Here are the key points to remember:
1. Allergy is predictable, plan for it.
2. Medications are best taken before they are needed.
3. Avoid what you can
4. If you need to reduce the medication load, consider allergy immunization.
Preparation for allergy
Look carefully at your skin test sheets and match it up with your memory of past allergic seasons. The graph we provided is a rough index of when WE think you are at biggest risk. Keep in mind that months of risk vary across the United States and even the world. The graph below is an example for someone who lives in Texas with Mountain Cedar and Ragweed allergies.
It suggests that you should be wary from the end of December until the end of March because of Mountain Cedar. Likewise, the time of late August until the first frost will likely cover the Ragweed period. During this period, take medications such as antihistamines pretty regularly, "needed" or not. It's also the time of year you should keep the windows down and the air conditioner on since pollen is usually highest from midnight to 6 a.m. Note that "sinus" infections that occur from April through August probably don't have much to do with allergy.
Talk to your allergists about the pollen seasons in your area. In general, trees come out first in early spring, following by grasses, and then by the end of the summer time we start to see weeds pollen into the fall. In some states that have a very long growing season, there is considerable overlap and pollens may be available throughout most of the year.
Learn which medicine to use and how to use them
DECONGESTANTS: Examples include Sudafed – but any drug with a "D" at the end of it likely has Sudafed. They don't relieve itching – they do open up the nasal passages. They may make you restless, and have the potential for heart side affects like fast heart beat and high blood pressure. Over the counter nasal sprays such as Neo-synephrine, Afrin, and Dristan are also classified as decongestants. They work quickly but carry the concern of rebound or "addiction". Best keep these sprays to 3 – 4 days only, or use them to prepare the nose for other medications like the nasal steroids. Nasal steroids and nasal antihistamine sprays work very well for congestion and do not have the same effects on the heart, or brain, and do not have rebound. These are considered the mainstay of treatment.
ANTIHISTAMINES: Over the counter medications such as Benadryl and Chlortimeton may work, but they may also make you drowsy. Any tablet you take by mouth will affect the whole body, like your brain (sedation), your heart (abnormal heart beats) your eyes (dry eyes) and even your bladder (unable to urinate). It is because of this that allergists tend to go with targeted therapy. Which means put the medicine where you need it, like a nose spray for the nose, and an eye drop for the eyes, and finally an asthma inhaler for the lungs. Antihistamines which have a low risk for drowsiness include Allegra, Clarinex, and over the counter Claritin. Zyrtec is a "tweener" – a little more sedation than the others, not at much as older over the counter antihistamines
COMBINATIONS: mixtures of antihistamines and decongestants such as Claritin D, Allegra D – I am usually not a big fan.
NASAL STEROID SPRAYS: They are used to treat all of the symptoms of allergic rhinitis (hay fever) and will reduce itching and clear drainage. They won't hook you or addict you no matter how long they are used- squirt them back deep in the in the nose – up and out towards the sinus cavities.
LEUKOTIENE INHIBITORS – these have historically been felt to be very safe medications, or tablets. However, there are not as good at controlling all of the symptoms of allergies. In some patients, however, they work very well. Talk to your doctor to see if this class of medication is good for you.
Here are some common situations allergic people face everyday and our general response to them.
"I'm itching and sneezing my head off"
If the mucus is clear and you have no fever, chances are that allergy is the culprit. Restart your allergy medications and keep it up. It won't work right away (which is why you should be taking some regularly during your risk seasons).
If the mucus is colored yellow, green, or white, chances are you have a respiratory infection. You may find that the only thing that gives you relief is a decongestant – that the antihistamine or nasal sprays don't do much. Talk to your doctor and you may need to come in for an exam.
"I have a sinus infection"
Maybe, but the majority of folks with colored nasal drainage and "sinus pressure" do not have abnormal x-rays. They have a viral cold infection that won't respond to antibiotics at all. In many cases antibiotics turn out to be a huge waste of time and money. If the infection hangs on, we'll often want to document it with an x-ray. People who use more than four or five sets of antibiotics a year need investigation and possibly consultation from an Ear Nose and Throat Surgeon if x-rays do not clear.
Here's a first aid for simple "sinus Infections":
Get off your feet/ Drink fluid (enough to make your urine clear rather than colored)
Stop antihistamines/ Start Decongestants
Use an anti-inflammatory (aspirin or ibuprofen for adults) even if you don't have fever – chicken soup helps too!!
Use a vaporizer or humidifier – let it hit you square in the face
ASK US ABOUT HOW TO DO SINUS IRRIGATION – it can reduce the number of antibiotics you use.
Make sure to wash your hands often so you don't spread it around.