What are nasal allergies, and why me?

The physiologic and immune mechanisms of allergic rhinitis are outside the scope of this discussion. Generally, allergic rhinitis is described as the body’s inappropriate response to airborne particles such as pollens, dust, mold, or animal dander  that normally are not harmful to us. The immune system mistakenly identifies these particles as an invading virus or germ, and generates an immune response to that substance. The body releases histamine, which drives a cascade of cell responses that result in the classic symptoms of nasal itching, sneezing, cough, throat clearing, runny nose, nasal congestion, post nasal drip, and ear fullness/ congestion.  Some asthmatic patients will also notice an increase in their symptoms of wheezing and shortness of breath.

We believe that allergic rhinitis is hereditary, though the degree and severity of the symptoms are widely variable within families. The tendency to develop allergies will also depend upon one’s environment. Unfortunately, Atlanta is a very punishing environment for those of us who are predisposed to allergy. The abundance of trees, grass, weeds and mold make the allergy season here longer than in other parts of the United States. The pollen season here persists for 10 months out of the year, from February to November! The pollens simply take turns bothering us- tree pollen in the spring season from February to late April; grass pollen in the summer season from May to July; weed pollens in the fall season from August to November. Mold becomes prevalent in the environment from May through November, with sharp increases once the leaves fall off the trees and disintegrate. This releases mold spores into the environment. These facts make it much more likely that a patient who suffered only seasonal allergies in the Northeast or Southwestern US will become a perennial (year- round) allergy sufferer here in lovely Atlanta. Welcome!

What can I do to treat my allergies , and when will they  go away?

Unfortunately, there is no cure for allergic rhinitis, so the condition is likely to persist for life. However, there are effective treatments that help control and minimize allergy symptoms. There are three categories of allergy management available to patients: avoidance, medications, and immunotherapy  (allergy shots).

Avoidance

The better known avoidance measures that are promoted by our profession are pillow/ mattress covers, keeping windows and doors closed during allergy season, vacuuming and dusting frequently, and HEPA filters on heating and cooling units. Avoidance measures are the most frequently overlooked allergy treatment though they can be highly effective. Additional tools of avoidance that have helped my patients the most are:

Medications

There are several categories of medications available to treat allergic rhinitis. I will start with the over the counter remedies first.

The prescription medications are more powerful weapons against more severe allergies that are refractory to OTC remedies

Immunotherapy

Otherwise known as “allergy shots”, IT has been an effective long term solution for severe allergic rhinitis. There have been many promising new developments in IT over the last five years. Traditionally, IT has only existed in the form of an injection given in the patient’s arm or thigh. It was administered in the doctor’s office and the patient would have to be observed in the office for at least 30 minutes to ensure no severe reaction to the shot occurred. 

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Recently, however, IT has become available in an oral drop given under the patient’s tongue. This is called sublingual immunotherapy, or SLIT for short. SLIT has offered advantages over traditional IT because it can be given at home instead of the doctor’s office. The greatest disadvantage of SLIT is cost, as it has not been approved by the FDA, and therefore is not covered by health insurance. 

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A most recent variety of SLIT has become commercially available to patients by prescription that specifically desensitizes the patient to pollens. Examples are Grastek and Ragwitek, which are given seasonally for patients with grass and ragweed pollen allergies, respectively. These have been approved by the FDA, and are covered by some insurance carriers.