Introduction
Spring, the harbinger of many good things, is a treacherous time for patients with seasonal allergies. While others are carefree, strolling through fields of daffodils, seasonal allergy sufferers are strolling through the pharmacy looking for relief from sneezing and itchy eyes.
A Red-and-Itchy Case Study
Mr. G., a 27-year-old accountant, had mild allergies in years past, particularly in the spring. When his eyes itched and he started to sneeze, he took an over-the-counter antihistamine. The medication helped his allergies, but made him feel drowsy. So he took it at night and felt a little groggy in the morning, but it wore off before anyone noticed at work. This year was very different for Mr. G., and he knew it on the first day of allergy season. First, when he arrived at work after his customary walk through the park, he could not stop sneezing for 30 minutes. His sides hurt badly when he finally blew his nose for the last of 26 times that morning. His eyes were red, itchy, burning, and tears were coming out of them. His boss suggested that he go home for the day to "take care of himself." So Mr. G. headed over to the pharmacy where he bought some cold-allergy pills, and the next morning…he was worse. In addition to runny nose and itchy eyes, he now had chest congestion and he couldn't breathe comfortably. He even noticed funny high-pitched accordion noises in his chest. Finally, he went to his physician, who informed him that he did not have a bad cold, but in fact was having a serious seasonal allergy attack, and the physician referred him to an allergist. And that's when I met Mr. G.
What are Seasonal Allergies?
Plants reproduce sexually by spreading pollen from one plant species to another, and as callous as it may sound, this is a flower's sole purpose. Some plants have beautiful, scented flowers that attract insects that will spread the pollen around as they move from flower to flower. Other plants produce ugly, unscented flowers that no self-respecting insect would bother with… hence, these plants rely on the wind to move the pollen around. As the pollen bursts from the plants and out into the air, it is inhaled by humans and animals. If you are one of the 40 million Americans who have the genetic tendency to be allergic, then this pollen is not merely dust that is inhaled and exhaled, it is the cause of major illness.
When does it begin and when will it end?
In the temperate zones of the United States, trees are the primary pollen producers from early spring to late spring. The farther south you live, the earlier the allergy season begins. For example, the tree-pollinating season in Florida is in January. In New York it begins in mid March. Grass pollen allergy is caused by weed-like grasses or cultivated grass that is allowed to flower. If you are allergic to grass pollen, sometimes sap from cut grass becomes airborne and then is inhaled, provoking symptoms. Again, depending where you live, grass allergy can begin in April in the southern parts of the United States, or in early June in northern areas. By July, pollen allergies generally subside. But in some areas of the United States, summer may be a time for airborne mold spores. In order to reproduce, certain molds or funguses send out mold spores that can cause allergic reactions. By late summer, ragweed pollen takes flight, and for those patients allergic to ragweed, the troubles start all over again. Frost finally puts an end to the pollen and outdoor mold season until the next spring, when it starts all over again.
What are the Treatment Options?
Before you think about treatment, first you have to determine if you have a seasonal allergy. Sneezing; runny nose; sore and itchy throat; itchy, watery eyes; wheezing; coughing; fatigue; and headache are some of the symptoms of which you should be suspicious. Allergy attacks can be mild or incapacitating with a few or all of the previously mentioned symptoms. For some, allergies lead to ear and sinus problems. If these symptoms sound familiar, and they occur at the same time each year and last longer than a cold, then you could be having seasonal allergies.
See your physician
If you suspect that you may have a seasonal allergy, see your physician. An examination and report of symptoms may be all that is necessary to make the diagnosis of seasonal allergies. Illnesses associated with seasonal allergies are allergic rhinitis, which affects the nose and throat, allergic conjunctivitis, which results in red, itchy eyes, and allergic asthma, which results in chest congestion, tightness, and wheezing. You could also experience a combination of these symptoms.
Get tested
Find out what is causing the problems. An allergy specialist is equipped to do some simple, accurate, and painless allergy tests. It may take only 15 minutes to identify the culprit behind your discomfort.
