Hay Fever 101

Hay fever, also called allergic rhinitis, is one of the quiet but costly medical problems in the US. It is estimated that the economic burden of allergic rhinitis is estimated to be in the billions of dollars, both in medical costs and in lost time from work. In different areas there are different allergens, but spring, early summer and sometimes fall are difficult seasons for allergy sufferers.

Most allergy sufferers can get help with their allergies. The good news is that we now have treatments that help most patients, and can avoid the traditional sedation of the first generation of antihistamines like Benadryl or the combination acetaminophen and antihistamine OTC products.

By the time I see patients they have usually tried an OTC antihistamine. There are several good generic non-sedating (this is a relative term, really meaning less sedating than Benadryl) available OTC. I suggest loratadine (generic for Claritin) or cetrizine (generic for Zyrtec. ) Fexofenadine (generic for Allegra) by prescription is another option. There are some newer prescription antihistamines that are minimally if at all better than the generic OTC meds.

An overlooked but quite effective treatment for seasonal allergic rhinitis is saline nasal rinse. The allergy symptoms are caused when inhaled allergens (the thing someone is allergic to that triggers the allergic response) come into contact with cells in the lining of the nose and respiratory tract and trigger the release of chemicals that cause swelling, mucous production, itching and sneezing. Use of a saline rinse to wash out the allergens from the nasal passages can be extremely helpful in reducing allergy symptoms. A brand I recommend of this is Neil-meds Sinus Rinse. The trick to successful use of this is to bend over a sink so the sinuses and nose are lower than the throat, so you don’t gag when you use the rinse, and to very gently exhale to blow out the saline. Forceful blowing the saline out will make you feel like the fluid is going into your ears. Try this, you’ll like it.

There is good evidence that nasal corticosteroids sprays can be more effective with less side effects than antihistamines. I have had excellent success having patients use this treatment. The key to this is to use it every day, once or twice a day, for the allergy season. It is not a medication that helps much used sporadically. It is also important to keep the spray in the nose, not to sniff so strongly that it goes into the back of the throat and you drink it. Spray it in nostril aimed away from the nasal septum, by using the right hand for the left nostril, and visa versa to avoid trauma and nose bleeds, sniff gently once and use a finger to compress the nose for about 15 seconds to allow the medication to be absorbed into the nasal tissues. The medication works by reducing inflammation and the allergic response with regular use. Unlike antihistamines which work on the day you take them, for intranasal corticosteriod sprays it can take a few days to notice improvement. More good news is that fluticasone nasal spray (formerly Flonase and others) is now generic and inexpensive. These meds are available by prescription only, so you’ll need to see your doctor for a prescription.

If these things don’t work another options is singular, a different immune system inflammatory process modulator, or allergy shots. Allergy shots are usually given by an allergist or Ear Nose and Throat specialist, and can be very helpful in refractory cases, but take a commitment of time and are fairly expensive. There are several prescription eye drops that can help if the itchy eyes do not improve with the treatments above. Sometimes a short course of systemic corticosteriods orally is needed to get initial control of severe symptoms before transitioning to the intranasal steroids and antihistamines. I avoid injected long-acting corticosteroid injections because of rare but serious side effects like aseptic necrosis of the hip.

Avoiding known allergens, like animal dander, house mite dust, and smoke can help, but for seasonal allergies, avoiding breathing the pollens is not realistic generally.

Ed Pullen, MD, is a board-certified family physician practicing in Puyallup, WA. He blogs at DrPullen.com — A Medical Bog for the Informed Patient.

This article originally appeared online at DrPullen.com.