Do You Have Allergies?

Allergies are a common problem affecting 35 million to 50 million Americans. Although children and young adults are most likely to be diagnosed, adults can also develop them. Symptoms include nasal congestion, runny nose, itchy eyes or nose, red eyes and sneezing. Allergies are often confused with the common cold. One key to diagnosing them is that the common cold typically lasts from four to seven days, so if your symptoms last longer, you may suffer from allergies.

The most common form of disease caused by allergies is allergic rhinitis or hay fever. Allergic rhinitis is caused by inflammation of the nasal passages that occurs when the body overreacts to an allergy-causing trigger or allergen. As the nasal passages swell, they block airflow, leading to nasal congestion. Allergic rhinitis may be seasonal if symptoms typically occur at a particular time of the year or perennial if symptoms occur year-round. Common allergens that cause seasonal allergic rhinitis include tree, grass and weed pollens and mold, while perennial allergic rhinitis is often triggered by indoor allergens such as dust mites, cockroaches, pet dander and mold.

The first step to improving the symptoms of allergic rhinitis is to identify and avoid the allergy-causing triggers. Sometimes this is easy, for example, if symptoms develop shortly after visiting a friend who has several cats. But often even a careful analysis of your allergy history fails to identify a responsible allergen. In this case, minimizing exposure to the most common allergens may reduce symptoms. For example, get hypoallergenic pillows and bedding. Don’t let your pets sleep in your bedroom. Consider using a HEPA filter in your home’s heating and air conditioning system and in your vacuum cleaner. Be sure to vacuum carpets and furniture regularly.

When avoiding or controlling allergen exposure doesn’t work, many over-the-counter and prescription medications may be helpful. Saline nasal flushes effectively flush out pollen and reduce or thin mucus. Over-the-counter antihistamines like Benadryl® may be beneficial for reducing nasal inflammation but often lead to excess drowsiness. Decongestants like Sudafed® can be helpful for reducing nasal congestion but do not treat other allergy symptoms. Nasal decongestants like Afrin® are best avoided and if used at all, are recommended only for use for two or three days. After three to seven days of treatment with nasal decongestants, rebound nasal congestion results.

The most common prescription medications include intranasal steroids and antihistamines. Intranasal steroids like Flonase® or Nasonex® are often the first drug doctors try for controlling allergy symptoms. Unlike other allergy medications, they don’t simply act to control the symptoms but actually decrease the immune response that causes the allergic reaction. As a result, they do not work instantly but do provide effective prevention when used regularly. Newer antihistamines like Claritin®, Allegra® or Zyrtec® do not cause drowsiness and will dry up runny nose and post-nasal drip and decrease sneezing and itchy eyes. Claritin® and Zyrtec® are available without a prescription. These antihistamines are particularly useful for occasional use for those with mild allergies and in conjunction with nasal steroids when nasal steroids alone do not control symptoms.

When an allergic trigger cannot be easily identified and symptoms are not controlled by the usual medications, your doctor may perform allergy skin testing. Based on the testing results, allergy shots can be used to bring long-term relief of allergy symptoms. Shots are usually given weekly for three to five months to gradually build resistance, followed by several years of monthly maintenance shots. Although time consuming, allergy shots can reduce or eliminate the need for other allergy medications.

Untreated allergic rhinitis can lead to acute sinusitis which, when compared to allergic rhinitis, is more often associated with yellow or green nasal discharge or postnasal drip, fever, headache and dental or facial pain.

Dr. McMahon, a graduate of Yale University and the University of Pittsburgh School of Medicine, is board certified in Internal Medicine. She is a member of the American College of Physicians and the Allegheny and Pennsylvania Medical Societies. She is in solo practice in the North Hills.