Achoo!!—Seasonal Allergies

Juliana Wong, M.D.

Many individuals thoroughly welcome the end of winter and relish the opportunity to get outside, to walk, bike, and play sports with the kids. Unfortunately, for the 20% of the population that is affected by allergic rhinitis (allergies), this warmer weather brings more pollen from trees, grass and weeds. Along with mold, dust, and animal dander, these allergens trigger the immune system in people with allergies to overreact – releasing histamine and other “mediators” to produce the symptoms of sneezing, itchiness, runny nose, postnasal drip, nasal congestion, headache, earache, red eyes, fatigue, drowsiness, and malaise. These symptoms can significantly impair one’s quality of life if not properly treated. The direct and indirect cost of allergies is estimated at $5.3 billion per year. Allergic rhinitis may also lead to worsened asthma, ear infections, sinusitis, allergic conjunctivitis (red allergy eyes) and eczema. Allergies might also create difficulty sleeping and concentrating.

People frequently come into my office with upper respiratory symptoms and ask, “Is it a cold or allergies?” There is not a single symptom that determines this, but rather a combination of symptoms. Allergies may appear at any time of the year or be worse in certain seasons. They are not accompanied by a fever, and usually produce a clear nasal discharge. People with allergies frequently have symptoms by age 20, have more chronic symptoms, a family history of allergies, asthma, or eczema, and may identify certain triggers to their symptoms such as exposure to outdoor pollens, animals, dust or mold. Irritants such as cigarette smoke, pollution, and strong smells may also worsen allergy symptoms.

Treatment for Allergic Rhinitis

Non-medicinal ways to help relieve symptoms include avoidance of provoking allergens and triggers. For pollens, keeping the windows and doors shut, avoiding going outside on dry windy days, and showering before bed to wash the pollens off may help. Avoid cigarette smoke, and keep pets away from your sleeping areas if possible. An air filter may help with pet dander. For dust mites, use zippered, "allergen-impermeable" covers on pillows and mattresses and wash bedding in hot (at least 130 degrees) water weekly. Nasal saline and sinus rinses may also help relieve some nasal symptoms without using medicines.

There are many allergy medicines available for those with more severe symptoms. Antihistamines block the effect of histamine in the allergy pathway, helping with symptoms of sneezing, runny nose, post nasal drip, and itching. However, they do not significantly help with congestion. Because of their improved safety and convenient once daily dosing, newer or second generation antihistamines are considered the first line of treatment for allergies. These include loratadine (Claritin®), fexofenadine (Allegra®), cetirizine (Zyrtec®), desloratadine (Clarinex®), levocetirizine (Xyzal®). Which one is better? Limited studies and clinical experience show they actually are about the same in relieving allergy symptoms. Older or first generation antihistamines such as chlorpheniramine (Chlortrimeton®), diphenhydramine (Benadryl®), and bropheniramine (Dimetapp®) are cheaper than second generation antihistamines. But, these medications have more side effects, and may make one sleepy. They also generally have to be taken more than once per day.

Nasal steroid sprays are effective in helping congestion, as well as sneezing, runny nose, and itching. They may be used alone, or in conjunction with antihistamines, and have even been shown to be more effective than taking an antihistamine alone. Common brands include fluticasone (Flonase®) and mometasone (Nasonex®). Side effects include nose bleeds or nasal irritation.

Decongestants such as psuedoephredrine and phenylephrine (found in Sudafed®, Mucinex D®, Actifed®, Dayquil®, and many other over the counter cold and allergy medications) are helpful for nasal and sinus congestion. It is important to be aware of potential side effects such as anxiety, insomnia, and high blood pressure.

Montelukast (Singulair®) may also help allergies by blocking the action of leukotrienes released by mast cells in the allergy pathway. It may be used when antihistamines, nasal steroids, and/or decongestants are not effective enough, or cannot be tolerated.

If you are concerned about how to best control your allergy symptoms, please make an appointment with your primary care provider.

Dr. Juliana Wong is board-certified by the American Board of Family Medicine and practices at Bay Valley Medical Group’s Danville office. She can be reached at 925-314-0260.