New Doctor - Allergy Testing

[super-sally888]

Hi Gals and Guys,

Saw a new Dr. last night. She is young (about my age... 36 - that's still young ), good patient rapport, very knowlegable (and I 100% agree with everything she said), and very up-to-date. She is an allergologist and she knows all about celiac (when she was doing her training in US she was part of a team that dealt with people who have celiac) and she confirmed that they don't test for it here (said I should push my endocrinologist on seeing if can arrange overseas testing - will see if I can do the enterolab test)... agreed it was a huge shame about the gastro who didn't do biopsy properly, and had very positive response when I said I look all this stuff up on the net. She believes I really have problems. She said even without 'testing' my case sounds pretty classic for celiac (even without me being thin), particularly the dramatic improvement in stomach problems by cutting out gluten. She didn't mince words about anything. Said allergies can be managed. "even mild asthma can have a serious attach and you'll be a gonner!" (that got my attention) Emphasised that I must have absolutely no gluten! Very impressed with her. Lucky me!

Anyway, she suspects I have asthma - testing for that (spirometry with and without brochodilator and also daily peak flow monitoring for the next few weeks). I was coughing in her office, and she said although my spirometry was in normal range it was way too low for an endurance athlete...

Also testing for IGE and says if that is positive, then we will do skin testing for other food allergies (which is also suspected). If it is negative, we will be doing elimination diet.... I guess the available testing here really is limited.

First impressions were good... Maybe I have found a great Dr. Let's see where it goes. Let's hope she doesn't migrate (we are losing so many doctors from here to US). Though if she does I'll be sure to tell you all so you can look her up.

Sally

[Ursa Major]

I am glad you found a sensible doctor, you must be relieved.

[tarnalberry]

Good luck with how that goes. I'm also cough variant asthmatic. I agree with her - it's something to take seriously, but also not something to be paranoid over. Pay attention to your body (just like you're already starting to do GI-wise), and you'll learn what *you* need to know. (I know that mine is triggered by particular types of odors, even if otherwise well controlled. I know that *every* cold will make it somewhat more 'brittle'. I know how to go about exercising aerobically to get it back to being more 'robust'. Etc, etc...)

[CMCM]

I guess I missed the intitial COUGH portion of this discussion, but I've got some stuff to add. In addition to my ongoing digestive problems, in my early 30's I started having unbelievable coughing problems. Also a kind of shortness of breath....sometimes I'd feel like someone was sitting on my chest. I'd get a horrible cough that would persist for months. Cold air would trigger coughing fits. I had an unbelievable array of tests....everything was so much like asthma, yet, I had strong lung function and asthma tests were negative. I even had an attack once that scared the dickens out of me....I could not breathe and I was panicking....I was given inhalers but they didn't really help all that much. Even about 3 years ago a doctor suggested Advair 2x a day as a preventative....well, maybe it helped slightly, but I couldn't be sure. I'n 57 now, and since this all started in my early 30's, I've had all sorts of testing to get to the bottom of this cough. One doctor suggested it was reflux causing irritation in my airways. Blah blah blah. Nothing helped....but...

GUESS WHAT? Eliminating gluten eliminated the cough!!!! Very quickly, too! No more inhalers. Almost zero coughing....but it starts to come back if I have gluten. The connection is obvious....to me!

[tarnalberry]

I guess I missed the intitial COUGH portion of this discussion, but I've got some stuff to add. In addition to my ongoing digestive problems, in my early 30's I started having unbelievable coughing problems. Also a kind of shortness of breath....sometimes I'd feel like someone was sitting on my chest. I'd get a horrible cough that would persist for months. Cold air would trigger coughing fits. I had an unbelievable array of tests....everything was so much like asthma, yet, I had strong lung function and asthma tests were negative. I even had an attack once that scared the dickens out of me....I could not breathe and I was panicking....I was given inhalers but they didn't really help all that much. Even about 3 years ago a doctor suggested Advair 2x a day as a preventative....well, maybe it helped slightly, but I couldn't be sure. I'n 57 now, and since this all started in my early 30's, I've had all sorts of testing to get to the bottom of this cough. One doctor suggested it was reflux causing irritation in my airways. Blah blah blah. Nothing helped....but...

GUESS WHAT? Eliminating gluten eliminated the cough!!!! Very quickly, too! No more inhalers. Almost zero coughing....but it starts to come back if I have gluten. The connection is obvious....to me!

lol - I'm on the other side of the fence - I have strong lung function, and my regular breath tests don't make me look asthmatic at all, but inhalers did help. (My case is complicated by my mother getting steroids for my lungs being underdeveloped in her last month of pregnancy.) So I'm kinda glad they explored that path, because too many doctors rule it out too easily, but I'm very sorry they didn't follow up any better. That was poor on their part!

[Helena]

tarnalberry, do you have any links to recommend on "cough variant asthma"? My respirologist . . whom I've been seeing for a number of years now . . . does not believe I have asthma. All the tests which require me to breathe out are normal. She keeps me on as a patient because based on breathing tests (requiring me to inhale) she believes I have mild vocal chord dysfunction which might *seem* to the patient as if it were asthma. My allergist, however (who has seen all the medical notes from my respirologist), says I have asthma--people with so many food and environmental allergies get asthma, he says.

I think they are both right . . . I think I have mild allergen-triggered asthma + mild vcd. I never realized that some respirologists recognize "asthma" even if breathing tests are normal and I'd be interested in reading more about it.

[tarnalberry]

sorry, I don't have any links; you'd have to do the google searching. it's something I talked to my allergists about - and they too expressed frustration at doctors not wanting to diagnos without wheezing or other 'classic' symptoms. I'm certainly not saying everyone with any symptoms has it - I'm clearly helped by inhalers.

you might also try searching on 'reactive airway disease', which is a superset(IIRC) of asthma. (basically, the airway, and bronchii get *very* twitchy (spasmically so) in response to a trigger - environmental, exercise-induced, illness-induced, etc.), and I cough - almost reflexively. when it's bad, it can get *BAD* (massive headache and muscle-ache inducing pain from the pressure that's generated by the process of coughing). when it's under control, it's practically non-existant. (I suppose my formal diagnosis probably should be RAD (reactive, which is different than restrictive), but it's treated similarly to asthma.)

I think one of the important things is to test *when you're at your worst*. And that doesn't always happen in the doctor's office. I think, regularly, my spirometry measured in the 103% range or so on most FEV's, but there's more to it than just percentages - there's ratios and falloffs and patterns... I don't know how to read them, only that there's more to them than meets the eye.

[Helena]

Thanks so much for the info. I'll try googling "cough variant asthma" and "reactive airway disease" as you suggested (although coughing isn't a major issue for me). My respirologist did send me for one of those methacholine challenge tests which came back negative.

I don't generally wheeze----only slightly when exposed to cigarette smoke. But sometimes I do get chest tightness (especially when cycling in the fall--the combo of exercise + cooler air + mould spores in the air gets to me), and Ventolin does help on the few occasions that I use it (I mostly just wait it out if it isn't too bad.) My respirologist renews my inhaler even though she thinks that I don't need it for asthma. (Also, I might need it in case of an allergic reaction to food.)

When I was a kid, I definitely had asthma . . . I spent a lot of time in the emergency room and from time to time was admitted to hospital and stuck in an oxygen tent. Once I started to take asthma medication in the first grade, I managed to stay out of the hospital. I seem to have largely outgrown it thank goodness . . .although I didn't "outgrow" my food allergies. And all of my environmental allergies are still with me.