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ASK THE GP: Why have I had a cold for 12 years?

Since I was 11 years old, I’ve had what appears to be a chronic cold. I sneeze continuously and it weakens me and gives me itchy eyes and pains in my face.

I’m now 23 and there are times when I cough and find it hard to breathe, but I’m not asthmatic, as far as I know. I wonder if I have an allergy, but I can’t point to what. The interesting part is that when I travel abroad, my symptoms normally stop.

The Color Toner Experts

Nancy Nyantakyi, by email.

To me, it sounds as if you do have an allergy — the nasal congestion, the sneezing, the itchy eyes and the facial pains (the latter being due to pressure changes in your sinuses) are all textbook symptoms.

Diagnosis? Rhinitis is the medical term for inflammation of the lining of the nose and sinuses

They occur as a result of the body trying to get rid of the allergen that it perceives to be a harmful invader.

I suspect you have chronic perennial allergic rhinitis, as well as allergic conjunctivitis. Rhinitis is the medical term for inflammation of the lining of the nose and sinuses.

Perennial simply means that this is not a seasonal allergy due to pollens, but most likely due to allergens that are constantly in your environment.

The most likely culprits are house dust mites, feathers in bedding or cushions, or possibly pets — cats are a common cause. The reason your symptoms abate when you go away is that you’re avoiding the allergy trigger.

Conjunctivitis is the term used to describe the symptoms the allergy causes in the eye — the itching and redness — but the symptoms you are having are at the more severe end of the spectrum.

The fact that you have difficulty breathing and cough from time to time suggests you also have asthma, probably triggered by the same allergen.

This is not surprising given that the lining of your nose and sinuses is one continuous surface that goes all the way down into your lungs: asthma is an inflammation of the lining of the airways and your cough with breathlessness may be an indication of that inflammation.

People with allergies often assume that their symptoms are colds, or catarrh even, for years.

People with allergies often assume that their symptoms are colds, or catarrh even, for years.

People with allergies often assume that their symptoms are colds, or catarrh even, for years.

Before you can start treatment, the diagnosis must be confirmed. This requires examination of your nose, throat and chest; a spirometry test, where the performance of your lungs is tested by measuring how much air you can breathe in and out in a forced breath; and allergy testing.

The latter involves skin tests and possibly a blood test to check for levels of the protein immunoglobulin E, which will be raised if you have an allergy.

Your GP can carry out all of these investigations or may refer you to an allergy clinic, an ear, nose and throat specialist or a chest physician. The choice will depend on what is available in your area. Once the diagnosis has been confirmed, then you can start treatment to hold your symptoms in check.

This may include a steroid nasal spray to reduce the inflammation, or one that contains both a steroid and an antihistamine, depending on the severity of your symptoms.

Write to Dr Scurr 

To contact Dr Scurr with a health query, write to him at Good Health Daily Mail, 2 Derry Street, London W8 5TT or email drmartin@dailymail.co.uk — including contact details. 

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His replies cannot apply to individual cases and should be taken in a general context.

Always consult your own GP with any health worries.

You may also be advised to use a preventer inhaler, to help with the cough and breathlessness, depending upon the results of the lung function tests. This inhaler has an anti-inflammatory, often the steroid beclomethasone or something more potent.

The simplest treatment, available even without full investigation, would be to try taking antihistamine tablets, which you can get from a chemist without prescription: examples include Clarityn or Piriton.

You can also buy a beclomethasone nasal spray, a steroid to help calm inflammation in the nose and sinuses.

If you use both preparations following the exact recommendations of the pharmacist, then you may experience considerable relief, which would help confirm if your condition is due to an allergy. There are also eye drops (Opticrom), which can be used on a regular basis to prevent itchy eyes.

If you are referred to an allergy specialist or other consultant, stop all of the above treatment several days before your appointment or the medication will interfere with any allergy tests that are carried out.

I am 76 and do not have, and have no intention of getting, any tattoos, but I am curious: if someone has heavy tattoos on parts of their body that are normally exposed to natural sunlight, does this reduce or prevent that person getting the required vitamin D?

Derek Cranage, Loughborough, Leics.

This is a good question given how widespread the fashion for tattoos has become. Vitamin D is an important nutrient and plays a key role in a number of processes in the body, including aiding the absorption of calcium, magnesium and phosphate from the intestine, as well as the immune system.

But, unlike many essential nutrients, vitamin D does not occur naturally in many foods — the exception is the liver of oily fish (sardines, which we eat whole, are a good source).

Skin you're in: The length of exposure, the skin type, the latitude, the season and the time of day are all factors that will influence how much vitamin D is formed

Skin you’re in: The length of exposure, the skin type, the latitude, the season and the time of day are all factors that will influence how much vitamin D is formed

The main source of vitamin D is the action of UV light from the sun on the outer layer of our skin — this requires direct sunlight, so sitting in a sun-drenched conservatory, for example, is of no benefit. The length of exposure, the skin type, the latitude, the season and the time of day are all factors that will influence how much vitamin D is formed. 

For instance, darker skin needs six times the sunshine exposure as fair, white skin to create the same amount of vitamin D.

Furthermore, in the UK, there is insufficient UV light, particularly the further north you travel, for us to create any vitamin D in the winter — where I live, in Scotland, the sun is so low in the sky that we are at greater risk of being vitamin D-depleted in the winter months.

Babies, the disabled and older adults may well not have the opportunity to ensure sufficient sunshine exposure — and a further issue for those over the age of 70 is that their skin is far less efficient at manufacturing vitamin D.

As to your question, I regret to inform you that there is no published data on this (I spoke to a specialist in dermatology to confirm this).

So, while many of us may not like tattoos, lack of vitamin D does not stand up as a reason against them.

IN MY VIEW…BEWARE INTERNET ‘ADVICE’

The discrepancy between what science tells us and what people believe is mystifying. It took a long time for mankind to accept that the Earth is round (though a few diehards are still convinced it’s flat) — and the same problem occurs in medicine.

Recently published guidelines stress that drinking cranberry juice (or taking cranberry tablets) is not an effective treatment for urinary tract infections: there is insufficient evidence to back its use.

And yet the mythology persists — even among doctors and nurses who continue to recommend the remedy, rather than sending a urine sample to the laboratory to identify the bacteria causing the problem (and, therefore, the correct antibiotic to prescribe).

And how many people still think eggs are packed with cholesterol and so limit their consumption? This is despite science showing us the cholesterol in eggs has little impact on cholesterol in our blood and that eggs are a good food which can be eaten freely.

Then there’s the near-epidemic of those on a gluten-free diet in a misguided attempt to ease symptoms of irritable bowel syndrome (IBS).

The science shows that the only people who benefit from such an approach are those with coeliac disease, which affects around 2 per cent of the population and is an inherited immune response to gluten, the protein component of wheat.

A GP’s role is to help educate. Patient and careful explanations of the science are essential. We need to steer patients away from the plausible misinformation so easily obtained from the internet.

But this requires two things to work: time — always a rare commodity — and the confidence of the patient, which is where continuity of care is helpful.

It is so much easier to be persuaded of good sense when you know and trust your doctor.

But, these days, so few do know their doctor — with that has gone trust, and into the breach step rumour and misconception over hard medical fact.

 

 



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