Blog About Health & Medicine

Inhalation challenge (nasal and bronchial provocation)

Because skin tests sometimes miss the mark entirely, some doctors use an inhalation challenge for allergy to inhalants. To test for mould allergy, for instance, a small amount of dried, powdered, sterilized mould is placed on the end of a toothpick and sniffed. Symptoms are expected to appear within five minutes if the individual is allergic to mould.

So far, these tests all carry an element of anxiety – the fear that you will react. No wonder – that’s the whole idea. The ideal allergy test, from the patient’s point of view, is one that’s accurate, yet doesn’t risk a reaction. Enter the RAST test.

RAST (radioallergosorbent test)

The RAST test measures the amount of IgE in your blood. It’s certainly safe, since the test is conducted on a blood sample in the laboratory. Anaphylactic shock, which occasionally occurs with skin testing, is impossible with a RAST test (although you still have to endure the discomfort of a needle). RAST is more sensitive than a puncture or scratch test.

‘One of the criticisms of the RAST test is that it’s expensive,’ comments Dr Jonathan V. Wright, from Kent, Washington, who uses the RAST test a great deal. ‘Unfortunately, no other test comes as close to it in accuracy.’

A RAST test measures the amount of IgE (allergy-provoking antibody) in the blood. In contrast, skin tests merely measure the weal-and-flare – indirect evidence of IgE activity. More precise measurement of IgE activity by RAST means that, if needed, allergy injections can be started at a customized dose, and relief can be expected in three or four months. In contrast, allergy injections based on skin tests are begun at a lower estimated dose and gradually increased until the optimal dose is reached, which sometimes takes six months to a year. (Incidentally, IgE levels run higher in smokers than non-smokers, for some unknown reason. Be sure to let your doctor know if you smoke so that factor can be taken into consideration when interpreting your RAST test.)

For all its advantages, the RAST test is somewhat controversial. Aside from increased cost, doctors must resist the temptation to rely on it too heavily for diagnosis. For instance, many people react positively to both skin and RAST tests for cereal grains, but eat them routinely with no ill effects. Like any allergy test, the RAST is meant to supplement, not replace, a good, thorough medical history. Consequently, many doctors feel that the most accurate way of testing for food allergy is still elimination and re-challenge.

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Nausea nearly always suggests food allergy. You may not vomit every time you feel nauseated – but you may feel like you’re going to. And that can certainly make you less sociable and productive.

Consider the case of a thirty-two-year-old woman who had felt nauseated nearly every day of her life since childhood. The only way she could keep from vomiting in public was by taking large doses of antihistamines. Car travel was an ordeal – a two-hour trip required several pit stops.

‘She became depressed, lethargic and lost her zest for life,’ say the doctors who treated her. ‘And her relationship with her fianc? was strained because she was becoming short-tempered and losing her sex drive because of her constant nausea.’

When the woman fainted after drinking a cup of tea, she was sent to a hospital for neurological tests. The doctors also decided to investigate the possibility of food allergies.

‘On the basis of her dietary history, tea was excluded from her diet, and the vomiting and nausea ceased,’ say Drs Ronald Finn and H. Newman Cohen. ‘By avoiding tea she has been symptomless for five months, and is able to travel long distances by car without feeling sick’. (Lancet.) And oh, yes – she got married.

Most people have far less trouble than this woman did in figuring out that a particular food is making them sick. Nausea usually occurs shortly after you’ve eaten something that disagrees with you rather than hours later. So it’s easy to notice a pattern. But if you occasionally feel nauseated for no apparent reason, you may need to keep a diet diary to trace your nausea to the offending food.

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Blood pressure is affected by seventeen known variables. Smoking, over-weight, salt consumption, stress, use of oral contraceptives, exposure to lead and cadmium – these, among other factors, are all possible causes of hypertension. To that list we may eventually add allergy.

