the DOCTOR is in Allergy
the DOCTOR is in Allergy season is upon us – but relief is possible After a long, cold and gray winter, many of us can’t wait for springtime and warmer weather. However, for about 10-20 percent of the U.S. population, with springtime also comes seasonal allergic rhinitis, commonly known as hay fever. If you suffer from allergic rhinitis, your immune system mistakes a harmless substance as an intruder. This harmless substance is an allergen. The immune system responds by releasing histamine and chemical mediators that cause symptoms in the nose, throat, eyes, ears, skin and roof of the mouth. Allergic rhinitis is often classified into seasonal or perennial (year round). Seasonal allergic rhinitis is due to pollen from trees, grasses, weeds and outdoor molds. Perennial is caused by indoor allergens such as dried skin flakes, urine and saliva found on pet dander, mold, droppings from dust mites and cockroach particles. Not all rhinitis is allergic in nature. About one in three people with rhinitis symptoms have non-allergic rhinitis. This is more common in adults and is the cause of year-round symptoms. Triggers are smoke and strong odors, or changes in the temperature and humidity of the air. Rhinitis Symptoms • Itching in the nose, roof of the mouth, throat and eyes Darlene Kassab Mansoor, M.D. SPECIAL TO THE CHALDEAN NEWS • Repetitive sneezing • Stuffy nose (congestion) • Runny nose • Tearing eyes • Dark circles under the eyes • Post nasal drip • Cough Diagnosis If your rhinitis symptoms are severe enough that they impact your sleep and daily activities, it’s a good idea to see a physician who specializes in allergy. The allergist will do a full history and physical exam and may perform allergy testing to possibly identify the allergen trigger or diagnose non-allergic rhinitis. There are two ways to do allergy tests: • The skin test is done by placing a drop of a liquid containing a possible allergen on the skin. The liquid is then introduced into the skin by a scratch or a prick. It is allowed to sit for 15-20 minutes and then read. If the skin develops a red, raised itchy area, it usually means that the person is allergic to that allergen. Sometimes if this initial test is negative and the doctor highly suspects an allergen, the doctor may chose to do an intradermal skin test in which the solution is injected into the skin. • In situations when patients can’t have skin testing, a physician may do an allergy blood test. However, skin testing is more sensitive in detecting allergens. Treatment & Management Treatment is threefold and includes: • Avoidance of allergic triggers, when identified • Medications • Immunotherapy (allergy shots) Avoidance Once specific allergens are identified, your allergist can advise you on avoidance measures. For example, if you are dust mite allergic, you can take steps in your bedroom to limit exposure by using allergen covers for pillows and mattress. For outdoor allergies such as pollen, avoidance measures include limiting outdoor activities during times of high pollen counts, keeping windows closed and taking a shower when you come inside. Medications There are a number of medications to treat rhinitis and decrease symptoms. These include: • Antihistamines available in pills or liquids (for children): Many are available over the counter. They can be sedating or non-sedating, and are best for itchiness and runny nose. • Nasal corticosteroid sprays: Prescribed by your doctor, these are the best agent for nasal congestion and work best when used continuously. • Nasal antihistamine sprays: Prescribed by your doctor, they are good for a runny nose. • Decongestant pills: Good for congested nose for short periods of time, but sedation is a side effect. • Eye drops: The best drops are antihistamine/mast cell stabilizers. Most are available by prescription. The majority of allergy medications work best if started before tree pollen is in the air. I suggest starting allergy medications as soon as the trees start budding. If allergy medications are started before first contact with pollen, the medication can prevent the release of histamine. As a result, allergy symptoms are prevented from developing or are much less severe. Immunotherapy (Allergy Shots) Allergy shots are a method called desensitization; they work on the immune system so it no longer views the allergen as an intruder. Allergy shots are a proven treatment providing long-term relief for many people. However, they require a big time commitment. Patients need to have allergy shots once or twice a week for three to six months and then once a month for three to five years. Eighty percent of patients do have relief while on allergy shots but it may be semi-permanent. While a very effective treatment, allergy shots are not a cure for “hay fever.” Allergic rhinitis symptoms can have a large impact on the quality of life. However, by working with your doctor most sufferers can get longlasting relief — and possibly even enjoy springtime. Darlene Kassab Mansoor, M.D., is an attending physician in the Department of Allergy and Immunology at Children’s National Medical Center in Washington, DC. 32 CHALDEAN NEWS MAY 2013
