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Euclid
Medical Building,
Suite 400
3201 South 16th Street
Milwaukee, WI 53215-4537
414-383-7528
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Jessica
Schreiner
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Allergies
Allergies and Hay Fever
Insight into causes, treatment, and prevention
Forty-five million Americans suffer from a recurring problem called allergy. Allergic rhinitis was once known as hay fever because workers would sneeze and develop nasal and sinus congestion when they worked around hay in the fields. Hay fever, asthma, and eczema are the most common symptoms of an allergic reaction.
Allergy symptoms appear when the body's immune system begins to respond
to a substance as though it were a dangerous invader (called an antigen
or allergen). It does this by sending specific defenders called antibodies
to the entry site. The 
battle
between allergen and antibody results in a release of chemical mediators,
such as histamine, into the bloodstream. Those chemical mediators cause
changes in the body, which produce the symptoms that we feel.
Symptoms that may be caused by allergy are itching eyes, sneezing, nasal stuffiness, nasal congestion and drainage, and sometimes headache. Some people experience hearing changes, scratchy sore throats, hoarseness, and cough. Other less common symptoms include balance disturbances, swelling in face or throat tissues, skin irritations, and even respiratory problems and asthma.
Some allergy
sufferers experience symptoms all year. Others find certain seasons bring
on attacks. Allergy symptom control is most successful when multiple management
approaches are used simultaneously. Minimizing exposure to allergens,
managing symptoms with medications, and desensitization with allergy shots
are all methods that can be useful in controlling allergic symptoms.
Medications properly used can be very helpful. Over the counter drugs can be beneficial, but some cause drowsiness. Sometimes prescription medications offer the best chance for good control.
Immunotherapy, or allergy shots, provide the only treatment method that can offer lasting relief or cure from allergies. Before beginning a series of such shots, allergy testing must be performed.
Beware of the Allergens
Anything can be an allergen. Some substances, because of their chemical
make-up,
are
more prone to generate an allergic response in humans. Pollens, food,
mold, dust, feathers, animal dander, chemicals, drugs such as penicillin,
and environmental pollutants commonly cause many to suffer allergic reactions.
- Hay fever is caused by pollens. The most significant cause of hay fever in the United States is ragweed. It begins pollinating in late August and continues until the first frost. Late springtime pollens come from the grasses, i.e., timothy, orchard, red top, sweet vernal, Bermuda, Johnson, and some bluegrasses. Early springtime hay fever is most often caused by pollens of trees such as elm, maple, birch, poplar, beech, ash, oak, walnut, sycamore, cypress, hickory, pecan, cottonwood, and alder.
- Certain allergens are always present. These include house dust, household pet danders, foods, wool, various chemicals used around the house, and more. Symptoms from these are frequently worse in the winter when the house is closed up.
- Mold spores cause at least as many allergy problems as pollens. Molds are present all year long, and grow outdoors and indoors. Dead leaves and farm areas are common sources for outdoor molds. Indoor plants, old books, bathrooms, and damp areas are common sources of indoor mold growth. Molds are also common in foods, such as cheese and fermented beverages.
- Colorful or fragrant flowering plants rarely cause allergy because their pollens are too heavy to be airborne.
Can Allergies Be Serious?
Allergies are rarely life threatening, but often cause lost workdays, decreased work efficiency, poor school performance, and less enjoyment of life. It is common for allergy sufferers to develop sinus or respiratory infections if allergy symptoms are not controlled. Considering the millions spent in anti-allergy medications and the cost of lost work time, allergies cannot be considered a minor problem.
Treatment and Prevention
A number of medications are useful in the treatment of allergy including antihistamine, nasal decongestant sprays, steroid sprays, and saline sprays. The medical management of allergy also includes counseling in proper environmental control. Based on a detailed history and thorough examination, your doctor may advise testing to determine the specific substances to which you are allergic.
The treatments employed by your otolaryngologists will depend on the materials to which you are allergic and the degree of your sensitivity to them. The only “cure” available for inhalant allergy is the administration of injections that build up protective antibodies to specific allergens (pollens, molds, animal danders, dust, etc.). Your physician will oversee your progress and care for any other nasal and sinus disorders that may contribute to your symptoms.
Tips for Controlling Your Environment:
-
Wear a pollen mask when mowing grass or house cleaning (most drugstores sell them). - Change the air filters monthly in heating and air conditioning systems, and/or install an air purifier.
- Keep windows and doors closed during heavy pollen seasons.
- Rid your home of indoor plants and other sources of mildew.
- Don't allow dander-producing animals (i.e., cats, dogs, etc.) in your home.
- Change feather pillows, woolen blankets, and woolen clothing to cotton or synthetic materials.
- Enclose mattress, box springs, and pillows in plastic barrier cloth.
- Use antihistamine and decongestants as necessary and as tolerated.
- Sleep with a brick or two placed under bedposts at the head of the bed to help relieve nasal congestion.
- Observe general good health practices; exercise daily, stop smoking, avoid air pollutants, eat a balanced diet, and supplement diet with vitamins, especially C.
- Consider a humidifier in the winter. Dry, indoor heat aggravates many
allergic people. Be sure to clean the humidifier regularly.
Your otolaryngologist has extensive training in the diagnosis, testing, and treatment of allergies and is the specialist best trained to help you with sinus problems or other complications from nasal allergy.
