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Hay And Barn

Be Allergy Aware

According to Webster’s Dictionary, the definition of awareness is “knowledge or perception of a situation or fact.” The fact is many people have allergies and don’t realize it.  If you don’t know or have the perception you may have allergies, how can you possibly manage and treat them effectively?

What are the symptoms of seasonal allergies?

  • Sneezing! Sometimes many times in a row.  Caution: don’t hold back a sneeze— serious complications including esophageal laceration and air bubbles into the brain may occur!
  • Itching! Nose, eyes, deep in the ears, palate and throat itching is annoying. If it itches, it is likely an allergy.
  • Runny nose: clear, drippy runny nose…like a faucet!
  • Nasal congestion: stuffy nose, plugged up ears, feeling of nose plugging up on one side then alternating to the other side. Stuffiness tends to be the most common complaint that interferes with quality of life.
  • Eyes symptoms: watery, puffy, red and itchy. Sometimes the swelling of the eyelids can be dramatic.
  • Fatigue: yes, that general feeling of un-wellness with lack of energy can affect your work, school or social life.

Timing:

  • A person may feel like they have a “cold,” but symptoms persist for weeks (a pollen season), intermittent (around pets) or even year around (perennial).  Historically, the term “hay fever” has been used, but current medical terminology suggests “seasonal allergic rhinitis” is most appropriate.  Besides, there is no fever and pollen is the trigger not necessarily hay.  Symptoms can range from mild to severe and vary year to year.

Who can be affected by allergies?

  • Anyone! Seasonal allergies are more likely to manifest over age 3 years old and tend to wane in the elderly. Perennial allergies can begin as young as 6 months old. I’ve diagnosed grass allergy in children less than 2 years old while practicing in Nevada where the grass pollen season is many months long. Likewise, I’ve diagnosed dust mite allergy in octogenarians who thought they were too old for allergies.

What if I don’t treat allergies?

  • Untreated allergies most commonly affect quality of life but can also increase one’s risk for sinus infections, trigger asthma and the chronic mouth breathing during childhood can even change the shape of one’s face leading to orthodontic issues.
  • Don’t suffer any longer! Many people are still under the impression that there is no effective treatment for allergies or the only treatment is antihistamines that lead to drowsiness.

How are pollen allergies treated?

Avoidance: 

  • Avoid what you are allergic to.  This is easier said than done and living in a bubble is not an option.
  • Pollen: some measures that may help include keeping windows closed during the day in peak pollen season, avoid using clotheslines; and, before going to bed, change those clothes and take a shower to decrease the amount of pollens that followed you indoors.

Medications:

