Patients find relief with strategies approved by physicians, pharmacists.
By Andrea Zarczynski
Springtime nasal allergies affect almost 50 million people in the United States, up to 30 percent of adults and 40 percent of children, according to the American College of Allergy, Asthma and Immunology. Unlike perennial nasal symptoms caused by allergic sensitivity to foods or indoor dust and dander, seasonal symptoms are usually triggered by tree, grass and weed pollen, or airborne mold spores.
“Environmental allergies can be challenging at any age,” said Devang Doshi, M.D., chief of pediatric allergy and immunology, Beaumont Children’s Hospital Royal Oak. “Any individual that suffers from seasonal allergies should try to minimize any and all exposure to known triggers if possible.”
Minimizing exposure includes staying indoors during high pollen times as well as showering and changing into fresh clothes immediately after spending any time outdoors. If possible, Doshi also recommends limiting yardwork during the entire spring season.
Using special allergen-proof pillow and mattress covers, and keeping doors and windows closed to stop pollen and mold spores from entering the home are other effective strategies. Adults and children who suffer from dust mite allergies can greatly improve symptoms by use of a home air filtration unit.
Unfortunately, perennial allergy sufferers should also avoid direct contact with pets. At the least, Doshi said, pets should be kept off of furniture and out of the bedroom. Frequently bathing and brushing animals can also help decrease the amount of shedding and dander in the home.
Christian Nageotte, M.D., service chief of allergy and immunology at Henry Ford West Bloomfield Hospital, said that the onset of seasonal allergy symptoms is usually abrupt and unpredictable. In Michigan, nasal congestion, frequent sneezing and eye irritation increase with temperatures during March and April. During particularly high-allergy seasons, foods may also become potential allergy triggers.
“Springtime allergies in Michigan are most commonly a result of tree pollen,” Nageotte said. “This can be dramatically affected by the weather conditions in the winter months leading up to spring. For example, if the temperatures have been low enough for several weeks, there tends to be a higher tree pollen count that spring due to stress on the trees.”
Because it is not possible to completely avoid all inhalant allergy triggers like pollen and pets, medication is the first course of action. For some adult and child patients over age 4, doctors may recommend allergen desensitization shots or medications given under the tongue.
Identifying allergies in children is especially important because the American Association of Pediatrics recently made changes to over-the-counter cough and cold medication recommendations for infants and children.
Full allergy panel testing is not always recommended for patients, because different clinics use different panels and not all are identical. Also, because allergy tests are not predictive of allergic reactions to items to which an individual has never been exposed, it would not be helpful, for example, to test a person for honey bee sting if he or she has never been stung.
“It is important to review different seasons and suspected situations where individuals feel they are affected by allergies,” Doshi said. “Additionally, one may wish to review potential occupational exposures in the work environment as well as their home environment that may be causing issues that may be identified.”
Many doctors are happy to suggest environmental control measures to help their patients minimize exposure to certain allergens. They may also help determine when it is appropriate to refer an individual to an allergy specialist who can better help identify and manage allergies while providing further diagnostic, treatment and management advice.
Doshi said that if traditional treatment for seasonal allergy symptoms is not effective, it may be time to see an allergy specialist for further testing. Allergists may also suggest therapeutic options like sublingual immunotherapy to better manage symptoms. Individuals with diagnosed spring allergies may find it beneficial to begin taking medications before spring arrives.
“One of the challenging things in managing environmental allergies is the potential impact on our normal daily lifestyle,” Doshi said. “However, several medications are available to help minimize symptoms in situations where avoidance of the allergen(s) is simply not possible,”
Over-the-counter and prescription medications including antihistamines, eye drops and nasal sprays are top recommendations among physicians. Patients should review all current over-the-counter and prescription medications during every visit to a primary care physician for possible drug interactions that can cause dangerous side effects like sedation or impairment while driving or operating machinery.
It is important for all patients to ask their doctor how a recommended allergy therapy may affect other existing health concerns. Any new allergies to medications or foods should also be discussed with the patient’s pharmacist. Nageotte said that a doctor who prescribes a dose of medication different than the recommended standard should always communicate the information directly to the patient’s pharmacy.
Considering the vast variety of over-the-counter and prescription medications available on the market, patients should also consult with a licensed pharmacist like
Zdzislaw Miloboszewski, co-owner of Troy Professional Pharmacy.
“Pharmacists need to encourage patients to seek a physician’s advice as the situation demands, this includes an initial consultation where the pharmacist determines that this would be beyond a simple case of seasonal allergic rhinitis or exposure to some other allergen,” Milobo-
Because many medications contain similar ingredients, it is important to discuss potential over dosing and excessive side effects. From recommendations on new over-the-counter and prescription medications to information on potential side effects and drug interactions, pharmacists are licensed drug experts who can help patients manage specific allergy symptoms more effectively.
“The initial question is, ‘Are you allergic to any of the following antihistamines?’” Miloboszewski said. “Antihistamines may impair your thinking or reaction time, and this would include the non-sedating ones. If driving a vehicle, you should account for this and be careful.
“Drinking alcohol can increase certain side effects of the drug class and should be avoided when taking these medications.”
Parents should also consider the sedating effect when treating children, as well as any potential to compound this effect and interactions with other medications like anti-epileptics and breathing medications. Pharmacists recommend non-sedating antihistamines. Children may be dosed at age 2 and older. Diphenhydramine, or Benadryl, is only appropriate for children age 6 and up.
Pregnant women should always consult with a doctor or pharmacist before treating springtime allergies, as some drugs can have detrimental effects on a fetus or newborn. Any patient who does not experience an improvement in symptoms or who experiences chest pain or heaviness upon taking an allergy drug for a significant amount of time should seek further medical treatment.
“These considerations show relative importance because they indicate there may be a progression to an infection or possibly a pulmonary episode that should be managed by the physician,” Miloboszewski said. “If allergy symptoms don’t subside and extend over a long period of time, a workup by an allergy specialist may be indicated.”
As a primary contact for a patient suffering allergy symptoms, pharmacists advise patients to first try over-the-counter medications. If allergy symptoms do not improve, or if they worsen within a few days of starting the medication, Miloboszewski said a physician visit is needed. NS
For More Information
Dr. Devang R. Doshi: 3216 Rochester Road, Royal Oak, (248) 588-2222
Dr. Christian Nageotte: 3500 15 Mile Road, Sterling Heights. (800) 436-7936
Troy Professional Pharmacy: 2891 E. Maple Road, Troy, (248) 689-0200