AAACHOO!

Some people know exactly when the weather changes and that one pollen starts blowing in the air. It’s allergy season. Ugh–The runny nose, nasal congestion, sneezing, itchy nose and throat, sinus pressure, constant coughing from post nasal drainage, and extreme fatigue! These are symptoms of hay fever or Allergic Rhinitis.   Allergic rhinitis symptoms occur when your body’s immune system tries to attack an allergen. Allergic rhinitis can be seasonal, like when caused by pollen. Cedar trees pollinate in January and February. Ragweed pollen starts blowing in the Fall. Allergic rhinitis can also be perennial (year-round). Year-round allergens include pet dander, mold, dust mite droppings or cockroach particles. But why does the immune system attack something as harmless as pollen? Shouldn’t it be busy fighting viruses and bacteria?   Mast cells, antigen presenting cells and IgE antibodies are some of the major players of the immune system that cause allergies. IgE is an antibody that is supposed to be made by the immune system to fight parasites. When you inhale a pollen (or other harmless allergen), your antigen presenting cells should recognize it as a harmless protein. But something goes wrong during this step and the antigen presenting cell gives a signal to other immune system cells to produce IgE in an effort to “kill” the pollen. That’s where the problem starts. When an IgE is made to an allergen, this is called “sensitization”. But wait, this is not the full story. If the IgE is made and just floats around the body doing nothing, then you still don’t have an allergy, you are just ‘sensitized’. A second thing needs to happen. This is when the mast cell comes into the picture. Once this IgE antibody is made, it needs to stick to a mast cell and cause it to release all the chemicals inside. The major chemical it releases is histamine. Histamine causes itching, swelling and redness—all the symptoms of allergies.

What can you do to relieve allergic rhinits?

 

1. The first step to relieving allergic rhinitis is identifying what you are allergic to. Sometimes careful observation can tell you what you are allergic to. Many people with cat allergies know within 3 seconds of walking into a room with a cat that they are allergic to it. Within minutes they start having sneezing, runny nose or watering of the eyes. Other times it can be more difficult to find out what you are allergic to. This is especially true if you are allergic to more than one allergen or to something that is present in your environment year round. Skin testing and blood testing are two ways to identify allergies. But there is a big difference between the two, and skin testing alone or blood testing alone should not be used to confirm an allergy.

 

2. The best way to treat allergies is to avoid your allergens. Dust mite allergies can be common in humid areas such as Houston, so looking into dust mite-proof bedding may be beneficial. While pollen can be difficult to avoid, using a nasal salt water sinus rinse can help flush out pollens and other allergens from your nose before they start causing problems.  Sinus rinses can even be made at home using this recipe.  Monitoring pollen counts can also be helpful because medications work best if taken before exposure to pollen. Look up pollen counts for Houston, or opt-in for emails that send you the daily pollen count.

 

3. Try an over-the-counter medication. The available ones include antihistamines pills, nasal corticosteroids sprays, and decongestants.

Antihistamine pills are most helpful for reducing itchiness. Because they can cause dryness, they may help dry up a runny nose; however, they will not help reduce nasal congestion (stuffy nose.)  Additionally, first-generation antihistamines like Benadryl can cause sedation so be careful when driving or operating heavy machinery.  Second-generation pills, like Allegra, Claritin, Zyrtec and Xyzal are less sedating.  However, Zyrtec and Xyzal can cause sleepiness sometimes.  If you try these medications, it is best to take them right before bedtime.

A nasal corticosteroid, such as Flonase, Nasacort, or Rhinocort, will be best for dealing with a stuffy nose, excessive itching and a runny nose or postnasal drainage. These medications take a several days to become fully effective so it is best to start using them a week or two before pollen season starts.

You can also combine oral antihistamines and nasal steroids with salt water rinses to get maximum allergy relief.  Just be sure to use the nasal corticosteroid after the salt water rinse so that you don’t flush out the medication.

Decongestants can be helpful when dealing with nasal congestion, however, if used for more than 3-4 days in a row, they can actually worsen symptoms by irritating your nose.

 

4. If all of the above fails, visit a board-certified allergist/immunologist to pinpoint what your allergy triggers are. It’s possible that your symptoms may not be caused by allergens at all and may be due to things like hormonal changes or medications.