Gifted Issues Discussion homepage Forums Age or Ability Specific Forums Pre-school Psychotropic drug, slightly OT

Ugh. Your situation sounds pretty miserable right now. I hope my earlier post didn't sound too condescending. Should've probably realized you had the basics down already, and if it were a straightforward fix, you wouldn't be asking for input.�
I do know that, even though I'm a doctor, I completely lack perspective and objectivity when it comes to my kids. �So, for me, I still think it would be helpful to collect some sort of data if I wanted to objectively compare things. If your son really has no other symptoms except rapid-onset, severe exacerbations, then that's all you can monitor, right? You had 3 months with no oral steroid use on the leukotriene antagonist, which is a huge deal. �Not exactly enough for a scientific study, but it's something to start with. �If it were my kid, and i felt strongly the first med had caused serious issues, and the pulmonologist had given the okay, I'd try the antihistamine until it proved itself to be inferior. Realizing that the need for a single oral steroid course,especially if it happens before Feb, might be enough to show this. �If we did make it to feb without needing it, then I'd cross my fingers and head into asthma season with this regimen. �
This seriously may not apply to you, but also think I historically may have�minimized my son's symptoms without even realizing it, so I'd just caution you to pay attention to the little things, like exercise tolerance/fatigability when he seems well, or intermittent occasional daytime cough. He may display some less obvious signs of control on a daily basis that you can use to help gauge symptom control. (he may totally not, though).
From a behavioral standpoint, while it's certainly possible the leukotriene inhibitor was doing it, but it's also possible it wasn't, or that the side effects are mild enough to figure a way to cope with. I know there has been concern about singulair, but from what I know the jury is still kind of out on it. So maybe a mood/behavior chart wouldn't be a bad idea. Maybe pick one or two behaviors to monitor? That way you've at least got something to compare to if you end up having to try it again.
I did hit on a sort of metaanalysis on the the singular issue. Here's the pubmed link. �I was able to get the entire article, but didn't have time to thru all the details. � http://www.ncbi.nlm.nih.gov/m/pubmed/19815116/
Of course it was sponsored by merck... �Also, it doesn't really matter how unlikely a side effect is. If it happens to you, it may as well happen to 100% of people who take it. The problem is there really are only so many options out there. And they all have risks and potential side effects. It becomes a balancing act, which you obviously already know.
My only other suggestion would be that if the antihistamine seems to make a big difference, you might consider further allergy testing/second opinions regarding underlying environmental triggers for your son's asthma. I may be missing something, but if it's responsive to this, I'd think that would indicate a atopic component. Right?
Once again I'm not sure any of this is helpful. If not, then just think of it as a post of support. Good luck again, with your older son and the baby (and yourself!)

He is on both. Initially, the antihistamine was for his eczema and hay fever, and we ended up adding singulair after a failed attempt at flovent, because he started having wheezing issues after a bout with H1N1 when he was 3.

He now takes both, and seems to need both. If he goes off the singulair, he starts to wheeze, and if he goes off the antihistamine, he starts to itch and have eczema issues again.

He has very significant food and environmental allergies, though. While he often needs his rescue inhaler during the first weeks of winter and during the spring pollen season, we have had no ear infections since starting this regimen, and no urgent visits for the nebulizer. In fact, our ped was surprised when we were in for strep this fall because he had had so few sick visits since finally hitting on this combination.

Mom of 1 - one additional thought (and thanks for asking the question; I've benefitted from the responses as well) - have you tried playing with the antihistamine you use? I found my boys responded to different antihistamines quite differently, and if we changed, it affected asthma control. We also -with the advice of our doctor and pharmacist - upped the dosage beyond the normally prescribed dose temporarily during the worst of allergy season.

Oh, and beyond all of the things I'm sure you're already doing to fight the allergies, we found that if my son showered and washed the pollen out of his hair before bed and if we changed his pillowcase nightly, it really helped.

Interestingly, frequent showers and baths made it worse for him until we put the pieces together and realized that his coconut allergy was causing him to react to all shampoos and soaps.

We tried every antihistimine there is before settling on the one he is on. He had behavioral side effects from C.laritin and Z.yrtec and A.llegra didn't help him at all. He does take a larger than normal dose of the X.yzal now, though, we may drop it back to normal now that the heat has been running long enough to get most of the initial dust out of heating systems.

As you alluded to, my takeaway from all of this is that medications are an art, not an exact science, and that frequent tweaking and careful observation is likely necessary for everyone.

This all started when he was an infant and I was taking a course in single subject research design. The professor and I actually talked about creating a program that would use single subject design principles to track allergic reactions. Now that smartphones are so prevalent, I think it would be a very popular app...

Michaela - You said that he is on Singulair. FWIW, my neighbor's middle school aged son started having suicidal thoughts on Singulair. The suicidal ideation disappeared in a few days once they stopped Singulair and switched to another med. The negative psychotropics were real and frightening in that case.
I would try a different med and treat Singulair as a last resort if you are seeing signs of psychotropic effects.

Hospitalmom: Thanks, I hope I didn't sound negative. Asthma's scary; nearly everyone describes theirs as "Severe" -- unless they happen to have spent a lot of time sharing a hospital room with someone whose asthma was worse I can't get the whole article from here, but should be able to get it at the library.

The last word on allergies was, approximately, "He's clearly allergic to stuff, we just have no way to identify what, beyond seeing a pattern in daily life, he'll probably never have a positive test result"

You guys kick ass. Just wanted to say it. I bought the full-page-per-day planner. I'm gonna print out some little tiny checklists & I'm gonna watch like a hawk. For now, we're going to stick with the antihistamine. We filled the other prescription, and put it in the medicine cabinet, so we can switch at a moment's notice.

I'm _really_ glad to have a place where people come back with something more useful than "do you smoke?" and "Can you move out of the city?" I'm even more glad because you guys explain yourselves in ways that get through to me even when I'm stressed and haven't slept. </lovefest>

-Mich