WebMD The Magazine - Feature
Laura J. Martin, MD
At last, the first warm days of spring! Time to open the windows, pack away the winter coats, get out in the garden -- and head to the pharmacy to stock up on allergy medications.
If you greet the arrival of spring each year with a stuffy nose and watery eyes instead of a happy heart, it's time to take a new look at your seasonal allergies. You may have been struggling with spring allergies for years, but that doesn't mean you can't learn a few new tricks about coping with them.
With the help of one of the nation's top allergy experts, WebMD has put together some tips for managing seasonal allergies that can help you enjoy spring instead of just suffering through it.
About 40 million people in the U.S. have some type of "indoor/outdoor" allergy, known as seasonal allergies, hay fever, or allergic rhinitis, says James Sublett, MD, FACAAI, a clinical professor and section chief of pediatric allergy at the University of Louisville School of Medicine and managing partner of Family Allergy and Asthma in Louisville, Ky.
"Allergies have a strong genetic component -- if your parents had allergies, you're far more likely to have them yourself," he explains. "Most allergies develop in childhood, but in some people, they develop later after exposure to environmental factors 'flips the switch.' For example, we know that diesel particulate exposure can trigger allergies. The end result is a runaway response in the immune system."
Among the most common allergy triggers, according to the Asthma and Allergy Foundation of America, are:
Seasonal and other indoor/outdoor allergies aren't just annoying. Asthma is sometimes triggered by allergies (although most people with allergies do not develop asthma). But if you do have asthma and your allergies aren't well controlled, you may be more likely to have asthma attacks, which can be dangerous and even life-threatening.
Here's what you need to know to control your allergy symptoms before they ruin a perfectly good spring season.
Spring pollen season starts much earlier than many people think. In large swaths of the country, including the eastern seaboard and the Ohio Valley, pollen starts filling the air as soon as the weather warms up just enough for the trees to begin budding.
"Here in Kentucky, we'll see pollen sometimes in mid-February," says Sublett. "As long as you're not in the snow belt up around the Great Lakes, the pollen season starts very early, and by mid-March we'll have our first peak."
This means that if you take medications to control your seasonal allergies, the time to start them is mid- to late-February, not late March. "Allergies create an inflammatory response that is like a smoldering fire. If you can keep it smoldering rather than flaring, you'll do a lot better," says Sublett. "By starting your medications early, you're less likely to have a snowball effect with your symptoms."
Three main kinds of over-the-counter (OTC) medications are used to help control seasonal allergies: topical nasal sprays, inhaled corticosteroids, and antihistamines; oral antihistamines; and decongestants.
If you have mild seasonal allergies, nasal sprays and inhalants and oral OTC antihistamines can both effectively manage your symptoms. Despite what you might have heard, antihistamines are not addictive, although they can lose some of their effectiveness over a few months.
If your symptoms are not controlled, consider switching brands periodically to make sure your medication is still packing the greatest punch. You may want to buy the kind that is called "nonsedating" on the label (unless you're planning to go straight to bed after taking them).
Sublett doesn't advise using OTC decongestants for allergies, although many people do. "They're designed for use with a cold, for seven days or less, while allergies last for weeks," Sublett explains. "They work by reducing the blood flow to your nose, letting you breathe better." However, nasal decongestants should be taken on a short-term basis only. If used for more than a week, a disorder called rhinitis medicamentosa may occur, where rebound nasal congestion (when congestion returns and gets worse) occurs each time the medication wears off.
Also, oral decongestants can cause significant side effects, including an elevation in blood pressure, nervousness, and sometimes heart palpitations. If you have high blood pressure, glaucoma, or heart conditions, talk to your doctor first before trying decongestants.
You don't want to have to stay indoors on a beautiful day just because you have allergies. But if you're going to be working outside, consider wearing a protective allergy face mask for tasks like mowing the grass, raking leaves, or washing the car. Depending on how severe your allergies are, you can buy a simple disposable paper mask or a more long-lasting "respirator mask" with a high efficiency particulate air (HEPA) filter.
Remember Sublett's advice about starting allergy medications early in the season so your allergic response doesn't get out of control? That applies to your daily life as well. If you're working outside in the afternoon, take your allergy medication at lunch so it will have a chance to get into your system before the pollen does.
"Keep an eye on the pollen counts, and try to plan more of your outdoor work for days when pollen counts are expected to be low and it's not so windy," says Sublett. If you have a smartphone, download an app that gives you regular pollen updates.
