Allergies, Then and Now

Another day, another doctor. Sighhhhh... Today was the allergist.

As I grew up, to me allergies meant poison ivy. I'd heard not everybody was allergic to the stuff, but I was just one of the lucky ones. Now I know I'm one of the lucky tens of millions. I learned to avoid the plant while wandering around on the resort, but it seemed to jump out and get me anyway, no matter how careful I was. Turns out the dog roamed around the resort too, and petting her defeated all our other precautions. About the same time we moved into town, I was put on an experimental regimen of poison ivy allergy shots. I thought they worked, still not connecting exposure mechanisms and the odds decreasing with "civilization". Next time I was exposed, it was just as ugly and itchy as ever.

I thought I might be allergic to chocolate, since I was binging on the stuff and breaking out in pimples at the same time. A doctor disabused me of that notion. Just as well, since I'd never give up chocolate willingly. Perhaps a world-wide shortage bordering on extinction of the plants....

My weird reactions to a couple of medications are listed under "allergies" on my chart, but the symptoms don't match any typical allergy reactions. I shrug it off and just assume everybody knows it still means I need to stay away from them and allergy is a handy word used as a shortcut to explain why.

As a result of all these experiences, I spent my first 40 plus years believing I had no allergies. Then I had a "cold" that wouldn't go away, and finally knuckled under to go in and see a doctor. I was informed that I had asthma and needed allergy testing. Asthma? Me? I don't wheeze. I'm not short of breath. OK, yes, I'd been coughing for a couple months, but asthma?

The doctor who did the testing was a bit cocky, absolutely sure I was going to turn out to be allergic to my cats or dogs. I was just annoyed by her assumptions, and felt thoroughly vindicated when the results were completely negative. But my "cold" was still there, so she progressed to the patch test. They glued a patch about 5" x 10" onto the middle of my back between the shoulder blades, told me not to scratch, and come back in a few days. By then I was starting to itch. As soon as she peeled of the patch, she immediately knew I was allergic... to the medical adhesive used to keep the patch in place! It was so bad she had to put the grid template up against my back, blocking out all the in-between spots that were red and swollen, to see what was going on in the little squares where the allergens were. Aha! There was one: nickel. Seems it goes along with being half Scandihoovian. I immediately applied clear nail polish to the metal parts of my watch and eyeglasses where they came in contact with the skin.

But there was much more going on than that. At the time I was breeding tropical fish. One of the best ways to do that is to feed high quality foods. Forget flakes and pellets, and shell out for critters, like bloodworms. Frozen are best, but dried will do as second choice. We were feeding both. You're wondering what bloodworms have to do with a nickel allergy, right? Well, to commercially cultivate them for sale to fish hobbyists, you put them in an environment rich in nutrients and waste, aka sludge, which concentrates such things as heavy metals, including nickel. So the worms are rich in it too. Skin contact with frozen ones produces contact dermatitis, and you're up for a heap of misery if you have the allergy and absently rub the corner of your eye before you get to soap and water. The dries ones are another issue. The crumbs get kicked up into the air, breathed in, and create the neverending "cold". Aka asthma. Since I was the primary family member taking care of the fish at that point, scratch that food source, meaning scratch that hobby.

Later experiences showed that bloodworms in a normal lake or pond environment don't have the nickel concentrated in their environment and I don't need to avoid them. So we can still have goldfish in the backyard ponds. And they'll breed with the changes in temperature, no expensive foods needed.

Some time after all that died down, I started noticing my arm would itch when I'd finished carrying a heavy box, usually braced on my hip with pressure on that arm. Cardboard boxes were the worst, since the edges of the cardboard added abrasiveness to the mix. I decided to mow the front lawn one day (back when I still had knees) and by the time I finished my hands were so swollen and sore I couldn't move them for hours. Something was weird. I was allergic to work!

I didn't have the terminology for whatever was going on then, not even to recognize it as an allergy. But I lucked out. My daughter had married a super fellow who, among his many wonderful attributes, happened to have a mother who had the very same thing. She'd been to her doctor and found out that it was called dermatographism. It's an inappropriate histamine response to pressure or irritation of the skin. Call it hives, because while it's shaped to the offending irritant rather than a cute little circle next to another cute circle next to.... well, it's the same mechanism.

