In late May to early June, we often start to see the cottonwood trees shed their seeds. White, fluffy, cotton-like material can be seen floating all over the place. Some people get itchy and sneeze right around this same time of the year. Naturally, they blame the cotton. Their symptoms must be due to cottonwood tree allergies, right? Wrong.

Cottonwood trees (also known as poplar trees) actually pollenate in April. Their large fluffy seeds that we see in late May and early June are NOT the allergen people react to. So, if it’s not the cottonwood, then what is it? It turns out that Hickory trees, Walnut trees, Sheep Sorrel weed, and mid-western grass all start to pollenate at the same time that the cotton-like seeds are released. In all likelihood, the allergy symptoms are caused by one or more of those 4 culprits. So, don’t blame the cotton!

Nasal decongestants come in two basic forms.  One is oral pseudoephedrine, better known as Sudafed.  This drug causes vasoconstriction of the blood vessels.  Since nasal stuffiness is caused by vasodilation of the nasal blood vessels, you can see how it can be an effective treatment.  Since antihistamines alone are not good at treating nasal stuffiness, drug companies quickly came out with combination products like Claritin D, Allegra D, and Zyrtec D.  The D stands for decongestant.  And the decongestant is pseudoephedrine.  The problem with this drug is its potential side effects which include increased blood pressure, racing heart, jitteriness, insomnia, and … it can make men pee in their pants.  Regular use of pseudoephedrine will often result in one or more of these side effects.  The other OTC nasal decongestant is oxymetazoline and comes in a nasal spray.  The most well known version is called Afrin, but I have seen “Meijer Nasal Spray With Saline” which is basically the same thing with different packaging.  This drug is a powerful, topical decongestant.  It improves nasal stuffiness effectively and quickly.  The problem, once again, lies with side effects.  People develop tolerance to this drug quickly, meaning it becomes less and less effective with continued use.  This is the spray that people can “get hooked on.”  Such patients often end up using this spray 6-12 times a day just to keep their nasal passages open a crack.  You should never use oxymetazoline more than 3 days in a row.  Most package inserts contain this warning.  And of course everyone reads package inserts, right?

Overall, I do not recommend either of these products on a regular basis.  As long as you are aware of its potential side effects, brief use may be helpful.  For patients with chronic nasal stuffiness, the best OTC treatment is the allergy nasal spray, discussed in Part 2 of this series.

Michael Park, MD

The next topic will be treatment for allergy eyes.  Unfortunately, allergy eye symptoms are among the most difficult to treat.  If you are a contact lens wearer, it is even worse because pollen just sticks to those lenses like glue.  There are two basic types of medications used in allergy eye drops.  One is a vasoconstricting drug which makes the blood vessels smaller.  This is how it “gets the red out.”  Unfortunately, people usually develop tolerance to this type of medication, meaning “you get used to it,” and it has a weaker and weaker effect the more you use it.  This type of medication is not healthy for the eye with daily use.  The other type of medication is an antihistamine in solution.  So, it works just like oral antihistamines work – they block histamine, the major substance involved in allergic symptoms.  Antihistamine eye drops are the preferred treatment for allergy eyes.  I usually recommend ketotifen.  This medication is available by a variety of different brands including Zaditor and Alaway.  I have also seen Meijer and Walgreens versions of ketotifen eye drops.  Other helpful tips for allergy eyes include NOT wearing contact lenses, and using lubricating drops to gently flush the pollen out of the eyes.  It also helps to keep the bedroom windows closed, wash your hair before you go to bed, and change your pillow case often.

In Part 1, I discussed oral antihistamines.  In this post, I will review OTC allergy nasal sprays.  The main OTC options are Nasacort (triamcinolone), Flonase (fluticasone propionate), Rhinocort (budesonide), and Flonase Sensimist (fluticasone furoate).  These allergy nasal sprays are far more effective compared to oral antihistamines when it comes to treating classic allergy symptoms.  So, if you have tried oral antihistamines but still suffer from allergy symptoms, you should try an allergy nasal spray.  Further, they are effective for nasal stuffiness, whereas oral antihistamines are not.  All of the 4 products above are topical steroid sprays.  They work best if used on a daily basis.  They are not as effective if used intermittently.  Further, they usually become more effective after 3-4 days of use.  Even though they are steroids, they are safe and most are FDA approved down to the age of 2 (Rhinocort is approved down to the age of 6).

