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Staying at home but sneezing?

The Patient Journey
A DTAP Stay Home Series Part 2


In part 1 of our series, we shared a bit on the statistics surrounding COVID 19 and some simple steps one can take in minimizing the spread of germs. This centered around the whole idea of preventing droplet spread. And because of this, many of us have opted to stay at home and even work from home.

In fact, droplet spread stems from coughing and sneezing and the droplets which contain viruses tend to stay on surfaces and ultimately persist for up to 24 hours. That is why the 2 biggest health recommendations were to wear a mask if you are coughing or sneezing to prevent the spread of germs via the droplets AND the washing of hands especially after touching surfaces outside. 

At team DTAP, not only have we encouraged each and everyone of our staff to maintain and work on their personal hygiene, we have also taken the active step to further increase the frequency of sterilization at our clinics. In fact this was a snapshot of our recent communiqué with our staff.

Our main priority always is to protect our staff and patients. If anyone is found to have fever and upper respiratory tract symptoms (coughing, running nose etc), the prerogative as per the Ministry of Health (MOH) Singapore’s recommendations is, for that member of staff to be on unfit for work status for 5 days and resting at home.

The rationale behind such a thinking is that if the infection causing the upper respiratory tract infection was the garden variety, ample rest would allow the body to recover. However, if the opposite were true and if this was indeed a COVID 19 infection, time would unmask this as the index person would have a persistent fever, signs of airway infection and even breathing difficulties.

The WHO-China report tabulated 56,-000 cases and found that almost 90% had fever as presentation, 7 in 10 had a dry cough, slightly less than half of those polled had lethargy and fatigue and only 5 in a 100 had upper airway nasal symptoms such as runny nose, blocked nose or even sneezing.

So if you are caught up at home in this period of MC5 (5 days of unfit for work) or even on a Stay Home Notice or Quarantine Order (see first article in series), there’s no need to fret as you allow your body to rest and recuperate.


But what happens when you continue to sneeze during this period, and, despite sanitization efforts, you worry that others may look at you funny and steer away from you?

Let’s delve deeper into what causes one to sneeze; when irritants or infective agents such as bacteria or viruses irritate the airway, chemicals are produced by the body to activate the mucus producing glands resulting in a “runny nose”. These chemicals also activate the nerve endings in the nose and result in one getting an “itchy nose” and ultimately an “AH CHOO”, sneeze !

Although the medical literature has reported that only 5% or 5 in a 100 cases of COVID 19 have concurrent symptoms of sneezing, running nose or blocked nose, I am sure that the persistence of your nasal symptoms may alarm you.

When you speak to one of our doctors, in the absence of fever (I will share more in our next article part 3 of our series on the persistence of fever), we will try to understand your travel and contact history and also see whether there are any known irritants you may have come into contact with recently that could signify an allergic cause of sneezing.

Sneezing is usually significant and caused by an allergy when,

  • There is an observable pattern of sneezing, especially coming into contact with certain environments
  • When it starts to affect your daily quality of life – going to work tired and drained, suffering the symptoms on a day to day basis – watery eyes, clogged nose

Based on these symptoms and history, the next step often is to figure out what allergies you might be suffering from – Take an allergy test!

This can be done with a few ways mainly either through a comprehensive blood test or through a skin prick test.

After the tests are done, a report (sample above for blood test IgE) is produced. This report will be discussed with you and the type of allergen as well as degree of allergy will be identified.

Also read: HOW DO I STOP SNEEZING? – ALLERGY FROM CLEANING


Knowing your allergy is the first step to finding an active plan in dealing with the allergy.

This active plan will be individualized and customised specific for your needs and lifestyle. But they might involve anything from Immunotherapy, avoidance of allergens, to even carrying around an Epipen with you in view of serious life threatening allergies.

Remember, if you are staying home and still sneezing, the chances of it being COVID19 is low if you had no contact with anyone from the infectious clusters locally or abroad. But if you are sneezing at home and persistently especially in the morning, it could well be an allergy that can be further investigated and treated.

Stay safe, dispose your used tissues in the bins and remember to keep sanitizing your hands!


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Why Should I Get My Allergies Treated?

A beginner’s walkthrough + secrets from the doctor on dealing with allergies…

There are many reasons and benefits to get your allergies treated. One of these reasons is to prevent the progression of the “allergic march”.

What is this allergic march you may ask? If the allergy is not diagnosed or treated, it can progress from sensitive skin (eczema), sensitive nose (allergic rhinitis) to food allergies or even sensitive lung (asthma).

