With allergy season back again, we've asked St. Petersburg allergist Mona Mangat to answer readers' questions about allergies. If you have a question for the doctor, please send it to health and medicine editor Charlotte Sutton at firstname.lastname@example.org.
There are so many different allergy remedies being advertised. Pills, nose sprays, air cleaners — how do I know which one might help me?
This allergy season has gotten off to a tough start, with very high pollen levels. Many people are suffering with runny noses, sneezing, itchy/watery eyes, congestion and cough or wheezing.
The remedy you should try depends on your symptoms and other health issues, such as high blood pressure, which some allergy medications can aggravate.
• When patients suffer from allergic rhinitis (the medical term for hay fever), most symptoms are due to the body releasing chemicals such as histamine to fight what it views as an alien invader. Antihistamines are great for treating runny, sneezy, itchy symptoms.
The older antihistamines (like Benadryl and ChlorTrimeton) work very well but tend to make you sleepy. Newer antihistamines like Claritin (loratadine) and Zyrtec (cetirizine) offer similar benefits without the sedation. Both now have generic equivalents available over the counter.
Decongestants are added to address nasal congestion and sinus pressure, but they must be used cautiously in people with hypertension, so read labels closely.
• Over-the-counter nasal sprays like Afrin offer rapid relief of nasal congestion or pressure. The risk with their use is that you can become dependent on them. So it can become harder and harder to breathe through your nose without the medication. These sprays also can cause blood pressure to go up. So if you use an over-the-counter nasal spray, don't do so for more than three days.
• If itchy, red eyes are your major complaint, Zaditor (ketotifen), an eye drop that used to be available only by prescription, can offer great results. The drops apply an antihistamine directly to the tissue of the eye. Contact lenses must be removed during use of these allergy eye drops.
• Air purifiers are often hyped as being essential in the homes and offices of allergy sufferers. An air purifier is intended to remove allergens from the air. The problem is that many allergens like dust mites and pollens are too heavy to float in the air, but drop down to the ground quickly, where they won't be extracted by an air purifier.
Animal danders are a different story. Those allergen particles are tiny and can float around for hours in the air. So they can be effectively extracted from the air with proper placement of an air purifier.
• Sinus irrigation has received a lot of attention lately, especially since Oprah talked about the neti pot on her show. The concept is sound. Flushing the nasal passages with saline can remove irritants and particles from the nasal mucosa. The saline also helps the cilia (tiny hairs) in the nose to properly handle secretions. There has been some controversy as to whether frequent and vigorous irrigation of the nose can cause sinus infections. The jury is still out, but it is best to make sure your irrigation device is kept clean and that you tell your doctor that you're doing this if you suffer with chronic sinusitis.
• Certain remedies don't require a drug or device. If you have pollen allergies and want to exercise outside on a day with high pollen counts, try going out after 10 a.m. Earlier in the morning, moisture causes pollen particles to aggregate and become more bothersome.
How do I know when I need to make an appointment with an allergist?
If home remedies and over-the-counter products aren't helping, it may be time to call an expert. An allergist can identify the source of the trouble — which may not be allergies at all, but another condition entirely.
Plus, once you know exactly what you're most sensitive to, you can take more effective action to avoid it. For example, if you have a dust mite allergy, special cases for mattresses and pillows, plus minimizing soft furnishings such as elaborate rugs and thick rugs, can decrease your exposure significantly.
Also, prescription treatments may help where over-the-counter remedies have failed. Nasal steroid sprays are the best treatments we have for rhinitis symptoms, but they must be used consistently as a preventive treatment, not when your nose is running like a faucet.
Finally, many patients require more aggressive treatment, such as immunotherapy, a.k.a. allergy shots. That's the only FDA-approved treatment for allergies that can offer long-term benefits, because it actually reduces your body's reaction to allergens over time.
Dr. Mona Mangat is board certified in allergy/immunology, pediatrics and internal medicine. She opened Bay Area Allergy & Asthma in 2007 and lives in St. Petersburg with her husband and four children.