In general, I usually recommend Nasacort as I feel it offers the best combination of effectiveness and tolerability.  Nasacort is odorless and gentle on the mucous membranes.  Flonase is effective but not as well tolerated as Nasacort.  It has an odor (artificial flowers) and seems to cause more irritation compared to Nasacort.  Rhinocort is effective, has a mild odor, and is fairly well tolerated.  Flonase Sensimist is the best tolerated of the four, as it is odorless and has the smallest volume compared to the rest.  However, that small volume comes with a price – less medication.  Flonase Sensimist only contains 27.5 mcg of medication per spray compared to 50 mcg for Flonase and 55mcg for Nasacort.

So, if your allergy pill is not doing the job, give an allergy nasal spray a try.

Michael Park, MD

Over the past 5 years, most of the best allergy medications have gone from prescription only to over-the-counter.  So, patients no longer need to go to a physician to receive good, basic treatment for nasal, eye, and skin allergy symptoms.  However, there are a lot of options out there, so it can get confusing.  I will try to clarify things for you.

There are 3 basic categories of OTC allergy medications:  oral antihistamines, nasal steroid sprays, and oral decongestants.  In today’s post, I will review antihistamines.  In future posts, I will review nasal steroid sprays and oral decongestants.

Oral antihistamines are the most familiar type allergy medication to most people.  Such medications include Benadryl, Claritin, Zyrtec, Xyzal, and Allegra.  Like the name suggests, antihistamines block the effect of histamine – the primary substance involved in causing allergy symptoms.  In general, antihistamines are effective in treating itch, sneeze, and drainage.  They are not effective in treating nasal stuffiness.

For adults and larger children, I usually recommend Allegra (fexofenadine) 180mg daily as needed.  This antihistamine is good, strong, and has the fewest side effects in the antihistamine class.  For smaller children who cannot swallow pills, I usually recommend Claritin or Zyrtec.  The dose depends on the size of the child and the clinical situation.

For mild allergies, antihistamines are a good first option.  However, if they are not effective enough, you should try a steroid nasal spray – the topic of the next post coming soon.

Michael Park, MD

ARLINGTON HEIGHTS, IL – (APRIL 2, 2019) – Allergy shots (subcutaneous immunotherapy or SCIT) have been available for more than 100 years. Allergy tablets (sublingual immunotherapy or SLIT) have been approved by the Food and Drug Administration (FDA) for use in the United States for four years. A new study in Annals of Allergy, Asthma and Immunology, the scientific journal of the American College of Allergy, Asthma and Immunology (ACAAI) shows that most American allergists now prescribe the tablets for some patients to treat certain allergies. The study was developed by the ACAAI Immunotherapy and Diagnostics Committee.

“Five years ago, allergy tablets hadn’t been approved by the FDA and weren’t being prescribed for people with allergies in the U.S.,” said allergist Anita Sivam, DO, ACAAI member and lead author. “Allergists were prescribing allergy shots because they were, and continue to be, a proven effective treatment. Once allergy tablets were approved in 2014, allergists began prescribing them for their patients. Of the 268 US allergists who responded to our survey in 2018, 197 (73 percent) reported prescribing allergy tablets.”

Allergy tablets are available to treat northern grass pollens, Timothy grass pollen, ragweed and house dust mite. The northern grass pollens and the Timothy grass pollen tablets are both approved down to age 5 years and the other two for those 18 years and older. The tablets differ from allergy shots because after the first dose is given in an allergist’s office, they can be taken at home. The tablets are placed under the tongue and dissolve.

In immunotherapy, the regular administration of the allergen doses causes your immune system to become less sensitive to the allergen. Reducing your sensitivity reduces your allergy symptoms.

“One of the big differences between shots and tablets is that shots are formulated by your allergist to treat your specific allergy or allergies,” says allergist Mike Tankersley, MD, MBA, vice-chair of the ACAAI Immunotherapy and Diagnostics Committee and co-author of the study. “Tablets target a single allergy, and our study found that was the main barrier for allergists in prescribing tablets. If a patient has more than one allergy and is able to travel regularly to receive allergy shots, an allergist may recommend shots over tablets.”

Both shots and tablets – the only FDA-approved immunotherapy treatments for allergies – are successful because they work by changing your immune system. They decrease some cells, chemicals and antibodies in your system that cause allergy symptoms and increase others that improve health. Allergy shots and tablets allow you to encounter your allergens without having a reaction. Immunotherapy also reduces the inflammation that characterizes hay fever and asthma, so many sufferers find their symptoms improve.

To find an allergist near you who can help create a personal immunotherapy plan for your allergies or asthma and help you lead the life you want to live, use the ACAAI allergist locator.

