How do you tell whether an attack is a cold starting, an allergy attack or non-allergic rhinitis from some other trigger?
I had a bad sneezing fit totally out of the blue a few days ago; went on dripping all night. OK the next day, then similar attack next evening. Mild headache. Pollens are very early this year here, so I couldn't make out what was going on.
Decided in the end it was an odd, short-lived cold. Luckily, symptomatic treatment is about the same regardless: Old (type 1) antihistamines, decongestants & OTC cortisone nasal spray. And it was over in 3-4 days!
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Tonitru
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Your symptoms sound exactly like what I had last year. Only it lasted a lot longer , I wasn't sure what caused it, I put it down to a head cold.as had mild head aches with it. Don't think it was linked to my Asthma.
I agree, my recent episode in the end seemed more like a cold or other virus. There are 100+ rhinoviruses (common cold) alone, plus some other viruses with similar symptoms, so there's plenty of room for variations! My attack (whatever it was) came on without warning, was accompanied by a mild headache, was mostly absent during the day & came back at night, lasted about 3-4 days, so I'm inclined to say "virus", but not the standard 7-day cold.
I have non-allergic asthma but I also seem to have hayfever. I was very confused by this but read up a bit and it is possible!
My asthma consultant however is quite sceptical about the hayfever. He has suggested it's a series of mild viruses. I can see what he means in terms of effect on asthma - I now think that what I believed was pollen affecting me was maybe something else tbat happened to be around at tbe same time. However, I think I still do have hayfever in spring and that's because the fexofenadine and flixonase spray are so effective against it, and because it is strongly seasonal. I can't imagine antihistamines would help a cold or non-allergic rhinitis much.
Patch/scratch tests for pollen, mould, etc. allergens are quite reliable, less so for food allergies. Besides being tested for seasonal pollens, I have had to learn about the local flora - e.g. where I live, the Japanese Plums usually blossom in in Feb-Mar, but I am actually allergic to Alder & related spp., which blossom at the same time. A friend of my father's was instrumental some years ago in getting the medical profession to recognize leaf mould allergy (late fall), so you may have allergies that are not on the official Test List.
Once you have a good handle on seasonal allergies, it's easier to distinguish them from the 100+ rhinoviruses. But not always, see my recent posts.
How well do you find flixonase spray (Fluticasone) works? In one paper, it rated slightly better than the traditional beconase (Beclometasone), and it's non-Rx where I live. I am currently trying Nasacort (Triamcinolone acetonide) because it was on sale; my first impression is, not quite as good as flixonase.
Haven't tried Fexofenadine (Allegra), I rely on cetirizine (Reactine), then add an old-fashioned antihistamine + decongestant (e.g. Dimetapp, chlorpheniramine + sudafed) if I get a bad attack.
I have been told by some drs that allergy tests are frustrating because negative ones don't seem to necessarily rule out allergies. I have never managed to get a positive test but seemed to be reacting near some trees, including with asthma. However, I do tend to react to strong scents including flowers, and that's not really an allergy but more a respiratory irritant, so it is confusing.
With me it is a bit odd as when I was first tested I had a very high total IgE of 1028, which suggested some allergies. It then came down but was still higer than normal (83), and now is generally normal. I think that confused everyone but now I am on antihistamines etc I wonder if that was the hayfever side showing itself? My asthma otherwise does not seem to be allergic given I have so many symptoms with normal IgE - they tested me for all sorts trying to see if one of the new biological treatments would work. And leaving aside the mystery pollen, my triggers are generally weather and irritant-based eg paint, scents etc.
I have found Flixonase good though I don't think I have tried other prescription ones. A previous consultant did advise me to start it earlier than i thought I needed it and that worked very nicely last year. He did seem to think i might have allergic asthma triggers (but was also keen to say he wasn't an asthma expert - a shame as he was lovely and really listened, but also good enough to refer on). He also pointed out that even if I didn't have pollen setting me off, the post-nasal drip effect if I didn't treat the hayfever was likely to cause problems with asthma so I should be on top of it anyway. I tried OTC antihistamines for the hayfever first but they didn't seem to do the trick.
I have also heard about the uncertainty with allergy tests - and experienced them. A GP's test kit may be used so seldom it has deteriorated. Even a good allergist might be testing with, say, Western Alder pollen when you're allergic to Eastern. Food allergies are the least reliable, unless really severe; according to one set of tests I should have died years ago from eating salmon and walnuts and petting cats! What I generally hear from allergists is that skin tests have to be combined with careful observation of seasonal variation or other exposure, which it sounds like you've been doing.
There's also the old antihistamine challenge, suggested by my pharmacist: stop taking any long-acting, 2nd-generation AH such as Allegra for 2-3 days (or even if you do take it keep the dose low). As soon as you sense symptoms take a 1st-generation AH such as diphenhydramine/Benadryl (50mg), chlorpheniramine maleate / Clor-Tripolon (4-8 mg) or Cyproheptadine (4-8 mg) (Rx in USA, OTC in Canada, UK & AU): these generally act fast, so if they suppress the symptoms, you're _probably_ dealing with an allergy. Still some uncertainty, as these AHs also help non-allergic rhinitis, & even a cold, by drying up mucous membranes. In my experience, chlorpheniramine maleate by itself is the best test as it has the least drying effect. Although the literature says the 2nd-generation AHs are slightly more effective than the older ones, that's an average - Your Mileage May Vary - and my old pharmacist definitely felt the older ones such as I named are more effective, or at least additive to the newer ones. Consult your pharmacist as these older meds may not be on the open shelves.
Good luck, as it can be a big problem distinguishing these different but similar conditions, as I'm finding myself. Did I mention my father's old friend who had a heck of a time years ago convincing doctors that he was allergic to leaf mould? Only summer pollens - hay, ragweed, etc. - were recognized. Eventually he found an allergist who would make him a desensitizing vaccine -- and his autumn symptoms went away!
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