What about inside? "There's a myth that if you keep your windows shut, you'll be OK," Sublett says. "But homes have to have ventilation, and about one-third of what's outside gets inside no matter what you do."
To minimize the allergens circulating throughout your house, get a high-efficiency furnace filter (MERV level 11 or 12 is what you're looking for), and be sure to change it every spring and again in early summer -- for example, in March and June. You can also cut down on circulating allergens by using a HEPA filter on your vacuum and getting a HEPA air filter.
And when you're in the car, keep the windows shut and set your ventilation to recirculate. "Studies show that recirculating air through the car's cabin filter can help with allergies," Sublett says.
One "don't" for coping with allergies indoors: vaporizers and humidifiers. "The droplets are so big that they don't get into your nose, and increasing the humidity in your home can lead to problems with mold and dust mites," says Sublett.
Some natural remedies do help with allergy symptoms, but keep in mind that they have their limits. One popular tool is the neti pot, which flushes out your nasal cavities by using gravity to rinse them with a saline solution. Studies show that neti pots are effective for minimizing seasonal allergy symptoms.
"They definitely help if you're congested and symptomatic," Sublett says. "But they're just rinsing the mucus and irritation out of your nose. They're not actually removing the pollen, which is causing the symptoms in the first place."
The jury is still out on acupuncture. Some swear by it as an allergy remedy, but studies on the subject so far have been mixed. Researchers reviewing the overall evidence say that a large, clinical trial is needed to resolve the conflicting data.
If the latest batch of OTC antihistamines in your medicine cabinet isn't doing the trick, a visit to an allergist can bring relief.
An allergist will help you determine precisely what you're allergic to by discussing your symptoms and doing skin tests, which involve exposing you to a small amount of an allergen through a skin abrasion to see if you react. Allergists can also test for antibodies in your blood that can signal the presence of allergies. Your allergist might ask you to keep an "allergy diary," tracking when and where you have allergic reactions.
Several prescription allergy medications are available:
"Eye symptoms can really make you miserable," Sublett says. "People often don't really appreciate the importance of good prescription eyedrops." But, he adds, some eyedrops cannot be used with contact lenses.
"The take-home message this allergy season is simple: You don't have to be miserable," Sublett says. "See an allergist, find out exactly what you're allergic to, and develop a plan."
About half of people with seasonal allergies say they do fine with over-the-counter medication, according to Sublett. The other half have moderate to severe allergies that may often leave them impaired -- missing work, missing school, or showing up but barely functioning. Some people are helped by prescription medications, but many could benefit from allergy shots, Sublett says.
Immunotherapy for allergies -- commonly known as "allergy shots" -- works by exposing the immune system to small amounts of an allergen. Over time and in increasingly larger doses, the body learns not to see it as a foreign invader and develops a tolerance to it. If neither OTC nor prescription medications do the trick, and you're suffering miserably through spring, fall, or both, then allergy shots may be the answer for you.
When allergy shots were first developed (they've been around since the mid-20th century), the process took years to be fully effective. But today, you can begin allergy shots in January and have a good chance that your symptoms will be significantly decreased, if not eliminated, by the time the first tulips peek out in April.
Clustering is an even more aggressive approach. It takes more of your time at the outset, but you can build up to full effectiveness within just four to five weeks. "Two times a week, you'll come in to the allergist's office for a couple of hours. You get one shot, and then wait, and then get another shot later in the visit," says Sublett.
No matter which approach you take, once you reach the maintenance level with allergy shots -- that is, you've built up a tolerance to your allergens, and your symptoms have become minimal -- your allergist will gradually decrease the frequency of your injections. Ultimately, you'll need them only once every month or so throughout the year, and after a few years you may even be able to discontinue them altogether without having your allergies return.
SOURCES:James Sublett, MD, FACAAI, clinical professor and section chief, pediatric allergy, University of Louisville School of Medicine; managing partner, Family Allergy and Asthma, Louisville, Ky.Allergy Foundation of America: "Allergy Facts and Figures."American Academy of Allergy, Asthma, and Immunology: "Tips to Remember: Indoor Allergens."Rabago, D. American Family Physician, November, 2009; vol 80: pp 1117-1119.Roberts, J. BMC Alternative and Complementary Medicine, 2008; vol 8: p 13.DiBona, D. Journal of Allergy and Clinical Immunotherapy, September 2010; vol 126.
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