Don't Let Your Al­ler­gies Bloom This Spring

Wellness Update - - Allergies -

The term al­ler­gic rhini­tis means al­ler­gic re­ac­tions oc­cur­ring in the nose and sur­round­ing tis­sues. Th­ese re­ac­tions are caused by air­borne sub­stances such as sea­sonal pollen, mold spores, house dust mites, dust from an­i­mals, and dust from cock­roaches. Ev­ery­one breathes th­ese ma­te­ri­als, but some peo­ple make IgE an­ti­bod­ies (al­ler­gic an­ti­bod­ies) and be­come al­ler­gic to th­ese sub­stances. An es­ti­mated 60,000,000 peo­ple in the United States have al­ler­gic rhini­tis, ap­prox­i­mately 19 per­cent of the pop­u­la­tion. The symp­toms of al­ler­gic rhini­tis are nasal itching, sneez­ing, runny nose, nasal con­ges­tion, ob­struc­tion of the nose at night re­sult­ing in poor qual­ity sleep (al­ler­gic in­flam­ma­tion be­comes much more in­tense dur­ing the night), snor­ing, post­nasal drainage, dry throat in the morn­ing, pop­ping and ring­ing and pres­sure sen­sa­tions in the ears, and si­nus pres­sure headaches. Some peo­ple with al­ler­gic rhini­tis also have al­ler­gic con­junc­tivi­tis and ex­pe­ri­ence in­tense itching and burn­ing of the eyes, ex­ces­sive tear­ing, swelling around the eyes, and dark dis­col­oration be­neath the eyes (al­ler­gic shin­ers). Some al­lergy suf­fer­ers de­velop a crease across the bridge of the nose (where the car­ti­lage joins the nasal bones) be­cause of con­stant rub­bing of the nose to re­lieve the itching. Sea­sonal al­ler­gic rhini­tis causes fa­tigue in ap­prox­i­mately 80 per­cent of pa­tients, and de­pres­sion in 30 per­cent. Sea­sonal al­ler­gic rhini­tis, caused by tree and grass pollen in the spring and weed and rag­weed pollen in the fall causes sev­eral other prob­lems to flare. Ac­tive sea­sonal rhini­tis nearly dou­bles pa­tients’ needs for doc­tor vis­its and new med­i­ca­tions for anx­i­ety, de­pres­sion, asthma, si­nus in­fec­tions, mid­dle ear in­fec­tions, and ton­sil in­fec­tions (Crys­tal-Peters, An­nals of Al­lergy, Asthma & Im­munol. 2002;89:457-462). Mi­graine headaches are more fre­quent when al­ler­gies are ac­tive. Em­bar­rass­ing symp­toms oc­cur in at least 25 per­cent of pa­tients.

The eco­nomic im­pact of al­ler­gic rhini­tis in­cludes 3,500,000 work­days lost each year and ap­prox­i­mately 2,000,000 days of school lost be­cause of al­ler­gic rhini­tis. When al­ler­gic rhini­tis is ac­tive, pro­duc­tiv­ity at work or school is im­paired by fa­tigue, dis­trac­tion by al­ler­gic symp­toms, and some­times by the se­dat­ing prop­er­ties of over-the-counter al­lergy reme­dies.