A few years ago, Dr Lloyd Rosenvold, of Hope, Idaho, noticed that some of his patients developed high blood pressure from allergy to certain foods. Another doctor, George Fricke, of Sacramento, California, studied a group of twelve hypertensive people – some with blood pressure as high as 210/140 – in whom elimination of allergic foods brought blood pressure down to normal. And in a study of food allergies and migraine, Dr Ellen Grant, a neurologist in London, discovered that when a group of fifteen hypertensive people avoided migraine-producing foods, their blood pressure also returned to normal (Lancer).

Surprising findings? Not really. High blood pressure is more than a simple matter of getting too much salt in the diet. After all, we all know someone who salts his or her food heavily and has normal blood pressure. Whether blood pressure rises or not seems to be a matter of individual sensitivity to many factors, some of which doctors haven’t yet identified clearly. Allergy, it seems, is one of those factors, and its presence could help to explain why certain foods or habits raise blood pressure in some people but not others.

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Most people think car sickness is just one variety of motion sickness – the nausea and dizziness that attack some travellers on aeroplanes, buses and cars. A few people with car sickness, however, may be reacting to car exhaust fumes, moulds and dust in the car air conditioner or the odour of new vinyl upholstery. All those triggers can make an allergic traveller feel nauseated and sometimes dizzy or headachy.

But even if they don’t feel outright nausea, people with allergy induced car sickness can become irritable and easily annoyed by delays or other drivers’ mistakes. And there are a host of other possible symptoms. They may feel dopey and under-react to traffic situations. Perceptions may dull and reflexes slow down. Vision may blur. The driver may underestimate the time and distance needed to stop, or even fall asleep at the wheel.

If you get sick, tired or irritable on car trips, take less heavily traveled routes to avoid breathing heavily polluted air. Above all, don’t drive in the wake of a bus or diesel truck if you can possibly avoid it.

When you stop to fill up, close the window while the service station attendant fills the tank. At self-service stations, wear a handkerchief over your nose and mouth to block out fumes while you fill your tank. (Be sure to remove the handkerchief when you approach the cashier, so he won’t mistake you for a robber!)

Allergic people should have their car air conditioners cleaned regularly before and during the hot weather season to eliminate mould and dust. As for sensitivity to vinyl car interiors and upholstery, you’ll be less likely to get sick if you buy a car that’s at least two years old. As vinyl ages, it gives off less odour.

Much of the fatigue that’s blamed on ‘highway hypnosis’ may actually be due to car-related allergies. Following these precautions will not only help you arrive at your destination feeling well, but will also cut down your chances of a traffic accident along the way.

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The pain suffered in a personal tug-of-war with allergy is like the pain of any struggle – partly physical and partly psychological. Anxiety, depression and fatigue may be direct results of an allergic reaction somewhere in the body. Or they may result from the many aggravations of dealing with a chronic allergy: sticking to a restricted diet. Vigilance against airborne allergy triggers. The fear that no matter how careful you are, you’ll get zapped anyway. The sense of alienation from your non-allergic spouse, family or co-workers. Resentment over your bad luck. And above all, the desire to lead a normal life again.

Those are the ‘effects of the effect’, as one highly allergic person put it. And easing the psychological and emotional effects of being allergic goes a long way towards successful, drug-free relief from the allergies themselves. In the case of asthma, for instance, one doctor observed that people who have uncontrolled apprehension – panic over breathing problems, fear of recurring symptoms and so on – tend to over-use steroids and other asthma medication. And they’re more likely to be frequently hospitalized for their condition, adds Jerald F. Dirks, Psy. D, former chief of clinical psychology at the National Jewish Hospital and Research Centre and the National Asthma Centre in Denver.

Actually, a little anxiety over allergy is useful – it motivates an individual to do something about the problem, rather than just roll up his or her sleeve for an injection or swallow a pill. Too much anxiety, on the other hand, can lead to an unhealthy with the illness, to the point where you begin to neglect the other important aspects of life – family and friends, career goals, travel plans, hobbies. In the case of food allergies in particular, over-anxiety can lead to what one doctor calls ‘food neurosis’ – an all-consuming obsession with what you can and cannot eat, and paranoia about eating away from home.

