The Third Day
by Rick Mitchell, M.D.
Then God said, “Let the land produce vegetation: seed-bearing plants and trees on the land that bear fruit with seed in it, according to their various kinds.” And it was so. – Genesis 1:11
In the next verse, we learn that God saw that his creation was good. But in this spring season, you might find it somewhat difficult to agree if you suffer from seasonal allergies! If your eyes are itchy and watery, it might be challenging to appreciate the beauty of a flowering crabapple tree. And you may not be in the best frame of mind to appreciate the intoxicating fragrance of a lilac if each sniff makes you sound like you’re breathing through a snorkel! In this month’s column, we’ll look at seasonal allergies a bit – how to know that’s what you have, and what you can do to improve your symptoms.
Your body has ways of differentiating “you” from “not you”. When your immune system finds “not you,” it attacks! And if you suffer from allergies, your body has a very vigorous attack response when it comes across pollen. Tree pollens allergies are most common in spring, grass allergies are common in summer, and ragweed allergies are the most brisk in the fall.
How do you differentiate allergies from colds? Colds last about 7-10 days on average and then get better. Seasonal allergies last all season –they might get worse when you’re outside or if you have windows open, and they may get better if you’re inside (especially if the air is sent through a filtration system). You may also notice purplish “bags” under your eyes – doctors call these allergic “shiners” – where the blood is flowing through the veins a bit more slowly and it pools and looks purple under the skin. Kids may develop a line across their noses from wiping the drips (called the allergic salute!) If you aren’t sure what you have, your primary care provider can help you figure it out.
If you have allergies, you are not doomed to suffer through springtime forever! There are many remedies that can help improve your symptoms. The first are the antihistamines: loratidine (Claritin), fexofenadine (Allegra), cetirizine (Zyrtec), chlorpheniramine (Chlor-Trimeton), and diphenyhydramine (Benadryl). These pills help control both watery/itchy eyes and congested or runny noses caused by seasonal allergies. As you go down the list from loratidine to diphenhydramine, the pills tend to work a bit better, but they also tend to make you more sleepy, so keep that in mind when you’re deciding where to start. Also, diphenhydramine can make older people confused, and can make urine retention worse, so be careful if you are over 70, especially if you use many other medicines.
If you are congested, phenylephrine (Sudafed-PE) or pseudoephedrine (Sudafed) can be helpful. Medicines that have the letter “D” after their name contain pseudoephedrine in addition to the antihistamine (for example, Claritin-D is loratidine and pseudoephedrine) and are good for controlling allergies AND congestion at the same time. But if you have high blood pressure, check with your primary care provider before using these medications since they can raise blood pressures. Also, some people find these medications make sleeping difficult. If that’s you, try the 6-hour dose of pseudoephedrine (60 mg for adults), and skip the dose around bedtime.
You can now get nasal steroid medications over the counter – triamcinolone (Nasacort), fluticasone (Flonase), and budesonide (Rhinocort). They all tend to work about the same; occasionally people will find one works better than another. These mostly work on the runny nose symptoms people have. They may take up to two weeks to work, so keep using it even if it doesn’t seem to help at first. Aim the applicator correctly or you’ll lose a lot of the medicine. Your pharmacist can show you how to do this if you aren’t sure. The biggest side effect people notice with these is a bloody nose. These medicines can be very effective, and some patients who never got good relief from antihistamines swear by them.
If your eyes are the big problem, drops can help – Visine Allergy, Opcon-A, Patanol, and Zaditor can all help relieve red, itchy eyes. Again, different people have better luck with one than another, but they all work about the same.
If you’ve managed to get through the whole armamentarium of over-the-counter allergy aids without enough improvement, then it’s time to get in to see your primary provider. We keep a few more tricks up our sleeves which could help you out!
I hope these tips help you get your allergy symptoms under control so you can get outside and enjoy God’s handiwork, and see that it is good indeed!
Blessings to you all! Rick Mitchell