Sniffles, Sneezes and Wheezes The allergy season approaches
By Vaishali Mankad, M.D. and Gurvinder Deogun, M.D. Spring is in the air! This is an exciting time for many people as the weather slowly begins to warm and gray days give way to blue skies and sunshine. But for the 4050 million Americans who suffer from allergies or “hayfever,” spring can be a very difficult time. Seasonal allergies can be caused by tree, grass and weed pollens as well as by mold spores. In the Carolinas, trees can begin blooming and releasing pollens as early as January, though most trees come into full bloom by March. By the middle of spring some grasses and weeds will also start to release pollen, though concentrations of grass and weed pollen are highest during the summer and fall, respectively. At these times, people with pollen allergies may develop a multitude of symptoms. These symptoms can include runny nose, sneezing, stuffy nose, post-nasal drip, sore throat, cough and throat clearing. Eye symptoms may include itchy, watery and red eyes. Other common complaints are itchy ears and itchy throat. When allergic inflammation becomes chronic there can be progression to sinus infections. Asthmatics who are allergic to spring time allergens can notice more asthma flare ups with symptoms such as shortness of breath, chest tightness, difficulty breathing and wheezing. The varying intensity of allergies can be attributed to time and weather. In general, pollen counts are at their highest in the early morning and in the early evening explaining why allergic symptoms will heighten during these times of the day. Pollens and mold spores are more easily distributed on days that are hot, dry and windy, and this can flare allergic symptoms. In contrast, days with rain or minimal wind can cause the pollen and mold spore count to decrease as the allergens are not as easily airborne. Thunderstorms can actually worsen nasal and eye allergies, and more seriously, can worsen asthma. One reason for this is that drafts from thunderstorms cause increases in wind, causing pollens and molds to become airborne. In fact, emergency room visits for asthma are highest right after a thunderstorm. All of these symptoms can greatly affect a person’s quality of life. With more than 12 million physician office visits per year for allergic symptoms, one can see how much work and school is missed annually due to allergic symptoms. Even when work and school aren’t missed, moderate to severe allergic symptoms can affect a person’s ability to focus and be productive. Fortunately, there are several steps that can be taken to manage seasonal allergies. Most treatment plans for seasonal allergies encompass three basic steps: reducing your exposure to allergens when possible, taking medications to help control symptoms, and if needed, receiving immunotherapy or “allergy shots”. Reducing exposure: Avoid being outdoors in the early morning and early evening when pollen counts are at their highest or when mold spore counts are high, March 2010
especially on hot, dry and windy days. Information about pollen and mold spore counts is available through a number of resources such as The National Allergy Bureau (www.aaaai.org/nab). Keep windows in the home and in the car closed at the height of your pollen season to keep pollen and mold out of these environments and use air-conditioning if possible. Change the filters in your heating/air-conditioning system at regular intervals. Your allergist may recommend a HEPA filter for your bedroom which is a specialized high efficiency air filter capable of removing 99.7 percent of small airborne particles including pollen and mold. Consider showering and changing clothes at the end of the day so that you are not continuing to be exposed to the pollen grains and mold spores on your clothing, skin, and hair once you are indoors again. Avoid mowing the lawn or wear a mask if grass pollens are a cause of your symptoms. Avoid raking leaves which can stir up mold. Medications: There are a number of medications that are effective in managing symptoms due to allergies. Antihistamines and anti-leukotrienes work by blocking several substances released by cells in the body which are responsible for allergy symptoms. Antihistamines can help with itchy, runny nose, postnasal drip, and sneezing as well as itchy eyes. Nasal steroid sprays are prescription medications which decrease inflammation and help with several allergy symptoms especially nasal stuffiness. Several types of prescription eye drops are also available to help with itchy, red, watery eyes. Finally, decongestants in the form of a pill or nose spray can be used sparingly to decrease nasal stuffiness not relieved by other medications. Medications can also be prescribed to control symptoms of asthma such as wheezing, chest tightness, persisting cough or shortness of breath. Your doctor can determine which medications or combination of medications are needed based on the severity of your symptoms. Immunotherapy or “allergy shots”: If your symptoms continue despite medications and attempts at reducing allergen exposure, if they are present many months of the year, or if you want long-term control of your allergies with less need for medication, your allergist may recommend immunotherapy. Immunotherapy is a form of treatment aimed at decreasing your sensitivity to different allergens. Immunotherapy works by giving a series of injections starting with small doses of purified allergens to which you are allergic and increasing doses over time to stimulate your immune system to become tolerant to the allergens. In over 85 percent of cases, immunotherapy can provide substantial, long lasting improvement in allergy symptoms and allow you to control symptoms with less need for medication. If your allergies are making you miserable, finding an allergist/immunologist, also called an allergist, can help. Your allergist can perform testing to identify the allergens (substances such as pollen which cause allergies) responsible for your symptoms, provide education about allergies and/or asthma, and work with you to formulate a treatment plan. Vaishali Mankad, M.D. and Gurvinder Deogun, M.D. are Board Certified Allergy and Immunology physicians who treat allergies and asthma in children and adults. Allergy Partners of Raleigh is located at 10010 Falls of Neuse, Ste 106 in Raleigh. Phone: 919846-0800. www.allergypartners.com/raleigh
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