Citation:  https://acaai.org/news/new-research-shows-73-percent-allergists-prescribe-under-tongue-allergy-tablets?

Park Allergy Center provides both oral drops or tablets for allergy immunotherapy treatment.

Common Seasonal Allergy Triggers

If you sneeze and cough during certain times of the year, you may have seasonal allergies. However, occasional allergies aren’t something you just have to live with. An allergist can pinpoint the cause and help you find relief.

In many areas of the United States, spring allergies begin in February and last until the early summer. Tree pollination begins earliest in the year followed by grass pollination later in the spring and summer and ragweed in the late summer and fall. In tropical climates, however, grass may pollinate throughout a good portion of the year. Mild winter temperatures can cause plants to pollinate early. A rainy spring can also promote rapid plant growth and lead to an increase in mold, causing symptoms to last well into the fall.

The most common culprit for fall allergies is ragweed, a plant that grows wild almost everywhere, but especially on the East Coast and in the Midwest. Ragweed blooms and releases pollen from August to November. In many areas of the country, ragweed pollen levels are highest in early to mid-September.

Other plants that trigger fall allergies include:

  • Burning bush
  • Cocklebur
  • Lamb’s-quarters
  • Pigweed
  • Sagebrush and mugwort
  • Tumbleweed and Russian thistle

While the timing and severity of an allergy season vary across the country, the following climate factors also can influence how bad your symptoms might be:

  • Tree, grass and ragweed pollens thrive during cool nights and warm days.
  • Molds grow quickly in heat and high humidity.
  • Pollen levels tend to peak in the morning hours.
  • Rain washes pollen away, but pollen counts can soar after rainfall.
  • On a day with no wind, airborne allergens are grounded.
  • When the day is windy and warm, pollen counts surge.
  • Moving to another climate to avoid allergies is usually not successful — allergens are virtually everywhere.
    

Allergy shots, or immunotherapy, allergen immunotherapy, is a useful thing to do. It’s useful not only because it helps with your symptoms, but it’s truly disease-modifying. It actually makes you less allergic.

Allergist Richard Weber, MD

Seasonal Allergy Management and Treatment

If you feel like you’re always getting sick, with a cough or head congestion, it’s time to see an allergist. You may think you’re sure pollen is causing your suffering, but other substances may be involved as well. More than two-thirds of spring allergy sufferers actually have year-round symptoms. Your best resource for finding what’s causing your suffering and stopping it, not just treating the symptoms, is an allergist.

Work together with your allergist to devise strategies to avoid your triggers:

  • Monitor pollen and mold counts. Weather reports in newspapers and on radio and television often include this information during allergy seasons.
  • Keep windows and doors shut at home and in your car during allergy season.
  • To avoid pollen, know which pollens you are sensitive to and then check pollen counts. In spring and summer, during tree and grass pollen season, levels are highest in the evening. In late summer and early fall, during ragweed pollen season, levels are highest in the morning.
  • Take a shower, wash your hair and change your clothes after you’ve been working or playing outdoors.
  • Wear a NIOSH-rated 95 filter mask when mowing the lawn or doing other chores outdoors, and take appropriate medication beforehand.

Our allergist’s treatment has unquestionably resulted in a better quality of life for Kealab.

Kealab’s mom

Your allergist may also recommend one or more medications to control symptoms. Some of the most widely recommended drugs are available without a prescription (over the counter); others, including some nose drops, require a prescription.

If you have a history of prior seasonal problems, allergists recommend starting medications to alleviate symptoms two weeks before they are expected to begin.

One of the most effective ways to treat seasonal allergies linked to pollen is immunotherapy (allergy shots). These injections expose you over time to gradual increments of your allergen, so you learn to tolerate it rather than reacting with sneezing, a stuffy nose or itchy, watery eyes.

Seasonally Related Triggers

While the term “seasonal allergies” generally refers to grass, pollen and mold, there is a different group of triggers that are closely tied to particular seasons. Among them:

  • Smoke (campfires in summer, fireplaces in winter)
  • Insect bites and stings (usually in spring and summer)
  • Chlorine in indoor and outdoor swimming pools
  • Candy ingredients (Halloween, Christmas, Valentine’s Day, Easter)
  • Pine trees and wreaths (Thanksgiving to Christmas))

Citation:  https://acaai.org/allergies/seasonal-allergies

Allergists treat two of the nation’s most common chronic health problems – allergies and asthma. Although symptoms may not always be severe, allergies and asthma are diseases and should be treated that way. Many people with allergies and asthma simply don’t realize how much better they can feel.

