"Seasonal Allergies"

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Hello and welcome to another edition of the HCAM News monthly medical segment To Your Health. I’m Dr. Jim Kenealy.

The days are slowly getting longer and warmer. Have you seen that bright green aura of buds that surrounds the tree tops just prior to the leaves coming out? After a long and particularly nasty winter, it’s a welcome sight. But for the 40 million Americans who suffer from seasonal allergies, it’s also the beginning of their annual battle with a season of suffering and misery.

You can recognize the allergic among us, tissues at hand, with nasal congestion and stuffiness, runny noses and itchy eyes. Some have a hacking cough or even wheezing. Others develop sinus pain, pressure and headache. Children often exhibit the most dramatic symptoms and those prone to asthma can experience an increase in the frequency and severity of their asthmatic attacks.

The cycle of seasonal allergies follows the procession of the seasons. First, the deciduous trees – oak, birch and maple – bloom from around Patriot’s Day to early May. Next, come the conifers – pine trees and evergreens – which shed their pollen from Memorial Day to late June. That thick, gooey, yellow-green dust that coats your car hood in late spring and early summer is pine pollen. When fishing offshore, I’ve witnessed huge clouds of the stuff coming off the bluffs at Cape Ann. Mid-summer brings the grass pollens – blue grass, red top, and fescue.

Many people have some confusion about grass pollen allergies. They think that, because they exhibit allergy symptoms while mowing the lawn, they are allergic to the grass, but they are not. Rather, they are allergic to the mold in the thatch and cuttings that is kicked up by the mower. Mold allergies also affect people during other landscaping activities such as mulching or raking leaves. Grass pollen, on the other hand, is only produced when the grass is allowed to grow long enough to go to flower, such as in a hayfield or untended lawn. If you live in near a farm or a rural area, you may experience true hay fever.

From Labor Day to Halloween, many are plagued by one of the most potent allergens of all – ragweed. That ubiquitous tall, yellow flowering weed that you see along roadsides and in fields from late summer to the first killing frost is ragweed. Along with another weed, plantain, it finishes off the cycle of seasonal allergens. Once we are driven indoors; however, there are dust, down and pet antigens to contend with.

Children usually do not manifest full blown seasonal allergy symptoms until they are 3 or 4 years old. It takes a few yearly seasonal cycles of exposure to get their immune system full sensitized; each pollen season is, in effect, a nature’s “booster shot.”

The most effective treatment for allergies is to remove oneself from exposure to the offending antigen. But, that’s not very practical for most of us, unless you plan on leaving New England for a desert climate. Fortunately, you need not suffer in silence with seasonal allergies. Many of the potent, once prescription strength, antihistamines are now available in an over the counter form. These include loratadine, cetirizine, chlorpheniramine and diphenhydramine. Antihistamines provide relief from runny noses, itchy eyes and even some rashes. But they can be sedating, depending upon the particular drug, so don’t drink alcohol, take sedatives or sleeping medication, or engage in activities which require concentration, like driving, when you take an antihistamine. Also, they should be used with caution in young children and asthmatics.

Decongestants, mainly preparations which contain pseudoephedrine, can help to alleviate nasal congestion and stuffiness. They are the “D” in combination products when added to an antihistamine. Decongestants can raise the heart rate, blood pressure, cause palpitations, insomnia, and restlessness. They can cause urinary retention in older men and those with prostate difficulties and they are associated with an increased risk of stroke in the elderly. For these reasons, they should be avoided in the very young and older patients.

Nasal sprays, like Neo-Synepherine or Afrin, can provide excellent temporary relief from nasal congestion and runny nose, but, if used regularly for more than 3 to 5 days, they can become addicting to your nose. Patients will experience what is called a “rebound” effect where the nose becomes congested, stuffy and obstructed upon withdrawal of the nasal spray. Never use them other than is directed on the package insert. This is also true for many allergy-relieving eye drops.

As always, when in doubt about the use or suitability of a medication for your particular health conditions, ask your doctor. Your doctor also has other, prescription, options as available for the treatment of seasonal allergies. Intranasal steroid sprays, like fluticasone and flunisolide, are very safe and effective first line agents for the treatment of allergies. If your doctor is unsuccessful in getting your allergies under control with medications, you can be referred for allergy testing and possibly allergy injections.

For more information on seasonal allergies visit the e Asthma and Allergy Foundation of America website.

Here’s hoping that the only fever that you have is spring fever. For To Your Health, I’m Dr. Jim Kenealy.