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May 2024Happy Spring! Otherwise known as allergy season. But, is it never not allergy season? Actually no, it is never not allergy season, it just depends on what you are allergic to.
It seems like every year I hear the same thing: Doc, this is the worst allergy season ever! It is never the same person telling me this season after season. I am sure there are resources out there to check pollen counts over time, but my sense is that there isn’t necessarily more pollen or even new pollens to react to, just that some years, an individual is more sensitive to what they are exposed to and thereby react more strongly to it.
There are many things that one can be allergic to. What all of these have in common is that the body makes an immune response to a specific chemical. This response can be fairly mild to immediately life threatening. Seasonal allergies, while annoying, are seldom life-threatening.
The symptoms of seasonal allergies are usually respiratory or skin related. The list of symptoms is long as any one who suffers with allergies knows.
Around here, as soon as the snow melts, we start to see allergies as the mold that has been growing under the blanket of white stuff becomes exposed. Then in April and May, the trees are pollinating. June and July are the grasses. Ragweed takes over from there until a good killing frost ends the growing season.
While it is not necessarily a seasonal allergy, when we transition into the house, dust mites and pet allergens round out the year. Probably one other point to make at this time is that there is a difference between wind and pollinator pollinating plants. The plants that require a pollinator, like flowers, generally do not cause allergies. Their pollen sticks to the pollinator and is transferred form one plant to the next. As a result, their pollen is unable to get into our respiratory tract to cause a reaction.
Wind pollinating plants are the only ones that can cause us allergies. So what causes people to react to flowers? Various volatile compounds that the plant gives off that gives them their distinctive aromas. This is not an allergy, it is more of an irritant. The symptoms are the same though. (Bear in mind, that 0 and 100 are difficult numbers to achieve in medicine.)
Since not much can be done to avoid these pollens, treating allergies is the strategy to make one more comfortable. There are a few antihistamines available, and there are only a couple that are still prescription-only. These are older medicines and have more risk of sedation so not used too often for allergies these days. The less sedating antihistamines that are now over the counter are what most are familiar with. There are differences between them, but not much, so pick one and see how well it works for you. There is enough difference though, that rotating to a different medication may help if one medication seems to lose its effectiveness over time.
Montelukast is a prescription that can be very helpful. This works on the immune system, in a very targeted way to shut it off, yet it is very safe and seems to be well tolerated.
Inhaled or nasal steroids may also be required. These medicines stop the allergic reaction also through the immune system. These also have been shown to be safe.
Another option that I think gets overlooked is desensitization therapy. An allergist is required to determine what you are allergic to, usually through skin testing. The idea is to give small, but increasing doses of the allergen to get the body used to the allergen and stop making a reaction to it. There are two ways to do this: Weekly injections or daily drops under the tongue. The formula for each patient is individualized based on the specific items that one is allergic to. Both require a fairly strict adherence to the schedule set up by the allergist. Missing a dose is usually not a big set back, but more missed doses means starting over. It also means a significant time commitment as it takes up to five years to compete the desensitization process. But when it is successful, no more allergies!
But there are alternatives to consider. Reducing exposure is important. Nasal rinsing will reduce the pollen burden in the nose. It is safe to use often throughout the day.
There are a few different ways to wash your nose but I think the easiest way is to use a squirt bottle. There are premixed saline packets to use with this and any water clean enough to drink is clean enough for your nose. Recipes are available to make your own saline, but I don’t think you save enough money to compensate for the time used to make it. Using diluted hydrogen peroxide by nebulizer can also be helpful. Likely, the peroxide does not break down the allergens as much as it helps the body clear the mucous that contains the allergen.
There are supplements that can be helpful. I have started to recommend a product from a local, high quality supplement manufacturer. This product contains Vitamin C, quercetin, stinging nettles, bromelain and N-acetyl cysteine. Having been a Western trained allopathic physician for many years, I did not have a lot of training in products of this sort. Having now recommended this to some patients with difficult allergies or allergy medication problems, and seeing the success they have had with it, I am a believer. I never want to claim that a biologically active compound has no side effects, but this seems to be extremely well tolerated and without side effects.
Allergies are just part of life. For those that have no allergies, this starts the season to be thankful. For those with allergies, there are ways to try and control symptoms that have fewer side effects yet may give better results. Time to enjoy the great outdoors again.
GenesisPrimaryCare.com