This means that if we treat allergies early enough, you can save yourself the trouble from developing a sensitive nose, lung sensitivities or asthma.

All in all, this represents cost savings to you and your family, saving on doctor’s fees, medications, downtime at work or even precious time with your loved ones. Furthermore, the improvement in one’s quality of life, especially being able to enjoy your day at work or play without the spectre of allergies looming is immeasurably priceless.

There are many permutations how a life where allergies are treated and under control can play out – from getting a good night’s sleep without sneezing, to starting your day at the park with your family without feeling lethargic and drained to even enjoying a cherished and quiet moment with your loved one at a cafe without having to reach for a packet of tissue papers to stop a runny nose dripping mucus down your face.

Many studies have shown that treatments for nasal allergies and asthma are cost-effective. Cost-effective because of the monies saved from seeing the doctor or taking medications during a flare-up, cost-effective also from an improved quality of life.

Also Read: Doctor’s Overview Of Allergies & How To Help You And Your Loved Ones

Doctor, so how then can I get my allergies treated? Is there a permanent solution for this?

Well my discerning reader, I am glad you asked. Because there is a very permanent solution to treating and curing nasal allergies. But before I jump to that I will discuss steps you can take at home and natural remedies to improve your condition. We can then discuss a little about medical treatments available and last but not least, the permanent solution for allergies we brought up earlier.

See: Cure for Allergy (Sublingual Immunotherapy) 

 

Natural non-pharmacological treatments

Without further ado, we start with some tips on, non-pharmacological in helping improve your allergies. I break them down into 2 major points. The first of which is things you can do at home and the second of which is a way to build your tolerance to allergies

Things you can do at home

  • Dehumidify your house – low humidities have been shown to improve lung functions of patients with asthma
  • Get rid of dust mites by Sunning and drying your pillowcases and bedsheets under the warmth
  • Air purifiers that also have a HEPA filter (think Dyson, Xiaomi)
  • Dust protectors
  • Washing and vacuuming carpets and curtains regularly
  • Smoking cessation

When it comes to pets, current studies done have been conflicting to whether having a child exposed to a pet cat or dog in the first year of life would improve or worsen allergy sensitivities later in life, BUT if you do have allergies yourself (another good reason to get tested), there is a higher chance of your child inheriting the same genes which cause sensitivities.

Also Read: How Do I Stop Sneezing? – Allergy From Cleaning

Building your tolerance to allergies

A well-described study 10 years ago listed the following tips which may help build a tolerance to allergies. There were some impractical suggestions such as taking unpasteurized milk or living on a farm but we will focus on the more practical solutions we can adopt in our daily lives

Read: How Do I Know If I Have An Allergy

 

Consumption of probiotics

  • Increase in outdoor physical activities and time in nature
  • Taking more fresh fruit and vegetables
  • Consumption of healthy diets – the Mediterranean diet has often been mooted as a healthy paradigm

PS: Of course, this list is not exhaustive and it serves as an adjunct to treatment.

Where possible, we always advocate medications when necessary.

 

What are The Causes of Allergy?

 

Medications

Antihistamines

The first line of treatment comes in the form of tablets known as antihistamines. They are useful in providing relief for mild allergies, but most of the time, for those who have moderate to strong allergies, the relief is often short-lived and minimal.

Furthermore, there is an effect known as tachyphylaxis where over time, there is a diminishing response to the medications. Some antihistamines are also unfortunately drowsy, good for sleeping at night but not good for those who need relief in the day during their work.

Examples of antihistamines include – Loratidine, Zyrtec, Diphenhydramine, Chlorpheniramine, Telfast

Decongestants

The next set of medications that are useful for allergies are decongestants. They act by constricting the mucous membranes in the nasal passages, decreasing the symptoms of a blocked nose and are available either as nose sprays or tablets.

Examples of decongestants include Iliadin nose drops, Fedac, Clarinase, Zyrtec (D) and Telfast (D)

For nose drops such as iliadin, preparations for infants and babies are also available, but caution is advised as these cannot be used for more than 5 days as it causes a rebound blocked nose. However, for short term use, they are safe and effective.

Nasal rinses (Salt water nasal washes)

For many patients with allergies, a thick layer of mucus or even allergens can get trapped in the nasal mucosa surfaces.

If using nasal spray medications such as decongestants or intranasal steroids, these medications can fail to get to where it is needed for absorption if the nasal passages are clogged with mucus.

Furthermore, some allergens may remain trapped on these airway mucosal surfaces resulting in the recurrence and unremitting of symptoms.