  • Antihistamines: this generally safe class of medications has been available since the 1940’s. There are 3 generations of antihistamines.
    • First generation antihistamines (before 1990’s): These include Benadryl™ (diphenhydramine), Chlortrimeton™ (chlorpheniramine), Atarax™ (hydroxyzine), and Tavist™ and others. While helpful in decreasing symptoms, these are very likely to cause side effects, especially drowsiness (that’s why diphenhydramine is the most common sleep aid available) because they penetrate into the brain. They do not last as long as the newer products so they need to be taken more often and are more likely to have other side effects including delayed reaction time, dry mouth, and appetite stimulation (with weight gain).
    • Second generation antihistamines: Claritin™ (loratadine), Zyrtec™ (cetirizine), and Allegra™ (fexofenadine) are all available without a prescription, taken once a day, approved for children and adults and as generics making them easily accessible and affordable. They help primarily for the itching, sneezing, and runny nose caused by allergies but are not very helpful for nasal congestion or stuffiness.
      • For dealing with congestion, all have adult formulations where they are combined with a decongestant such as pseudoephedrine. These are marketed as Claritin-D, Zyrtec-D and Allegra-D where the “D” stands for decongestant.
    • Third generation antihistamines: These include the prescription Clarinex™ (desloratadine) which was derived from Claritin™ and non-prescription Xyzal™ (levocetirizine) which was derived from cetirizine (Zyrtec™). As you can see, antihistamines can be related: Xyzal comes from Zyrtec and Zyrtec comes from Hydroxyzine.
  • Decongestants
    • Decongestant pills are still available like pseudoephedrine and phenylephrine but not suitable options for children and have nuisance side effects including dry mouth, constipation, trouble urinating in older men, poor appetite and neuro-stimulation including impaired sleep (insomnia). There are limits on the amounts of pseudoephedrine that can be obtained from the pharmacy as industrious illegal drug makers “cook” these into “meth.”
  • Nasal sprays:
    • Topical nasal steroids: This group of medication has been the “cornerstone” of treating nasal allergies for many years.  The cortisone spray treats the inflammation of the nose and not only helps all of the nasal symptoms but can reduce eye allergy symptoms as well.  Most of these watery-based products are now available over-the-counter including Nasacort™, Flonase™, Flonase Sensimist™ and Rhinocort™.  A few are still prescription including Nasonex™ and the dry-aerosol spray options including Qnasl™ and Zetonna™. The advantages are they work well and have no addiction potential, drowsiness, drug interactions or neuro-stimulation. Some of these products are FDA-approved for children down to 2 years old!
    • Topical nasal decongestants: For immediate relief of nasal congestion and ear plugging, oxymetazoline, the active ingredient in Afrin™ and other over-the-counter nasal sprays is very helpful. Beware: regular use beyond a few days may result in becoming dependent on these sprays (called Rhinitis medicamentosa). Don’t get hooked on these—it is very challenging to stop!
    • Topical nasal antihistamines: while these tend to be used less often, don’t underestimate the beneficial effects.
      • Azelastine products (Astepro™ and Astelin™), while they may have a bitter taste and even mild drowsiness for some, are very beneficial to those with allergic and non-allergic induced nasal symptoms.  If that bitter taste is bothersome, chew some cinnamon gum—it helps!
      • Olopatadine product (Patanase™) also is helpful without drowsiness and used twice a day.

Note on nasal sprays: the most common side effect of any nasal spray is nose bleeds (epistaxis). This can be reduced by aiming the spray a little to the outside to avoid spraying up against the nasal septum where there are many blood vessels.

  • Singulair™ (montelukast): Although most often used for treating asthma, this is FDA-approved for treating allergic rhinitis down to 6 months old.  Since montelukast is a leukotriene modifier and not an antihistamine, decongestant or steroid, it has none of the side effects associated with them. It is approved for infants 6 months of age and older for year round allergies.
  • Eye Drops: There are a variety of eye drops available to help those bothersome eye symptoms. They are typically divided into antihistamines, mast cell stabilizers, combination antihistamine-mast cell stabilizer, other ant-inflammatory and steroids.  Steroid eye drops are best prescribed by an eye doctor.

Immunotherapy:

  • Injections (allergy shots): this tried and true treatment has been helping patients for over 100 years. Yes, long before medications were discovered. Allergy injections change your immune system making you less allergic; this is called disease modifying. In other words, after completing a course of allergy injections (initial build-up phase of several months, followed by 3 to 5 years of monthly injections), the good effect of allergy injections may last years to decades. The “ingredients” in the allergy shots are just the items a person is allergic to such as pollen, dust, pet dander, and/or mold without any medications per se. The treatment is natural and offered to patients over 5 years old whose allergies are not adequately controlled despite avoidance measures and medications or those who desire a more natural approach and want to avoid medications.
  • Under-the-tongue pills (sublingual) are now FDA approved in the U.S. and available for grass (Oralair™ and Grastek™), ragweed pollen (Ragwitek™) as well as dust mite (Odactra™).  These types of treatments have been used for years in Europe. They are effective, safe, and can be taken at home once a day.  However, if you have stomach or esophageal issues or serious asthma, it’s best to pass on these.

What is NOT appropriate allergy treatment?

  • Steroid injections such as Kenalog™. Don’t be lulled into this “allergy shot.” An injection of steroids into your backside that sends steroids to…well, everywhere including your eyes, bones, adrenal glands, muscles, etc and is not, in my opinion, the best way to treat nasal symptoms. This treatment for allergies should have went by the wayside in the 1970’s. It may be cheap and even effective; but, beware of the serious consequences to other parts of your body.

To help sort out if you have allergies and which treatments may be most effective for you, contact an allergist!

At Family Allergy & Asthma Care of Montana, we individualize treatment to get you back outdoors and enjoying the beautiful area we live in.

This information is solely for informational purposes and not intended as a substitute for consultation with a medical professional.

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