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Dr. Andrew Rynne

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Suggest alternative medicine for allergy

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Dr. Parin N. Parmar

Allergist and Immunologist

Practicing since :2006

Answered : 870 Questions

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Posted on Tue, 26 Aug 2014 in Asthma and Allergy
Question: Hi,

Over past 10 years of so I experience bowel movements after lunch / dinner of when I am ready to go out. Normal frequency for motions is twice a day an that causes lot of inconvenience, is it normal? how can I reduce this once per day. Getting access to toilets is a pain when you are out on move and that leads to eat less food. On top of it I suffer aspergillus allergy which goes wild If I am hungry. Also I have developed lactose allergy, so cant drink milk or food made of milk. Earlier I I used to take Avil 25 but now it seems its banned by FDA. Is there any option to improve this or need to live with it. Can you suggest any anti allergy non harmful medicine to fight allergy. I guess my immune system is bad and no much improvement is expected there.
doctor
Answered by Dr. Parin N. Parmar 1 hour later
Brief Answer:
Please give more details, improve immunity

Detailed Answer:
Hello XXXX,

Thank you for asking at HCM.

I went through you history and reviewed your allergy reports.

I would like to know more details about your symptoms:

a. What sort of inconvenience you experience while motions? Is it pain, flatulence or any other? Do you experience pain in abdomen or at anus?

b. Have you ever had constipation?

c. Do you experience diarhhoea often?

d. Have you ever had blood in stools or black colored stools?

e. What happens if you eat milk or milk products? How much time after eating, you get symptoms? Which milk products cause troubles to you - milk, curd, buttermilk, butter, ghee, milk sweets, cheese, paneer - all of these or specific from these?

f. Do you experience symptoms to any foods apart from milk/milk products?

I would like to know about above questions for possibility of food allergy.

g. What are your symptoms of Aspergillus allergy - nose allergy (sneezing, nasal congestion, running nose, etc), skin allergies or asthma (breathing difficulty, wheezing, etc)? Since what age you developed these symptoms?

h. Do you have frequent headaches, loss of smell, facial heaviness?

i. Which are the worst seasons for you?

j. Do you get more allergy symptoms at night time or at day time? Do you get more allergy symptoms at home or at work?

k. What is your occupation?

l. Do you smoke? Are you exposed to dusts/smokes/air pollution etc?

m. Does anyone from your family have allergies?

n. Do stress/worries worsen your symptoms?

I will be happy if you could give me above details on the follow-up. That will help me to understand your complaints better.

From your history and allergy reports, I would like to make following suggestions for you at present:

1. Your allergy reports (IgE levels) for air-borne allergens (inhalants) are higher for Aspergillus fumigatus (a mold), house dust mite, house dust, paper dust & perfumes.

Were I treating you, I would consider aspergillus fumigatus and house dust mites important for you. I would suggest you following measures to control them:

a. Washing bedsheets, pillow-covers, mattresses, etc in hot water every week and change the frequently.

b. Allowing generous airflow and sunlight into all the rooms, especially bedroom, to reduce humidity and to wash-out indoor allergy causing substances. (Both house dust mites and molds grow maximum in warm, humid environment)

c. Minimizing carpets, curtains and upholstered furniture in home, especially in the bed room. (These act as reservoirs for house dust mite and mold particles)

2. As per your food allergy reports, you have higher IgE levels for cabbage, ground nut, lady's finger, yeast, cucumber & lemon.

I would request you not to consider yourself as "allergic" to these all foods. It is possible to have higher IgE levels to foods without being actually allergic to them.

Were I treating you, I would suggest to eat each of the above food items and observe if you have increased symptoms. If you have no increase in symptoms, in my opinion, you could safely continue consuming that particular food.

If you specifically observe increase in your allergy symptoms following consumption of a particular food, personally I would like to confirm allergy to that particular food by allergy skin testing or ImmunoCAP IgE levels before concluding that you are "allergic" to that particular food.

3. As Avil is not available, I would suggest you an antihistamine drug like cetirizine/levocetirizine/fexofenadine - any one of them. (I assume you use Avil for nose symptoms).

All these medicines are considered safe for long term use. They are considered to have even less side effects than Avil.

4. Yes, you are right in the view that allergies are usually due to an abnormal functioning of immune system. But it's not one cannot do anything for it. I always suggest following measures to my patients to do good for own immune system:

a. A healthy & balanced diet rich in vitamins, minerals and anti-oxidants is very important. The daily diet should have equal components of grains (whole grains preferable), proteins (nuts & legumes, egg preferable), green leafy vegetables and fruits (try to include variety of fruits) and a small component of dairy.

b. It is important to maintain hemoglobin levels around 13-14 g%.

c. Regular exercise, preferably in non-polluted natural surroundings, does a very good job for immune system.

d. Often ignored factor is stress (physical/mental/social) which really adversely affects one's immunity. Personally I prefer "the XXXXXXX Way" to reduce stress - i.e., regular Yoga, Pranayama & Meditation.

5. Were I treating you, personally I would suggest complete blood counts, serum vitamin D levels, stool examination (particularly for ova & parasites, occult/frank blood, reducing substance) and ImmunoCAP/skin testing for milk protein, house dust mite and common molds in your region including Aspergillus Fumigatus. Please discuss the necessity of these tests (if not done previously) with your treating doctor.

Hope above suggestions will be helpful to you.

