Top Prevention Tips: Seasonal Allergies
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. Commonly, seasonal allergic rhinitis is called 'hay fever' or 'allergic rhinitis'. Rhinitis is another word for stuffy or runny nose. A scratchy throat, cough, sneezing, and red and itchy eyes are common symptoms 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.
Airborne pollen from trees, grasses and ragweed can occur in the spring and summer months, while mold spore allergies are linked with summer and fall months. 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 visit to your doctor is in order for allergy evaluation and treatment. The doctor will ask about a family history of allergies, your specific symptoms, when they occur, and your history of asthma, hives or skin eczema. A physical exam is performed and your nose, eyes and throat are checked.
Your past medical history may help pinpoint your allergy. However, to identify exactly what you are allergic to, a simple blood test may be needed or you may need to see an allergist for skin testing.
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, and the use of air conditioner may help. Avoid heavy yard work or wear a face mask, and shower and shampoo 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 be effective. Avoid hanging clothes outside to dry, too.
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, 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 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 in less expensive store brands and are labeled for dosing in children. 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?
It's best if antihistamines are started about two weeks before allergy season starts. They are used each day during the allergy season to prevent symptoms such as sneezing, runny nose, and watery eyes. But beware - antihistamines may be found in combination with other drugs, like cough/cold products, pain relievers or sleep aids, so be sure to read the OTC Facts Label on each medication to avoid doubling up on medications. Also, ask your pharmacist to 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 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 other spray options to prevent allergy symptoms. Antihistamine nasal sprays are more likely to be associated with adverse effects such as drowsiness, bitter taste, or fatigue and they are generally less effective than corticosteroid nasal sprays.
Intranasal anticholinergic agents (such as 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
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) and combination allergy relief tablets include Allegra-D, Allerphed, and Zyrtec-D.
But decongestants should only be used for quick and temporary symptom relief, not as an everyday medication. They can increase blood pressure, cause headache, insomnia, and irritability in some people. They should not be used during pregnancy or for people with high blood pressure, cardiovascular disease, glaucoma or hyperthyroidism.
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
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.
Allergy Options: Immunotherapy
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.
Oralair is a mixed grass pollen allergens extract that is a form of oral immunotherapy. It is given under the tongue (sublingually) and may 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%.
Finished: Top Prevention Tips - Seasonal Allergies
- Asthma and Allergy Foundation of America. Allergy overview.
- American Academy of Allergy, Asthma and Immunology. Allergies.
- American College of Allergy, Asthma & Immunology. Frequently asked questions.
- Sur DK, Scandale S.Treatment of allergic rhinitis. Am Fam Physician. 2010 Jun 15;81(12):1440-6
- Allergic rhinitis. Medscape. http://emedicine.medscape.com/article/134825-overview