Diagnosing and Treating Allergies Seasonally
and Beyond-Allergy Therapy Without The Shots
By Jay Youngerman, M.D., F.A.C.S
As the pollen count rises, allergy sufferers are reminded that the season has changed – spring has arrived! While the warmer weather is greeted with widespread enthusiasm, it is also a harbinger of seasonal
allergies. As most people are aware, allergies can be annoying and interfere with normal daily activities. From a medical perspective, they can also cause and lead to chronic sinus problems or infections, chronic runny nose and cough, nasal polyps, asthma and chronic skin conditions such as eczema.
Allergies can be a nuisance and impact your lifestyle, but many people can put them in check through various methods ranging from antihistamines to saline sprays. Commonly known as “hay fever”, the diagnosis is allergic rhinitis. During the spring, trees, grass and ragweed release their pollen into the air, causing your immune system to send histamines or chemicals that trigger inflammation in the sinus tract, nose and eyes. This inflammation causes sneezing, nasal congestion, watery eyes, itching, and a host of other symptoms that can turn a beautiful spring day into agony for many hay fever sufferers.
Some allergy sufferers deal with swelling, teary-eyes, itching and runny noses year round. For these people, it is important to know when to recognize the need to take your allergy treatment a step further, and how to seek the treatment you need. The answer is relatively simple: If you experience a persistent allergic reaction, and traditional over-the-counter methods are not improving your symptoms, the next step is to visit an otolaryngologist. The specialist in Ear, Nose and Throat diseases can provide a comprehensive At Long Island ENT we perform tests to determine both environmental causes – anything from mold to foods to household pet dander – and structural issues that may be the lingering cause(s) of your condition.
GETTING TO THE ROOT OF THE PROBLEM
At Long Island ENT, one of our highly skilled physicians will take a detailed allergy history and perform skin testing. Step one in uncovering the cause of your allergies is to screen your triggers. We provide our patients with a questionnaire that allows them to track their symptoms over the course of the 12 months, and pinpoint when they experience irritation and discomfort. It is important to share which medications you currently take, if any, to control your symptoms, and how well you have been able to control them with these methods. We will ask you to check off any allergens, irritant triggers, weather change triggers or ingestant triggers that you have noticed, which may have led to an allergic reaction. In combination, these questions allow us to determine whether or not your symptoms are due to allergic rhinitis.
ALLERY SHOTS AND DROPS
Traditional methods of allergy treatment include allergy shots (subcutaneous immunotherapy), which are not always well tolerated by every patient, and allergy drops (sublingual immunotherapy). We offer both options in our practice, and find that this broadens the spectrum of available treatments for patients who cannot tolerate or prefer not to commit to an injectable regimen. Specifically, children, asthmatics and others with unique sensitivities may be better suited for sublingual therapy.
Allergy drops are precisely what they sound like – drops of liquid placed below the tongue to treat multiple allergens, ranging from food to pollen. These drops are customized to address the specific allergies of each patient, and formulas can be prepared in as little as two weeks. There is a three step process in which allergy drops begin to work. In the first stage, you will develop a tolerance. The drops then begin to take effect in relieving your allergy symptoms. Finally, the body becomes accustomed to your allergies.
It is important to commit to the full scale of treatment, which requires taking your allergy drops three times each day during the course of your regimen. While the course of treatment will generally continue for three to five years, you will need to check in with your doctor every three months to remix your serum, increasing the concentration and
advancing the allergy therapy.
NAVIGATING THE DRUGSTORE AISLES
Just walk into any drugstore and you will see shelves and counters filled with allergy treatments in the form of tablets, capsules, sprays and more recently, dissolvable leaves. The main categories of over the counter therapies fall into two main groups: decongestants and antihistamines. Some of these will make you drowsy, while others will cause sleeplessness and jitters.
Antihistamines combat common allergy symptoms, including sneezing, runny or itchy nose, watery or itchy eyes and hives, by blocking the action of histamine, the chemical released by the body in response to an allergen producing the reaction. Histamine has many actions within the body, including stimulating salivation and dilating blood vessels. Antihistamines work to counter these reactions, and some antihistamines, both prescription and non-prescription, can slow reaction times, impair judgment, cause dry nose, mouth and throat, and make you sleepy. These side effects occur more commonly with over-the-counter antihistamines. Some antihistamines can also interact with other prescription drugs, which can lead to an increased risk of irregular heartbeats. Driving, piloting an aircraft or working with dangerous equipment should be avoided.
Decongestants shrink swollen nasal tissues, and come in tablets, syrups and nasal sprays. Decongestant nasal sprays can dry and irritate the nose, causing bleeding and holes or perforations in your septum. Oral decongestants can cause nervousness, restlessness and insomnia. For severe congestion from swollen nasal membranes, sprays help reduce inflammation quickly. For milder cases of congestion, a pill form may give you more controlled, longer-lasting relief. Combination drugs that are antihistamines and decongestants work in two ways; they block the action of histamine, and relieve congestion,sneezing and other classic allergy symptoms. Long-term use of nonprescription decongestant nasal sprays can lead to the drug no longer working and symptoms may return worse than before.
Prescription Nasal Sprays
Nasal corticosteroids are anti-inflammatory drugs that inhibit allergic reactions and reduce nasal swelling and mucus secretions. These sprays relieve congestion caused by allergic rhinitis. Instead of waiting until symptoms develop, these medications should be used before allergy season starts and must be used on a daily basis.
Cromolyn is a non-steroidal spray that interferes with the release of histamines to prevent sneezing, itchy, and a runny nose. Common side effects of nasal sprays include dryness or burning sensation in the nose, unpleasant taste, yeast infection in the mouth, nosebleeds and headaches. Newer antihistamine nasal sprays reduce inflammation, and swelling, and block the release of histamine in the nose preventing allergic reactions. Some may even help eye symptoms.
Although many medications are available without a prescription, for the best advice, consult with your doctor before embarking on over the counter treatments that may end up not getting you the relief you
so desperately need.