Telemedicine
The Allergy Patient's
Survival Guide
Practical Information for the Allergy Season
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:
When exposed to the outdoors for more than 30 mins, I encourage patients to wear a mask to protect the nose from the offending allergens. This includes activities such as yardwork, gardening, outdoor exercise or sporting events. 3M has a wide variety of disposable masks to filter out pollens, dust and mold spores. I also like cloth masks, as these can be washed and re-used. These are available on amazon.com at average cost of about $15.00 per mask.
Salt water , or saline nasal washes are another effective tool of avoidance for allergic rhinitis. Some popular products are the Neilmed rinse, the Navage, and smaller sprays that can be carried in a purse or bookbag, like Ocean Nasal Spray or Simply Saline. All are helpful to use at least once daily, especially after exposure to allergens like pollens, molds, dust, or animal danders. The allergen load in the nasal passage is physically reduced and evacuated from the nose.
The air purifier is another helpful means of controlling your surroundings to remove allergens from the environment. Be careful not to confuse this with a humidifier. The humidifier is the opposite device, which will blow moisture into the environment. The moisture makes it easier to dust mites and mold spores to thrive in the environment, which will worsen it for the allergy sufferer. The air purifier dehumidifies the environment, filters allergens out of the air, and places clean air into the environment.
Medications
There are several categories of medications available to treat allergic rhinitis. I will start with the over the counter remedies first.
Steroid
Nasal
Sprays
The Academy of Otolaryngology/ Head and Neck Surgery recommends this class of medications as a first line of defense against allergic rhinitis. The steroid nasal sprays, such as fluticasone (Flonase) and triamcinolone (Nasacort) are more effective by themselves than other medications as a first line of treatment.
Antihistamines by Mouth
Oral antihistamines are also highly effective as a first line of treatment, to be use alone for mild symptoms or in combination with steroid nasal spray for moderate to severe symptoms. The most popular of these include loratadine (Claritin), fexofenadine (Allegra), cetririzine (Zyrtec) and levocetirizine (Xyzal), and diphenhydramine (Benadryl).
The prescription medications are more powerful weapons against more severe allergies that are refractory to OTC remedies
Leukotriene Antagonists
These are used in severe sufferers in addition to the OTC remedies and are also helpful in patients with lower airway symptoms, like sore throat, cough, and those with allergic asthma. Example- montelukast (Singulair).
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.
What happens if I don’t treat my allergies?
In some cases, untreated allergic rhinitis can produce repeated sinus infections, nasal polyps, and asthma. The “allergic march” is defined as the development of allergic rhinitis, asthma, and eczema (an allergic skin condition) over a patient’s lifetime.
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The allergic march is most frequently observed in patients who have gone untreated for their allergies. When repeatedly exposed to environmental allergens, the reaction worsens over time, so symptoms become more pronounced. Repeated sinus infections can evolve into chronic sinusitis with or without polyps, which can require sinus surgery to reverse.
When should I see a doctor about my allergies?
If you believe that you have environmental allergies, practice the avoidance measures and try the OTC medications discussed above. If you do not get relief, it is time to see an ENT doctor or Allergist.
There is a common saying in our community:
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“If you do not suffer nasal allergies, keep living in Atlanta and eventually you will!”
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The doctor will order allergy testing, asthma evaluation if applicable, and CT scan of the sinuses if sinus disease is suspected. From there, a comprehensive treatment plan will be put in place for you.
Always remember that there is no need for your suffering to continue, help is available. We are only a phone call away.