Seasonal Allergies: Top Prevention Tips
What is An Allergy or Seasonal Allergic Rhinitis?
An allergy is an exaggerated immune response to substances (allergens) that are generally not harmful, such as tree or grass pollen, molds, pet dander, food or dust mites. Your immune system overreacts to these allergens by producing antibodies called Immunoglobulin E (IgE). IgE antibodies travel to cells and release certain chemicals that cause allergy symptoms. Seasonal allergic rhinitis is also called 'hay fever' or 'allergic rhinitis'. Rhinitis is another word for stuffy or runny nose. Other symptoms, such as a scratchy throat, cough, sneezing, and red and itchy eyes are also common with seasonal allergies.
When Does Hay Fever Most Frequently Occur?
Allergies that occur throughout the year (perennial allergic rhinitis) are often due to a year-round sensitivity to animal dander, dust mites or cockroaches. Seasonal allergic rhinitis, or hay fever, most often occurs in the spring and fall seasons.
Trees, grasses and ragweed release airborne pollen during spring and summer, while concentrations of mold spores are higher in summer and fall. An individual’s specific hay fever season is fairly predictable and may occur year after year.
How Do I Know Which Allergy I Have?
A doctor can evaluate your allergy, help pinpoint the most likely cause, and advise on the most appropriate treatment. Your doctor will check your family history of allergies, ask about specific symptoms and when they occur, and question you about other allergy-related disorders, such as asthma, hives or eczema. Your nose, eyes and throat will be checked during a physical exam.
Pinpointing the actual allergy may be easy in those with a predictable response to a given substance. In others, a blood test or referral to a specialist may be needed.
Is There Any Way to Prevent Hay Fever?
Yes! One way to help prevent allergies is to stay away from the allergen, but in many cases, this is not practical or possible.
For hay fever, staying indoors as much as possible during the allergy season, keeping doors and windows closed, using the dryer to dry clothes, and cooling the house down with an air conditioner may help. Wear a face mask if you can't avoid yard work or ask somebody to do it for you. Always shower and wash your hair before bedtime to remove any pollen that may have accumulated on your skin and hair during the day. The use of HEPA filters in the home to trap particles such as pollen and dust can also be effective.
What Medicines Are Available For Allergy Prevention?
Both prescription and over-the-counter (OTC) medications are used for allergies. Common treatments include 1st and 2nd generation oral antihistamines, saline nasal rinses, corticosteroid nasal sprays, decongestants, leukotriene antagonists, and immunotherapy.
Oral and corticosteroid nasal spray medicines must be used daily to prevent symptoms from occurring; conversely intranasal decongestants should only be used for a few days at the most. Each treatment has benefits and risks, and it is important to discuss these with your doctor. There is a wide selection of OTC treatments available, and many allergy products can be bought in the generic form, which will save you money for spring break!
Allergy Options: First Generation H1-Antihistamines
First generation oral H1-antihistamines are familiar to many patients. Most can be bought without a prescription and at a low cost: over-the-counter (OTC) examples include diphenhydramine (Benadryl), chlorpheniramine (Aller-Chlor), and clemastine (Tavist Allergy).
First-generation antihistamines like diphenhydramine can cause drowsiness, and are also found in OTC sleep medications. Do not drive when you take first generation antihistamines, or mix with them with alcohol or other sedating drugs. For other common side effects with antihistamines, check here.
Allergy Options: Second Generation H1-Antihistamines
The first oral treatment used for mild to moderate hay fever symptoms is usually a second generation oral H1-antihistamine, such as levocetirizine (Xyzal), fexofenadine (Allegra), loratadine (Claritin) or cetirizine (Zyrtec).
All of these are available without a prescription and are labeled for dosing in children. Store brands are less expensive than branded products. Cetirizine may be associated with drowsiness and can be taken at bedtime if needed. Fexofenadine, levocetirizine and loratadine do not usually cause drowsiness at recommended doses.
How Do Antihistamines Work?
IgE antibodies are formed in the body in response to the presence of an allergen such as pollen or mold spores. When you are exposed to this allergen your body releases histamine. Histamine attaches to cells in your body and causes them to swell, leak fluid, and cause typical allergy symptoms - itching, sneezing, runny nose and watery, red eyes.
Antihistamines help to prevent allergy symptoms by blocking histamine attachment to the cell receptor site.
What Are Some Take-Away Points About OTC Antihistamines?
For best results, experts suggest starting antihistamines two weeks before allergy season starts.
Antihistamines are taken daily to prevent symptoms such as sneezing, runny nose, and watery eyes. But beware - antihistamines may be found in combination with other drugs, such as cough and cold products, pain relievers or sleep aids, so be sure to read the OTC Facts Label on each medication to avoid doubling up on antihistamines and other medications. You may also like to ask your pharmacist if he/she could complete a drug interaction review of all medications including your OTC, prescription and herbal drugs.
