by Tony Marchand, M.D.

Seasonal Allergies:

Basics: Seasonal allergies is an inflammation of the mucous membranes of the nasal cavity but also can involve the conjunctiva of eyes and throat which can cause runny nose, itching and watery eyes, dry scratchy throat and sometimes cough. Allergy season typical kicks off in the spring when we begin to see the air borne pollens of flowers, tree and grass and also can be seen again in the fall with pollen from rag weed and other sources. Over 40 million Americans can be affected1, some enough to disable their normal daily routine.

Although allergies can show up in later life, they often begin before the age of 20. But I must say, I've seen as many individuals in mid or later life with their first symptoms.

Causes: Pollen and in some cases spores from mold enter through the mucus membranes and in some sensitive individual triggers an immune responses. The particles are seen as "foreign" and kick off the bodies normal defense mechanism which involve a cascade of chemical responses. These involve elements of "antibodies", "B Cell Lymphocytes", "mast cells"," histamine" and other cells and chemicals that results in localized inflammation and irritation within 5 to 10 minutes2,3. With first exposure, allergens result in production of IgE antibodies by B lymphocytes (and plasma cells). The IgE antibody attaches to Mast cells containing histamines. On further exposure, the allergens attach to the IgE coated Mast cells resulting in release of histamines which initate the inflammatory response.

One must remember that other causes of allergies such house dust and animal dander from pets may accentuate the seasonal symptoms as I've seen in my own personal case.

Symptoms4:
  • Sneezing
  • Runny nose
  • Congestion
  • Itchy watery eyes
  • Dry throat
  • Occasionally headache associated with the above.
Diagnosis:5In many causes the causes are obvious occurring when pollen is at it's peak in the spring and sometimes fall due to ragweed. The symptoms are those described above and usually last a few weeks to a month.

Persistent, severe or debilitating symptoms require consultation by a physician with experience in this field, i.e., a Board Certified Allergist. He can perform a number of steps to rule out significant other disorders and identify the allergens:
  • A thorough history linking symptoms to allergies and rule out other causes.
  • A physical exam to rule out nasal obstruction, polyps, tumors or bacterial infection such as sinusitis. Clear nasal discharge is usually associated with allergic responses. Yellow or color thick discharge suggest the possibility of bacterial infection.
  • Allergy testing can determine the allergens responsible. Skin testing is quick and easy using today's methods. Blood testing is NOT recommended because of the large number of false positive results, i.e., only 1 out of every 10 to 20 positive results from a blood test actually cause symptom (personal experience) where as skin testing is much more reliable.
  • Finally, a CAT scan or other testing if sinus problems are the major symptom.
Treatment6,7: Although minor symptoms can be treated with over the counter medications, even with these medications there are certain do's and don't's:

Do's:
  • Avoid allergens such as pollen and grass when possible (close your windows when the grass is being cut or use an air filtering devise or air conditioning in the hight of the season). This is easier said then done.
  • Over the counter (OTC)oral antihistamines:
    1. Diphenhydramine (Benadryl) has been around for many years, with few side effects other then drozziness (caution should be taken when driving). Benadryl need to be taken every 4 to 6 hours.
    2. Newer antihistamines such as loratadine (Claritin), cetirizine (Zyrtec), and fexofenadine (Allegra) work up to 12 to 24 hours depending on the product. Certirizine, which I personally use during the worst of my allergy season, causes less drowsiness then Benadryl and the generic Shoprite brand is far cheaper then it's equivalent brand name Zyrtec.
    3. A variety of side effects can occur with these newer meds ranging from weakness, confusion, vision or urinary problems, jaundice or less severe effects such as headaches, nervousness, drowsiness, dizziness or dry mouth. Be familiar with your medication and consult your medical specialist for any unusual side effects (you can type in the medication in reference 10 and click on the name under "drug matches" for additional information). Never exceed the dosage outline on the box or label!
  • An over the counter (OTC) nasal spray:
    1. Corticosteroid sprays such as triamcinolone acetonide (Nasacort) or the prescription mometason furoate (Nasonex) and fluticasone (Flonase) block the inflamaroty response. Never exceed the prescribed dosage! Consult your medical specialist if you experience fever, chills, brusing, weakness, blurred vision or other side effects (again, you can use reference 9 to find out more about these medications).
    2. Most antihistamines nasal sprays are prescription based such as olopatadine (Patanase) and azelastine (Astepro) which block inflammation by inhibiting histimine release. They too can have side effects from nose bleeds, mouth sores, burning on urination among others. This does not mean you should not use these medications, but rather, be familiar with side effects.
    3. Nettle is a folk remedy (nettles tea is sold in the supermarket) for the sneezing, itching, and swelling associated with allergies. The plant contains quercetin, a substance that has been shown to inhibit the release of histamine. In a controlled study, Nettle has been found to be mildly effective compared with a placebo and is considered safe6.
    4. Quercetin, a heart-healthy chemical called a flavonoid, found in tea, onions, grapes, and tomatoes, is a natural anti-inflammatory that can block histamine's effects. Recommended dosage is 500 mg supplement up to twice a day, starting a few weeks before allergy season. Another helpful herb is butterbur, which may block the production of leukotrienes. Typical dose: 50 to 75 mg of standardized extract twice daily6. I do not know of any controled studies using these herbal suppliments.
  • Always follow directions on the medications labels. All medications have side effects. In the case of oral medications, this includes drowsiness, blurred vision, light headiness. Even nasal OTCs may occasionally lead easy brusing, weakness, bleeding, blurred vision and other side effects. Stop all medications if such side effects occur and consult your medical specialist for alternate therapies.
  • If allergy symptoms persist more then a few weeks, worsen or become debilitating, stop all medication and consult your medical specialist and consider a visit to an allergy specialist..
Don't's:
  • Do not use an over the counter (OTC) nasal decongestant such as pseudoephedrine which constrict vessels and can lead to decreased blood flow to the nasal cavity after 3 days use. The results can be devastating with bleeding and severe tissue damage.
  • Don't use oral corticosteroids such as predisone without a physcian's consultation. Use of oral corticosteroids, other then very short term, can lead to serious side effects.
  • Don't use medications such as phenylpropanolamine (PPA) found in some cold remedies since these have been linked to stokes, even it the risk is low.
  • Pregnant and breastfeeding women should speak with their doctors before using allergy medications.
  • Discontinue any medication if side effects such as nose bleeds, drossiness, light headiness or worsening symptoms occur. Immediately consult your medical specialist.
Remember: If your symptoms are other then minor, consult an Allergist who can perform skin testing to identify specific allergens (as stated above, blood testing is not specific). Through immunization injections (relatively painless), symptoms can be greatly alleviated if not totally relieved. A series of injections can make you less sensitive to the effects of pollen by helping your immune system become increasingly resistant to it. "Immunotherapy" involves injecting small amounts of the specific allergen you are allergic to and gradually increasing the dose so that you develop a tolerance to it. To be effective, injections must be given a regular basis (determined by your allergist) over the course of several years8.

Your physician can also prescribed specific medications such as Montelukast (Singuliar) which acts at a different point in the inflammatory response and gives excellent results (usually without the drossy side effects) and Nasonex which is similar to Nasocort but may be covered in part, by insurance and may windup being cheaper then the over the counter medication.

Know your medication9,10 and it's side effects, search using WebMd11.

References:
  1. Seasonal allergies   PDRHealth
  2. Allergies Health Center   WebMD
  3. Understanding the allergic response   from freshlife.com
  4. Seasonal Allergies: Symptoms, Diagnosis, and Treatment   from NIH Medline Plus, a publication of the National Institute of health
  5. Seasonal allergies Diagnosis   from PDR Health (Physician Desk Reference)
  6. Problem Solved: 10 Solutions For Seasonal Allergies   from Prevention
  7. Treatments for Seasonal Allergic Rhinitis   from the Agency for Healthcare Research and Quality
  8. Allergens: Tips to Remember  American Academy of Allergy, Asthma and Immunolog
  9. Allergy Medications   Side affects from allergy medication from RxList
  10. Allergy medications: Know your options   from the Mayo Clinic
  11. Medication Side Effects   search on a medication, from WebMD


  12. Addendum:
    Basics of Inflammation:
    Inflammation is a protective response involving host cells, blood vessels, and proteins and other mediators that is intended to eliminate the initial cause of cell injury, as well as the necrotic cells and tissues resulting from the original insult, and to initiate the process of repair. The cells and molecules of host defense, including leukocytes and plasma proteins, normally circulate in the blood, and the goal of the inflammatory reaction is to bring them to the site of infection or tissue damage.



    Robbin Textbook of Pathology, 14th Edition




    Immune System: Innate and Adaptive Immunity plus Microorganisms by Stephen T. Abedon, April 14, 2014
    Steroid, asprin and indomethacin act on other chemical components of the inflammatory response.