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How to Treat Spring Allergies

US News & World Report - Health logo US News & World Report - Health 4/16/2018 Purvi Parikh, M.D.

Portrait of an allergic woman surrounded by seasonal flowers wearing a protective mask: Decisions about how to treat allergies can be complicated. © (Getty Images) Decisions about how to treat allergies can be complicated. Understanding the updated allergic rhinitis guidelines.

Short of living in a bubble, most people find exposure to environmental allergens extremely difficult to avoid, especially in the spring, as pollen and mold spores swirl through the air and hitch rides into our homes on clothes and pets. 

To ease the resulting allergy symptoms, we often turn to medications. But which are the most effective?

You can listen to ads on TV, read labels in the pharmacy or talk with your friends to help you decide – but physicians like to turn to what's been proven in clinical studies. The difficulty there is keeping up with new developments, so periodically a team of experts will get together to evaluate recent research and summarize the results in published guidelines.

Comprehensive allergic rhinitis guidelines published 10 years ago were recently updated. Allergic rhinitis symptoms include stuffy and runny nose, sneezing and postnasal drip. The guidelines are written for doctors, but the findings are helpful for patients as well.

Here's what the guidelines tell us:

Corticosteroid nasal sprays are the first choice for treating sneezing and runny nose of seasonal allergies – or allergic rhinitis – and often give added relief to eye, throat and ear symptoms. They are extremely effective, widely available, relatively inexpensive and don't have a lot of side effects. For best results, corticosteroid nasal sprays should be taken daily, starting seven days before your allergy season begins and lasting throughout. Some people might also find relief using them as needed, treating symptoms when they arise. Do not continue taking if you experience nosebleeds.

Patients who don't find significant relief from a corticosteroid nasal spray may benefit from an antihistamine nasal spray (available by prescription only), which work faster than oral antihistamines and are good for sneezy, itchy, runny nose symptoms. The guidelines recommend using both corticosteroid and antihistamine nasal sprays over antihistamines alone, but this would be a cost versus benefit decision. You can take two separate nasal sprays or use a medication that combines both ingredients in one device.

For patients unable or unwilling to use a nasal spray, the next choice is a non-drowsy second-generation antihistamine: cetirizine (Zyrtec), levocetirizine (Xyzal), fexofenadine (Allegra) or loratadine (Claritin). These antihistamines cause fewer disabling side effects, like drowsiness, than first-generation diphenhydramine (Benadryl), hydroxyzine (Vistaril), and clemastine (Dayhist), and they last longer, so they can be taken just once or twice a day.

More is not better. For most people, there's no extra benefit from taking an antihistamine pill along with a nasal spray, unless your doctor advises it.

Leukotriene modifiers, like montelukast (Singulair), are another option for those opposed to nasal sprays. This is an individual decision: Some of my patients do very well on them; others less so. The guidelines say that corticosteroid nasal sprays are more effective, but some, especially those using montelukast for asthma, may find enough relief to be satisfied. It comes in tablets or chewables.

Intranasal cromolyn sodium is less effective than corticosteroid nasal sprays, but it can be useful for prevention and treatment of allergic rhinitis and is associated with minimal side effects.

Allergy immunotherapy should be considered for patients whose allergies have been specifically identified. Allergy shots can build resistance to a wide range of allergens, while newer immunotherapy tablets target grass, ragweed and dust mites. Deciding to use immunotherapy will depend on the degree to which symptoms can be reduced by avoidance and medication, the amount and type of medication required to control symptoms and the adverse effects of medications. This is the closest thing we have to an allergy cure – many medications suppress symptoms and inflammation, but immunotherapy actually helps you decrease severity of allergy symptoms by making your immune system less allergic.

You can see that decisions about how to treat allergies can be complicated. That's why if your allergies are disrupting your life, it's time to see a board-certified allergist. We can do testing to find out exactly what you're allergic to and rule out other medical conditions that may be disguising symptoms or complicating treatment.

After reaching a diagnosis, I work with my patients to find solutions that fit their personal preferences and lifestyles as well as their medical profile. Some factors we discuss:

  • How severe are your symptoms: Do they impact your lifestyle, making it difficult for you to work, go to school or exercise?
  • How long do symptoms usually last: weeks? months?
  • Do you know what you're allergic to? Have you had allergy testing?
  • Are you able to minimize exposure to your allergens? Is it realistic to stay inside on high pollen days, for instance?
  • Do you have other conditions that affect your allergies, such as asthma, eye or sinus problems?
  • Are you pregnant or trying to become pregnant?
  • What are your preferences for using nasal sprays versus pills or liquid? Have you tried a nasal wash?
  • How does your insurance coverage affect your choice of using non-prescription medications over brand name or generic prescriptions?
  • If considering immunotherapy, how easy or difficult would it be for you to keep weekly doctors appointments?

Allergies are unpredictable and personal – they affect individuals differently, and any one person's symptoms may vary from year to year. Working closely with your physician in a shared decision making process can help you understand treatment options and find relief.

Gallery: 17 tricks to prevent spring allergies from taking over your life (courtesy Reader's Digest)

Copyright 2017 U.S. News & World Report


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