Signs of Spring: Daffodils and Allergies

The story is the same every spring — this could be the worst allergy season of all time. It sounds alarmist, but there’s some truth to the idea. As the climate gets warmer, tree pollen becomes more prolific. So for the person who may be suffering for the first time, or for the seasoned allergy-fighting pro, here’s some news you can actually use.

First of all, an allergic reaction is caused by your body’s immune system overreacting to harmless things such as pollen, dust or molds. These elements are considered “allergens,” and the body treats them as foreign and reacts by producing substances that cause allergic symptoms. Typical seasonal allergens include pollen from trees, grass, and weeds. Year-round allergens include mold spores, house dust mites, cats, dogs, cockroaches, and rodents.

Anyone who suffers from allergies knows the symptoms:

• Runny, stuffy and/or itchy nose

• Loss or change of sense of smell

• Draining in the back of the throat

• Cough

• Itchy, watery and/or puffy eyes

You know how you feel, but how do you find out what you are allergic to? Getting tested by a board certified allergist can help in finding which allergen is triggering your symptoms. Testing can be done by a skin prick test or blood test. An allergist can find out which test is appropriate for you. In the skin prick test, a tiny drop of extract of an allergen is pricked into the skin; if you are allergic to the allergen, expect a small swelling at the site of the prick. A reaction occurs within 15 minutes. In the blood test, blood is drawn and sent to a lab to identify allergies by blood work.

Treatment OptionsTo treat allergies, the first step is avoidance. Keep the windows closed when pollen counts are high and try to stay indoors as much as possible, especially when pollen counts peak at midday. Use air conditioning when you are at home or in your car; outdoors, wear sunglasses or a hat to keep pollen out of your eyes.

The next step is medication. There are a variety of over-the-counter options. For your nose, there are intranasal corticosteroids, which are local topical steroids that work by reducing inflammation in nasal tissues. They are effective in treating nasal allergies and can help with nasal congestion, runny nose, sneezing, and itching. They may take several days to become effective, so daily use can improve symptoms.

There are also oral antihistamine tablets that block the effect of histamine, which is a chemical substance released during an allergic reaction. These pills can help with sneezing and runny nose symptoms. Keep in mind, some of these medications may cause drowsiness, but second generation antihistamines, such as loratadine (Claritin), cetirizine (Zyrtec), fexofenadine (Allegra), levocetirizine (Zyzal), have less drowsiness than the first generation antihistamines such as diphenhydramine (Benadryl), and doxylamine (Vicks and Nyquil).

For your itchy and watery eyes, there are a variety of allergy eye drops that can help. Eye drops usually contain antihistamines but may also include decongestant medication, which constrict blood vessels in the eye, so don’t use them if you have glaucoma.

Oral (pseudoephedrine) and nasal decongestants (oxymetazoline) alone are not recommended for treatment of allergic rhinitis, but they can be used in conjunction with other allergy medications for short periods of time. Using nasal decongestant sprays (which are different from corticosteroid sprays) for more than a few days can rebound and cause swelling of nasal tissue with prolonged use. Also, you should avoid oral decongestants if you have high blood pressure.

Other therapies you may try include saline sinus rise in a rinse bottle or a neti pot. This method physically removes thick nasal mucus in the nasal passageways. Make sure to follow manufacturer’s instructions in preparation of the neti pot, and avoid using unfiltered tap water.

Shots and ImmunotherapyFor some allergy sufferers, over the counter medications may not be enough. For such patients, allergy shots or allergy immunotherapy can be beneficial. Allergy immunotherapy is a long-term treatment that consists of injections of increasing amounts of diluted allergy extract under the skin of the arm. Your immune system gets used to the allergen and does not overreact when exposed to it in the environment. Allergy shots have been shown to decrease symptoms in nasal allergies, eye allergies and asthma.

Please be sure to see a board certified allergist to learn more about allergy immunotherapy and to answer any other questions you might have.

Roshni Naik, MD is an assistant professor of medicine (Clinical Immunology and Pulmonary, Critical Care and Sleep Medicine) at Mount Sinai Beth Israel