Seasonal & Environmental Allergies from Dr. DeMeyere-Coursey
Allergies are one of those annoying things your body may have or do for no apparent reason. I took two full courses of immunology, and while these may have explained to me the “why” of them, it still doesn’t really explain…Why. There’s no benefit I can fathom to having itching eyes, skin, nasal passages, accompanied by sneezing, mucous, and congestion. In the caveman days, allergies certainly wouldn’t be advantageous to running from a saber tooth tiger.
My job, as your doctor, is to try and mitigate all these horrible symptoms. How do we do that? What treatments are available?
When I’m talking to my patients, I like to get to know which symptom is bothering them the most, then I try to target their treatment based on those. Of note, every medication I talk about below can be found over the counter, but your doctor can prescribe them as well. Basic treatment of allergies can be broken up into a few different types:
1.) Saline rinses – For those who would like to avoid medical therapy, I’m a big fan of giving saline rinses a try first. Neti pots have been shown to help alleviate symptoms and are generally well tolerated (once getting past the weirdness factor of trying it the first time). What have you got to lose?
2.) Systemic therapy – “Systemic” in the medical world means something that has the chance to travel through the whole body. In this case, oral therapy. For allergies, we have first generation and second generation oral therapy. The most well-known first generation medicine is Benadryl/diphenhydramine, though there are others. First generation allergy medications work well, however they can cause drowsiness in some. Second generation allergy medications are less likely to cause drowsiness, and will usually last 12-24 hours, so they tend to be more prescribed in this day and age. These medications include Zyrtec/cetirizine, Claritin/loratidine, and Allegra/fexofenadine.
3.) Steroid nasal spray – This is probably my favorite way to treat allergies, and the literature has found it to be the most successful. I personally use Flonase/fluticasone, (others available include Nasonex/mometasone, and Nasacort/triamcinolone) on a daily basis to help against sneezing, congestion, runny nose, and it can help with some eye symptoms as well. Though it does have the name “steroid” in it, these steroids will not go through your body and cause any of those unwanted side effects one can read about on WebMD. The most notable side effect tends to be epistaxis – fancy medical terminology for “nose bleed”. If this occurs, treatment can be adjusted or switched around. I like to tell my patients that it is important to use this spray at least every other day, and also that they may not notice a difference until a week of therapy. Think of it as a vitamin for your nose. If you don’t take it regularly, it won’t work.
4.) Eye drops – If your nose doesn’t bother you as much, but eyes are the main problem, eye drops may be the way to go for you. I personally have found most success with ketotifen, which is an eye drop that can be used every 8-12 hours. If you wear contacts, it is advised to place the drops first, wait 15 minutes, then insert your contacts.
Beyond these very basic things to try at home, there are other medications which require prescriptions, and if symptoms are very severe or my patients would like to pursue allergy shots, that is when I start to think about referring to an allergy specialist. On the whole, allergies can be a frustrating, but very treatable problem, so don’t hesitate to bring it up at your next visit!