San Antonio Express-News (Sunday)
Allergy sufferer seeks newadvice
Dear Dr. Roach: I am 62 years old and have no health problems except seasonal allergies during spring and fall. I exercise regularly and eat only healthy vegetarian food and fruits.
My symptoms are watery eyes and nose, itching, chest congestion, sneezing, coughing and difficulty sleeping at night due to pollen in the air during early spring/fall seasons. I have had this issue for the past 30 years, since moving from India. The allergies last for 10 to 15 days each season, and then I am normal. During allergy season, I can do only mild exercise since my chest is congested and breathing becomes tough.
During this time, I try not to go outdoors, use HEPA-filter fans and air conditioning to filter out indoor pollen and dust. This gives me a lot of relief most of the time. I take antihistamine drugs (Claritin) and cough medication for chest congestion if the problem is acute, but don’t like their side effects of raising blood pressure, uneasiness and sleepiness.
I was told by doctors that this is an immune overreaction issue and will never go away in my lifetime. Do you think I can train my immune system to gradually accept pollen? I hate to take medications due to their side effects. Is there any natural therapy, traditional or natural medication or homeopathy?
M.K. A: In the spring, tree pollens are an abundant source of allergens, while in fall, weed pollens cause misery to those afflicted. Those may be your triggers, but it’s only a guess. Finding your specific allergy trigger can help in making a plan for avoiding allergens, although what you have done already is a very good start for most outdoor allergens.
Allergies are indeed an effect of a robust immune system that’s been activated against what it perceives as an invader. Tamping down the immune system is one effective strategy. Antihistamine drugs work against one part of the cascade. They are helpful for many, but don’t seem to be working perfectly well for you. Loratadine (Claritin) has the advantage of not getting into the brain, so it does not cause uneasiness or sleepiness any more than a placebo. It also does not raise blood pressure. It’s much more likely that it’s the decongestants causing that side effect.
If one antihistamine doesn’t work, it is reasonable to try another, such as cetirizine (Zyrtec) or fexofenadine (Allegra). Nasal steroids are more effective than antihistamines for most, and the combination of the two is highly effective. Unfortunately,
since nasal steroids take at least a week to reach full effectiveness, you would have to start them before symptoms develop in spring and again in fall. There are alternative medications, such as leukotriene inhibitors (another part of the inflammatory cascade) and mast cell inhibitors (which block a key cell in the pathway).
Some plant-based substances used in traditional medicines have similar effects as Western prescription or over-the-counter medication. For example, butterbur inhibits leukotrienes, similar to the prescription medication montelukast (Singulair). Quercetin stabilizes mast cells like cromolyn (Nasalcrom). Homeopathic medicines are expensive water, which do not contain enough active medication to have any pharmacologic effect.
Training the immune system to tolerate allergens is the theory behind immunotherapy, where minuscule amounts of what you are allergic to are injected, gradually increasing until the immune system learns to tolerate it. Immunotherapy is an effective but slow treatment method. This must be done under trained supervision, since
severe allergic reactions can occur.
Dear Dr. Roach: Now that we are six months into the pandemic, I could use a refresher on what underlying conditions cause people to fare worse when they contract this virus. I have heard that diabetes and high blood pressure are two risk factors. Do those with controlled diabetes and high blood pressure have the same risk as uncontrolled?
E.T. A: Diabetes is clearly a risk for developing complications in people who are infected with SARS-CoV-2, the virus that causes COVID-19. It is likely, but not definitive, that diabetes that has not been well controlled, especially for a long time, is a much greater risk factor than wellcontrolled diabetes. High blood pressure is also likely a risk factor, and again, those with high blood pressure that was caught early and promptly treated with goals reached are probably less likely to have complications than those with poor control.
Other risk factors include any immune system disease or treatment (HIV, cancer, organ transplant);
heart or lung disease; chronic kidney disease; sickle cell; and obesity. There are many other conditions that probably increase risk. In fact, a majority of older North Americans will have at least one risk factor, which is why we all need to continue to physically distance and wear masks.
Dear Dr. Roach: I am a healthy, active 86-year-old woman. I am a lifelong volunteer, and a 35-year volunteer in a hospital in a project involving patient contact. As a child, I had a severe allergic reaction to egg whites. Because of that, I have never had a flu shot, and except for one longer bout in 1970, I can remember only two or three other times having the 24-hour flu. In recent years, my doctor has been advising me to try a flu shot, but I have refused. The memories of my battle as a child are still vivid and nasty. I have been hospitalized several times with reactions to medications, so am hesitant to try things new to my system. Am I being unreasonable in my fear of the flu shot?
Anon A: Thank you for your hospital service. We love our volunteers. I understand completely why you are leery, given the severe reaction you had, but the amount of egg protein in modern flu vaccines is so small that allergic reactions are no more common with flu shots to people with egg allergies than to those without. You should be able to get a flu vaccine safely.
However, there is a flu shot made without eggs, and you can ask about it if it would make you feel more comfortable. The brand name is Flucelvax. Of all the years to get a flu shot, this is the year, given the coronavirus pandemic. It’s not too late.
Dear Dr. Roach: I am a longtime GERD sufferer and have used omeprazole (up to 80 mg daily) for years. I have tried everything else over 50 years, with limited success. I tried a product containing caraway oil and menthol three months ago, and have had no symptoms since. Just a food supplement? It’s hard to believe. How would you explain it?
P.M. A: Since gastroesophageal reflux disease is so common, I try hard to stay current with new treatments, but had not read about using caraway oil and menthol.
Caraway oil is reported to relax the smooth muscle in the duodenum and menthol has anti-inflammatory effects. In a study from 2019, looking at the effectiveness in 95 people with functional dyspepsia (many of whom are likely to have had GERD), after 28 days treatment, 61 percent of the subjects taking caraway oil and menthol had improvement, but 49 percent of the control subjects did as well (these took a placebo, an inactive substance that looked just like the medication). Similarly, 7 to 10 percent of people taking medication improved their symptoms scores (compared with placebo).
It seems you may be in the lucky group that improved with this product, although in any one person it is impossible to exclude a placebo effect. There were fewer adverse events in the active medication group compared with the control group, and no serious adverse effects in any subjects. Other studies have shown that caraway oil may decrease blood sugar, so people with diabetes who try using caraway oil should monitor their blood sugar to be careful of dangerously low blood sugars — which is unlikely, and I am not recommending this product for treatment of diabetes.
There are other products containing caraway oil and peppermint oil that have also shown some benefit. The current studies cannot determine which product is better or which component might be most active, or whether a combination is best.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell .edu or send mail to 628 Virginia Dr., Orlando, FL 32803.