Those Dreaded Allergies

The old fashioned expression for allergies has notoriously been given the name

“hay fever”. We now know, it has nothing to do with hay and certainly nothing to do with fever. It does, however, have many symptoms that can be quite annoying and bothersome.

The basic definition can be summarized as an inflammatory condition of the nasal passages that is characterized by some form of obstruction of the nasal passages associated with nasal drainage, sneezing, itching, tearing and ocular irritation. Not all individuals will present with all the above manifestations, but may exhibit one symptom to a greater degree.

Seasonal allergies are the most common and are caused by exposure to pollens. In most parts of the country where there are true seasons, the blossoming of trees is the main source of allergens in the spring. Oak and maple are the more common allergens. This is followed by grass exposure in the summer and ragweed in the fall. Mold allergies can also be a source of allergies, and these can be seen at any time of the year. Perennial allergies are present in those individuals who have symptoms year round and mostly due to contact with house dust (a source of dust mite antigens) and animal dander.

Allergies do have a genetic predisposition, which is coupled with airborne environmental exposure. It is very possible to “outgrow” this allergic state and not manifest any allergies as an adult. It is also possible to have symptoms develop in our adult years.

The pathophysiology of how these symptoms develop are as follows: the pollen and other allergens on the nasal mucosa of affected individuals results in triggering cells called mast cells that release mediators producing the swelling, redness and excessive production of mucus (fluid) nasally and in our eyes This inflammation allows the penetration of allergens deeper into tissue and prolongs the annoying symptoms. When the allergen count decreases or is eliminated, the inflammation is decreased and eventually returns to a normal state.

Diagnosis is quite straightforward. An accurate history of symptoms correlates with the predominant type of plant in a given locale, coupled by the classic symptoms listed above.

Physical examination usually reveals boggy and red nasal mucosa, associated with an itch of the nose, eyes or both. A distinction between a cold and allergies—allergies occur slowly over several days (cold symptoms occur quickly over a day). Allergies manifest (for the most part) with no fever or body aches. One may have some “aches” but these occur when symptoms are not medically controlled and prevent good sleep at night. With allergies we are simply tired not from the condition, but inadequate rest.

There is no need for any specific immunologic testing but they are available.

An allergist can perform skin testing but blood tests are being utilized with equal results. Radioallergosorbnet test (RAST) can be quite helpful. The spectrum of possible allergens can be helpful in cases where there is perhaps even a food allergy component. Most of these tests can be done with only a simple blood test and most are covered by insurance plans.

Prevention of exposure to the offending agents is quite helpful but can be challenging. One cannot, literally, walk around in a bubble, but certainly one can keep windows closed, especially in the bedroom.

The number of medications and choices has greatly expanded in the past several years. Many prescription medications are now available in prescription strength as an over the counter choice.

The mainstay of treatment is use of medications. Allegra, Claritin and Zyrtec are very commonly used. The benefit is once a day dosage, generic availability, relatively low cost, minimal side effects (such as somnolence) and is effective.

These are available without presenting to the pharmacy counter. They are also available in combination with a “D” decongestant component. This agent is a drying agent and useful in situations where there is significant nasal discharge. The combination medication must be requested at the pharmacy counter. They do not need a prescription.

Topical nasal sprays are also an option. Sprays that are topical vasoconstrictors, marketed as Afrin, should be used sparingly due to rebound congestion. This translates simply: after several days, inflammation is increased, not decreased. This type of medication should only be used when your nose is literally “running”.

Topical steroids have now become over the counter. They are quite effective, do not cause rebound and are well tolerated. They are somewhat expensive but well worth the cost.

Desensitization/hyposensitization therapy with an immunologist is also an option for certain individuals who do not respond to the suggested medicinal treatments.

I sincerely hope your allergy symptoms are either not an issue or are under good control. Hopefully you may incorporate some information presented to alleviate those dreaded allergies.