Cold weather sometimes leads to allergy misdiagnosis

Janna Tuck
Janna Tuck

According to the American College of Allergy, Asthma and Immunology, allergies are the sixth leading cause of chronic illness in the U.S, affecting more than 50 million people annually.

Contrary to what some may think, there is no seasonal break for most of these patients, Janna Tuck, MD, an allergist with Allergy Partners in Cape Girardeau, Missouri, told Healio Family Medicine.

“Winter allergies, with some exceptions, are to the same things that happen the rest of the year, such as dust mite and mold allergies. There are a lot of people who have year-round allergies and don’t think they should, because it’s winter.”

Compounding the confusion, she added, is that many allergy symptoms mirror those of the common cold or influenza.

“Even for me, as an allergist, it’s hard to discern the difference from time to time,” Tuck said.

To help primary care physicians better understand allergies, Healio Family Medicine asked Tuck, a spokesperson for the American College of Allergy, Asthma and Immunology, to discuss tips for diagnosis and options for managing the condition. – by Janel Miller

Question: What questions can PCPs ask patients to distinguish between colds, influenza and allergies?

Answer: PCPs are at an advantage because they see patients horizontally. That is, they get to know their patients over time. When they see patients over and over again for sore throats and colds, if the symptoms are going on for weeks, or if a patient comes in saying he or she has a sinus infection and is experiencing a lot of nasal pressure but not a lot of color in their drainage fluid, in all these instances, the PCP needs to start thinking it might be allergies causing the discomfort rather than a cold or influenza. PCPs who don’t see their patients frequently, such as those at convenience clinics, may miss the subtlety of what’s going on medically over time.

Q: How does cold weather make allergies worse?

A: Cold air can make a patient have a runny nose which seems like allergy or a cold. Dry air in the winter increases congestion and the sensation of congestion for many people. These situations can increase nasal irritation leading to worse allergy symptoms.

Q: Parties and entertaining during the winter will lead to some patients claiming an allergy to alcohol. Is this accurate and what should PCPs tell their patients?

A: There are people who have an intolerance to alcohol that shows up as a stuffy nose, headache and/or flushed skin in the neck and upper region of the body immediately after drinking. Not all symptoms have to be present — it can be one, or a combination. This is not because the user is allergic, but rather because of the reaction to the vasoactive amines produced during the fermentation process. This intolerance is more likely to occur with darker alcoholic beverages. Such patients can change their beverage and change the amount they intake.

Q: How can PCPs and patients work together to keep the discomfort from allergies to a minimum?

A: Patients and PCPs who have a very good idea of what the source of the allergy or allergies are can come up with an action plan. Let’s pretend a patient has a cat allergy and they are going to a friend or relative’s house that has cats. PCPs should tell the patient to take an antihistamine at least an hour before going to the person’s house so it has time to work. These patients should also avoid contact with the cat and limit the exposure to it. Once the patient is back home they should change their clothes, take a shower, and rinse their nose with saline as soon as possible and if needed, take another antihistamine. Or if possible, patients should start taking their allergy medication, a few weeks before the worst time for exposure, so they are in an ideal position before that peak season or individual event starts.

Q: Are there instances when a patient should be referred directly to an ED for allergies?

A: If the patient tells you they’re breaking out in hives, they’re wheezing, they’re vomiting, they should go to the nearest ED, because anaphylaxis is much harder to treat if you wait. It’s better to be safe than sorry.

Q: When should a PCP refer a patient to an allergist?

A: Patients whose condition is difficult to control with traditional allergy medications, or those who don’t like taking medications, can be referred to allergists for allergy shots. Allergists can also be useful in determining the source of the allergy when the PCP and/or patient is unable to pinpoint the cause. A lot of patients think they have to suffer from allergies, but they don’t have to. A person’s quality of life goes down when they don’t control their allergies. But allergies can be controlled, and a patient can have a productive life.

Reference: American College of Allergy, Asthma and Immunology. Allergy Facts. http://acaai.org/news/facts-statistics/allergies. Accessed Dec. 13, 2017.

Disclosure: Tuck reports no relevant financial disclosures.

