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Springtime Allergies

posted Mar 21, 2015, 7:30 AM by Thomas Stern
It is that time of year again - everything is blooming and pollen is filling the air. While I enjoy the warmer temperatures and the flowers blooming I don't enjoy the allergy symptoms that come with it.  I have suffered from allergic rhinitis for years.  I remember sneezing and blowing my nose a lot - especially in the morning.  My grandfather, who lived through the depression and was a World War 2 vet, would frequently give me hard time about using a lot of tissues when my nose would run.  I did not receive treatment for my allergies until l was older - in middle school.  Now there are very good treatments for nasal allergies - and most are available over the counter.  There are several classes of medication over the counter which I will explain.

1) Antihistamines.  These are the most frequently used medications for allergy treatment. Within the category of antihistamines there are 2 classes - the older sedating antihistamines (such as diphenhydramine known as Benadryl) and the newer less sedating antihistamines (like cetirizine which is known as Zyrtec).  Antihistamines are taken by mouth and delivered systemically.  You will get relief within an hour of taking them.  The good news is that they will help with runny nose, itchy eyes, or rash.  The bad news is that you also get systemic side effects - namely drowsiness.  The drowsiness is definitely worse with the older antihistamines.  My personal experience is that the older antihistamines are more effective taking care of my allergy symptoms.  My nose is less runny while I nap!  I routinely use zyrtec to help with allergy symptoms and go to work.  I would have a hard time doing that on a full dose of benadryl. Antihistamines are very inexpensive.  A months worth at Wal-Mart will only cost $4 if you get the generic brand - which is what  personally buy.

2) Nasal steroids.  These are medicines such as flonase and rhinocort. You spray the medicine right into the nose.  These are topical steroids that help with inflammation in the nose and sinuses.  The mention of steroid scares a lot of people away but it shouldn't.  Nasal steroids are dosed in micrograms - which is one millionth of a gram.  Systemic steroids - are dosed in milligrams - or one one thousandth of a gram.  It is this extremely low dosing that prevents systemic side effects so they can be used chronically.  Nasal steroids are used to prevent nasal allergy symptoms.  A dose taken today will help in a day or two so they are not very helpful for immediate symptoms.  Nasal steroids are a good adjunctive treatment for people with persistent nasal symptoms and are also reported to help with eye symptoms.  They are more expensive - about $20 a month over the counter.

3) Nasal saline.  Most people would not think of nasal saline as an allergy treatment.  I recommend nasal saline to whoever has nasal congestion.  The job of our nose is to prevent particles in the air from going deeper into our respiratory tract.  The nose is effective in filtering particles 10 micrograms and larger.  Pollen is about this size.  Nasal saline simply washes the pollen out of your nose and sinuses.  Nasal saline is inexpensive - you can get it for $2 a bottle.  I recommend using nasal saline before using nasal steroids.

4) Topical opthalmic antihistamines.  This is simply an antihistamine that is put directly into the eye.  Despite being on several anti-allergy medications, when I work in the yard in early spring I feel like I want to scratch my eyes out.  I have callouses on my eyes because I used to rub them so hard as a child when they itched.  Thankfully I was introduced to opthalmic antihistamines several years ago.  They provide immediate and complete relief to my itchy eyes.  I am a big fan of topical anithistamines because the concentration of antihistamine in the targeted area is much higher than when you take a systemic antihistamine.  Since the medicine is topical there is less systemic side effects.   You can get a bottle of ketotifen opthalmic over the counter for around $10.

So if there are good treatments for seasonal allergies over the counter why go to a doctor?  If symptoms persist despite over the counter treatment there are additional meds and interventions we can use to provide relief.  Montelukast (singulair) is a great medicine for both allergies and asthma and still requires a prescription.  I think nasal anti-histamines such as azelastine still require a presciption as well.  Those are really the only 2 meds I prescribe for allergies.  If your symptoms still persist you need to see an allergist.

So in summary - if allergies are causing you symptoms I would start with an non-sedating antihistamine.  If you still have nasal symptoms add nasal saline and then a nasal steroid. If you still have eye symptoms use an antihistamine eye drop.  After that you can talk to your primary care about montelukast or azelastine and if all that fails - look for an allergist.  Enjoy your spring!
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