Allergists are specially trained to help you take control of your allergies and asthma, so you can live the life you want. They find the source of your symptoms and provide the most effective treatment options. Don’t let allergies or asthma hold you back from the things you love. Find expert care with an allergist.

Here are some of the conditions allergists treat:​

Asthma and Frequent Cough

Asthma is a disease that affects the airways in your lungs, making them inflamed and swollen. The inflammation makes your airways more likely to be bothered by allergens or things like smoke, stress, exercise or cold air. Airway muscle spasms block the flow of air to your lungs, causing symptoms that may include difficulty breathing, a tight feeling in your chest, coughing and wheezing. Sometimes your only symptom is a chronic cough, especially at night, after you exercise or when you are laughing. Sometimes asthma has only mild symptoms, but it can be life-threatening if you have an attack and stop breathing.

Hay Fever (Allergic Rhinitis)

Hay fever is a common condition that causes symptoms such as sneezing, stuffy nose, runny nose, watery eyes and itching of your nose, eyes or the roof of your mouth. Allergic rhinitis can be seasonal or perennial, and each has different symptoms:

  • Seasonal allergic rhinitis symptoms occur in spring, summer and/or early fall. They are usually caused by allergies to pollens from trees, grasses or weeds or to airborne mold spores.
  • People with perennial allergic rhinitis experience symptoms year-round. It is generally caused by sensitivity to house dust mites, animal dander, cockroaches and/or mold spores. Underlying or hidden food allergies rarely cause perennial nasal symptoms.
Eye Allergies

Allergic reactions in your eyes, called eye allergies or allergic conjunctivitis, result in itching, redness and burning. They are often caused by the same allergy triggers that cause hay fever and can result in many of the same symptoms such as sneezing, sniffling and a stuffy nose. While many people treat their nasal allergy symptoms, they often ignore eye symptoms which can be treated effectively with medication or immunotherapy.

Skin Allergies

Contact dermatitis, eczema and hives are skin reactions that can be caused by allergens and other irritants. Sometimes, your reaction can happen quickly. Other reactions may take hours or days, as in poison ivy. Common allergens can be medicines, insect stings, foods, animals and chemicals used at home or work. Your skin allergies may be worse under stress.

Food Allergies

An allergic reaction to food can cause mild to serious symptoms. Symptoms can include vomiting, nausea, stomach cramps, indigestion, diarrhea, hives or other skin rashes, wheezing and coughing, headaches, runny or stuffy nose and sneezing. In extreme cases, food allergy can trigger a severe and life-threatening reaction called anaphylaxis. Some mild symptoms may be caused by a food sensitivity rather than an allergic reaction. An allergist can help determine if it is a true allergic reaction. Shellfish, peanuts and tree nuts are the most common food allergies in adults. Milk, eggs, soy, wheat, shellfish, peanuts and tree nuts are the most common food allergies in children.

Anaphylaxis

An allergist can help you determine if you have a severe allergy – one that might result in anaphylaxis, and help you identify triggers. Anaphylaxis is a rare allergic reaction that affects many parts of your body at the same time. If not treated quickly, it can be fatal. The trigger may be an insect sting, a food (such as peanuts), the latex in rubber products or a medication. The most dangerous symptoms of anaphylaxis affect your breathing and/or cardiovascular system (heart and blood pressure). Symptoms can include some or all of the following:

  • Hives, itchiness and redness on the skin, lips, eyelids or other areas of the body
  • Wheezing or difficulty breathing
  • Swelling of your tongue, throat, nose and lips
  • Nausea, stomach cramping and vomiting or diarrhea
  • Dizziness and fainting or loss of consciousness, which can lead to shock and heart failure

Frequently these symptoms start suddenly without warning and rapidly get worse. At the first sign of anaphylaxis, you should get help immediately, call 911 or go to the closest emergency room. If you have been prescribed epinephrine, you should use your epinephrine auto injector.

Sinus infections

Sinus infections, also called sinusitis, are common in people with nasal allergies such as hay fever. The constant stuffy and runny nose can inflame your nasal passages and make them swell. Symptoms include a runny nose with a thick discharge, cough and occasionally pain in your forehead, around and in between your eyes, in your upper jaw, cheeks and teeth. In some cases, sinusitis can be chronic and cause several infections a year. If you have asthma, you are more likely to have chronic sinus infections which can complicate your disease and make your symptoms more severe.

