Joe Biden’s allergies are a significant part of his medical history. Vice President (now President) Joe Biden has released his medical summary history and in it there are notable findings pertaining to allergies and asthma.
He has a history of atrial fibrillation, hyperlipidemia, acid reflux and seasonal allergies. Under the seasonal allergies category his doctor wrote “This patient has dealt with seasonal allergies and sinus congestion for most of his life.” This means he is only allergic to 1 or all types of seasonal pollen, notably trees, grasses and weeds. The summary does not state he has perennial allergens which would be dust mites, cat dander, dog dander or mold. As a Senator from Delaware, if he was allergic to trees, the peak season would be spring. For grass pollen it would be summer and for weeds it would be early fall. His report did not state if he’s allergic to all 3 major seasonal allergens or just some of them. In Los Angeles, the seasonal allergens are as follows:
The next line under his Seasonal Allergies category states, “His sinus symptoms have improved after several sinus and nasal passage surgeries, but he still uses fluticasone/azelastine (Dymista) and over the counter fexofenadine (Allegra) for these symptoms.
I spoke to Beverly Hills based ENT (Otolaryngology) physician, Dr. Andrew Berman and he said “he most likely had endoscopic sinus surgery to open his nasal passages and drainage ports, which is due to recurrent inflammation and infection.”
In terms of treatment, the gold standard for the treatment of allergic rhinitis is a nasal steroid spray. Dymista has the benefit of a steroid (fluticasone) as well as an antihistamine component (azelastine) in 1 bottle. Fluticasone is over the counter, it is commonly referred to as Flonase. Azelastine or its trade name, Astelin requires a prescription. Many insurance companies do not cover Dymista because the prescription form is more expensive than using its individual components of Flonase and Astelin. But depending on your insurance carrier, it may be covered with a prior authorization. Recently Dymista became available in the generic form, although the price is still expensive for a generic medication for now.
The other medication he is taking is Allegra or its generic name fexofenadine. Of note, he is not taking Allegra-D. The “D” component is Sudafed (pseudoephedrine), which is not recommended for long term use. With his history of atrial fibrillation, Vice President Joe Biden should not be taking Sudafed at all, as it can trigger his atrial fibrillation. Sudafed works primarily as a decongestant. Not mentioned in his letter, is if he’s using a Neti-Pot or a nasal saline wash, which can help as well.
As we scroll to the bottom of his health summary, his doctor wrote about Joe Biden’s allergies “As is often seen in patients who have significant allergies this patient experienced exercise induced asthma as a teenager and young adult. This has resulted in no sequelae other than perhaps experiencing bronchospasm with the occasional upper respiratory infections that all of us experience. He has no lung disease at all now. Chest x-ray was normal this year.”
His physician is correct that many patients with allergies also suffer other allergic diseases such as asthma, eczema or food allergies. In Vice President Biden’s case, he had exercise induced bronchospasm (asthma) when he was younger. This happens when a patient after exertion develops tightness and wheezing in his/her chest. The treatment for this is an albuterol inhaler, 15 minutes prior to exertion or Singulair 10mg (montelukast) 2 hours before exercise. Albuterol can also be given when it does happen too. If symptoms of exercise induced asthma are frequent, it may be advantageous to use Singulair daily as a preventative measure and it can also be used to treat allergic rhintis.
In the second half of his summary, Vice President Biden’s physician describes him as having viral induced asthma. A typical cold or flu virus results in symptoms of runny nose, cough, fever, sore throat and congestion. Patients who have a history of allergies or asthma, can also develop asthma like symptoms of wheezing, chest tightness and/or shortness of breath. Treatment for this also is albuterol, but for more severe symptoms it could require inhaled or oral steroids. Most people actually do not develop bronchospasm with upper respiratory infections, only those with a history of asthma, as is the case with Vice President Biden. A good way to monitor a patient with asthma is a pulmonary function test (spirometry). His report did not state if he received one or not.
Back in 1968, Joe Biden got a 1-Y draft deferment for “asthma as a teenager”, meaning he would not have to be drafted for the Vietnam War. This disqualified him from the service due to asthma. Although Biden had asthma and was excused from the war, it did not preclude him from having an active childhood, as he participated in high school football and was a lifeguard. Most asthmatics are able to be controlled and have no symptoms, in fact many olympic athletes have asthma.
Allergies are very common, if you recall we wrote a blog about then Democratic nominee Hillary Clinton and her allergies.
In summary, it seems Joe Biden’s allergies are controlled with the medication he is taking. Other treatment options available could be Allergy shots, which would desensitize him to his allergic triggers or take montelukast (Singulair) to help with his exercise and viral induced asthma as a more preventative measure if his symptoms become more frequent.