more allergen than the adult lions. One option would be for her to dose herself up with a non-sedating antihistamine (fexofenadine 180mg) about an hour before exposure, and this should give her some symptom protection. Otherwise I hope you enjoy this amazing wildlife experience in South Africa.

Night time cough in child

Question from Pretoria:

My son is 4 years old. He coughs a lot and we just want to know if this could be due to some allergic reaction? He does not display any fever or cold flu symptoms’ as this generally occurs through most of the year. Sometimes a week would pass that he would be OK but then it starts up again. This is especially bad at night when he is sleeping. Then he coughs almost every few minutes. We had him tested for food allergies but that came back as a negative apparently. But the specialist did say that he has a high allergy count. Seems we just don’t know what it is for. I had a suspicion maybe dust as that is common everywhere. Please help.

Dr. Morris answers:

These symptoms have all the hallmarks of Cough-variant Asthma especially with intermittent night-time cough throughout the year, and a high allergy count. Childhood asthma is very often diagnosed about this age (4 years), and may well be triggered by house dust mites in bedding and carpets. Before embarking on costly dust mite avoidance measures, it would be a good idea to test for inhalant allergies to dust mites, pets, mould and pollen and at the same time have a trial of asthma medication such as Asthavent inhaler at night delivered via a spacer device.

Asthma and eczema

Question from Johannesburg:

My 4 year old son has struggled with chronic eczema his entire life. I have taken him to dermatologists who have diagnosed him with chronic eczema and prescribed steroid creams to be used daily. He has recently been diagnosed with asthma. Please can you suggest a way forward to help him live a normal life?

Dr. Morris answers:

It sounds like your son is “Atopic” and prone to allergies. Usually there is a family history of asthma, hay fever and eczema. Chronic eczema starts in infancy and may be associated with food allergies to cow’s milk, egg and nuts. With age, the eczema tends to ease and the asthma becomes a problem, and as the asthma is out grown, hay fever may be a teenage issue. The way forward is to treat the asthma and eczema effectively and rule out any triggers with allergy testing. Fortunately for the majority of Atopic children, their symptoms improve with age.

Dripping nose in adult

Question from Somerset West:

Since about June this year, I have had a constant post nasal drip at the back of my throat which makes me constantly clear my throat. One doctor put me on 100% cortisone tablets for 5 days. I had a bad reaction to the cortisone and came up in rash on the one side of my neck. I suffer from allergies and know what I am allergic to, but this I cannot shake. Advice PLEASE.

Dr. Morris answers:

You may have a condition called Vasomotor rhinitis and not related to your other allergies, therefore its best to start out doing allergy testing and then plan treatment from there.

Childhood eczema

Question from Cape Town:

My 3.5 year old son has suffered from eczema from a few months old, but now it is chin to ankle and most severe behind his knees. I have been treating him with advantan cream and in between with a base moisturizer and argan oil, I recently started giving him fish oil supplements to try the internal approach but nothing is working. Please advise, many thanks

Dr. Morris answers:

Your son’s eczema may be infected (Staphylococcus) and hence out of control. He may need antibiotics to get control, at the same time check for allergies to common environmental allergens. Once controlled the main aim would be to keep the skin well moisturised and treat any outbreaks of eczema very aggressively. Fish oils sound good, but have not been proven to make any real difference, while acidophilus strain probiotics seem to enhance correct immune responses and reduce eczema if used continuously from birth.

Desensitising food allergies

Question from Johannesburg:

My 3 year old daughter is allergic to food, we did a test a year ago. They found that she has allergies in the following: egg, wheat, peanuts, soy. I understand there is a treatment that is out there not sure what is called but I think is desensorsize the allergies. Where can I go to get the treatment?

Dr. Morris answers:

Young children will normally outgrow their egg, wheat and soy allergies by 5 years of age. Only 20% will outgrow peanut allergy. That’s why it is important to retest every few years. There are new treatments to “desensitise” allergies, usually grass pollen and dust mite allergies. There are not treatments as yet to desensitise to food allergies. However on the internet there are many bogus treatments that promise to desensitise to food allergies, these may be dangerous or of no value at all and should be avoided.

IgG testing and sensitivity

Question from Hampshire, UK:

My query relates to the general allergy consensus about IgG positive foods (finger prick blood test via York Test Laboratories). The allergy specialist at The General in Southampton told me it was only an indicator of foods that were being consumed.

My query is…if this is the case, how is it that my son had an immune reaction to kiwis and lentils which he has NEVER eaten, and certainly not in the last six months which is what the York Test Laboratories say they can test food intolerances for.

Dr. Morris answers:

The Specialist at Southampton General is correct; the IgG test only shows exposure and has no diagnostic value for food allergy or intolerance. So it’s a bit of a confusing test, as you end up avoiding numerous foods that are not problematic.  Exposure need not necessarily be by consuming the food but can occur by being touched by someone who has handled the food or even via the respiratory tract.  Many peanut IgE sensitised infants have never actually eaten peanuts but become sensitised by touch, creams and breathing in microscopic peanut particles.

Pet allergy and tolerance

Question from Cape Town:

I am 50 years old.  I have lots of allergies and am very allergic to cats. I have had dogs all my life with only mild allergic reaction which I manage by washing my hands after petting them, and occasionally have a puff of ventolin or take antihistamine. 2 years ago my daughter got a Pekinese puppy and my allergic reaction was so bad that I struggled to breathe. I had allergy testing done and it confirmed that I was allergic to dogs. The Dr who conducted the tests said the only solution was to remove the cause and so we had to give the puppy away, which was devastating for the family. My two old dogs died a few months apart earlier this year and thinking my bad reaction to the Pekinese was breed specific I adopted a puppy from the SPCA this week and am again reacting with a very tight chest and difficulty breathing. I want to keep my dog so am writing to ask if you able to assist in helping me overcome this allergic reaction either medically or by giving me allergy injections.

Dr. Morris answers:

Unfortunately there is no easy treatment option after becoming severely dog dander allergic.  At this stage in life your asthma will in all likelihood progressively get worse with further dog exposure.  The younger dogs release more allergen than older dogs (males more than females). The Pekinese (a heavy dander shedder) must have heightened your reactivity and you would also have lost any acquired dog dander tolerance in those few “dog-free” months earlier in the year.  My advice unfortunately is that the new SPCA rescue dog should have a new home found to prevent you developing progressively worsening asthma and chronic irreversible bronchitis.