Sunday, April 28, 2013
Tuesday, April 12, 2011
- During the spring and fall my office is full of patients complaining of "hay fever", persistant cough, runny nose, and congestion. This can have several causes, but many times it turns out to be allergies. So could you have allergy symptoms?
- When the "allergen" affects your airways it can trigger asthma, and when it affects your eyes it can cause conjunctivitis (itching, redness, watering). But for most allergy suffers it affects your nose, causing allergic rhinitis. Allergies can start at ANY age, and are common here in Florida. Seasonal allergy sufferers can be allergic to pollens from trees or grasses, or even molds. Year-long allergy sufferers can be allergic to dust mites, pets, molds, cockroaches, etc. Symptoms from rhinitis (the nose) can cause sneezing, coughing, post-nasal drainage with sore throat, congestion, facial pressure, loss of taste, ear discomfort, a hoarse voice, etc.
- So how do you fix this? Well, the only possible "cure" is allergy shots, but they typically take 1-2 years to be effective and usually only lessen symptoms at best. Also allergy shots do not work for everyone. Most people with allergies treat the symptoms only, and for seasonal allergies this may be in the fall and spring only. It is important to take steps to reduce exposure to any potential allergens, and then there are several medications that can be helpful.
- The most common indoor allergens are dust mites, dog and cat dander, and mold. Even after removing the allergen from your home it may take 3-6 months to notice an improvement in symptoms. The bedroom is one of the most important rooms because of the many hours spent in there sleeping.
- Dust mites are insects that live in bedding, sheets, carpets, sofas, or any woven material. To reduce dust mites consider covering pillows and mattresses with dust mite covers (plastic material), and wash all sheets and stuffed animals in hot water once a week. Use a vacuum with a HEPA filter weekly, and try to minimize carpets and horizonal blinds and drapes in frequently used rooms when possible.
- It is difficult to reduce pet dander without getting rid of your pet. It will help some to use a vacuum with a HEPA filter. Also make sure you do not have a rodent or cockroach problem, because they have allergens in their urine and stool.
- Mold can also cause allergies, and is found in humid hot places like air conditioning vents, water traps, refrigerator drip trays, shower stalls, leaky sinks or pipes, etc. Reduce dampness and leaking in these areas, and treat for any existing mold. Mold also grows well on soap film that covers tile, sinks, and grout. Clean these areas with dilute bleach once a month.
- Outdoor allergens like pollens can be more difficult to avoid. Try to keep windows closed, stay inside when pollen counts are high, shower before going to bed, and wipe down pets that go outside to remove pollens. Consider using a nasal saline rinse such as NetiPot to wash away pollens in your nasal passage (this is over-the-counter, and can work well if tolerated).
- There are lots of different medications for allergies. Try over-the-counter treatments first, and if they are not helpful you may need to discuss prescriptions with your doctor.
- The most common medication to try first is an antihistamine. Benadryl tends to work the best, but will cause drowsiness (so try to take it at night). Less sedating options are Zyrtec, Allegra, and Claritin (or generics). They may help with itching, sneezing, and runny nose. They do not help with congestion. Prescription only ones include Clarinex and Xyzal.
- One of the most effective medictions for allergies are nasal steroids like Flonase (now generic), Nasonex, Nasocort, Veramyst, Omnaris, etc. Side effects are usually minimal. You may not notice the maximal effect until after days or weeks of regular use. People with glaucoma should not use nasal steroids.
- Be careful about using nasal decongestants like Afrin for more than 3 days. They initially work very well for congestion and runny nose, but if used for longer periods of time you can develop a condition known as rhinitis medicamentosa. This condition can cause constant congestion that will not go away unless the medication is used regularly, and it is difficult to treat. Do NOT use Afrin for more than 3 days.
- Beyond that there are lots of other options that should be discussed with your physician.
Here are a few good websites with more information about allergies:
- Amer College of Asthma, Allergy, and Immunology -www.acaai.org/public/advice/rhin.htm
- Amer Academy of Family Physicians patient education website - http://www.familydoctor.org/
My husband has had severe allergies for many years. He has been on every medication that can be prescribed. During the "high pollen" season he will take an antihistamine like Zyrtec, or a prescription version called Xyzal. He will also take Singulair. He will use two different nasal sprays, one is a steroid called Omnaris (newer) and the other is a nasal antihistamine called Astepro. In addition to all this he rinses his nose daily with a NetiPot nasal rinse, and also has tried allergy shots. The allergy shots were unsucessful, although we did not do a great job keeping up with the recommended schedule (3 times a week in the beginning). He continues to have congestion and sneezing at times, but the medicatons help. We are still waiting for a cure!