Allergy Options: Nasal Sprays for Seasonal Allergies
Guidelines consider corticosteroid nasal sprays the most effective treatment for controlling moderate nasal symptoms of allergic rhinitis. They can also be combined with oral antihistamines if needed. Several different types are available, including beclomethasone (Beconase), fluticasone (Flonase), and triamcinolone (Nasacort). Both Flonase and Nasacort are available over the counter.
Effects of intranasal corticosteroids (INS) are usually evident within three to 12 hours; however, it may take several days of use for their full effects to be seen. Side effects of INS are generally mild and may include nasal irritation and minor nasal bleeding. Spraying the corticosteroid away from the nasal septum (middle part of nose) may minimize side effects.
Antihistamine nasal sprays, such as azelastine (Astepro), olopatadine (Patanase), and OTC cromolyn (Nasalcrom), a mast cell stabilizer, are also used in the treatment of allergy symptoms. Antihistamine nasal sprays are generally less effective than corticosteroid nasal sprays and some are more likely to be associated with side effects such as drowsiness, tiredness, or a bitter taste in the mouth.
Intranasal anticholinergic agents (for example, Atrovent Nasal spray) reduce mucus production in the nasal cavity and can be used alone or in conjunction with other medications (such as antihistamines or decongestants).
Decongestants: Save For When In Dire Need
Although decongestants are effective at relieving nasal congestion and unblocking blocked noses, they are not a medicine that should be taken daily and are best reserved for quick and temporary symptom relief. Decongestants may increase blood pressure, cause a headache, interfere with sleep and make some people irritable. They are not recommended during pregnancy or for people with heart conditions, glaucoma, or hyperthyroidism.
Decongestants are often found in combination with antihistamines or pain relievers in combination tablets or liquids used to treat not only allergies, but colds and flu as well. One of the most common decongestants is pseudoephedrine (Nasofed, Sudafed), also available in combination with an antihistamine in products such as Allegra-D, Allerphed, and Zyrtec-D.
Nasal decongestants must be used even more sparingly. Repeated use of agents such as oxymetazoline (Afrin, Nostrilla) or tetrahydrozoline (Tyzine) for more than three days at a time can cause rebound congestion - recurring or worsening congestion that occurs as soon as the decongestant is stopped.
Allergy Options: Leukotriene Antagonists
Leukotriene modifiers prevent the action of specific inflammatory mediators called leukotrienes in the body. These mediators are released as soon as the body detects the presence of an allergen, and cause a narrowing of the tubules in the lungs as well as increased mucus production, swelling and inflammation. This causes symptoms such as wheezing and shortness of breath.
Montelukast (Singulair) is currently the only leukotriene modifier approved for allergies and allergic rhinitis. It is approved for treatment of children 6 months of age and older and is a good choice for patients with asthma that is aggravated by allergies. A cost-effective generic formulation is available as well as kid-friendly chewable tablets and dissolvable granules.
Immunotherapy: Allergy Shots
Allergy shots (immunotherapy) are occasionally recommended if the allergen cannot be avoided and symptoms are hard to control. Regular injections of the allergy trigger are given, with each dose slightly larger than the previous dose. Allergy shots keep the body from over-reacting to the allergen. Allergy shots do not work for everybody and require frequent visits to your doctor, but may be an effective treatment for patients with severe allergies that interfere with daily activities.
Immunotherapy: Oral Extracts
Oralair is a mixed grass pollen allergen extract that is given under the tongue (sublingually) to help reduce allergy-type symptoms caused by perennial ryegrass, Kentucky bluegrass, Timothy grass, Orchard grass, and Sweet Vernal grass. Oralair needs to be initiated 4 months prior to the grass allergy season.
A specific sublingual immunotherapy against Timothy grass is Grastek. It is approved for adults and children aged older than five but must be started at least 12 weeks prior to the grass pollen season.
Ragwitek can help reduce allergy symptoms in adults induced by ragweed by about 27-43%.
Odactra is an oral allergen extract used to treat symptoms of house dust mite such as nasal inflammation (allergic rhinitis) and eye redness (conjunctivitis). The first dose is administered under the tongue under the supervision of an experienced health care professional. Eight to 14 weeks of once daily dosing may be needed before a reduction in symptoms of around 16-18% is seen.
Finished: Seasonal Allergies: Top Prevention Tips
- Asthma and Allergy Foundation of America. Allergy overview. http://aafa.org/display.cfm?id=9
- American Academy of Allergy, Asthma and Immunology. Allergies. http://www.aaaai.org/conditions-and-treatments/allergies.aspx
- American College of Allergy, Asthma & Immunology. Frequently asked questions. http://www.acaai.org/patients/faq/Pages/default.aspx
- Sur DK, Scandale S.Treatment of allergic rhinitis. Am Fam Physician. 2010 Jun 15;81(12):1440-6
- FDA Approves Odactra. March 1, 2017. Drugs.com https://www.drugs.com/newdrugs/fda-approves-odactra-house-dust-mite-allergies-4494.html
- Allergic rhinitis. Medscape. http://emedicine.medscape.com/article/134825-overview