There are many nasal rinses that are available over the counter from pharmacies – from Nettipot to Sinusrinses. BUT again caution is advised that these rinses have to be done with Saline (salt water) and not normal water otherwise it would not work! Also, the saline comes as sachets which you mix water with, and these come together with the sinus rinse / nettipots as a package.

Anti-leukotrienes

This fancy sounding tablet medication blocks the chemical reactions that can lead to  inflammation in the airways. This medication is relatively new, only introduced in the last 10 years and is used in both sensitive nose and sensitive lungs. It can be taken with antihistamines and it improves symptoms. It is also safe and well-tolerated for children (with a chewable form with a nice flavour)

Examples: Montelukast, Singulair

Nasal Glucocorticosteroids

People are often worried about the negative connotations behind steroids as treatment. In fact, low doses of steroids especially targeted at the nose are found to be extremely effective for allergic nose symptoms.

These are very well tolerated but usually, need at least 1 week for a cumulative effect to build up and subsequently see the manifestation of its benefits.

Common examples of this include Nasonex and Avamys.

Inhaled Glucocorticosteroids

In treatment and prevention of asthma, inhaled steroids – often known as the brown, red or purple inhalers, help reduce and prevent airway inflammation and subsequent asthma symptoms.

Examples of this include Symbicort, Seratide and Beclomethasone.

In asthma, inhaled corticosteroids are used for moderate to severe asthma. Again, because of the life-threatening incidences of asthma, it is always advisable to keep asthma under control and prevent flare-ups.

Whether it is inhaled steroids or nasal steroids, at recommended doses which is targeted, they are very safe, even for children and have NO long term or negative effects on children and adults.

Oral Glucocorticosteroids

In adverse situations where asthma control is poor, tablet steroids are given as a short course over a few days to quickly reduce the inflammation in the airways. These have their own short term side effects such as risks of gastric ulcers or causing blood sugars to rise in those with diabetes, and your doctor will balance the pros and cons of this treatment, including the necessary precautions before prescribing this.

Examples of this medication include prednisolone, hydrocortisone.

Topical steroids

For conditions such as eczema, topical steroids such as creams or lotions are effective in the short term reducing the inflammation and irritation on the skin. But long term usage causes the skin to thin and may resultantly interfere with the skin’s repair.

For the skin’s natural barrier repair and protection, we always advocate using moisturizers instead.

Common examples of topical steroidal preparations include hydrocortsone, elomet, clobetasol, desowen.

Doc, you’ve rattled on and on about different medications I can take for my allergies, but what about the long term, the permanent solution you were talking about?

Well, if you have read on this far, let me cut to the chase.

The definitive way of treating allergies is ultimately to target the root cause. And at Dr Tan & Partners (DTAP Clinic), we offer a2 step solution in identifying the root cause and treating it.

Step 1: Allergy Testing

This is either done with a Skin Prick Test – suitable for children and adults. And whilst skin prick does sound scary, rest assured that it is well tolerated by children where a plastic prong is used to introduce a small amount of allergen onto the skin, thereby eliciting a response.

More on that in our allergy testing video

How Does Skin Prink Test Work?

This procedure is PAINLESS but ITCHY. The downside about skin prick testing is that the choices for testing are limited and not as vast as blood testing. Some patients do prefer a simple and quick blood test where others preferred to be spared the pain of a blood test. Whichever your choice, knowing your allergy is half the battle.

Step 2: Allergy Treatment

Allergy Treatment would then involve “priming” the body on a daily basis to recognize and eventually stop reacting to the exact cause of the allergy. This treatment is also known as Sublingual Immunotherapy or SLIT.

A mix of low dose allergens are created in a spray, this spray is taken once a day under the tongue for 3-5 years. Another preparation specifically for dust mite allergies also come as an under the tongue tablet for adult patients. For those with dust mite allergies and frequently on the go, this might be a better option of SLIT rather than the spray.

This 2 step approach has brought lots of success for allergy sufferers and usually, patients start to see an improvement of their symptoms at 6 months

Improvements such as lesser frequency and or severity of symptoms, lesser usage of medications, effects of cure lasting long even after treatment has been completed.

In fact, 2 large medical bodies have further supported the benefits of SLIT. The World allergy organization describes the benefits of SLIT as follows: besides controlling symptoms, SLIT has the potential to completely cure such allergies for good and or even prevent them from developing at all (allergic march).

Singapore’s Ministry of Health has also released recommendations that SLIT should be considered for children over 5 that have poor control of their sensitive nose (repeated attacks and symptoms) even with maximum oral therapy and also for those children who are unable or will not take medications. In simple terms, SLIT is good for children who do not like taking medications or when medications are no longer effective.

