Allergies

Source: Adapted from Know Your Options: The Definitive Guide to Choosing The Best Medical Treatments, Reader

What are allergies?

Allergy symptoms arise because your immune system over-responds to microscopic pollens, molds, and other allergy triggers known as allergens. If you breathe in or touch a particular allergen to which you are sensitive, it will combine with a component of your immune system called an immunoglobulin E (IgE) antibody. IgE is normally a helpful substance that protects your body against parasites, germs, and other foreign invaders. If you have allergies, however, harmless substances like pollen cause IgE to activate specialized mast cells in your nose, eyes, or other areas that have come in contact with the irritant. As a defense, mast cells then release inflammatory substances, such as histamine, which cause the congestion, itching, sneezing, hives, and other complaints so familiar to allergy sufferers.

Treatment for allergies

Identifying your allergy triggers, then doing your best to avoid them, is your best bet for preventing an allergy attack. Many drugs are effective at relieving allergy symptoms, allowing you to get on with your daily affairs. Until recently, OTC antihistamines and decongestants were the mainstays of allergy treatment. Antihistamines block the irritating effects of histamine on the nasal passages, eyes, skin, or other tissues and can be very effective at easing symptoms. They are often combined with a decongestant, which shrinks the swollen membranes in the nasal passages.

In recent years, newer nonsedating prescription antihistamines and steroid nasal sprays have proven safe and more effective for the majority of allergy sufferers. Most people with seasonal allergies know when their first symptoms appear. That’s when to begin their medication programs, which continue for the duration. For more serious cases, specialized medications or procedures like allergy shots can be very effective. If you have allergies all year, you’ll have to turn detective to discover what’s causing your symptoms. And you may also be more willing to make the prolonged commitment allergy shots require. A number of sensible changes you can make in your daily life can also help keep your allergies in check.

Medications for allergies

Most allergy drugs act quickly to relieve symptoms. You’ll get considerable relief, for instance, within an hour of taking an antihistamine, which helps dry out the sinuses, relieve itching and hives, and prevent sneezing. Such drugs are most effective if taken prior to an allergy attack, say before you plan to go outside. Most older OTC antihistamines can cause drowsiness or slowed reactions. This can be dangerous if you’re driving or handling heavy machinery, but helpful if you want to go to sleep. Newer prescription antihistamines cause less drowsiness but are more expensive.

If allergies have you all stuffed up, decongestants can be very useful, and they also help prevent sinusitis. Nasal decongestants come in a multitude of sprays, gels, drops, mists, or vapors. Phenylephrine (4-Way, Neo-Synephrine, Dristan Mist-Spray) or naphazoline (Naphcon Forte, Privine) should not be taken for more than three days in a row. They can lose effectiveness or cause dependence if used for too long. There are also many oral decongestants (such as Sudafed or Drixoral), which typically contain pseudoephedrine.

Antihistamines and decongestants may be more effective combined with a steroid nasal spray, which works more slowly (some doctors recommend using the steroid spray daily). These sprays, which gradually reduce inflammation and block the allergic response, are effective for hay fever. Use daily one week before allergy season starts. Familiar brands include fluticasone (Flonase), beclomethasone (Beco-nase, Vancenase), flunisolide (Nasalide), triamcinolone (Nasacort), budesonide (Rhinocort), and mometasone furoate (Nasonex). Nasal steroids are safer than oral steroids and have few severe side effects. Cromolyn nasal sprays, such as Nasalcrom, quiet inflammation by preventing mast cells from releasing histamine. They’re not as effective as steroids, but may relieve symptoms of milder allergies. Children often respond well to these sprays, which have virtually no side effects if given before a reaction begins.

For itchy or watery eyes, your doctor may add eyedrops. There are many choices. Some, such as ketotifen (Zaditor), olopatadine (Patanol), and levocabastine (Livostin), contain antihistamines. Others, such as phenylephrine (Allergan Relief) and tetrahydrozoline (Murine Plus, Visine), include decongestants. Still others, such as loteprednol (Alrex, Lotemax), contain steroids. Some eyedrops, such as cromolyn (Opticrom) and pemirolast (Alamast), contain mast cell-stablizers.

Finally, potent asthma drugs called leukotriene antagonists may relieve certain allergies. Montelukast (Singulair) helps reduce hay fever symptoms in children, and zafirlukast (Accolate) may help those allergic to cats.

Lifestyle Changes

Where allergies are concerned, prevention is still the best treatment. There’s a lot you can do to help keep your symptoms at bay.

Stay indoors during peak pollen periods, typically between 2 pm and 4 pm. Hot, dry, and windy weather spurs high counts. Levels tend to be lowest on rainy, cloudy, or windless days. Avoid raking grass or leaves, which can stir up molds and pollens.

Change clothes and shower after being outdoors. Pollen collects on skin, hair, and garments. Don’t hang clothes outdoors to dry.

Get a HEPA vacuum. Studies show that vacuums equipped with HEPA (high-energy particulate air) filters remove allergens better than standard appliances. Carpets trap allergens, so vacuum often. Better yet, have hardwood or tile floors. Air cleaners may also help.

Forgo house plants. They can trap mold and other allergens, so decorate with discretion.

Avoid feather pillows and down bedding. Anti-allergen pillowcases and mattress covers may be best for you.

Related procedures for allergies

If your allergies are mild, a nasal wash can help clear mucus from your nose. Buy a saline solution at a drugstore or make your own (1 teaspoon of salt per half-litre of warm water). Bend over the sink, pour some solution into your palm, inhale it through one nostril, then let it out and blow your nose gently. Repeat with the other nostril.

If your symptoms persist or you have them all year despite medications, allergy shots, or immunotherapy, may be the best solution for you. Rather than just treating your symptoms, as many drugs do, this approach affects the underlying immune processes that trigger your allergies. You will need to go to the doctor’s office for the shots, as often as twice a week initially, and then every two to four weeks. The shots contain tiny amounts of allergens: The dose is gradually increased, usually over the course of two to three years or longer. This allows your immune system to slowly become desensitized to a particular trigger, relieving your symptoms and lessening your need for medications.

Alternative therapies for allergies

Instead of standard drugs, you might try supplements with quercetin, a plant pigment found in apples (500 mg two or three times a day). It can block allergic reactions to pollen and reduce inflammation in the airways. Naturally-oriented physicians also recommend stinging nettle, a native weed long used in folk medicine (250 mg three times a day). Look for capsules that contain the freeze-dried herb, or an extract standardized to contain 1% plant silica.

Living with allergies

If you have allergies, here are a few helpful hints so that your allergies don’t rule your life:

‘ Identify what’s causing your allergies. Keep an allergy diary, recording the times of day and year when symptoms occur and any foods, plants, pets, or other factors that trigger reactions.
‘ Close the windows at night to keep pollen and molds out. Use a central air conditioner equipped with a filter to clean and dry the air. You might even run it off-season with the cooling gauge turned off. Use your car’s AC too.
‘ Use a dehumidifier to keep mold counts down.
‘ Take a vacation by the sea. Pollen counts are often lower at the beach.