Citation:  https://acaai.org/allergies/allergy-treatment/when-see-allergist/what-does-allergist-treat?

aaaai.org/conditions-and-treatments

During the winter, dry indoor air is often the cause of chapped lips, dry skin and irritated sinus passages. The moisture from a humidifier can soothe dry sinus passages. However, if you have indoor allergies, dust and mold from the humidifier may cause more harm than good.

The number one indoor allergen is the dust mite. Dust mites grow best where there is moisture. Moisturizing the air with a humidifier creates the perfect home for dust mites to live and prosper. Keep the humidity level in your house between 40-50%. You can monitor the levels with a hygrometer.

Mold spores can also be an issue for people with mold allergies. It is important to clean and change the filter in the humidifier on a regular basis so mold does not grow in the unit and blow into the home. Read the manufacturer instructions for tips on cleaning your humidifier.

If possible, use distilled or demineralized water in your humidifier. The higher level of minerals in tap water can increase bacteria growth, resulting in a white dust and additional irritation to your sinuses.

If you have indoor allergies, check with your allergist / immunologist to see if using a humidifier can help you and your sinuses survive winter.

Citation: https://www.aaaai.org/conditions-and-treatments/library/allergy-library/humidifiers-and-indoor-allergies

By Michael Blaiss, MD

ONE OF THE GREAT THINGS about winter is that there’s no pollen in the air. All the leaves have fallen off the trees, and the grass is brown and may even be covered with snow, allowing sufferers of hay fever a reprieve from their nasal symptoms. So, you may be asking, “Why am I having constant sneezing, and my nose is itching and running during the winter months? How can that be?”

Unfortunately, for many people, the winter can be a terrible time for allergies. But since winter is “cold” season, how do you know if your nasal problems are from an allergy or a virus?

Here are some ways to help distinguish whether you have a virus or an allergy:

  • Viruses may be associated with fever, while allergies never result in a fever.
  • Viruses produce colored mucus from the nose, while allergies cause clear drainage.
  • Viruses typically don’t have any eye symptoms, while allergies may produce watery, itchy eyes.
  • Viruses may lead to sore throats and body aches, while these are not seen with allergies.
  • Viruses are short-lived, usually lasting up to two weeks, while allergies may last throughout the season or longer.

If your symptoms suggest that you are miserable from a winter allergy, what could be the cause? According to the American College of Allergy, Asthma and Immunology, these are some of the most likely culprits:

  • House dust mites: These pests are barely visible to the naked eye and grow in carpet, bedding and upholstered furniture. In the winter, they die, and their decomposed body parts and feces can trigger allergy symptoms.
  • Animal dander: Your cat or dog can cause year-round allergy symptoms, but these may be more noticeable in the winter when you spend more time indoors.
  • Mold spores: Like pets, molds can lead to allergy troubles all year, but especially in the cold, wet winter months. The most common locations to observe mold growth are your bathrooms and basement.

What can you do about these allergy triggers? The first step is avoidance. For house dust mites, removing the carpet from bedroom floor, washing all the bedding with hot water – at least 130 degrees Fahrenheit – removing dust collectors from the bedroom and putting mite-proof encasings on the mattress and box springs can help reduce symptoms. To avoid pet dander, always keep your pet out of your bedroom. Some studies suggest that frequent bathing of your pet is beneficial in keeping dander down to a minimum. Remember, there is no such thing is a “hypoallergenic” cat or dog. Any area where mold is growing needs to be scrubbed thoroughly, and be sure to control any moisture or water source that’s causing mold development. In a basement with mold problems, a dehumidifier can be effective.

Second, medication may be used to minimize your nasal misery. Over-the-counter medications, such as non-sedating antihistamines, like Claritin and Zyrtec, and intranasal corticosteroids, like Flonase and Nasacort, can be beneficial. These treatments don’t cure your allergies and need to be taken regularly to control the nasal symptoms. Depending on the severity of your allergies, these remedies may be enough to improve your quality of life.

What if avoidance and medication don’t work well enough, you’re having side effects from the medication or you’re just tired of using medications all the time? What can you do? If this is the case, it’s time to seek medical help from a board-certified allergist. You’ll probably require allergy testing to determine exactly what’s causing your symptoms. You may find after speaking with your allergist that you’re a candidate for allergen immunotherapy. This is a type of vaccination where you’re given small amounts of what you’re allergic to by a tablet under the tongue (house dust mites) or by injections (pets, molds, house dust mites), over a three- to five-year period. Allergen immunotherapy has been shown not only to reduce symptoms, but also to help get rid of your allergies permanently.

Citation:  https://health.usnews.com/health-care/for-better/articles/2019-01-11/winter-allergies-how-to-cope?