Benadryl didn't help. It was very good however at putting me to sleep behind the wheel. She was taking something better, but I hadn't gone in to my doctor yet to get a prescription, and besides, it was very expensive. Back then I had insurance, but the high deductible made it practically useless. Somebody gave me a Claritin to try at a party, and boy was there a difference! It took over an hour to kick in, but it really did. So I went in and got my own prescription. $83.00! Per month! That hurt almost as much as what it was treating. Lucky me, though, it came off its prescription patent about four months later, and within a year was very affordable in bottles of 60 tablets under a generic label. It's on the shelf with my other must-take-every-day-regardless pills.

How time flies. Today my allergist tells me that was about ten years ago. And the reason I was there today is that it has become less and less effective. I tried calling up my co-mother-in-law to find out what medication she had switched to, and as a result tried Allegra. No difference. I tried that one whose name starts with a Z - the name escapes me - and again, no difference. Both are now off patent, and thus somewhat affordable. But generic Claritin is even more affordable and since the others don't do much, why spend more? I'm back on Claritin. My regular doctor informed my there's something better out there new, still on prescription, so I went in to see if I could score that. That's all I wanted, just score a better pill.

They sent out a questionaire about all kinds of possible environmental allergens, 5 pages worth. I glanced at it, decided it could wait until just before the appointment, and set it aside. A phone call mentioned that I needed to go off the Claritin three days before the appointment. That was two days before, and I'd already had a pill that morning. Nice timing! Of course, going over the form later that night, I found in the not-so-fine print a whole list of medications to discontinue however many days before going in. Oh, yeah, hey, I guess reading it at the time might have been a better idea. But she thought I might be OK anyway, with the stuff out of my system long enough to find out what I react to.

And that's where we started today. I got a prick of histamine under the skin so they could tell if I was reacting. Then they took my blood pressure, weight, all that good stuff. The BP cuff was really tight, being run by a machine. It took pumping up twice to register properly. By the time they removed the cuff, that arm was already beginning to itch. It was spectacular by the time the doctor walked in, while the site of the histamine prick was just a teeny tiny red spot. Very unimpressive. But now I had something else to show the doctor what I was talking about.

His theory is that people with dermatographic uticaria have an underlying allergy. Unlike red eyes and runny noses, we lucky folks get blotchy hives in reaction to pressure or irritation. He wanted to test me on a variety of possible allergens. I figured I might as well humor him, since I wasn't having to pay for it. So my arms were marked with blue lines and dots, and bits of stuff injected just under the skin in a variety of places. The theory is that I'd react to everything at first, but after about 15 minutes, the initial swellings would go away and any that remained would be what I was really allergic to. Sure, why not?

After several minutes, all I was reacting to was... dogs, cats, mice, dust mites, tree pollen, grass pollen, mold.... I was tempted to disbelieve I could possible be allergic to all those things. Maybe I was just still doing my usual puffy thing to all of the sites. Eventually, however, there were about 5 sites with no reaction, and even I could see a difference.

Next came education about how to get the allergens away from me. They were smart enough to realize that the dog and cat are not leaving, but stressed that I should set up a "free zone" where I'd be most clear from everything for the most amount of time. That meant my bedroom. That meant new pillows with covers protecting against dust mites, covers for mattress and box springs, washing bedding - all of it! - in hot water weekly, using the AC instead of windows, washing after pet contact, leaving my clothes outside my room and showering before bed, getting HEPA air filters...

OY! This is only going to be about 80 extra hours of work a week, right? That's so going to happen. But I did go shopping for some of the things that can be dealt with that way: $200.

There's a prescription - what I came for, right? - but for one of the OTC meds I've already tried, only twice a day since once clearly wasn't cutting it: my allergist's words. When I picked it up, the pharmacist cautiously asked me if I realized he'd prescribed twice a day on this pill, because, "We usually don't see that."

I know. I'm special. Lucky me. I itch.

I need to try that for two weeks. If that doesn't work, there'll be the other OTC to try for two weeks as well. Once those both fail, he can then prescribe the "good stuff", the stuff that costs about $100/month, with some hope that my insurance will then cover it since nothing else works. Those are their rules. Of course, I can take the paper prescription he printed out for me and go to a Canadian website he named and get about 100 pills for $50 while I'm waiting for insurance coverage. It seems to be a common problem.

And I can chose allergy shots, now that they know what I react to. We'll discuss that in a month when I go back.

Meanwhile, I've washed most of the blue lines and dots off my arms. The rows of red spots are still there, and there's still some puffiness with the ones I reacted most strongly to. I'll find out in the morning if they actually go away. The only good part of all those prick tests is that none of them ever itched. Not one. Bless them!