By Rand Hayes, M.D., R. Ph., a family medicine physician with Williamson Medical Group. His office is in Tollgate Village in Thompson’s Station
As a family medicine practitioner I am seeing many of my patients coming off cold and flu season in the early spring, but jumping headfirst into allergy season. One of my goals this time of year is to help educate people about the differences between colds and flu and seasonal allergies and how to treat each of them effectively.
During the winter, I see a lot of patients saying they are struggling with allergies. They will tell me they are taking Claritin and it isn’t working. I have to tell them it’s probably not seasonal allergies during that time of year unless they have a house full of cats or something. In the winter, we just don’t have seasonal allergies, but we do see colds and the flu.
But this time of year as people venture back outside as the weather warms up, you guessed it: suddenly it is allergy season.
Histamine reaction
When you are outside and pollen is in the air, you breathe in the microscopic pollen spores through your nose. These particles come in contact with the lining of the nose and it causes the mast cells to secrete histamine. When your body secretes histamine, it causes tissues to swell with fluid which results in congestion, nasal drainage, and itchy, teary eyes.
Histamine is a chemical secreted by the body’s own mast cells in reaction to the allergens when they enter the nasal passage. It’s essentially an overactive natural immune response by the body and some people’s immune systems are more reactive than others. This is why some people have more trouble with “allergies” than others.
This where anti-histamines come in. You can take medications like Benadryl, which block a great deal of the body’s histamine response, and subsequently reduces the swelling and drainage by the body.
Older antihistamines like Benadryl are very broad, so they block H1 and H2 receptors, which are the two different types of histamine receptors. They are very effective, but tend to cause drowsiness. That’s why medications like Claritin, Zyrtec, and Allegra were developed. These newer antihistamines only block the H1 receptors, which tends to greatly decrease the sedation effect. They aren’t always as effective as the broader spectrum medications like Benadryl, but are a nice option for someone who cannot afford to be drowsy during the day.
Additional Relief
There are other medications that previously were prescription only, such as Flonase and Nasacort, that are now available over the counter which are also very effective.
If you are suffering from allergy-like symptoms, I recommend trying these antihistamine medications and/or nasal sprays first. If you are continuing to have symptoms like discolored, thick drainage, pressure and pain in the teeth areas after 10 days, then you may want to seek further treatment with your provider, as this may indicate the presence of an infection.
For seasonal allergies, the newer antihistamines are effective and more available than ever before since they are available without a prescription. If these aren’t effective enough alone, you can then add Flonase or Nasacort Nasal Sprays and this combination is usually quite effective.
Nasal Sprays
If you are looking to a nasal spray for allergy relief, stick with the steroid or saline nasal sprays and avoid the over-the-counter decongestant nasal sprays like Afrin or 4-Way. While these sprays can be beneficial in the short-term, they are notorious for causing rebound congestion when you try to stop using them. Before you know it, you are using these nasal sprays many, many times a day just to keep your nasal passages open to simply be able to breathe.
With a steroid nasal spray like a Flonase or Nasacort, it may be slightly irritating if your nose is raw, but you won’t have rebound congestion, which is most often much worse than the original problem you began using the nasal spray to begin with.
I recommend if you spend time outside mowing, gardening, golfing or whatever, use some saline nasal spray first thing when you come back inside to rinse out the nasal passages. By doing this first, you can decrease the entire allergic process by getting rid of the provoker before it has a chance to wreak havoc in your body.
Other options
I have seen patients have success with Neti pots or other nasal irrigation systems. These are fine if you can use them properly. This time of year, especially, if you can use it at the end of the day after prolonged exposure to allergens, these nasal irrigations can have a huge benefit. However, I don’t recommend doing it more than once a day.
For severe congestion, keeping the temperature cooler in the home can also help keep the nasal passages open. People tend to have fewer problems at night if sleeping in a cooler room because things tend to be less swollen. We all tend to naturally swell in our nasal passages at night, so the slightly cooler air can have a positive effect on that.
Preemptive strike
Another trick I recommend to seasonal allergy sufferers is to be preemptive with medications. Listen to your body. Look at pollen maps. If you start to see pollen counts going up, it’s not a bad idea to go on and take a daily antihistamine. I think this is a great idea for those who also suffer from asthma because if you can keep the allergy part controlled, you can keep the asthma at bay a great deal of the time.
I recommend for patients who have seasonal asthma or severe seasonal allergies to use a daily antihistamine until the pollen counts start to go down, which around here usually occurs in late June. Then we can start this process all over again in late August when Ragweed begins to bloom. I would recommend then to continue the antihistamine, if needed, until our first frost occurs.
The amount of rainfall can also dictate the severity of seasonal allergies as rain can help reduce the pollen levels circulating in the air. However, increased rainfall can cause increased mold growth, which can unfortunately cause the same problem of increased allergic reactions. So living in the South can be difficult for severe allergy sufferers. Often times this subset of patients who seem to always have allergy symptoms, can greatly benefit from allergy testing and treatment from an Allergy specialist.
I used to have bad seasonal allergies, the only downside of living in Williamson County in Middle Tennessee! Two years of allergy shots barely helped. I still had bad allergies and frequent migraines triggered by the allergies. Four years ago, on the recommendation of a friend, I started drinking a specific daily nutrition drink he had been using and, within three weeks, all of my allergies ceased – and have never come back. I no longer need my Advair, Zyrtec, rescue inhaler or migraine medicine. If anybody wants more information, please email me.