By Melanie Haiken
CONSUMER HEALTH INTERACTIVE
Your head feels like someone stuffed it full of old socks. Your eyes are so red and itchy you're afraid to leave the house without eye drops. The ache in your cheeks lets you know that your sinuses are involved, too. But you hang on for yet another week without calling your doctor, thinking that hay fever season couldn't possibly last much longer.
First, the bad news: For many people, allergy season has become a year-round stint, according to the American Academy of Allergy, Asthma & Immunology (AAAAI). But there's good news too. "With the latest allergy treatments available, there's no reason for anyone to go around feeling miserable," says William Howland, MD, director of the Asthma and Allergy Center of Austin, Texas. "By combining a variety of medications, we can get symptoms completely under control. I tell my patients, 'You have a right to breathe.'"
The first step is to try minimizing your exposure to the substances that trigger your allergies, such as pollen, mold, and animal dander. If that doesn't help, talk to your primary care doctor about medication options. He or she may recommend over-the-counter medications such as Benadryl (diphenhydramine) or Claritin (loratadine), or prescription medicines such as a daily nasal steroid, such as Flonase (fluticasone), Rhinocort AQ (budesonide), Nasonex (mometasone furoate), or Beconase (beclomethasone), or a leukotriene inhibitor, such as Singulair (montelukast sodium). If your symptoms aren't responding after a number of therapies, it would be wise to consult an allergist who can help identify what you're allergic to and how best to treat your case. Often, the sooner you start treatment, the easier it will be to improve your condition. Waiting may only make things worse, doctors say.
"We're seeing a trend where patients are waiting longer and coming in with more severe disease," says Dawn Beckman, MD, chairwoman of the Asthma and Allergy Center of DuPage Medical Group in Illinois. "We want people to come in and see us before they get really sick."
What are allergies?
Allergies are your body's way of reacting to perceived threats in your environment. When the body is exposed to a substance you are allergic to, called a trigger or allergen, your immune system tries to fight off the assault by producing an antibody called immunoglobulin E (IgE). The problem is, these antibodies cause your cells to release proteins called histamines, which in turn can cause itching, swelling, runny eyes or nose, or, in more severe cases, problems with swallowing and breathing.
According to the Asthma and Allergy Foundation of America, some 50 million Americans suffer from hay fever -- more properly known as "seasonal allergic rhinitis" -- and have some type of allergy. That's one in five people, making allergies the fifth leading cause of chronic disease in the country.
What causes allergies?
There are hundreds of different allergy triggers, but the most common ones include pollens, molds, dust mites (tiny creatures that live in household dust), animal dander, and industrial chemicals.
If your allergies seem to flare up at specific times, most commonly in the spring, then you probably have hay fever, in which case pollen is responsible. But if your symptoms seem to come and go year-round, then it's time to evaluate whether you might be reacting to mold, mites, or animal dander, all of which are more common allergy triggers than people realize, say the experts.
"I have people come in here all the time and tell me they have hay fever that never seems to go away, and it turns out they're really allergic to mold spores, which can occur year-round," says Howland, the allergy specialist in Texas.
Another common misconception involves pets, according to Illinois allergist Beckman. Many people believe it's possible to be allergic to some animals and not to others of the same species, but this just isn't so -- if you're allergic to dog dander, for example, then you're allergic to all dogs. "People come in here and say, 'I'm not allergic to my dog, just my neighbor's,' but that's not possible," she says.
Instead, it's simply a different type of reaction, Beckman explains, because you're more likely to have an acute reaction to an animal you don't see regularly. "If you live with a dog, you're more likely to have a chronic, lower-level reaction." The way to tell? If you go away for a few weeks and then experience an allergic reaction when you come home, chances are your beloved pet is the culprit. (Of course, low levels of allergy symptoms are something many animal lovers are willing to put up with if the other option is to get rid of their favorite pet. Often, if your symptoms are mild, say doctors, you can simply be treated with low doses of medications so you don't have to bid farewell to Fido.)
How can you reduce allergies when you are outdoors?
As your symptoms have probably already let you know, any outdoor activity can be risky when pollen spores are out in force. But there are many ways to work exercise into your routine without having to breathe pollen-laden air. For example, swimming, yoga, and weight training are all good ways to get a good workout with less risk of an allergy or asthma flare-up.
If you just can't live without your daily walk or run, then try to schedule it for a time of day when pollen counts are lowest, typically later in the day. Pollen in the air is densest between 5 and 10 am, according to the AAAAI. To find a pollen and mold report for your area, go to the AAAAI’s localized service.
Because many people have to work or exercise outside when pollen counts are high, they often tie a scarf or surgical mask around their faces to keep allergens out. You may look a little strange on the hiking path, but it may keep you from developing a severe allergic reaction later. Sunglasses will help protect your eyes from floating pollen. Allergists also advise running the air conditioner at home and in the car to help filter out pollen.
Lastly, be sure to wash your hands and shower when you come inside after a run or walk. "I tell my patients to take off their exercise clothes and leave them outside," says Beckman, who also recommends washing your hair. "You don't want to have pollen in your hair and put your head down on your pillow. Then you're just bringing the outside in."
What does an allergy exam involve?
Your primary care doctor or allergist will start by taking a thorough history, asking you about the timing of your allergic reactions, and recording which medications did or didn't work for you. Your doctor will also screen you for associated disorders such as a sinus infection or asthma.
"About 50 percent of the patients who come to our clinic don't turn out to have allergies at all," says Beckman. "They tell me antihistamines aren't working, and when they test negative for allergic triggers, we know why."
