John Hunt, MD
Chief Medical Officer, Liberty HealthShare
We are entering what is commonly called allergy season, so now is probably a good time to talk about managing allergies and asthma. In addition to my responsibilities as chief medical officer of Liberty HealthShare, I am an allergist/immunologist and pediatric pulmonologist, so this subject is comfortably within my area of expertise.
Certain airborne particles trigger allergies in some people when they are inhaled and make contact with the mucous membranes of the nose and lungs. These particles are not dangerous for the non-allergic person, but they do cause a reaction in those who are allergic.
Allergies to inhaled particles result primarily from the development of an immune response to proteins found in pollen, dust mite excrement, or mold. These immune responses, which serve no protective purpose, run in families and cause what are known as allergic diseases. The most common allergic diseases are:
- atopic dermatitis (the most common form of eczema)
- allergic rhinitis (commonly known as hay fever)
- allergic conjunctivitis (allergic eyes)
- allergic asthma (the most common form of asthma)
What all of these disorders share in common is inflammation (of either the mucous membranes or skin).
Allergies to dust mite excrement are the most common. We inhale these particles into our airways all the time. Microscopic dust mites are harmless to the non-allergic person. They live in our sheets, pillows, and carpets year-round, causing year-round inflammation in those who are allergic, making the spring allergy season even harder on those who are also allergic to pollen.
The best way to avoid the symptoms of allergies is to avoid allergens. It’s quite possible to keep dust mites at bay with dust mite-proof mattress and pillow covers and a weekly hot water wash of bedclothes. On the other hand, you can’t avoid pollen unless you move away from it entirely. If you have an allergy to pollen, your body will let you know with itchy eyes, a runny nose, sneezing, and possibly flares of allergic asthma and eczema, especially during spring and fall.
After a few years of pollen allergies, you should start noting when your own personal allergy season starts (which may be different than the “allergy season” you usually hear about). Trees tend to pollinate in early spring, grasses in late spring, and weeds in the fall. Molds can be year-round but some are worse when leaves are rotting.
I am an allopath (an MD). We treat allergies with medications because most of us aren’t trained in the natural or alternative methodologies of dealing with them. I must plead ignorance about those natural methods and won’t comment about them here. However, we do use allergen immunotherapy quite effectively. These are allergy shots or sublingual (under the tongue) allergens given approximately once a week. During allergen immunotherapy, patients are exposed to a controlled dose of natural allergens to help them overcome their allergies, and it usually works better than all medications, so we allopathic doctors have learned something!
Immunotherapy is a good option for some, but for most allergy sufferers, medications are the mainstay because of their simplicity and relatively low cost. TV advertisements are lousy teachers, so here’s a quick run-down of helpful tips for managing your allergies. Remember, I only present the allopathic options here. How they work at the biochemical and cellular level is mostly well understood.
For hay fever:
Nasal steroid spray medications beat everything else. They are now available over-the-counter (and are therefore affordable), are low-dose, and have very few side effects. Used daily prior to and throughout your allergy season, they prevent problems in most people. They take a few days to start working.
Montelukast (Singulair) is now an inexpensive generic prescription and will hopefully be available over-the-counter soon. It’s a once-a-day pill that is effective in many people (but not all). It has nearly no side effects.
Antihistamines are the wimpiest allergy drugs. The ones that have been around the longest have the most side effects, too. If you are using antihistamines as your allergy medication, you can probably do much better with nasal steroids. Antihistamines do have the benefit of working quickly, which is why people turn to them first and think they work well. Unfortunately, they work incompletely. Benadryl, as well as many other over-the-counter antihistamines, sedates most people. Antihistamines branded as “non-drowsy” don’t work quite as well for hay fever, but they are more conducive to safe driving. Brand names for these include Claritin, Allegra, and Zyrtec. These are all available in generic versions, which are just as good and less expensive.
It’s okay to use all three classes of medications (nasal steroids, montelukast, and an antihistamine) to get through your allergy season if you need them.
For atopic dermatitis:
If you are an allergic person who also has eczema, the two are likely related. Eczema in infants is most commonly triggered by certain food proteins (such as milk or egg), but as people get older, inhaled allergens like pollens and dust mites are usually the culprits. Atopic dermatitis is typically characterized by a dry, inflamed, itchy rash which can become infected. Treatment varies depending on severity and symptoms.
It’s important to control each of these symptoms. Dryness can be addressed with moisturizing soaps and lotions, creams, or ointments, depending on how severe it is. Inflammation can be controlled by avoiding relevant allergens and applying topical steroids and creams. It is often useful to incorporate low dose nasal and inhaled steroids because, even though eczema is a rash, allergens that land on mucous membranes can trigger inflammation everywhere else. Itchiness can be treated by antihistamines if the moisturizers and steroid creams aren’t working well enough. Unfortunately, this likely calls for the sedating variety of antihistamines. If eczema is not minimized with the above therapies, infection is likely and oral antibiotics may be necessary.
For allergic conjunctivitis:
There are many eye drops available over-the-counter that work well with no systemic side effects. My advice is to generally avoid drops that have vasoconstrictor in them (the ones that “get the red out”) because those are not safe to use over the long term. Antihistamine drops and other anti-inflammatory drops you can get over-the-counter are fine. Use them according to their instructions. Oral antihistamines (non-drowsy are fine), taken each day, usually prevent the need for eye drops. Be aware that redness without itching is probably not allergy-related.
Asthma is not one disease, but rather many very different diseases. It is treated in very different ways depending on cause. Although most allergy drugs are available in generic or over-the-counter formulations (and are therefore cheaper by far), the best drugs for asthma are inhaled steroids, which are unfortunately very expensive, prescription only, and not available in generic forms.
The most common cause of asthma is allergies, but it can also be caused by viruses, dry air, parasites, gastroesophageal reflux, exercise, and other factors. If you have asthma, your first step is to get a diagnosis as to what is causing it.
Asthma is too complex a topic to go through in detail here, but you can download an electronic copy (PDF) of my book, Your Child’s Asthma. It’s free for Liberty HealthShare members. It contains many resources on childhood asthma, and can also be of some help to adult asthma sufferers.
If you are currently in the midst of experiencing allergy symptoms and are desperate for relief, try implementing some of the suggestions and therapies I’ve suggested above. Turn to your physician for advice as you feel appropriate. I hope you are able to breathe easy this spring!