Spring Allergies

Well, it has been a long, cold and wet winter in North Carolina, but it is almost over. Now that the ice is melted we can look forward to sunny skies, blooming flowers, pollen, allergies… Well, mostly good stuff.

Along with the beautiful blooms and balmy breezes, spring in North Carolina brings lots of pollen. Many of the pollens that trigger spring allergies are from trees and grasses, not necessarily the blooms that enliven our yards and parks. For the most part, the yellow pollen that covers our cars and floats in puddles after those April showers is from pine trees. These pollen particles are large and tend to settle out of the air. The smaller particles are the ones we breathe in and cause the misery of “hay fever.”

The symptoms of allergies are caused by our immune systems responding to proteins and other large molecules in the pollen. It takes previous exposure to these proteins in order to develop allergies. No-one is born with allergies, but the tendency to develop them does run in families.

Symptoms of pollen allergy usually affect the respiratory system, since our exposure is through the air we breathe. Previous exposures to the allergens (substances we have developed an allergy to) have caused our immune system to produce antibodies called IgE (Ig stands for immunoglobulin, the name for the antibody proteins produced by the immune system). These antibodies attach to the surface of immune cells in the mucous membranes of the nose, throat and lungs. These cells are called mast cells. When pollen from an allergen settles onto the mucous membrane it causes the mast cell to release a number of chemicals.

One of these chemicals is histamine. Histamine results in immediate symptoms by causing the blood vessels to become leaky. This results in swelling of the mucous membranes, and therefore congestion. Histamine also contributes to the itching sensation, sneezing, and runny nose and eyes. Other chemicals cause inflammation, which results in further congestion, mucous production, and the ongoing misery up to days after the exposure.

For some people, avoiding allergens by staying in on high pollen days, using home and car air conditioning to filter the air, and avoiding activities like mowing the lawn, allergy symptoms can be controlled without medicine or with occasional use of over the counter allergy medicines.

Over the past few years, treatment for allergies has improved a great deal. Older antihistamines, like Benadryl, can be quite effective, but have to be taken frequently and cause drowsiness and dry mouth in many people. Newer antihistamines, like Claritin, Clarinex, Allegra and Zyrtec can be taken once a day, and are far less sedating. Since Claritin went over the counter, many people can control their seasonal allergies with minimal side effects without needing to see a doctor.

For those who need more than an antihistamine, many people with predominantly nasal symptoms (congestion, sneezing, runny nose) benefit from steroid nasal inhalers. The cortisone like medications in these inhalers reduce inflammation and often dramatically improve congestion that is not controlled with antihistamines and decongestants (like Sudafed, and the D part of Claritin D for instance). They are also helpful for folks with high blood pressure who cannot take decongestants, as well as for people who either do not benefit from or cannot take antihistamines.

A medicine that was until recently used only for asthma, Singulair, is now available for people who have trouble controlling their allergy symptoms. Singulair helps counteract some of the chemicals other than histamine that contribute to allergy symptoms by causing inflammation.

Some people with allergy symptoms need more help than they can get from over the counter medications, and even medicines prescribed by a primary care doctor. These folks need referral to an Allergist for allergy testing and, if appropriate, desensitization (otherwise known as immunotherapy or allergy shots). It is not unusual for a patient who thinks they have allergies to have negative allergy testing. Such patients may benefit from an evaluation by an Ear Nose and Throat doctor to see if there are any conditions causing congestion (like polyps or a deviated septum) that can be fixed.

So, enjoy the flowers and the sunshine, but if your allergies start acting up, don’t get too discouraged. The options for treating allergy symptoms continue to improve. If over the counter medicines aren’t helping, see your doctor or come to MedEx. We are here to help.