‘Allergic people can easily slip into the me versus them attitude if they’re not careful,’ says Iris R. Bell, a psychiatrist in San Francisco. ‘Many people begin to look at their environment as their enemy. Soon, they feel that everything they eat or breathe might make them sick. And it’s a very difficult position not to get yourself into, because it’s true that certain things can make you sick,’ she acknowledges.

‘But too much worry over allergies can make allergies worse,’ Dr Bell continued. ‘That may explain why some people feel worse when they first begin to pay attention to their diet or environment. One theory is that they develop what psychologists call a “conditioned response”. After one or more symptom-causing encounters with an identified allergen, they may break out from simply looking at chocolate, or start to feel sick when someone nearby reaches for a cigarette.’

The secret to avoid ‘worrying yourself sick’ is to learn to cope with allergies realistically, rather than to let yourself slip into the role of a lonely exile. And coping is easier if you avoid focusing on being a ‘patient’. Granted, you may feel like a patient if you have to record every mouthful of food you eat or if you’re following a Rotary Diet. Nonetheless, says Dr Bell, you should try your best to shift away from the mindset of ‘I’m sick’ -towards ‘I’m getting well’.

‘Some people say, “I’m sick today, and until I’m well I can’t do this or that,” ‘ continued Dr Bell. ‘That attitude can lead to a terrible cycle in which you never do anything, and then you feel worse about yourself because you aren’t doing anything you enjoy.’

In other words, allergies can exact quite a toll in terms of damage to self-image – but only if you let them.

‘I don’t expect people to deny that they’re sick,’ says Dr Bell. ‘But on the other hand, I’ve seen people who focused so much on being allergic that it became their whole identity – and a way to avoid life’s stresses.’

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With all of these physical changes going on in her body, a woman probably has every reason to feel distraught. When our bodies change at puberty there is usually an adjustment psychologically to the things which are happening to us. We need to learn to cope mentally with the changes in our bodies which signal the beginning of our reproductive lives. Menopause is another signal, and a marker for a different stage of life, and it is not unreasonable that it should have a significant effect.

These physical changes often occur at a time in a woman’s life when other changes are happening. Menopause often coincides with children growing up, leaving home, and perhaps a woman’s role as a mother and carer may be changing. Women who work outside the home are often looking at their careers and jobs, and contemplating retirement. Husbands may be retiring, or getting sick, or the woman herself may be suffering from diseases which are more common with age. A woman may be caring for an invalid parent, or coping with the death of a parent. Having one of these life stresses may be a handful,- coping with several could fee) overwhelming.

Hormonal variations can often cause fluctuations in mood. Premenstrual syndrome is evidence of this, and so are the ‘baby blues’ (relatively short-term lowering of a woman’s mood following the birth of a baby— very common) and postnatal depression (a more significant lowering of mood, longer lasting than the baby blues). The hormonal changes which occur during the climacteric may also give rise to emotional mood swings. Women have sometimes told me that they feel they are not in control of their emotions; as though their bodies can cry, independent of their thoughts. A woman recently was trying to explain this to me. Just the act of telling me about her hot flushes brought on a fit of sobbing. ‘I don’t normally do this. I don’t know what’s happening to me.’ Some women are aware that they are more ‘brittle’, with less emotional reserve. Things which normally would wash over them, like misbehaving teenage children, suddenly provoke a torrent of rage or tears. This kind of emotional fragility is not necessarily ‘depression’, in the medical sense.

Psychiatrists have classifications for disorders of mood. Depression is a very common condition in our community, with estimates of one in ten people having significant depression, warranting treatment, it is not just a state of feeling sad, but a condition where there are physical and emotional changes, like disorders of sleep, eating and thoughts. It is believed to be related to a change in the levels of some of the chemical messengers in the brain, and this is the basis on which specific anti-depressant medication works. The changes in mood many women experience around menopause may have some features of depression, and may be mild and short-lived. Some peri-menopausal women will have more significant symptoms, and may benefit from specific treatment for depression.

