Spring is beautiful...

but pollen triggers allergies for many

Spring is a beautiful time of year. The flowers bloom, the birds chirp, we see neighbors who have been stuck inside all winter.

We’ll be able to spend more time outside and have fun in the fresh air. Unfortunately, for those of us with allergies, we need to prepare a bit so we don’t suffer from congestion, sneezing, and cough. Especially in the context of the pandemic, controlling allergies can help to prevent the worry that you might have a contagious infection.

I don't want anyone to be afraid to enjoy the beautiful outdoors, so let’s talk about how we can all work to control allergies.

Why treat allergies?

I often hear parents say that they don't want to give their kids medicine to treat allergies because, well, it's medicine. They prefer to be “natural” and the symptoms don't seem bad enough to warrant medicine.

Before you decide if the symptoms require treatment or not, be sure to recognize all the potential consequences of allergies. It's not just a runny nose and sneezing.

Allergies can impair sleep (leading to all the problems associated with not enough sleep) in addition to the annoying symptoms of itching, coughing, sneezing, runny nose, and watery eyes.

Some kids get a crease across their nose from wiping in the “allergic salute” fashion.

Others get purple circles under their eyes called allergic shiners.

For people with asthma, allergies are a known trigger for wheezing. It's especially important that people with wheezing tendencies keep up on allergy prevention and treatments.

Some people with allergies will chronically mouth breathe, which can affect the growth and development of their jaw, lead to bad breath, and increase the risk of cavities. Dr. Deborah Burton, an ear, nose, and throat specialist, discusses these and other consequences of mouth breathing.

How do you know it's allergies?

We all need to learn to recognize allergies, what to do when you have them, and what your risks are if you don't treat them - and in today’s pandemic setting, we need to know when to assess for viral illness.

Allergies can cause runny nose, headache, congestion, sneezing, watery eyes, itching eyes, sore throat, itchy throat, and itchy skin. Not all symptoms need to be present. They all sound very much like symptoms of COVID, which makes it difficult to know what you’re dealing with without regular testing.

COVID makes it tricky

This means that when community rates of COVID19 are high, you need to be on high alert with any symptoms that could be viral. Testing is the only way to know if you’re contagious to others. Testing once is not going to be sufficient if symptoms persist. You will need to test regularly, especially if you learn of an exposure.

Rapid antigen tests (which include most home tests) are good to tell if you’re likely contagious at the time. They may take a couple days to turn positive, so early in an infection you may not know you can spread germs, so it is recommend that you mask around others if you have any symptoms. If you do have an infection and you’re blowing your nose and sneezing more than normal, people will appreciate seeing your mask.

Even if you recently had COVID, we know that some variants (such as Omicron) do not provide long lasting immunity. There are reports of people getting Omicron 2.0 just weeks after recovering from Omicron. We can’t rely on a recent infection for immunity. We should test regularly if we have symptoms to protect our friends, family, coworkers and classmates.

Know your seasonal risk

Most people with seasonal allergies don’t need expensive allergy testing. The treatment doesn’t vary unless you plan on doing immunotherapy (allergy shots), and there are other ways to learn to predict your risks.

It's easy to track pollen counts online, so you can anticipate seasonal allergy risks and start your allergy regimen before the symptoms get bad.

Treatments to control allergies

It is best to treat before the symptoms get bad. Treatments include not only medicines, but also limiting exposure.

Use what you can to prevent and treat allergies, which most often means using more than one of the following preventions and treatments.

Limiting Exposure:  

Limiting exposure can help decrease symptoms. This does NOT mean you should stay inside all spring!

Cover your nose

One added benefit I’ve learned about masks is that my allergies are MUCH better when I wear a mask outside during high pollen times. I know many people don’t like their masks, but I personally appreciate all it does to help me control my allergies as well as prevent infections.

Avoid bringing allergens into the home

Remove clothing and shoes that have pollen on them when entering the house to keep pollen off the couch, beds, and carpet.

Keep the windows closed. Sorry to those who love the "fresh air" in the house. For those who suffer from allergies, this is just too much exposure!

Beloved pets cause unique issues

If someone's allergic to animals or suffers from year long symptoms, learn if your family pet is a problem.

