April showers bring May flowers…and a whole bunch of allergy suffering to boot. Allergies can be a real bummer impacting many areas of life. Especially sleep patterns. Experts are saying we could have another record year of seasonal pollens. So, I checked in with Dr. Rankin to get some survival tips on how to stay one pedal stroke ahead of your allergies.
OCA: What exactly is an allergy?
JR: An allergy is basically when your body reacts to a substance in your environment that is normally harmless. There are many types of hypersensitivities, but the type most people are dealing with are what we refer to as Type I hypersensitivity reactions (aka IgE-mediated). After you’ve been exposed to an allergen, such as tree or grass pollen, pet dander, etc., the body will sometimes mount an antibody response to that allergen. (Genetics plays a strong part in why some people have this response and some don’t.) Then, when you’re exposed to that allergen again, this antibody response goes haywire and causes some of your blood cells (mast cells) to release inflammatory chemicals such as histamine into the blood and surrounding tissue. It is these chemicals which produce the typical allergy symptoms such as runny nose, itchy eyes, sneezing, and in some people, airway constriction.
OCA: How do I know I have seasonal allergies?
JR: Some people are allergic to things that are around year-round. Examples of this would include animal dander or insect stings. On the other hand some people only have symptoms of allergies during periods of heavy plant pollination which most commonly affects people in the spring time when trees pollinate. Therefore, if your allergy symptoms tend to abate at times during the year with less pollination, it’s more likely your allergies are seasonal.
OCA: What allergy medications are available and how do they work?
JR: The most common medications available without a prescription are oral antihistamines. As the name implies, these medications block the action of histamine released from mast cells. First generation antihistamines include diphenhydramine (Benadryl). Newer generation antihistamines include loratadine (Claritin), certirizine (Zyrtec), and fexofenadine (Allegra) among others. The mechanism by which all antihistamines work is similar, but the newer generation meds are typically recommended for daily use as they are less likely to cause sedation. Recently, nasal steroid sprays have been made available over-the-counter. These steroids are intended to treat inflammation caused by more of the aforementioned chemicals than just histamine (such as cytokines, interleukins, and other inflammatory mediators). There are also ocular antihistamine drops available OTC and some by prescription that are used to treat symptoms localized to the eyes. Another commonly prescribed medication for allergies and asthma is montelukast (Singulair). This medication works through yet another chemical receptor blockade (leukotriene inhibitor).
OCA: Can medications like nasal antihistamines, eye drops, steroids etc. be taken before symptoms take hold?
JR: Absolutely. In fact, I have a lot of my patients with a history of seasonal allergies start taking their medications a month prior to their particular problematic season (trees in the spring, grasses in the summer, and weeds in the fall). The nasal steroids in particular are most useful if started prior to allergy season as most are not rapid acting.
OCA: Are there practical things around the house I can do to help?
JR: That depends on what you’re allergic to. Obviously if you’re allergic to cats like I am, you may need to find Whiskers a new home if you want to be totally symptom free. (And, yes, I’ve made a few people unhappy with that recommendation.) But also use of a HEPA filter in your vacuum and AC filter will help reduce the number of particles in the air to which you may be allergic.
OCA: How important is to protect your eyes from pollen?
JR: If eye itching, redness, and clear discharge is most of your problem, protecting your eyes from the offending pollen is very helpful. This can be as simple as wearing a hat and sunglasses when outdoors and/or using ocular eyewash like saline solution to wash any pollen away.
OCA: Should I avoid the outdoors on high pollen count days?
JR: If your allergy symptoms are definitely related to pollen (which can be determined by a skin test administered by an allergist), then yes, it is recommended by the American Academy of Allergy, Asthma, and Immunology (AAAAI) that you limit outdoor activities on high pollen count days.
OCA: How do I know when the pollen is high?
JR: There are many apps for smart phones that have this feature including the Weather Channel App. Also, the AAAAI’s website (aaaai.org) has this information.
OCA: Should I go see an allergist and get tested?
JR: For most people that I see with allergy symptoms that are generally mild-moderate in severity and limited to seasonal flares, I wouldn’t necessarily send for allergy testing. These are the people that can get away with an antihistamine daily for a few weeks and be fine. On the other hand for people who have more severe and persistent symptoms, an allergist evaluation would be important in the course of the evaluation. Additionally, if your allergies are severe and are due to allergens you are unlikely (or unwilling) to get away from, immunotherapy (allergy shots) to desensitize you to these allergens may be possible and would require testing and treatment by an allergist.
OCA: Finally a question from PCG (my wife). She wants to know why her allergy symptoms go away while exercising then return when finished.
JR: That’s a good question and something I’ve experienced myself, even with cold symptoms. When you have allergies, the blood vessels inside the tissues of the nose become filled with blood which is the cause of nasal congestion and runny nose, which can lead to further symptoms of sneezing and headache. When you exercise, blood is diverted from these less important areas (through the process of vasoconstriction) to your muscles and other hardworking organs which are demanding the blood to deliver oxygen to them. This effect can last for quite a while, but if you are still exposed to the allergens that produced the response in the first place, your symptoms will return.
OCA: A big thanks to Dr. Rankin for the interview and providing some helpful tips! Now get outside Arkansas!