So there are several different factors which may be affecting a woman’s mood around the climacteric. There are adjustments to her physical state, changes in her lifestyle and roles, and hormonal variations. These may give rise to a variety of psychological symptoms. Some of the most commonly described include tearfulness, lowered mood and self-esteem, irritability, and lack of concentration and memory.

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How effective is abortion? Though there is no guarantee that abortion is 100 percent effective, it is almost 100 percent, especially if it is done after six weeks from your last period. If you have it before then, it may not be successful because the embryo is so small it could be missed.

After a later stage abortion, you might need to have a curette, where a different instrument is used to clear the walls of the uterus so that no tissue from the pregnancy is unknowingly left inside. Tissue from the pregnancy could cause bleeding and infection if it is not completely removed.

Why would I want to choose abortion? There could be many reasons why you would want to have an abortion. It might not be the right time in your life to have a baby. It may be that your physical or emotional state, or your living situation or Financial circumstances would affect the wellbeing of a child or yourself if you continued with the pregnancy.

You might want to choose abortion if you have a medical condition that would make it dangerous for you to continue with a pregnancy. You may also want to have an abortion if you know that the foetus has a severe abnormality, or if the pregnancy is a result of rape or incest

Are there any reasons why I could not have an abortion? Abortion is not available on request in Australia. Each state has its own laws about abortion, and you may have to meet certain requirements if you want to have one. Even in states where there are fairly broad requirements there is usually a stage of pregnancy where the line is drawn and you cannot have an abortion after that time. In some states that time is 12 weeks and abortions are not permitted after that Other states permit abortion up to 23 weeks as long as the other conditions are met, or even later if there is a big risk to the mother, or where the baby has a severe abnormality. If you want to find out what the law requires in your state, contact a Family Planning Centre or Community Health Centre. The availability of a doctor willing to perform abortions may also mean that even where the state permits abortion it can be difficult for a woman to actually have one.

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Are there any reasons why I could not use breastfeeding as a method of contraception?

If you do not produce enough milk to fully breastfeed, you would not be able to rely on breastfeeding to protect you against pregnancy. If you have HIV, you would not be advised to breastfeed because the virus can pass on to the baby through your milk. If you are working, you may not be able to breastfeed frequently enough to keep up the level of hormones your body needs to prevent ovulation.

How do you use breastfeeding for contraception? Well, the three things we discussed earlier: no periods, fully breastfeeding, and your baby being under six months old are very important. The main thing for you to do then is to make sure that your baby sucks frequently.

Sucking on the nipple causes your uterus to contract and also causes your body to release a hormone called prolactin, which helps in the production of breast milk. Prolactin can also prevent ovulation.

Some other questions people ask about breastfeeding to prevent pregnancy

Q. If you’re not having any periods how can you get pregnant?

A. The first period comes about two weeks after the first ovulation, so it is possible to ovulate and to get pregnant even before you have started to have periods again. As well, if you’re not used to having regular periods it might be several months before you even realise that you could be pregnant.

Q. I got some light bleeding for a couple of months after I had my last baby. Does this count as a period if I wanted to use breastfeeding for contraception?

A. This light bleeding is called lochia and is it is quite normal to get this, on and off usually, for up to six weeks after having a baby. As long as it is light and it is less than two months since you had the baby it doesn’t count as a period. Heavy periodlike bleeding (even early on), or light bleeding later than two months, probably does count and you should see your doctor or Family Planning Centre for advice.

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DMPA is a liquid that contains the hormone progestogen, similar to the progestogen in the progestogen-only pill.

Things to think about if you are considering using DMPA

• Once you have the injection, you will have the effect of DMPA in your system for three months. You cannot do anything to stop it or take it away. So while you are covered for contraception for three months, you will also have any side effects for those three months.

• After you stop having injections of DMPA, it may take up to twelve months before your periods get back to normal.

• If you stop having injections of DMPA and you want to be pregnant, it may take a while, though most women will become pregnant within two years.

• If you stop having injections of DMPA and you don’t want to be pregnant, you should use another method of contraception right away. Some women become pregnant very quickly after stopping DMPA.

