Seasonal Allergies: Why must we suffer?

Seasonal allergies are the one thing that everyone dreads come springtime, especially springtime in Kansas. The flint hills are well known for its beautiful vistas and rolling hills, but along with that natural beauty, comes several allergens that can make springtime borderline misery. Allergy symptoms vary from person to person, and may include itchy watery eyes, runny nose, congestion, sneezing, post nasal drainage, and fatigue. The most frustrating part about it is that it is your own immune system that is causing the symptoms in response to those unwanted particles that float on that spring breeze. This is meant to be a protective response to clear these foreign invaders, but all to often lead to misery. The good news is that there a some good options available in our arsenal to help combat these unwelcome symptoms.

Oral antihistamines

Antihistamines such as diphenhydramine (Benadryl), loratidine (Claritin), cetirizine (Zyrtec), and fexofenadine (Allegra) are one of our safest first line therapies. The key is to take the medicine before symptoms develop, such as early in the morning. Another important thing to remember is that some of these medications can cause drowsiness and should be used cautiously during the day, especially if you are driving. At BlueFire Med, we can offer our members the medications for around $1-2 for a month supply or more if desired.

Nasal steroids

Another first-line treatment for seasonal allergies is an intranasal corticosteroid such as fluticasone propionate (Flonase). These sprays are available without a prescription and you can use them as-needed. Nasal steroid sprays have been shown to help with both nasal symptoms of runny nose and congestion, as well as eye symptoms. When using these sprays, it is important to direct the spray away from the nasal septum, as there have been some cases of nosebleeds from using these sprays. If this happens, stop using the medication and let your doctor know. BlueFire Med has Flonase available for BlueFire members for around $4.60 for one bottle.

Decongestants

Nasal decongestant sprays such as phenylephrine and oxymetazoline (Afrin) should be used cautiously. Although they may work well in the short term when used occasionally, if used regularly for more than a few days (approximately five days), you may find your nose more congested than usual. This is called rebound congestion. I usually recommend patients not use these products for more than three days. Using these sprays too often causes a biochemical change in certain receptors on your cells, resulting in a vicious cycle of dependence — the more you use it, the worse your symptoms, and the more you need to use it. If this happens, stop using the medication, and talk to your doctor about switching to another type of nasal spray (intranasal glucocorticoid spray) which has been shown to help with this condition.

Oral decongestants such as pseudoephedrine or phenylephrine may help reduce symptoms as well. You should also use these medications cautiously. They mainly work by constricting blood vessels, and may cause side effects such as increased blood pressure, palpitations, headaches, nervousness, and irritability. These medications should not be used by patients with a history of uncontrolled high blood pressure, heart rhythm problems, strokes, glaucoma, or other conditions.

Alternative therapies

Other therapies that have been shown to be beneficial include nasal saline irrigation. Irrigating the nasal passages with prepared solutions, such as with neti pots, has been shown to improve symptoms of runny nose, congestion, and itchy throat, and to improve quality of sleep in children with acute sinusitis and allergic rhinitis. When using these products, however, make sure you are using distilled, sterilized, purified, or previously boiled water, as there have been rare cases of fatal infections by amoeba when using tap water that was contaminated. Although the evidence for menthol rubs such as Vicks is limited, some patients find that rubbing a little menthol ointment under the nose can sometimes also offer congestion relief.

Steroid Injections

Sometimes, we do all of the above and still unduly suffer. In some cases, an injection of a steroid can reduce the symptoms of allergies. This is not without its risks though, as steroids will reduce the overactive immune system, but can have other risks along with that. These can include increased risk of infection, gastritis, weight gain, irritability, insomnia, elevated blood sugar (not a good option for diabetics), and other side effects. You will need to talk with your doctor to determine if this is an appropriate option for you.

Allergen immunotherapy, also known as desensitization or hypo-sensitization.

A medical treatment for some types of allergies. It is useful for environmental allergies, allergies to insect bites, and asthma. The benefits of oral immunotherapy for food allergies have been demonstrated by successful treatment of thousands of patients both in private practice and in studies for the past few decades, primarily in the United States. Immunotherapy involves exposing people to larger and larger amounts of allergen in an attempt to change the immune system's response.

Research has found that injections of allergens under the skin are effective in the treatment in allergic rhinitis in children and in asthma. The benefits may last for years after treatment is stopped. It is generally safe and effective for allergic rhinitis, allergic conjunctivitis, allergic forms of asthma, and stinging insects. The evidence also supports the use of sublingual immunotherapy against rhinitis and asthma, but it is less strong. In this form the allergen is given under the tongue and people often prefer it to injections. Immunotherapy is not recommended as a stand-alone treatment for asthma.

Side effects during treatment are usually local and mild and can usually be eliminated by adjusting the dosage. Anaphylaxis has occurred on rare occasions and this is why treatment should only be administered in a medical environment.[1]

Discovered by Leonard Noon and John Freeman in 1911, allergen immunotherapy is the only medicine known to tackle not only the symptoms but also the causes of respiratory allergies. A detailed diagnosis is necessary to identify the allergens involved. It is currently being studied as a possible treatment for eczema and food allergies in children.[1]

Call BlueFire Med at 785-539-9218 or check out our website at www.bluefiremed.com to learn more about how this awesome clinic and its doctors have time to write educational blogs for our patients and others. Imagine for a minute what the most meaningful primary care experience could mean to you, and I think you will find just what you are looking for at BlueFire Med. Come see us at BlueFire Med to learn more about how we can help our patients get more affordable and accessible primary care as well as the ridiculously steep discounts on medications, labs and imaging.