Please give me the details mentioned from "a to n" regarding your nature of your complaints. I will try my best to help you with me knowledge and experience. Should you have any further query, please feel free to ask on follow-up.

Wish you the best of the health.

Thank you and Regards.

Dr. Parin N. Parmar

Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju
doctor
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Follow up: Dr. Parin N. Parmar 47 minutes later
a. What sort of inconvenience you experience while motions? Is it pain, flatulence or any other? Do you experience pain in abdomen or at anus?
Slight pain in lower abdomen at times after 15min to 30 min after heavy food and little flatulence.

b. Have you ever had constipation?
In child hood I had it some times.

c. Do you experience diarrhea often?
No, I can digest anything under the sun and rarely I suffer form diarrhea.

d. Have you ever had blood in stools or black colored stools?
No not generally.

e. What happens if you eat milk or milk products? How much time after eating, you get symptoms? Which milk products cause troubles to you - milk, curd, buttermilk, butter, ghee, milk sweets, cheese, paneer - all of these or specific from these?
If I drink Coffe like Latte small or a bottle of Cow milk, Basundi are killer ones. After around 4-7 hours I usually get little pain in lower abdomen and I have to go for motions. Curd, cheese and Buttermilk are ok in moderate quantity. Paneer and sewwts made of milk are total no no now a days. I used to eat a loads of it till I was in college though.

f. Do you experience symptoms to any foods apart from milk/milk products?
Some times if I eat a lot of veggies like shepu, methi but its not that bad.

I would like to know about above questions for possibility of food allergy.

g. What are your symptoms of Aspergillus allergy - nose allergy (sneezing, nasal congestion, running nose, etc), skin allergies or asthma (breathing difficulty, wheezing, etc)? Since what age you developed these symptoms?
I cant say its food or aspergillus but symptoms are runny nose, watery eyes and sometimes sore throat. I have developed these symptoms since 1996 on-wards.
A few years back finally I had to ask my doctor to suggest if it was allergy and then he made me do this test.

h. Do you have frequent headaches, loss of smell, facial heaviness?
No.

i. Which are the worst seasons for you?
Rain and Summer, winters are generally bearable.

j. Do you get more allergy symptoms at night time or at day time? Do you get more allergy symptoms at home or at work?
Generally symptoms are observed while i sleep, many times i getup in the midnigt suddenly with runny nose. Some times my nature of work causes it when I visit server rooms etc where there is cold and dust.

k. What is your occupation?
I am a IT manager by occupation.

l. Do you smoke? Are you exposed to dusts/smokes/air pollution etc?
Occasionally I have smoked. I work in an AC office and that also causes iddues. If AC vent is on top of my teat I usually get cold.

m. Does anyone from your family have allergies?
No.

n. Do stress/worries worsen your symptoms?
Yes I have seen at times but not regular affair.
doctor
Answered by Dr. Parin N. Parmar 43 minutes later
Brief Answer:
monteluast-levocetirizine & diet supplements

Detailed Answer:
Hello XXXX,

Thank you very much for your details and follow-up.

I went through your history and would like to make following suggestions to you:

Regarding nose symptoms:

1. Personally I would suggest you to use cetirizine/levocetirizine/fexofenadine with montelukast (combined preparations are available). This will help your allergy symptoms.

2. Please observe measures for house dust mite & mold control (as in previous answer) regularly. They will reduce the concentration of mites and molds in the room and will reduce your symptoms gradually.

However, it is important to mention here that it takes 3-6 months to get the rooms clear of allergen particles, so you may not see clinical benefits as soon you implement these measures.

3. Your night-time symptoms, symptoms in server room and symptoms worsening in rains & summer - all point to house dust mite and mold-induced symptoms.

I would suggest you to get confirmatory allergy testing with skin testing/ImmunoCAP specific IgE levels for house dust mite & common molds in your area.

Depending upon these results, you may be advised specific allergen immunotherapy to that particular allergy-causing protein, which works on your immune system (like a vaccine) to improve your allergy symptoms. However, a thorough evaluation by an Allergist-Immunologist is essential prior to suggesting immunotherapy.

4. Your symptoms under AC vent are due to direct irritation effects by cold air (not because of "allergy" to cold air). I would suggest you to cover your nose by a Personal Protection Device such as a mask while entering server room as will as while facing cold air currents inside or outside.

5. Personally I would suggest you to avoid exposure to dusts, smokes and air pollution. Regular breathing exercises and a balanced diet which will be helpful in a long run. Please avoid smoking.

6. Regarding your digestive symptoms, were I treating you, I would suggest you confirmatory allergy testing with skin testing/ImmunoCAP IgE for milk protein only. That will help to differentiate between milk protein allergy and lactose intolerance.

7. If it is not milk allergy, I would suggest you to consult a Gastroenterologist rather than an Allergist-Immunologist.

8. Were I treating you, I would prescribe you probiotics (such as saccharomyces boulardii, lactobacilli, etc) for at least 4-8 weeks and multivitamin & mineral supplements containing especially vitamin D, vitamin E and zinc.

9. I would like to suggest you to follow the strategies to improve immune system mentioned in my 1st reply.

Hope above suggestions will be helpful to you.

Should you have any further query, please feel free to ask on follow-up. Also I will be happy if you could give your feedback on follow-up.

Wish you the best of the health.

Thank you & Regards,

Dr. Parin N. Parmar
Above answer was peer-reviewed by : Dr. Ashwin Bhandari
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