Reactions to oak, maple, and birch are among the most common tree pollen allergies. Some of the grass pollens that result in allergic illness are Timothy, June, orchard, and Bermuda. Ragweed is the most common offending weed pollen, but others such as English plantain, chenopodium, cocklebur, and mugwort can be the cause of problems as well.
Get treated
In general, allergy treatment begins with avoidance. Then we add medication, and if medication is not effective, we consider allergy shots, which immunize the patient to the pollen itself.
Avoidance: It is often hard to avoid tree pollen when it's all around us in the air we breathe. But here are some basic avoidance tips:
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By all means, close your house and car windows.
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Wash you hair before going to bed if you have been out where
pollen can land on your hair.
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Wash pets that have been outdoors.
Still, for most allergy sufferers, avoidance is impractical and doesn't do the trick. When avoidance isn't enough, we turn to medication.
Medication: The good news is that there are very effective medications for the treatment of seasonal allergies, and these medications can address a whole range of symptoms. Allergies of the eyes, nose, and lungs can all be treated with one pill or liquid.
Antihistamines: Antihistamine pills are the best example of anti-allergy medications that treat a wide range of symptoms. The older, over-the-counter antihistamines such as Benadryl make people drowsy, but newer antihistamines are very safe and effective and cause little or no drowsiness. Claritin and the prescription medication Allegra do not cause drowsiness. Zyrtec may make a few individuals sleepy and can be taken at night.
Sprays and drops: Other effective medication methods are those used directly on the affected surfaces. For example, sprays can deliver medication directly to the inside of the nose. Corticosteroids (anti-inflammatories) such as Flonase, Nasonex, Nasocort, Nasarel, Nasalide, Rhinocort, Nasalcrom, or Atrovent are all effective nose sprays. Antihistamines block the effects of histamine, which causes sneezing, itching, and wheezing. Corticosteroids block inflammation in general. A good antihistamine spray for the nose is Astelin. There are also a number of eye drops that can help control symptoms of allergic conjunctivitis.
Allergy shots: A person with allergies has an immune system that's working overtime. There is nothing defective about it, it's just taken a wrong turn. Allergy shots get your immune system on the right track. Allergy shots actually consist of small amounts of the offending allergen, given by injections at weekly intervals. The body slowly builds up immunity to this particular substance, and eventually your body no longer follows the allergic path in response to the allergen. Sometimes allergy shots are so effective, they remove all traces of allergic illness. Recent studies show that improvement persists for three or more years after stopping allergy shots.
Not everyone who has seasonal allergies needs allergy shots, but if your life is being impaired by seasonal allergies, you should discuss this with an allergist.
Get better!
Gone are the days when people need to put up with allergic illness. From simple one-pill treatments to multiple medications and allergy shots, there are solutions for the mild and severe allergy sufferers alike. Don't be a sneezy, silent sufferer…get tested, get treated, and get better!
A Case Study Happy Ending
Remember Mr. G. from the beginning of the article? Well, I saw him in my office and after hearing his sad story I examined him. I found that he was suffering from severe seasonal allergic symptoms. He was skin-tested and not only was he allergic to the tree pollens (oak, birch, maple, elm, sycamore, and cottonwood), he was allergic to grass and ragweed pollen as well. He mentioned to me that he was allergic to many fruits and nuts and that eating them made his mouth itch. I told him that many patients who are allergic to birch pollen have these types of food reactions.
He was given a non-sedating antihistamine, a steroid nose spray, and eye drops. He was able to return to work that day and has not had a bad allergic reaction since. He and I have discussed allergy shots as an alternative to seasonal medication, and we will begin shots at the end of the fall allergy season. Next spring Mr. G. will be better.
Additional sources of information about seasonal allergies can be found at the Web site of the American College of Allergy, Asthma and Immunology: http://allergy.mcg.edu
or http://theallergyreport.com.
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