And if you are a parent, worried about your child’s allergies, you would be pleased to know that across numerous studies, SLIT significantly reduces their nasal symptoms and has a nearly 4x likelihood of NOT developing asthma. For those children who already have asthma, SLIT also shows a reduction in asthma and the associated lung allergies.

Safety and side effects

To sum everything up, it is also important to know that SLIT has an extremely good safety profile. In more than 60 studies done in the year 2006, more than 1 million doses of SLIT were administered across more than 4000 patients with ZERO life-threatening reactions.

However, just like all medical treatment, there were still some side effects which occurred in 14 out of the million doses. These included itchiness and swelling over the mouth, lips or throat. Stomach pain, discomfort, nausea, asthmatic symptoms.

 

If you wish to speak to our doctors about the above allergy testing and allergy treatment, please email us at hello@dtapclinic.com. You can also walk-in or call our Holland Village or Raffles Place branches for Skin Prick Testing or Sublingual immunotherapy (SLIT) Allergy Treatment.

 

Other Read:

  1. How Do I Stop Sneezing? – Allergy From Cleaning
  2. How Does Skin Prick Test Work?
  3. How Do I Know I Have Allergies?
  4. Why Should I Get My Allergies Treated?
  5. Doctor’s Overview Of Allergies & How To Help You And Your Loved Ones

Tag: allergy test singapore

How Do I Stop Sneezing? – Allergy from Cleaning

A “How To” series by Dr Tan & Partners
Have you been caught up with the whole Marie Kondo craze recently, discovering long lost items buried beneath heaps of other stuff that do not spark joy? Or simply packing and repacking your house because the festivities are around the corner?
But wait, as you happily get into your rhythm of packing and cleaning, you find that your nose starts to tickle, you take a few deep breaths and before you know it, a loud uncontrollable “Ah-Choo!”  You wipe away the mucus and continue packing but the sneezing does not seem to stop at all.
Apart from the possibility of someone constantly thinking about you, you start to wonder whether you have caught the flu. Or worse still, developed an allergy, an allergy to cleaning!
Also Read: How Do I Know If I Have Allergies 

via GIPHY

Could It Be Possible That You’ve Developed An Allergy to Cleaning?

Does An Allergy to Cleaning Even Exist?

What is An Allergy?

Allergy is a common condition that can happen at any age, where the person’s own immune system overreacts with substances that are usually harmless for most people.
These allergens include anything from house dust mites, pollen, moulds (fungi), pet danders, insect sting/bites, a certain type of medicines and foods.

via GIPHY
Allergy is, however, more common in people with atopy ( genetic / hereditary tendency for allergy), family and personal history of allergic rhinitis (sensitive nose), eczema (sensitive skin) and asthma (sensitive airways).
When exposed to allergens, the immune reaction is triggered! Subsequently, the allergic person produces antibodies called IgE antibodies, which results in the release of a chemical known as histamine.  This chemical histamine is then responsible for the various inflammatory symptoms that can be uncomfortable and distressing such as

  • Rashes ( eg. eczema flare ups),
  • Hives/urticaria,
  • Swelling of face/ lips/around the eyes,
  • Throat and tongue,
  • Runny or blocked nose,
  • Itchy watery eyes,
  • Abdominal pain,
  • Vomiting, and diarrhoea,
  • Wheezing,
  • Asthma,
  • and even difficulty in breathing.

These IgE mediated allergy symptoms typically appear within 1-2 hours after exposure to the particular allergens.
Sometimes, allergic reactions can be very serious and potentially life threatening, condition known as anaphylaxis. Patients with history of anaphylaxis, especially due to food allergy, are usually prescribed an emergency adrenaline injection, known as Epipen Injection, as delayed intervention can be fatal. These patients are also educated on how to use the injection and the importance of carrying it with them all the time.
Hence, It is very crucial to identify the potential allergy so that we can try avoid and reduce exposure to the particular allergens.

“So Yes I hear you about the whole allergy thing and how one may die from it but you have not told me how to stop sneezing yet!”

Yes my discerning reader, we are getting on to that in just a bit, bear with me, i’ll first have to cover this bit on testing for allergy. It is always better to know what we are dealing with rather than fight in the dark. 

How Do We Test For Allergy?

An allergy can be diagnosed with these 2 commonly used methods – an IgE blood test or a skin prick test. They can test for both food and non-food allergies.

Wait what a skin prick test? That sounds painful!