• DMPA does not protect a woman from sexually transmitted infections (STIs). You may want to think about using condoms as well as DMPA because condoms help to protect you from STIs.

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Speak to most doctors about anal incontinence and they’ll tell you it is predominantly a women’s problem, is often traced back to problematic childbirth and is hardly heard of in healthy men.

This traditional view was recently turned on its head when a small group of Sydney specialists began analyzing the responses they received from a random survey of 1000 men and women.

To their surprise they discovered that almost double the number of men compared to women live with some form of anal incontinence. Based on overseas studies, they expected that up to 10 per cent of women and about 1 per cent of men would have the problem. Instead they found that 20 per cent of Australian men and only 11 per cent of women have it.

Anal incontinence can be severe or mild. The severe form, which requires surgery, is more common in women, but milder forms, which can be treated with dietary changes and medication, now seem to occur more frequently in men.

Men suffering mild anal incontinence experience seepage or uncontrollable flatus or both. A degree of flatus is, of course, normal, but incontinence arises when the passing of wind is beyond control and is socially embarrassing.

Mild incontinence is largely a hidden problem. Men don’t regard it as normal but believe there is little that can be done for it. They find it debilitating and a nuisance because it often means they have to remember to clean themselves up three or four times a day. Some can feel when it’s happening and know when it’s time to mop up. Others are not aware and, because the seepage is insidious, only realize after a certain threshold is reached.

A number of these men can’t feel what is happening because of nerve damage. They have a history of straining at stool, and the straining has caused such damage to their pelvic-floor nerves that tests show they can’t even feel a pin prick.

Mild anal incontinence can occur at any age. The survey showed that 19.6 per cent of men under the age of sixty-five lived with it, compared to 20.8 per cent over the age of sixty-five. One-third experienced incontinence more than once a week and two-thirds less than once a week.

This type of incontinence is particularly problematic for men who wear whites for work or sport. One such man complained it was affecting his game of bowls. He feared each time he bent over that stains would be visible.

Overseas, men are generally quite happy to contain the problem by wearing small cotton wool balls. Back in Australia men find this idea too fussy and delicate, but the survey showed a large number do use anal pads.

While no one really knows what causes mild incontinence in men, it is known that men (and not women) suffer from a bowel peculiarity that causes them to lose sensation in the rectum. They suffer an isolated degeneration of nerves around the area, and if a balloon is placed in the rectum and inflated, they can’t feel it. It is not known why this happens or why it is exclusive to men.

One footballer complained that he only experienced anal incontinence while he was running. He was a serious player and would unknowingly soil himself while on the field. Tests showed that the man had lost some rectal sensation and couldn’t tell with accuracy when his rectum was full and needed to be emptied. Because he was not aware he could not take steps to withhold until a socially acceptable time. The running and exertion caused a build-up of pressure in his abdomen and incontinence resulted. The player was treated by instructing him to use a suppository before each match so he could be sure his rectum was empty.

Treatment for mild anal incontinence usually involves dietary change and drugs and is successful only in about 50 per cent of people. Medication may be an antidiarrhoeal drug to slow the stool or a drug to help tighten up the anal muscle. Special diets are used to eliminate food causing loose stools. Alcohol, for example, is a potent cause of loose stools, and it’s not unusual for people who drink half a dozen schooners a day to develop mild anal incontinence.

There is a high prevalence of anal incontinence among people suffering irritable bowel syndrome. About 15 per cent of the population suffer from this syndrome and about 5 per cent of them have the incontinence. But it’s a little discussed problem as patients usually don’t volunteer the information and doctors don’t always think to ask.

One gastroenterologist describes continence as basically a struggle between the anal sphincter and the combined forces of colonic propulsion, rectal contractions and gravity. The consistency of the stool is an important factor in deciding if the battle is lost or won. Even the sphincter of an Arnold Schwarzenegger may be overcome by the violent propulsive force of vigorous colonic contractions and a flood of liquid diarrhoea when acute dysentery strikes.

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