Next your doctor will want to test your reaction to various allergens. If it's a difficult case, the testing phase is usually where the specialist comes in. The most common type of test is a skin test, which doctors prefer because the results are available immediately. There are two types of skin tests: One involves pricking your skin with a small pointed needle coated with a common allergen; the second involves injecting a small amount of allergen under your skin.
These simple tests aren't right for everyone, though. If you are on antihistamines and can't go off them, or if your allergic reaction is particularly severe, your doctor may order a blood test instead of a skin test. Results from a blood test are usually delivered within a month.
How are allergies treated?
In most cases, your doctor will start by prescribing a medication or combination of drugs to control your allergy symptoms. A common combination might include a corticosteroid nasal spray to reduce inflammation and an antihistamine to ease the annoying symptoms of swelling, itching, and a runny nose. Your doctor may also recommend eye drops and, if you're stuffed up, a decongestant as well.
Your doctor can help determine whether you need an over-the-counter (OTC) antihistamine or the prescription variety. Although the older OTC drugs, known as "first-generation" or sedating antihistamines, may cause side effects like drowsiness or anxiety, newer antihistamines are much less likely to when taken at the recommended dosage.
But even antihistamines that cause drowsiness work well in some cases, as long as the patient doesn't drive, operate machinery, or other tasks that require alertness while taking the drugs. (Even if you don't feel sleepy while taking them, your reaction time can be affected.) The first generation of sedating antihistamines such as diphenhydramine (Benadryl) and chlorpheniramine (Chlor-Trimeton) are effective for many patients, especially if they have symptoms that keep them up at night. In addition, not everyone gets drowsy when taking Benadryl and Chlor-Trimeton. Another advantage is that they are very inexpensive. (Benadryl, however, should be avoided by the elderly, as it could be potentially harmful.)
A caution: Don’t take tranquilizers or drink alcohol when you’re taking sedating antihistamines; check with your doctor, too, before taking them if you have glaucoma, thyroid, heart, or prostate problems. Women who are breastfeeding should also consult a doctor before taking antihistamines, as should anyone taking a monoamine oxidase inhibitor (MAOI) for depression or other conditions.
Your doctor can also help you avoid other pitfalls. Some OTC decongestant nasal sprays, for example, can cause a resurgence of symptoms: users become dependent on the sprays, then find their symptoms worsen when they try to stop using them. (Doctors call this syndrome "rhinitis medicamentosa.") Visine and similar eye drops can cause the same problem with eyes.
Your doctor will also probably discuss ways to control your exposure to whatever is triggering your allergic reaction. In Austin, Texas, for example, most people who are allergic to pollen are allergic to the oak trees common in that city, says Howland. "So it's important to be aware of pollen counts and what times of year the oak trees are dropping pollen," Howland says. Similarly, if you're allergic to mold, you can ease your reaction by getting rid of moisture in and around your house that might be causing mold spores to be released. If your doctor suspects that you may have asthma, a more severe respiratory reaction, he or she will give you a test that measures your lung capacity, or how deeply you can breathe.
More and more often, allergists prescribe a course of immunotherapy, more commonly known as allergy shots. Your doctor will give you a series of injections containing small, purified doses of your allergy trigger -- pollens, mold, pet dander, or whatever you are allergic to. The dose is gradually increased over time until your immune system stops reacting to the allergen. In addition to relieving your allergies, the shots can help prevent more serious problems, like asthma. In fact, the American College of Allergy, Asthma & Immunology (ACAAI) recommends immunotherapy as a means of preventing asthma from developing in children who have allergies.
Should I get allergy shots?
Your doctor will consider allergy shots if your symptoms don't seem to respond well to medication or if you have year-round allergies and prefer not to be on medication all the time. Medications can control symptoms, but allergy shots -- if they work in your case -- are a more lasting solution.
Allergy shots have a high success rate -- as high as 70 to 90 percent, according to the AAAAI. The downside is that immunotherapy requires a substantial time commitment. During the initial series of shots, your doctor will need to see you every week or two for three to six months. After that, you will need booster shots once or twice a month for up to five years. Because allergy shots administer doses of an allergen, in rare cases they can trigger a severe allergic reaction. Your doctor will need to monitor you closely when you get the first few injections. The American College of Allergy, Asthma, and Immunology says you should wait at least 20 minutes before leaving the allergist's office.
How do I find an allergist?
If your symptoms don't respond to a range of increasingly aggressive treatments proposed by your family doctor, ask him or her to refer you to an allergist, or ask if there is an allergy clinic available through your medical group or HMO. You can also use one of the search services run by the professional associations of allergists. The AAAAI offers a specialty search service available under the "Find an Allergist" tab on its Web site (http://www.aaaai.org).
You can also call the American College of Allergy, Asthma & Immunology (ACAAI) at 1-800-842-7777 to receive a list of allergists in your area. Visit the group's patient Web site (http://www.acaai.org/), which features an allergist locator.
The most important advice you'll receive is to seek treatment for your allergies sooner rather than later. Recent studies show that allergies actually have an effect on the brain. "They affect your ability to concentrate, your ability to be productive at work, even your ability to sleep," says Howland. "We want people to know there's no reason to go on like that when allergies can be controlled."
-- Melanie Haiken is a freelance health and medical journalist in the San Francisco Bay Area. She is the former health editor of Parenting magazine and a former executive editor at BabyCenter.
Interview with Dawn Beckman, MD, chairwoman of the Asthma and Allergy Center of DuPage Medical Group in Illinois
Interview with William Howland, MD, director of the Asthma and Allergy Center of Austin, Texas
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Reviewed by Michael Potter, MD, an attending physician and associate clinical professor at the University of California, San Francisco. He is board-certified in family practice.
Last updated May 28, 2009 Copyright © 2004 Consumer Health Interactive