I’m not an atopic/allergic person by any stretch of the imagination, having never suffered from allergies. However, I got a good dose (pun intended) of what it feels like to be in Washington, DC recently, when I had an acute flare of environmental allergies. As a family physician I understand the toll that allergies can take; at the same time, it’s as impressive a condition as any that requires a person to stay indoors for fear of their eyes swelling shut.
Given that I’d never had anything to this degree before, I wanted to figure out the best approach to control things. I also found it challenging to explain to people that yes, this was my first time, and I truly didn’t know what to do about it in the most acute phase.
So I started looking.
A very well regarded medical database that I use started off with this description of the condition:
Allergic conjunctivitis is a relatively benign ocular disease that causes significant suffering and use of healthcare resources, although it does not threaten vision.
I’m not sure if this was supposed to be reassuring or comforting from the perspective of a patient. I would say on balance it was not. At the same time, this is a very factual statement made from the medical perspective, which is the audience this is for.
My next task was to figure out if taking supratheraputic doses of non-sedating antihistamines to control symptoms had any basis in experience or science. I was only able to find that a 400 % dose of loratidine is not associated with a fatal heart arrythmia. That was very important for me to know (I’ll leave the details out here). I also needed to know if it’s typical for patients to need this much to control symptoms. I came up empty, except in conversations with friends who said, yes, this can be the case.*
*Disclaimer: I do not recommend a supratherapeutic dose or off-label use of any medication. I am just illustrating the uncertainty that comes from an unexpected dose-response experience.
As things started to calm down, I wanted to find out if there’s something going on in my community that makes this a one-time event for me, or a prelude to more allergic challenges. I was able to find pollen counts, and a news story that allergies are flaring in Washington, DC. Otherwise, I depended on my short conversation with a staff member at the local Safeway who said that she, too, was having her very first allergy flare. Ok, so that means I’m not alone. Oh, and every allergy medication aisle in Dupont Circle was nearly empty.
What does that leave a patient like me with, though? With a few side conversations, rumor, gossip, luck, and an entire health care industry that can’t provide me with more information than the fact that the standard dose of loratidine and ceritrizine is 10 mg per 24 hours.
In my profession’s defense, I was able to get enough information to quickly change my topical ocular antihistamine to one that’s less likely to cause rebound (ketotifen), and better for long term control – but from my “special” medical sources. Nothing in the pharmacy said, “take this one if you’re really having problems.” If I had not switched, I would probably be sitting indoors still.
So I’m writing this post about my first time allergy flare in Washington, DC, so that it can be picked up by others in the blogosphere who wonder if they are alone (keywords: allergic, allergy, allergies, first-time, first, conjunctivitis, flare, DC, Washington). I am hopeful that Health 2.0 projects (like PatientsLikeMe.com) will help fill in the gaps that medical knowledge leaves us with: Am I the only first-timer in my community (bad sign for me, it may happen again)? How well does that drug work? How much do you really need to take to get relief? Are we getting better? This will work very well as a partnership, so patients and physicians can learn what happens between FDA approval and patient experience, the most crucial part of health.
It’s being said that pollen counts are going to massively increase in the next few weeks in DC. That’s okay, Washington – my like for you is still blind, even if you nearly made me go blind.