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Doctor/Patient: An Allergy Survival Guide

Martha Stewart Living, June 2008

The allergic reaction we commonly associate with hay fever, or seasonal allergic rhinitis, is due to an overly sensitive immune system. The system normally works to destroy potentially dangerous invaders such as bacteria and viruses. But in the case of seasonal allergies, pollen is mistakenly identified as one of those threats, and the immune system kicks in.

As a defense, immune cells called mast cells release the chemical histamine. In turn, histamine triggers another chain of events. The end result is the body's inflammatory response -- the familiar onslaught of runny nose, watery eyes, and endless sneezing.

The Pollen of the Month?
Thirty-five million Americans suffer from air-related allergies, which are the sixth leading cause of chronic illness in the United States. If you're one of them, here is my prescription for surviving the season.

Identify Which Pollen You Are Allergic To
This can help, especially if you can eliminate the culprit from your surroundings. Plants that are wind pollinated are the biggest offenders. Insect-pollinated plants (usually recognizable by bright flowers and foliage that beckon insects) actually produce pollen that is too large to remain airborne -- so these plants present little risk to your upper airway.

Time of Year
Allergies from tree pollen generally flare up in late April and May. Some of the most common tree allergens come from birch, poplar, willow, oak, ash, elm, hickory, and mountain cedar.

If your allergies are worse in the summer, its likely due to grass and weeds. Kentucky bluegrass and Bermuda grass, common in many American lawns, are well-known seasonal troublemakers. Symptoms beginning in late August through the first frost are usually because of ragweed.


Give Allergens the Slip
On just the slightest breeze and in a matter of a couple of minutes, a grain of pollen can travel as far as a half mile. Ragweed pollen, which has been documented 400 miles out at sea and two miles high in the air, is particularly pervasive.

While it may not be possible to avoid pollen completely, there are some simple things you can do to limit your exposure:

  • Plan outdoor activities for later in the day. Pollen counts are highest during the early-morning hours (5 a.m. to 10 a.m.).

  • Do lawn work or gardening after a rain shower, which removes pollen from the air.

  • Remove clothes and shoes in a mudroom before entering the house. When you go outdoors for long periods, your clothes, skin, and hair get covered in pollen, even if you don't see it. Take a shower or bath upon coming home to wash any residual pollen from skin and hair.

  • Keep your home's doors and windows closed as often as possible.
  • Redecorate where you can: Hardwood and other smooth floors retain fewer allergens than carpet. Leather furniture hangs on to fewer particles than fabric-covered pieces.

 

Many people will need some pharmaceutical intervention to ameliorate their worst allergy symptoms. Here is what you should know about the most common therapies.

Antihistamines
The release of the chemical histamine plays a large role in allergic reactions. So it makes sense that antihistamines -- drugs that block the actions of histamine -- are the primary treatment. Several are available over the counter. Older formulations, such as diphenhydramine (Benadryl, for example), can cause drowsiness. Newer ones, including Claritin and prescription Allegra, usually do not.

The best time to use an antihistamine is before you are exposed to the allergen. Doing this will not only lessen the likelihood of a reaction but also reduce the risk of developing a secondary health problem, such as a sinus infection, from your allergies.

Decongestants
These medications, which come in pill form and as nasal sprays, can seem like miracle drugs when your nose is severely stuffed up. They often contain the active ingredients pseudoephedrine or phenylephrine and can generally be purchased without a prescription (such as Afrin and Sudafed).

Decongestants can elevate blood pressure. If you have a history of hypertension, make certain your physician knows that you are using these medications. Use of the nasal-spray form should be limited to three days at a time if possible. Often, the more your nose gets accustomed to the spray, the more you need to use to feel its effects.

Cromolyn Sodium (Nasalcrom)
This is available without a prescription but requires two to four weeks of use before it begins to control symptoms.

Nasal Steroid Sprays (Including Flonase and Nasacort)
These are available only by prescription. These can help reduce swelling in your nose but also can take up to two weeks before the maximum benefit is evident.

Allergy Shots
Think of these as a vaccine for allergies. In order to partake of the therapy, it's necessary to know exactly what you're allergic to, and an allergist will likely need to give you a skin or blood test to determine this. The doctor will then give you injections of a weak allergen solution on a regular schedule, gradually increasing the amount of allergen so that your body gets habituated to it and no longer overreacts.

This treatment option can take a few months to a few years to work, but according to the American Academy of Allergy, Asthma & Immunology, this form of immunotherapy can produce allergy relief in up to 90 percent of patients with seasonal allergies. You can learn more at aaaai.org.

When it finally comes time to stop and smell the roses, heres hoping that you will be fully able to.

Text by Brent Ridge, M.D.