‘Tis the season—for itchy eyes, runny noses, scratchy throats, incessant coughing, relentless headaches, and all the other fun stuff that allergies bring. Anyone who suffers from allergies can tell you that they are no joke. It’s almost as if we have to pay for the beauty and wonder of spring. But the seasonal environment is just one type of allergy. A person can be allergic to many things—and allergies can develop at any time, meaning that, even if you weren’t allergic to something from the beginning, you can become allergic to it at some point. Fun, right?
A physician with ENT and Allergy Associates, where she specializes in adult and pediatric allergy, asthma, and immunology, Yelena Kopyltsova, MD, has seen and treated virtually every type of allergy symptom. She shared some of her knowledge and insight with us.
What are the most common allergies you see in your practice and what are their symptoms?
I see patients with environmental, food, and medication allergies and asthma. Dust-mite and pollen allergies are some of the most common environmental allergies. They can affect you in variety of ways, from typical hay-fever symptoms, such as sneezing, runny or stuffy nose, and itchy, watery eyes to sinus issues and headaches. Some people are so sensitive to their allergens, they can have a cough or shortness of breath when exposed to their allergenic trigger.
How can a person be sure that he or she has a seasonal allergy and not something else?
Allergen-triggered asthma can be under-recognized. I still meet patients every day who think coughing and being short of breath during pollen season is part of ‘spring allergies.’ It is really important to recognize these symptoms and seek help. In my office, I use both skin testing for allergies and lung-functions tests to diagnose and treat allergies that affect lungs.
Have you seen an uptick in new or different allergies in the past decade and, if so, to what do you attribute this?
There has been an alarming increase in prevalence of food allergies, especially peanut allergy. There are different theories as to why this is the case. For example, hygiene hypothesis suggests that early environmental exposures can be helpful. We are learning more about possible ways to prevent development of food allergies, especially with kids at risk. An important study called the LEAP [Learning Early About Peanut Allergy] Study from the New England Journal of Medicine is changing the guideline landscape in terms of food introduction. We are learning that early introduction of peanuts might be rather helpful at preventing the development of peanut allergy. Families with a history of food allergies, children with egg allergy or eczema are considered at risk and should undergo evaluation for possible peanut testing. When you come for your visit, we will determine together if it would be helpful for you or your child to get tested for food allergies. For families with no history of food allergies, I recommend to not hold off on introducing a variety of age-appropriate foods.
How can a person tell if they have an allergy, a sinus infection, or a cold?
Colds generally start to improve after five to seven days, while allergies will linger. If your nasal congestion does not improve after two weeks, it is possible you are dealing with an allergic process. Itchy eyes are also more likely to be an allergy symptom.
If a person has “typical” seasonal allergies, are there any OTC meds that you would recommend? Not recommend?
Antihistamines, such as Claritin, Allegra, or Zyrtec, can help adults and children with sniffles and a runny nose. Antihistamines block your body’s response to allergies and usually work in less than an hour. But read the package carefully. Some older drugs, like chlorpheniramine and diphenhydramine, can make you drowsy.
Steroid-based nasal sprays have become available over the counter, such as Flonase or Rhinocort.
For more severe allergies, try a nasal spray. But don’t expect symptoms to vanish right away, as they may take a few days to work. Since they can have side effects like burning, dryness, or nosebleeds, use the lowest dose that controls your symptoms.
Be careful with decongesting nasal sprays, such as Afrin. If you use it daily for prolonged periods of time, your nose can become dependent on this type of nasal spray to stay open and congestion-free. Eye drops that contain antihistamines, such as Ketotifen, can be helpful for relieving itchy and watery eyes.
Yelena Kopyltsova, MD
When should you see a doctor?
If you are having difficulty controlling your allergy symptoms with over-the-counter medications, consider getting an evaluation. Start with OTC antihistamines: cetirizine, fexofenadine, and loratadine are all great options, as well as nasal steroid sprays (Flonase and Nasacort) and eye drops (Zaditor and Alaway). If you don’t notice any relief in about two weeks, make an appointment to discuss other prescription options and other methods of treating allergies, such as allergy shots or tablets (subcutaneous and sublingual immunotherapy).
While allergies do not cause sinus infections, they can be a risk factor for developing one. If you suffer from sinus infections, consider checking to see if you have allergies.
Is there a way to prevent allergies?
It is a good strategy to start taking anti-allergy medications during pollen season. In fact, start taking medicine long before your eyes get watery and you’re sneezing nonstop, at least one week before the season begins. That way, the medicine will be in your system by the time you need it.
Some herbal remedies may help stave off allergy symptoms. More research is needed, but an extract from a shrub called butterbur shows promise. Biminne, a Chinese herbal formula with ingredients like ginkgo biloba and Chinese skullcap may also help. One study found that people who took biminne five times a day for 12 weeks still felt the benefits a year later.
Tell your doctor first. ‘Natural’ or ‘alternative’ doesn’t necessarily mean safe.
Butterbur may cause an allergic reaction in people who are sensitive to plants like ragweed and marigold. Biminne doesn’t always work well with diabetes medicines. And because it’s unclear how these herbs help, the possible long-term side effects are unknown.
Are there any promising new treatments or medications on the horizon?
FDA-approved use of allergy tablets (sublingual immunotherapy) for grass and ragweed allergy. It’s a method of treatment that has been used for over 10 years in Europe and now making its way to the US. Allergy shots or subcutaneous immunotherapy is another method used to treat allergies. Allergy shots are not medications. They act similar to vaccines, teaching your body to develop protection against allergies. They are the only way to modify how your body reacts to the allergens. The medications we use will treat the allergy symptoms, but cannot modify the course of allergies.
What else would you like people know about allergies?
Consider checking pollen counts during the spring season. The American Academy of Allergy, Asthma and Immunology recommends checking actual pollen counts rather than pollen forecasts. Pollen and mold counts measure the amount of allergens present in the air. Pollen counts reflect real-weather conditions. On the other hand, pollen forecast is typically based on past pollen data and general weather forecasts. The National Allergy bureau (NAB) is the only pollen and mold counting network certified by AAAAI. You can check pollen and mold levels from certified stations across the nation at www.aaaai.org/nab.
On high-pollen-count days, when you do head outdoors, wear glasses or sunglasses to keep pollen out of your eyes. A filter mask can help when you mow the lawn or work in the garden. Different types are available, so ask your doctor to suggest one that will work best for you. Once you head back inside, always take a shower, wash your hair, and change your clothing. Otherwise, you’ll bring pollen into your house.