Thanksgiving is a wonderful holiday for most Americans. Families get together to celebrate each other’s company, watch football, and enjoy some delicious turkey, stuffing and a smorgasboard of trimmings. Sadly, I’ve noticed that the holiday raises several concerns for patients in my allergy practice.
For one thing, patients who are highly sensitive to cats or dogs are usually apprehensive of spending Thanksgiving at the homes of their pet-owning relatives. This makes for an uncomfortable situation: do they suffer through the dinner sneezing and wheezing, do they insult the host by declining the invitation, or do they ask that the pet — often considered a family member in it’s own right — be put away during the visit? None of these options are ideal.
I have found that the best chance of a successful holidy for pet-allergic patients lies in having a solid plan. I strongly recommend that plan begin with the use of over-the-counter Nasalcrom twice per day for at least a week before the pet exposure. Nasalcrom is a mast cell stabilizer and it must be initiated in advance for optimal results. For Thanksgiving Day, I recommend they take a long-acting antihistamine such as Fenofexitidine for acute protection. Additional recommendations for asthmatics include preparing ahead with maximum doses of steroid inhalers leading up to the day, and use of their rescue inhaler, if separate, an hour prior to entering the home. I prefer to maintain asthmatics on an inhaler with a combined corticosteroid and beta-agonist, such as Dulera or Advair.
Of course, planning far ahead provides the very best chance for a happy holiday for pet-allergic patients. The most effective strategy includes treatment with sublingual allergy drops, which build up their immunity to the pet allergens and significantly minimizes symptoms. I once had a patient who refused to visit her mother-in-law’s home for years because the mother-in-law had three cats and the patient became ill upon entering the home. As you can imagine, this led to a lot of family tension at holiday time. I treated the patient with sublingual drops for cat dander and her symptoms, and the family tensions along with them, completely abated. The patient was extremely happy but her husband was even happier!
Drops can take up to 12 weeks to begin taking effect — though usually much less — so it’s probably too late for them this Thanksgiving. However, Christmas, Hanukah and Kwanza are right around the corner so starting patients on an allergy drop treatment now is quite appropriate.
Food allergies represent another potential point of holiday anxiety. The elaborate Thanksgiving dinner, with all kinds of stuffings and side dishes, may look like a veritable mine field for a patient with significant food allergies. Patients need to be proactive about contacting the host regarding specific food allergies and requesting appropriate exclusions and/or, at the very least, labeling of dishes. A severe food allergic reaction can put a real damper on the holiday spirit for everyone! Of course it is always important to remind your severely food-allergic patients to carry their epinephrine injector with them everywhere in case of emergency. This is especially critical in the midst of festive gatherings where there is likely to be a plethora of offerings.
While many food allergies are clear-cut, making avoidance do-able if not exactly easy, you must always be prepared to play detective — especially during the holiday season when special situations are the norm. My most interesting Thanksgiving allergy story was that of a patient who developed hives and swelling two Thankgivings in a row. I was intrigued because she had no known food allergies and she said she ate turkey the rest of the year without reaction. I performed extensive food allergy testing and all results came back negative. Upon review of her chart, I noticed that she had a history of allergic reaction to Cephalosporins. After some research, I discovered that turkeys are often fed antibiotics on the farm. Obviously, this supersensitive patient was triggered by exposure to the antibiotics consumed by the fresh turkey. The deli turkey she ate during the year was so processed that any antibiotic proteins it contained were likely rendered into a form no longer recognizable to the body as the original antigen.
There you have a few of my own experiences in treating allergy patients during the Thanksgiving holiday. I would love to hear any unusual cases you’ve encountered or answer any questions you have. If there’s a chance that I can help make other allergy patients’ Thanksgivings more comfortable, I am up to the challenge!