Are You Itching, Sneezing and Tearing? It’s Allergy Time — Again

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Are You Itching, Sneezing and Tearing? It’s Allergy Time – Again

Contributor: Michael Benninger, MD, chair of the Head and Neck Institute at Cleveland Clinic

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Many of us have been there: Spring and fall seasons are a time of misery when one experiences an itchy nose and eyes, a runny nose and congestion in the nose and face. You feel tired, run-down and are not sleeping well. It’s allergy season! Up to 30 percent of us dread its arrival.

The formal term is allergic rhinitis, although it’s commonly called hay fever. In the United States, allergies are largely lumped into seasonal and perennial, meaning year-round. In Europe, allergies are categorized by the severity of the symptoms and how long the symptoms are present.

The distinction is probably not important for allergy sufferers, although the U.S. approach makes it easier to identify what people are allergic to, and the European approach helps guide treatment.

What most people may not understand is that allergies, particularly seasonal allergies, can have a significant impact on quality of life. Difficulty sleeping and chronic fatigue are common problems in patients with allergies.

However, some of the other known effects may be less obvious. Decreased work productivity has been well substantiated, both because of missed days of work and presenteeism — attending work while sick. Recent studies also have shown that allergic rhinitis can have a negative impact on sexual drive and activity. Chronic fatigue with nasal blockage, decreased smell and a drippy nose do not lead to amorous feelings.

Know what you’re allergic to

Spring allergies are caused by tree pollens; early summer allergies are triggered by grasses; fall allergies tend to come from weeds such as ragweed and molds.

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There are clear geographic differences. Ragweed allergies are mostly in the U.S. North-Central region, and allergies caused by the Mountain Cedar tree are found predominantly in the U.S. South-Central region. Molds like a moist environment can be year-round in parts of the South. Certain allergies caused by pets and dust mites are fairly common throughout the country.

Knowing what you are allergic to can help steer a major part of the treatment, which is avoidance or environmental control. In some cases, the offending allergen is obvious, but in many cases, allergy testing is needed to identify the culprit.

How you can defend against allergies

What can you proactively do? Avoid the offending allergens. If they are outdoor and seasonal, keep windows and doors closed as much as possible. Keep track of pollen counts, and stay inside on high pollen days. The National Allergy Bureau tracks pollen levels and offers a pollen/mold app.

If you have dust mites or pet allergies, look for ways to reduce the indoor allergens in your home. In other words, allergy proof your home! For instance, vacuum frequently to remove pet hair, dust and clean carpets, as they can sustain allergens. Keep your pet out of your bedroom. Air purifiers may also be helpful.

Avoidance is helpful, but it’s usually not enough to manage significant allergies. Fortunately, many very good home remedies, over-the-counter and prescription medications exist. Saline rinses or irrigations, either with a rinsing device or neti pot, can clear the offending allergens from the nose and can reduce swelling.

Over-the-counter non-sedating antihistamines such as fexofenadine, sold under the brand name Allegra®, loratadine, sold under the brand name Claritin® or cetirizine, sold under the brand name Zyrtec® are great for managing sneezing, itchy eyes and reducing nasal drip. However, they are not very effective with nasal congestion. If congestion is not a problem for you, try these first.

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I recommend some caution with the sedating antihistamines, like diphenhydramine, which is sold under the brand name Benadryl®. They probably should be used primarily at bedtime, as they can affect function because of the sedation. There is some evidence that long-term use of these, particularly in older adults, may be associated with increased memory loss.

If congestion is a big problem, you may want to try one of the intranasal steroid sprays such asfluticasone, which is sold under the brand name Flonase® and triamcinolone, which is sold under the brand name Nasacort®. Since they are now over-the-counter, they might be a reasonable first treatment. These are very effective and are even more so if the treatment is started a few weeks before the onset of the allergic season.

When to see a specialist

If you’re still having bothersome symptoms, it might be worth seeing a specialist such as an otolaryngologist or allergist. They can recommend other prescription medications and immunotherapy if necessary.

Traditionally known as allergy shots, the immunotherapy treatment is now available in tablets and drops that can go under the tongue. Right now, these products have Food and Drug Administration approval only for grass and ragweed, but others are on the way.

The good news is that with avoidance, hygiene and treatment, most people can live with their allergies and manage them.

This post is based on one of a series of articles produced by U.S. News & World Report in association with the medical experts at Cleveland Clinic.

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