By John Hunt, MD
Pediatric Allergist/Immunologist and Pediatric Pulmonologist
Allergy season will be here before you know it, and if you're one of the many who suffers from seasonal allergies, you might be dreading it. Fortunately, you don't have to just let your symptoms roll over you, leaving you feeling like you've been hit by a truck. There are many affordable and easy ways to mitigate the sneezing, itchy eyes, runny nose, and other common symptoms of allergies.
Seasonal allergies result from pollen exposure in people who have developed allergic sensitivities to the pollens. In general, trees and grasses that pollinate in the springtime present problems. In the middle latitudes, trees begin pollinating in late February, with various species continuing to pollinate through May. Grasses pollinate in May and June. However, there are substantial geographic variations in this pattern.
Symptoms of pollen-induced allergies include itchy eyes, repeated sneezing, nasal congestion, and runny nose. These symptoms occur throughout the times that the plants you are allergic to are pollinating. The term "hay fever" is commonly used to describe this reaction. Sometimes, the allergic inflammation can be so bad that fevers do occur, although that is far from normal these days.
It is hard to tell the allergic rhinitis (runny nose) caused by seasonal allergies apart from the common cold. The common cold peaks in April and September/October, which happen to roughly coincide with peak pollen times (most weeds pollinate in the fall). A prominent sore throat is more likely to indicate a cold virus than an allergy.
There remain no therapies which are proven to shorten common colds to a significant degree, but there are plenty of ways to improve seasonal allergies.
As always, the diagnosis comes first. People who have seasonal allergies usually know it. They get their nasal and eye symptoms in the spring and/or autumn. Allergy skin testing or blood testing can be performed to identify which pollens in your area you are sensitized to which can be helpful information for three reasons:
- If you are allergic to one or a small number of pollens, you can know exactly when your symptoms are likely to start and intervene with medications before your pollen season hits (see below).
- Allergy immunotherapy (either by injections or sometimes with drops under the tongue) can, over a period of years, potentially cure some pollen allergies. To ascertain if LHS will share in the cost of allergy immunotherapy, a treatment plan must be submitted for prior approval.
- When seeking pollen allergies, usually we allergists also test for allergies to dust mites, pets, and molds. These are indoor allergens. Although it is very hard to avoid pollen exposure, exposure to indoor allergens can be decreased. For example, dust mites are found in every bed and pillow and can cause chronic allergy symptoms in people who are allergic to them. Additionally, chronic allergic exposure to dust mites can make reactions to seasonal pollen even more severe. It is easy and cheap to apply dust mite-proof mattress and pillow covers to your bed. If you are allergic to dust mites, doing so will likely improve all your allergies.
Because avoidance of pollen is nearly impossible without living in a plastic bubble or in Antarctica, we usually rely on treatments. Fortunately, the most effective medications for seasonal allergies are now available over-the-counter.
Although most people think of antihistamines, nasal steroids are actually much more effective medications for treatment of seasonal allergies. Nasacort and Flonase are now over the counter, and cost perhaps $20 per month or so. One spray of these nasal steroids, each day can often entirely prevent seasonal allergy symptoms. They work by preventing the body's wasteful immune response to pollens (pollens are harmless things, really). If you know when your allergy symptoms are likely to begin, try using nasal steroids starting 1-2 weeks beforehand and continue for a couple of months. You may well avoid problems altogether! These are also fantastic medications for most people with chronic, year-round allergies from dust mites and pets. Nasal steroids can be used in small children and all adults. Note that they take a few days of use before they really start working, and make sure you stop using them in the rare event that your nose starts hurting.
Sometimes the pollen is overwhelming and you may find you need extra help beyond nasal steroids. These are called breakthrough symptoms. There are many additional agents to consider using if breakthrough symptoms occur.
- Add Montelukast (generic for Singulair). This is still a prescription drug, despite the fact that it is perhaps the safest medication ever made. The generic version is now inexpensive. Montelukast can be used in small children and adults. It helps treat symptoms as well as helping prevent the allergic response. In general, it takes a few days of use before Montelukast is working to its full potential. Note that it does not work for all people.
- Add antihistamines. These medications do little to prevent the pollens from causing immune responses. Instead, they only treat symptoms, but they tend to work within 30 minutes of taking them. They are mostly over-the-counter now. They are particularly helpful for itchy eyes. There are two general groups:
- Sedating antihistamines—these are the “old” medications, including the active antihistamine ingredients in Benadryl (diphenhydramine) and many cold and allergy preparations. These medications commonly cause sedation as a side effect but are quite effective at blocking breakthrough allergy symptoms.
- Non-sedating antihistamines. This group includes Claritin (loratadine), Allegra (fexofenadine), Zyrtec (cetirizine), and their various branded and unbranded generic versions. These drugs are all very well tolerated (although Zyrtec may cause a small percentage of patients to be sedated). They all work very well for breakthrough symptoms. I recommend using the cheapest generic version that you can find.
- Allergy eye drops. There are many of these now—some that contain antihistamines, and some that contain nonsteroidal anti-inflammatory agents. Many are over the counter. These are primarily used for breakthrough symptoms, as well. Note that nasal steroids (the best drugs for most people with seasonal allergies) are not perfectly suited for allergic eyes (and are not to be used in the eyes!). Allergy eye drops are often powerfully effective if your eyes bother you, but beware that some allergy eye drops also contain another drug (a vasoconstrictor that helps “get the red out”). Try to avoid those if you are going to use them for more than a few days. The single-drug only eye drops (containing only an antihistamine or only an anti-inflammatory) are safer for chronic use.
One more thing. Pollen allergies can and do worsen the allergic forms of asthma and atopic dermatitis (allergic eczema). Treatment of allergic rhinitis can help lessen pollen’s impact on these conditions.
In summary—know yourself and your disease. Start treatment before symptoms start, and keep treating until your pollens are no longer flying around and you can glide right through allergy season.