Healthtips

Spring is a beautiful time in the Piedmont Triad, but for some, the beauty comes with a beast. Those individuals sensitive to grass and tree pollens unfortunately have difficulty enjoying the outside at this time of year. Sensitive individuals may complain of nasal obstruction/congestion, sneezing, runny nose, itchy eyes, post nasal drainage and wheezing. Thankfully, there are excellent options in management.

Though avoidance of the offending pollen is the first line in management of allergies, total avoidance is often near impossible. The best one can do is to stay inside as much as possible with the windows closed and the air conditioning on. Cleansing the nose with an over the counter nasal saline (salt water) spray or sinus wash at the end of the day is also helpful in minimizing exposure.

Allergic symptoms happen primarily due to the action of histamine, a product of the immune system. So antihistamines serve as first line medications in managing allergic symptoms. Most common over the counter antihistamines (e.g. diphenhydramine or chlorphenaramine) work quickly, effectively and cheaply in relieving sneezing, itching and runny nose. They unfortunately also cause much drowsiness in many folks. We now, however, are fortunate to have Loratidine (Claritin, Alavert) as an option, which is the only over the counter antihistamine that causes no drowsiness. Antihistamines do not do very well in relieving nasal obstruction, so many antihistamine products come with a “-D” version where the decongestant pseudoephedrine is added to the antihistamine to maximize congestion relief. Decongestants work quickly, effectively and cheaply, but they do sometimes cause excessive jumpiness or difficulty sleeping. Also, folks with high blood pressure should be careful using decongestants as they can elevate blood pressure.

If avoidance and over-the-counter antihistamines are not enough to control symptoms, the next step would be to add to or replace your over the counter antihistamine with a prescription medication. Nasal steroid sprays (Flonase, Nasacort, Rhinocort and Nasonex) and monteleukast (Singulair) are two classes of prescription medications that fight allergic symptoms from different directions than antihistamines. Nasal steroid sprays are the best bang for the buck medication in relieving all allergic symptoms including nasal congestion. Their down side is they take a few days to reach their maximal effect, so they are not as good as antihistamines for individuals who only use their allergy medications intermittently. Singulair is the newest medication for treating allergic symptoms. When compared head-to-head with antihistamines and nasal steroid sprays, Singulair does not always perform as well in allergy symptom relief, but it does have the unique benefit of helping asthma symptoms significantly. So it is a great option when wheezing is a component of allergic symptoms, as is often the case in kids.

If avoidance and medication are still not enough to control symptoms, then one of two things is going on. Either your allergies are so bad they are overwhelming your medication therapy or your symptoms are not caused by allergy alone. That’s when allergy testing can be helpful. The classic skin prick test is still the best in evaluating your allergic sensitivities, but for small kids or individuals who are felt to be dangerously sensitive, there is a blood test to check for allergies. If allergy tests are significantly positive, you may choose to undergo immunotherapy where slowly increasing doses of what you are allergic to are given to you over time to lessen the allergic reaction that you usually experience with exposure. This is classically done by shots, but some allergy practices are starting to offer treatment by drops placed under your tongue. And finally, your “allergy” symptoms may be caused by other problems besides allergy such as infection, stomach acid reflux into your throat, migraine headaches or abnormal nasal anatomy. This is where the detective role of your physician comes into play to get you maximally symptom free.

It’s a great time of year to live in the Piedmont. Hopefully these pointers will help you enjoy it in spite of the beast.