Saturday, March 11, 2017

Allergies?

Sometimes I don't know whether to trust my doctors, particularly when I don't understand them.

I have a relatively recent history of allergies, considering my age. As a kid, it was just poison ivy. Who doesn't get that, living where it's ubiquitous and the family dog wanders at will through it and then comes looking for affection? At least, that's how I explain those cases I got long after I learned to identify and avoid the plant. My parents always thought I was just careless, of course.

Back in the mid 90s I developed an allergy after getting really involved, along with my youngest, in a tropical fish hobby. We had a fish room in the basement, joined a club, bred both fish and plants, won awards. Then one day, while working on my income taxes, apparently after feeding the fish and not washing my hands, I rubbed one of my eyes and got a strong irritation in it. One might even call it blistering. A few weeks later, I was repackaging some of the special foods we fed the fish to keep them in top breeding condition. I can't remember why it was being done in my mother's kitchen. I started coughing, figured it was because of the dust raised by the dried worms, and Mom decided to "help". She turned on the ceiling fan, thinking she was clearing the dust out of the room for me when all she did was raise more. I had to leave the room for over an hour.
 
A doctor identified my symptoms as asthma. It was time to see an allergist. The results were unexpected.

She was convinced I was allergic to our cats and dogs, maybe pollen. Those were the most common. She did the skin test where she injected 8 of the most common allergens and waited confidently for results to show up in a few minutes. Nothing showed.

I think she was annoyed.

We agreed to a patch test, where a big adhesive patch with dozens of embedded allergens was fastened to my back for 4 days. It got a little itchy, but I tolerated it. I can't describe the sound she made when she peeled the patch off, but it wasn't anything resembling happiness. The first thing we found out was that I was allergic to the medical adhesive holding the patch on. In other words, my back was one big nearly solid red mess. She had to dig out a plastic grid form, laying it over the red blotch, and study all the holes in the grid to try to figure out where the red wasn't.We found a second thing I am allergic to: nickel. Unusual, yeah, unless you happen to be half Scandinavian. For us, not so much.

In addition to ruining an enjoyable hobby, a little research revealed that those ultra-rich breeding-conditioning foods, mainly bloodworms, are harvested commercially from effluent. Think concentrated sewage. Think concentrated all-kinds-of-stuff, including nickel.  No more hobby, no more asthma. Ever. And no more jewelry with nickel, no replacement knees out of stainless steel. I got the special order kind.

A few years later the world got itchy. Skin irritation, pinching, rubbing, tight clothing including shoes without super thick socks, all turned into red, raised, itchy patches. One day I mowed the front yard and just from the vibration from holding the mower handles my hands swelled so much I couldn't use them until the next day, and even they were still tender. Another doctor visit, different allergist recommended this time after my regular doc diagnosed allergies. Of course, without insurance, I spent a few years just taking Claritin daily instead of seeing one. Lucky for me, after only 3 months of paying $81 per each 30 pills, it came off of patent, and generic versions were available OTC. While it was mildly amusing to say I was literally allergic to hard work, I preferred fighting the itchiness.

It took about another three years to get insurance again, and I took advantage of it by seeing that other allergist. He gave what I had a name: dermatographic uticaria. That's a big mouthful of jargon for my kind of hives. His office had me stop taking the antihistimines for several days before seeing him. I wondered if I'd be symptomatic enough by then that I could show him what was going on. I need'nt have worried. Just the blood pressure cuff raised a huge welt. Skin tests diagnosed dog, cat, pollen, dust mites, and black mold as other things to avoid. Their approach was two-fold: how to avoid everything (not gonna happen) and allergy shots. I could continue the generic Claritin, but another new drug was just out in generic OTC form and it was more specialized for the hives: Ceterizine, or Zyrtec. I switched. I even went with his recommended double dose. And the shots lasted until after the insurance ran out again. By then I was down to monthly shots, at my cost of $30 a visit. I could handle that. But those vials eventually ran out, and - sticker shock!! - my next refills would cost me $3 grand.

You know, if I had that, I could have afforded insurance.

So no more shots. Kept the dogs, still lived with one or more cats, pollens still wafted by, mold still sprouted here and there, and dust mites... well, I'm sure they're still nearly as abundant as ever, despite different protective bedding. The symptoms changed, however. No more hives. Some drippy nose, tickley throat kind of stuff took over the symptom menu.

The years rolled by. I qualified for Medicare, got supplemental insurance, took care of a bunch of other stuff. I finally decided last month it was time to check in with an allergist again, see what was what.

This time I was told to stop antihistamines for 10 days before my appointment. While dreading that, I decided to add an extra day to that, since I was still taking the double dose I'd been on for years. Not too much happened. A scratchy throat for a couple days, a bit of a cough, that was all.The second this allergist heard my initial diagnosis of dermatographic uticaria, she bluntly stated it meant I was allergic to everything. She used her fingernail to scratch across my back, set a timer, and had a staff member come back to check.

Nothing.

Hmmmm....

They marked about 40 dots on my back, injected allergens at each location, set another timer, came back, and....

Nothing.

This time she sent me out to a lab to donate 8 vials of blood for testing. Because one of my meds is a beta blocker, they couldn't give me the larger doses of the various histamines which are the next step in the testing. If I reacted by going into anaphalactic shock, even if they used an epi-pen, which they keep on hand, the beta blocker would slow down it's getting into the system in time to save my life.

OK, lab it is then. Full screening, everything they can test for. I mean the works!

I waited for the call back to see where my allergy levels were. It took over a week. I got a very puzzled doctor on the phone. It seems my blood was full of histamines, meaning I was allergic to something. Maybe a whole lot of somethings. But there was absolutely nothing I tested positive for. Nothing they could do for me.

Nada.

She sounded disappointed. Unsolved mystery? Or no patient to treat? Who knows?

I still get an occasional drippy nose, dry throat cough. About two days after the blood draw I started getting mild symptoms again. So I'm left to wonder: do I still have allergies? I mean, besides medical adhesive which I know I'm still allergic to.  Was the 11 days off my meds not enough to clear my system? At any rate, I'm still occasionally taking cetirizine, just limiting it to one a day.

And still wondering.

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