Antihistamines, Decongestants, and "Cold" Remedies
Drugs for stuffy nose, sinus trouble, congestion, and the common cold
constitute 
the
largest segment of the over-the-counter market for America's pharmaceutical
industry. When used wisely, they provide welcome relief for at least some
of the discomforts that affect almost everyone occasionally and that affect
many people chronically. Drugs in these categories are useful for relief
of symptoms from allergies, upper respiratory infections (i.e., sinusitus,
colds, flu), and vasomotor rhinitis (a chronic stuffy nose caused by such
unrelated conditions as emotional stress, thyroid disease, pregnancy,
and others). These drugs do not cure the allergies, infections, etc.;
they only relieve the symptoms, thereby making the patient more comfortable.
Antihistamines
Histamine is an important body chemical that is responsible for the congestion, sneezing, and runny nose that a patient suffers with an allergic attack or an infection. Antihistamine drugs block the action of histamine, therefore reducing the allergy symptoms. For the best result, antihistamines should be taken before allergic symptoms get well established.
The most annoying side effect that antihistamines produce is drowsiness. Though desirable at bedtime, it is a nuisance to many people who need to use antihistamines in the daytime. To some people, it is even hazardous. These drugs are not recommended for daytime use for people who may be driving an automobile or operating equipment that could be dangerous. Newer non-sedating antihistamines, available by prescription only, do not have this effect. The first few doses cause the most sleepiness; subsequent doses are usually less troublesome.
Typical antihistamines include Benadryl,®* Chlor-Trimetron,®* Claritin,® Dimetane,®* Allegra,® PBZ,®* Polaramine,® Tavist,®* Teldrin,® Zyrtec,® etc.
Decongestants
Congestion in the nose, sinuses, and chest is due to swollen, expanded, or dilated blood vessels in the membranes of the nose and air passages. These membranes have an abundant supply of blood vessels with a great capacity for expansion (swelling and congestion). Histamine stimulates these blood vessels to expand as described previously.
Decongestants, on the other hand, cause constriction or tightening of the blood vessels in those membranes, which then forces much of the blood out of the membranes so that they shrink, and the air passages open up again.
Decongestants are chemically related to adrenalin, the natural decongestant, which is also a type of stimulant. Therefore, the side effect of decongestants is a jittery or nervous feeling. They can cause difficulty in going to sleep, and they can elevate blood pressure and pulse rate. Decongestants should not be used by a patient who has an irregular heart rhythm (pulse), high blood pressure, heart disease, or glaucoma. Some patients taking decongestants experience difficulty with urination. Furthermore, decongestants are often used as ingredients in diet pills. To avoid excessively stimulating effects, patients taking diet pills should not take decongestants.
Typical decongestants are phenylephrine (Neo-Synephrine®*), phenylpropanolamine (Dura-Vent,® Entex,®), and pseudoephedrine (Novafed,®* Sudafed®* etc.)
* May be available over–the–counter without a prescription. Read labels carefully, and use only as directed.
Combination Remedies
Theoretically, if the side effects could be properly balanced, the sleepiness sometimes caused by antihistamines could be cancelled by the stimulation of decongestants. Numerous combinations of antihistamines with decongestants are available: Actifed,®* Allegra-D,® Chlor-Trimeton D,®* Claritin D,® Contac,®* Co-Pyronil 2,®* Deconamine,® Demazin,®* Dimetapp,®* Drixoral,®* Isoclor,®* Nolamine,® Novafed A,® Ornade,® Sudafed Plus,® Tavist D,®* Triaminic,®* and Trinalin,® to name just a few.
A patient may find one preparation quite helpful for several months or years but may need to switch to another one when the first loses its effectiveness. Since no one reacts exactly the same as another to the side effects of these drugs, a patient may wish to try his own ideas on adjusting the dosages. One might take the antihistamine only at night and take the decongestant alone in the daytime. Or take them together, increasing the dosage of antihistamine at night (while decreasing the decongestant dose) and then doing the opposite for daytime use.
For Example: Antihistamine (Chlor-Trimeton,®* 4mg)—one
tablet three times daily and two tablets at bedtime.
Plus
Decongestant (Sudafed,®* 30mg)—two tablets three times daily
and one tablet at bedtime.
"Cold" Remedies
Decongestants and/or antihistamines are the principal ingredients in "cold" remedies, but drying agents, aspirin (or aspirin substitutes) and cough suppressants may also be added. The patient should choose the remedy with ingredients best suited to combat his own symptoms. If the label does not clearly state the ingredients and their functions, the consumer should ask the pharmacist to explain them.
Nose Sprays
The types of nose sprays that can be purchased without a prescription usually contain decongestants for direct application to nasal membranes. They can give prompt relief from congestion by constricting blood vessels. However, direct application creates a stronger stimulation than decongestants taken by mouth. It also impairs the circulation in the nose, which after a few hours, stimulates the vessels to expand to improve the blood flow again. This results in a "bounce-back" effect. The congestion recurs. If the patient uses the spray again, it starts the cycle again. Spray–decongestion– rebound–and more congestion.
In infants, this rebound rhinitis can develop in two days, whereas in adults, it often takes several more days to become established. An infant taken off the drops for 12 to 24 hours is cured, but well-established cases in adults often require more than a simple "cold turkey" withdrawal. They need decongestants by mouth, sometimes corticosteroids, and possibly (in patients who continuously have used the sprays for months and years) a surgical procedure to the inside of the nose. For this reason, the labels on these types of nose sprays contain the warning "Do not use this product for more than three days." Nose sprays should be reserved for emergency and short term use.
(The above description and advice does not apply to the type of prescription anti-allergy nose sprays that may be ordered by your physician.)