Published: Jan. 30, 2009
Updated: Jan. 30, 2009
Many patients ask me what to do about their itchy, runny noses. The symptoms are often worse in the spring and fall, but sometimes they occur year-round. The problem is environmental allergies.
Dr. Michael Land describes below what environmental allergies are and what can be done about them.
-- Dennis Clements MD, PhD, MPH
As your child grabs for a third tissue to blow that runny nose and sneeze in the process, it’s easy to wonder if he or she might have “allergies” or rhinitis.
Rhinitis is one of the most common conditions in the U.S., affecting over 50 million people. Typical symptoms include sneezing, watery/runny nose (also called rhinorrhea), nasal congestion (stuffy nose), and nasal itching.
Not all rhinitis is caused by allergies, but when it is, it is commonly referred to as “allergic rhinitis” or hay fever. Allergic rhinitis may be seasonal or perennial (year-round). About 10-30 percent of adults and up to 40 percent of children may suffer from allergic rhinitis.
When it is seasonal, common triggers may be from tree, grass, or weed pollens. If it is year-round, it may be triggered by dust mites, cockroaches, animal proteins, or spores from fungi.
Patients who have allergic rhinitis are also at a higher risk of having asthma or atopic dermatitis. Having uncontrolled rhinitis may make it easier to get upper respiratory, sinus, or ear infections.
People who have uncontrolled rhinitis may also have headaches, facial pressure or pain, fatigue, and a decreased sense of smell.
Living in one of the most beautiful states in the U.S., it is easy to see why we have so many adults and children who suffer from allergic rhinitis here in North Carolina and in the South.
We have beautiful blue skies, plenty of trees and wildlife, and a temperate climate that supports the growth of a lot of vegetation. Among the different types of pollens out there, tree pollens are the most prominent pollens in the springtime; while grasses dominate the summer, and weeds dominate the fall.
We are surrounded by trees, grasses, and weeds at home, at work, on our roads and highways, and in the parks where we bring our families. Our great weather and beautiful surroundings are also unfortunately responsible for our high load of allergens.
The best way to get rid of the symptoms of allergic rhinitis would be to avoid the allergen that is triggering the symptoms. Reducing exposure to outdoor allergens is important when the pollen count is high.
Keeping the windows closed in your home and car while running air conditioning to keep cool in warm weather is an important way to avoid outdoor pollens.
Also, pollens are often emitted in the early morning hours (between 5 a.m. to 10 a.m.), and avoiding early morning outdoor activity can help extremely sensitive people. In grass allergic people, mowing lawns and being around freshly cut grass can worsen their symptoms as well.
Checking the local pollen count and avoiding prolonged outdoor activity when the pollen count is high may also help reduce exposure. You can check your local pollen count by visiting the American Academy of Allergy, Asthma, and Immunology and clicking on the “Patients and Consumers” tab and “Pollen Counts.” Our local counting stating for North Carolina, Virginia, and West Virginia is located at the Duke Asthma, Allergy, and Airway Center here in Durham.
Establishing control of symptoms is a key element of treating the condition. The first step would be to identify the triggers and reduce exposure to them. Your doctor might send your child to an allergist for an evaluation and skin testing to identify the triggers.
In addition to avoidance, most people will need to take some medications. The most effective single maintenance medication for allergic rhinitis is a topical nasal glucocorticoid spray such as mometasone or fluticasone. These nasal sprays are used on a daily basis to limit inflammation in the nose and decrease nasal congestion.
Other medicines include antihistamines such as loratadine or cetirizine, anti-leukotrienes such as montelukast, cromolyn sodium, and ipratropium bromide. These may all help to decrease symptoms caused by allergen exposure. These will of course only be prescribed by doctors and only for children of the appropriate age.
Allergy shots are considered by some to be a natural way of dealing with allergies, although they are still a medical treatment and need to be prescribed by a doctor trained in allergy/immunology and given in a doctor’s office.
Also known as immunotherapy or allergy vaccines, these injections actually expose your body to small amounts of what you’re allergic to. By starting with tiny amounts and gradually increasing regularly, these injections slowly change your immune system to be able to tolerate larger amounts of the allergens.
Over time, your body then has a lower “sensitivity” to what you were allergic to and you may be able to decrease your need for medicines to control your symptoms. Instead of treating your symptoms, allergy shots go directly to the source of the problem, your immune system, and in effect, the injections “train” your immune system not to react.
However, there is always a small theoretical chance you could have an allergic reaction to the shots each time you receive them -- and thus, you should always have them administered at a doctor’s office and wait at least 20-30 minutes after each shot to make sure you do not have a reaction.
There are many practitioners who might recommend non-medical treatments for allergic rhinitis.
Some patients benefit symptomatically from nasal saline rinse, which washes out debris and pollens from the nasal cavity. Based on the available medical literature, however, there is not enough strong evidence to recommend the use of herbal supplementation, acupuncture, or “special diets” for the treatment of allergic rhinitis.
Some complementary and alternative medicine treatments may actually be harmful in allergic rhinitis patients. In fact, patients who take St. John’s wort may decrease their levels of loratadine (a non-sedating antihistamine). Also, Echinacea, a common herbal supplement, is a derivative of the coneflower, which has extensive cross-reactivity to ragweed, and should be avoided in very sensitive ragweed-allergic patients.
-- Michael Land, MD, is an allergy and immunology specialist with Duke Children's.
-- Dennis Clements, MD, PhD, MPH, is the chief of primary care pediatrics at Duke Children's Hospital.