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One of the commonest problems I'm coming across at the moment are pats using nasal decongestants for weeks on end.

Although often sold next to #hayfever nasal steroid sprays, most allergists & ENT specialists will not recommend their use for more than a few days.

Why? 2/

You'd think if you had a blocked allergic 'hay-fevery' nose that nasal decongestants would help.

However, when used for more than a few days, decongestants sold as nasal sprays can cause a rebound swelling.

Doctors even have a name for this - rhinitis medicamentosa.

🧵

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This 28F has positive skin prick tests to chlorpheniramine & loratadine & an equivocal skin prick test to Cetirizine.

The history: developing dramatic urticaria (esp on face) <1 hour after taking po Chlorpheniramine & fexofenadine; on three different occasions. 2/

Piecing the history and skin-test together, it seems likely she is allergic to 1st and second generation antihistamines.

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At the moment pollen counts are high & lots of people are reporting terrible #hayfever

If this is you - then this post may be useful.

This thread is about #thunderstorms & specifically a v.v. rare but serious phenomenon called #thunderstorm asthma.

bbc.co.uk/news/uk-658695… 2/

Normally pollen is too large to enter the lungs, but when a thunderstorm is brewing, updrafts of air can lift whole pollen grains up into the clouds. When exposed to moisture, these grains rupture into tiny pieces and this makes them highly allergenic.

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#Hayfever

The grass pollen season is here 🤧

Many pats tell me nasal steroid sprays for hay fever don't help. But often this is due to not being taught when & how to use them.

Here are several tricks of the trade which help >90% of my pats to put hay fever behind them. 2/

Nasal steroid sprays take time to build up.

Don't be disappointed if you don't notice a difference for a week or even two. Antihistamine tablets act quickly but nasal steroids need to be used regularly.

If you use them correctly, they are incredibly effective!

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Buyer beware!

Cold remedies designed to unblock your nose & nasal steroid sprays, for hay-fever are often found on the same “allergy” shelf

Do not chose the ones that are marketed as cold relief, decongestants or to treat sinusitis! 2/

You'd think if you had a blocked 'hay-fevery' nose that treatments for a blocked nose would help. And you’d be right. They’ll help for a few days. But they are not designed for hay fever & if you use them for more than a few days you may develop rebound stuffiness/blockage.

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Seen a few tweets where people are reporting #hayfever It is likely this is due to the early tree pollens & suggests birch pollen; the cause of much misery in spring is not that far behind. This calendar from my book can help you work out which pollen is giving you problems 2/

One tip if antihistamines are not doing the trick is to start using a nasal steroid spray 2 weeks before your pollen season.

If buying over the counter, then I suggest to my patients fluticasone proprionate & if via the GP fluticasone furoate but other products work too.

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Anaphylaxis is a spectrum.

Urticaria & a persistent cough can be anaphylaxis.

As can angioedema, wheeze & low blood pressure.

However urticaria & angioedema are not essential to make the diagnosis & in severe reactions may not be seen at all. 2/

The first-line treatment for anaphylaxis is Adrenaline.

Seems easy enough no?

But time & time again studies show a delay in administering it.

Pumphrey (2000). Lessons for management of anaphylaxis from a study of fatal reactions. Clin Exp Allergy 30(8), 1144–1150 ⬇️