1. Skin Prick Test :

Hold on there, before you start worrying about anything which might be painful.. From our own personal experience (yes this writer has done the test on himself), apart from the mild discomfort, it is a procedure that i personally, and most patients tolerate well. There will certainly be no bleeding during the procedure.
For patients with sensitivity to the particular allergen, i.e a positive result, they will likely experience some itch and mild irritation over the test area.

This is a simple, quick and accurate test to diagnose allergy and the results can be known on the same day within 15-20mins !

How this Skin prick test is usually done is that small markings will be drawn on skin and tiny drops of allergens applied onto the skin. The allergens are introduced into the skin via tiny lancets that barely penetrates the skin surface.
This skin prick test is done on the inner forearm or upper back ( small children). After which, the doctor will look for a specific skin reaction, that appear as red, raised and itchy bumps, known as wheals. Size of the wheals will be measured and measurements more than 3mm is indicative of an allergic reaction.
Another caveat also is to avoid oral antihistamines at least 1 week before the test.
Skin prick test is generally very safe as only tiny amounts of the allergens are introduced into the skin. However, there are situations where skin prick test may not be suitable, such as :

  • Patients who are unable to come off oral antihistamines/ steroids prior to the test
  • Those who have severe eczema/ skin rash over the forearms/ back
  • Those with previous history of life threatening anaphylatic reaction.

2. IgE Blood Test :

As mentioned before, for persons with atopy, the immune system produces IgE antibodies against certain allergens. Therefore we can detect these specific IgE antibodies in a blood test.
A wide range of allergens can be tested via a single blood test in one setting. It usually takes about 1 week for results to be ready. No special preparation is necessary prior to blood test.
Sometimes, both IgE blood test and skin prick tests are done in a complementary fashion as useful parameters in the prediction and diagnosis for allergy.
 So if you have patiently read all this way till now, let me fill you in on what you’ve been waiting for.

How Do I Stop Sneezing !!

Allergy Treatment

There are several ways we can deal with allergy :

a) Avoidance

We can try our best to avoid the offending allergen, however, most times, it is just not feasible to avoid certain allergens especially inhalant allergens. Avoidance alone is usually inefficient.

2) Anti allergic drugs

Medications like oral antihistamines, oral decongestants, nasal sprays and corticosteroids can help ease or reduce symptoms caused by allergy as long as the symptoms are not serious or life threatening. However, they do not treat the allergy condition.
This means symptoms typically appear again when you stop taking the drugs.
For example, dust mites allergy is very common in those with allergic rhinitis. It is almost impossible to avoid dust mites completely, hence, patients will usually have to be on long term medications for symptom control.
 

3) Sublingual immunotherapy (SLIT)

Immunotherapy is the only treatment that is capable of treating the root cause of the allergy.
This therapy works by desensitizing and downregulating the body’s reaction towards a specific allergen that is responsible for producing symptoms. Hence, gradually modifying the body’s allergic responses over time.
This is accomplished by intentional regular exposure of the specific allergens administered via under the tongue ( sublingual spray).
Sublingual immunotherapy significantly improves quality of life, reduces consumption of medications, and also reduces risk of developing asthma and new allergies in the future.

Clinical papers show success rates of SLIT up to 80% especially for inhaled allergens.

Improvement of symptoms can be seen as early as 2-3 months from start of the therapy. It is recommended duration of treatment is 3-5 years, hence, a firm commitment from the patient is necessary to help determine the success of treatment. Persistent effects from immunotherapy have been documented to last up to 10 years.
Symptoms can relapse if treatment is stopped prematurely.

How Do I Use SLIT?

2 sprays under the tongue daily is all that is needed. Generally we advise patients to avoid eating or drinking in the first 15 minutes after the spray to allow maximum efficacy of the treatment on the administered area. It has a pleasant pineapple taste.
 

How Safe is SLIT?

Sublingual immunotherapy is safe for children as young as 2 years old. Only about 1% of patients report temporary mild itching/ tingling under the tongue which resolves within 1 week.
SLIT is strongly recommended in World Allergy Organization (WAO) clinical studies.
So my dear reader, our 3As approach is what we advocate to acing your allergies. If you feel that it is time to act to alleviate your symptoms, speak to us already so that we can accompany you to ameliorate your sneezing. Okay with all these A words, you get the point of our 3 As – Avoidance, Anti-allergic medications, A novel therapy in Sublingual Immuotherapy
If you are interested to have an Allergy Testing, Skin Prick Test or Allergy Treatment, please drop us an email for appointment hello@dtapclinic.com.
Stay Safe and May Your Cleaning Always Be a Joyful One!


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