How to con­trol of al­ler­gic rhini­tis

We have gained a de­tailed un­der­stand­ing of the mech­a­nisms of al­ler­gic rhini­tis. This has led to the devel­op­ment of a broad range of pow­er­ful in­ter­ven­tions can pro­vide nearly com­plete con­trol of al­ler­gic rhini­tis symp­toms and meth­ods to elim­i­nate th­ese al­ler­gic re­ac­tions, with mild or no ad­verse re­ac­tions from med­i­ca­tions. Rea­son­able ex­pec­ta­tions of th­ese in­ter­ven­tions: · No symp­toms. Symp­toms of al­ler­gic rhini­tis usu­ally can be sup­pressed to the point that they are of lit­tle con­se­quence in most pa­tients. · No sleep dis­tur­bance. Ag­gres­sive in­ter­ven­tions can elim­i­nate noc­tur­nal nasal ob­struc­tion which leads to poor qual­ity sleep. This seems to be the main rea­son for fa­tigue and other al­ler­gic rhini­tis com­pli­ca­tions. · No com­pli­ca­tions. Ag­gres­sive man­age­ment of al­ler­gic rhini­tis should min­i­mize the chance of com­pli­ca­tions such as bac­te­rial si­nusi­tis or flares of asthma. Three lev­els of care for al­ler­gic rhini­tis: Self-care, physi­cian care, and spe­cial­ist physi­cian care Self- care: Ap­prox­i­mately 80 per­cent of peo­ple with al­ler­gic rhini­tis ei­ther en­dure the prob­lems or use over- the-counter med­i­ca­tions. Keep­ing the win­dows in the home and car closed helps. HEPA air fil­ters in the bed­room may help. Oral an­ti­his­tamines can be help­ful for itching, sneez­ing, runny nose, and itching and burn­ing of the eyes, re­duc­ing symp­toms 25% bet­ter than a placebo. Older se­dat­ing an­ti­his­tamines such as diphen­hy­dramine can be help­ful, but also have been shown to im­pair our abil­ity to drive and learn. Newer, nonse­dat­ing an­ti­his­tamines are avail­able over-the-counter that pro­vide re­lief and are much safer. An­ti­his­tamines have lit­tle ef­fect on nasal or si­nus con­ges­tion. Oral de­con­ges­tants can pro­vide some re­lief from the con­ges­tion, but they also dis­rupt nor­mal sleep ar­chi­tec­ture, and can cause heart rhythm prob­lems, dizzi­ness, anx­i­ety and tremors. Nasal spray de­con­ges­tants can be ef­fec­tive for con­ges­tion, but many peo­ple quickly be­come de­pen­dent upon the de­con­ges­tant sprays. Once the ef­fect of the de­con­ges­tant spray wears off, the nose swells shut and is very un­com­fort­able un­less the spray is used again. In­tranasal cro­molyn and in­tranasal sa­line also help some in­di­vid­u­als. Is self-care ef­fec­tive? For some in­di­vid­u­als, self-care pro­vides ac­cept­able re­lief from symp­toms, pro­tec­tion against sleep dis­tur­bance, and pro­tec­tion against com­pli­ca­tions such as si­nusi­tis. Physi­cian care: Ap­prox­i­mately 20 per­cent of pa­tients with al­ler­gic rhini­tis see a physi­cian for more pow­er­ful in­ter­ven­tions. Pre­scrip­tion med­i­ca­tions proven to be ef­fec­tive for al­ler­gic rhini­tis in­clude in­tranasal steroids, in­tranasal an­ti­his­tamines, in­tranasal nerve block­ing agents, oral med­i­ca­tions that block leukotrienes (al­lergy me­di­a­tors that along with his­tamine ac­count for most of the al­ler­gic man­i­fes­ta­tions), and in ex­treme cases, oral or in­jected steroids. If the al­ler­gic rhini­tis symp­toms are sup­pressed, sleep isn't dis­turbed, and there are no com­pli­ca­tions, the goals rea­son­ably ex­pected have been achieved.

Ex­pert care: When symp­toms are not well con­trolled, and sleep is dis­turbed by noc­tur­nal nasal ob­struc­tion, or when com­pli­ca­tions of al­ler­gic rhini­tis such as asthma or si­nusi­tis are present de­spite th­ese in­ter­ven­tions, an Al­lergy and Im­munol­ogy spe­cial­ist is able to pro­vide ef­fec­tive re­lief. Ac­cu­rate di­ag­no­sis is nec­es­sary to es­tab­lish that the prob­lem really is al­ler­gic rhini­tis, to guide spe­cific mea­sures to avoid ex­po­sure to the causes and ag­gra­vat­ing fac­tors, and to iden­tify pa­tients whose prob­lems can be min­i­mized or erad­i­cated by im­munother­apy (al­lergy shots). The eval­u­a­tion also in­cludes search­ing for com­pli­ca­tions or con­cur­rent prob­lems such as nasal polyps, nasal sep­tal de­vi­a­tion, other anatom­i­cal prob­lems in the nasal pas­sages, bac­te­rial si­nusi­tis, med­i­ca­tion ef­fects on the nose, and mul­ti­ple other fac­tors that mod­ify or mimic al­ler­gic rhini­tis. Con­cur­rent prob­lems such as asthma, sen­si­tiv­ity to non-steroidal anti-in­flam­ma­tory drugs, Vi­ta­min D de­fi­ciency, and an­ti­body im­mun­od­e­fi­ciency should be iden­ti­fied and cor­rected. In­ter­ven­tions se­lected and ad­justed for in­di­vid­u­al­ized care usu­ally pro­vide ex­cel­lent con­trol of al­ler­gic rhini­tis. The like­li­hood al­ler­gic rhini­tis will spon­ta­neously go away is ap­prox­i­mately 1-2 per­cent per year. Sea­sonal al­ler­gies usu­ally re­turn and be­ing pre­pared is es­sen­tial to the longterm man­age­ment of this prob­lem. Start­ing in­tranasal steroids be­fore the pollen sea­son can markedly re­duce or elim­i­nate the flare in some pa­tients.

Im­munother­apy (al­lergy shots), es­pe­cially rush im­munother­apy, may be use­ful to greatly re­duce the sever­ity or com­pletely elim­i­nate sea­sonal al­ler­gic rhini­tis. Pa­tients with al­ler­gic rhini­tis se­vere enough to re­quire the help of an al­ler­gist are usu­ally ex­cel­lent can­di­dates for ther­apy aimed at cure, rather than re­lief.

Don’t ac­cept dis­rupted qual­ity of life be­cause of al­ler­gic rhini­tis.

We now have a large ar­ray of over­the-counter, pre­scrip­tion, and spe­cial­ist in­ter­ven­tions to sup­press, and even, elim­i­nate sea­sonal al­ler­gic rhini­tis. You do not have to put up with sea­sonal al­ler­gies any­more. Don’t let your al­ler­gies bloom this spring. -Ti­mothy J. Sul­li­van, MD and Vicki J. Lyons, MD

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