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From his column To Your Health

to-your-health-07-13-1Over the course of the years I have written this column, we’ve talked about a lot of things that have serious consequences to health when not appropriately managed. Sometimes, however, there are things that make us feel miserable without causing other major problems. Hay fever is a condition I include in this category. Occasionally, it may cause significant issues, but most of the time it just triggers miserable days now and then.

The appropriate medical term for hay fever is allergic rhinitis (AR) which means the allergic process originates in the nose. It is caused by pollen in the air (trees, grasses, weeds, mold, dust mites, and animal dander). It’s estimated that one out of every five people suffer from AR, making it the most common form of allergy. I am one of those who suffers from this discomfort for a period twice every year. Because of my own experience, I've discovered some things that seem to work well for controlling my symptoms.

First of all, if you don’t have year-round symptoms, I encourage you to not spend a great deal of money for testing. While a person can receive desensitization treatments, I find that for most people with minor and intermittent symptoms, the time commitment to weekly allergy shots and the low success rate do not make the process worthwhile for hay fever sufferers. These shots are helpful in some situations—such as with severe asthmatics. Also, in a few people, hay fever and asthma conditions overlap and require the attention of an allergist.

In treating AR, the best therapy is that which blocks the body’s response to the pollen particle rather than fighting symptoms after the fact. You may not be able to prevent all symptoms from developing, but you can decrease them significantly.

The substance released by the body that causes our distress is “histamine”—thus the term for defending against them—“antihistamine.” Antihistamines can be very effective if used before exposure to pollen, so it’s important to know when you experience symptoms and start a good antihistamine regimen in advance. Some effective drugs are Claritin, Allegra, or Zyrtec, but the generic forms of these brand names are equally effective. Benadryl is another potent antihistamine, but is more sedating and must be taken every six hours to be most effective; therefore, it isn’t recommended in the chronic management of AR.

In my case, I know I’ll have symptoms in late May or early June each year, so around May 20th, I begin taking my chosen antihistamine. Depending on the pollen counts in a given year, that may be all I have to do. In the fall when my hay fever is at its worst, a single dose of antihistamine each day is not enough.

Another medicine I have found effective in controlling symptoms before they get started is a steroid nose spray. Unfortunately, this medicine requires a prescription and can be fairly expensive. Several brands are available, and, depending on the brand, they may be taken once or twice a day. There is a spray called NasalCrom available over the counter that is reported to be effective if used early before symptoms begin and will work in tandem with antihistamines. In my case, I tend to use a nasal spray in the morning and take an antihistamine at bedtime. This combination generally gives me control of my symptoms.

The eyes also may be affected by pollens and allergic conjunctivitis can cause some misery. Fortunately, there are several over the counter preparations that will help. Again, these are most effective when used before suffering full blown symptoms. I find that if I use eye drops when I feel the first twinge of itching eyes, I can bring the situation under control fairly quickly.

The miserable part of hay fever occurs when the symptoms get a head start on us. Many wait too long or mistake them for a cold, but hay fever tends to be associated with bouts of severe sneezing and more intense itching of eyes, nose and throat than those caused by the common cold.

So what to do when you are all congested and miserable? The answer (for some relief) is a decongestant—either as a nasal spray, nose drops, or pills. There are multiple brands available over the counter and the best active ingredients are either pseudoephedrine or phenylephrine. A big caution on these two medicines: do not exceed three days of continuous use, or you may develop rebound symptoms that will make it difficult to stop using them. Also, there are decongestant drops for the eyes that provide some relief.

If you find yourself in the position of having started control medicines too late and are suffering, take a decongestant to treat the symptoms, but also start immediately with control medications.

I hope these suggestions provide you with many symptom-free days in the future.

Dr. Paul Wardlaw is a board-certified family physician who has enjoyed the practice of medicine in various settings for 40 years.

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