Janna Tuck
Janna Tuck

According to the American College of Allergy, Asthma and Immunology, allergies are the sixth leading cause of chronic illness in the U.S, affecting more than 50 million people annually.

Contrary to what some may think, there is no seasonal break for most of these patients, Janna Tuck, MD, an allergist with Allergy Partners in Cape Girardeau, Missouri, told Healio Family Medicine.

“Winter allergies, with some exceptions, are to the same things that happen the rest of the year, such as dust mite and mold allergies. There are a lot of people who have year-round allergies and don’t think they should, because it’s winter.”

Compounding the confusion, she added, is that many allergy symptoms mirror those of the common cold or influenza.

“Even for me, as an allergist, it’s hard to discern the difference from time to time,” Tuck said.

To help primary care physicians better understand allergies, Healio Family Medicine asked Tuck, a spokesperson for the American College of Allergy, Asthma and Immunology, to discuss tips for diagnosis and options for managing the condition. – by Janel Miller

Question: What questions can PCPs ask patients to distinguish between colds, influenza and allergies?

Answer: PCPs are at an advantage because they see patients horizontally. That is, they get to know their patients over time. When they see patients over and over again for sore throats and colds, if the symptoms are going on for weeks, or if a patient comes in saying he or she has a sinus infection and is experiencing a lot of nasal pressure but not a lot of color in their drainage fluid, in all these instances, the PCP needs to start thinking it might be allergies causing the discomfort rather than a cold or influenza. PCPs who don’t see their patients frequently, such as those at convenience clinics, may miss the subtlety of what’s going on medically over time.

Q: How does cold weather make allergies worse?

A: Cold air can make a patient have a runny nose which seems like allergy or a cold. Dry air in the winter increases congestion and the sensation of congestion for many people. These situations can increase nasal irritation leading to worse allergy symptoms.

Q: Parties and entertaining during the winter will lead to some patients claiming an allergy to alcohol. Is this accurate and what should PCPs tell their patients?

PAGE BREAK

A: There are people who have an intolerance to alcohol that shows up as a stuffy nose, headache and/or flushed skin in the neck and upper region of the body immediately after drinking. Not all symptoms have to be present — it can be one, or a combination. This is not because the user is allergic, but rather because of the reaction to the vasoactive amines produced during the fermentation process. This intolerance is more likely to occur with darker alcoholic beverages. Such patients can change their beverage and change the amount they intake.

Q: How can PCPs and patients work together to keep the discomfort from allergies to a minimum?

A: Patients and PCPs who have a very good idea of what the source of the allergy or allergies are can come up with an action plan. Let’s pretend a patient has a cat allergy and they are going to a friend or relative’s house that has cats. PCPs should tell the patient to take an antihistamine at least an hour before going to the person’s house so it has time to work. These patients should also avoid contact with the cat and limit the exposure to it. Once the patient is back home they should change their clothes, take a shower, and rinse their nose with saline as soon as possible and if needed, take another antihistamine. Or if possible, patients should start taking their allergy medication, a few weeks before the worst time for exposure, so they are in an ideal position before that peak season or individual event starts.

Q: Are there instances when a patient should be referred directly to an ED for allergies?

A: If the patient tells you they’re breaking out in hives, they’re wheezing, they’re vomiting, they should go to the nearest ED, because anaphylaxis is much harder to treat if you wait. It’s better to be safe than sorry.

Q: When should a PCP refer a patient to an allergist?

A: Patients whose condition is difficult to control with traditional allergy medications, or those who don’t like taking medications, can be referred to allergists for allergy shots. Allergists can also be useful in determining the source of the allergy when the PCP and/or patient is unable to pinpoint the cause. A lot of patients think they have to suffer from allergies, but they don’t have to. A person’s quality of life goes down when they don’t control their allergies. But allergies can be controlled, and a patient can have a productive life.

Reference: American College of Allergy, Asthma and Immunology. Allergy Facts. http://acaai.org/news/facts-statistics/allergies. Accessed Dec. 13, 2017.

Disclosure: Tuck reports no relevant financial disclosures.