When you have pets that go outdoors and then into the home, bathe them regularly.

Don't let pets on the couch or beds and keep them out of the bedrooms of allergy sufferers.

If you know a household family member is allergic to a specific type of animal, don't get a new pet of this type!

If you already have a loved pet someone in the home, consider allergy shots against this type of animal. Talk to your pediatrician and consider a trip to an allergist.

Wash and clean

Wash towels and sheets weekly in hot water.

Vacuum and dust weekly. Consider cleaning home vents.

Consider hard flooring in bedrooms instead of carpeting. They collect less dust and allergens.

Wash stuffed animals and other toys regularly and discourage allergic children from sleeping with them.

There are many types of air filters that have varying benefits and costs. For information on air filters see the Environmental Protection Agency's interactive page on indoor air quality.

Smoke is a "no"

Keep smoke away. Smoke is an airway irritant and can exacerbate allergy symptoms.

Remember that the smoke dust remaining on hair, clothing, upholstery, and other surfaces can cause problems too, so kids can be affected even if you don't smoke near them.

And for those of you who vape, it's not better.

Wash it off of you!

Wash hair, eyelashes, and nose after exposures -- especially before sleep. They all trap allergens and increase the time your body reacts to them.

Learn to rinse your nose

I have found the information and videos in Nasopure.com's library to be very helpful. You can teach kids as young as 2 years to wash their noses.

Note: I have no financial ties to Nasopure — I just love the product and website!

If you wear contacts

If itchy eyes are a problem for contact lens wearers, a break from the contacts may help. Talk with your eye doctor if eye symptoms cause problems with your contacts.

Medications

I don't want kids with outdoor allergies to be afraid to go outside, so taking medicines to keep the symptoms at bay while out can help.

Antihistamines

Antihistamines work to block histamine in the body. Histamine causes the symptoms of allergies, so an antihistamine can help stop the symptoms.

Some people respond well to one antihistamine but not others, so sometimes you must use trial and error to find the right one.

In general I prefer the 12-24 hour antihistamines simply because it's very difficult to cover well with a medicine that only lasts 4-6 hours, such as diphenhydramine (Benadryl) and they're less sedating. Long acting antihistamines include loratadine -Claritin (24 hour), fexofenadine- Allegra (12 hour for kids, 24 hour for teens and adults), and cetirizine- Zyrtec (24 hour).

Different antihistamines work better for some than others. Personally loratadine does nothing for me, fexofenadine is okay, but cetirizine is best. I have seen many patients with opposite benefits. You will have to do a trial period of a medicine to see which works best.

If antihistamines make your child sleepy, giving it at bedtime instead of the morning might help.

Prescription antihistamines are available, but usually an over the counter type works just as well and is less expensive. Insurance companies rarely cover the cost of antihistamines these days.

Antihistamine and decongestant combinations

Antihistamine and decongestant combinations are available but are not usually recommended. Decongestants can cause dizziness, heart flutters, dry mouth, and sleep problems, so use them sparingly and only in children over 4 years of age.

Once control of the mucus is achieved, a decongestant isn't needed. Giving a medicine that isn't needed just increases the risk without increasing the benefit.

If you need a decongestant initially, you can use one with your usual antihistamine.

Most decongestants on the shelves are ineffective. If you ask the pharmacist for pseudoephedrine, it is available behind the counter. It was replaced by phenylephrine years ago due to concerns of methamphetamine production, but works a little better than phenylephrine.

Decongestants do NOT fix a cold, they only dry up some of the mucus. They should be used temporarily until congestion is brought under control. For this reason, I don’t recommend combination antihistamine with decongestant in the same pill. It’s easier to stop the decongestant if they are separate.

Nasal spray steroids and antihistamines

Nasal spray steroids and antihistamines are available over the counter or as a prescription. An office visit to discuss the value of these for your child and proper use is recommended.

Nasal steroids are often the preferred treatment based on effectiveness and tolerability.

See How to Use Nose Sprays Correctly - many people use them improperly and complain they either cause problems or don't work. Proper use solves many problems.

If your child resists nose sprays

You can help your kids get used to nasal sprays with saline sprays. Saline is simply salt water, so it is okay to let your kids practice with these without risking any overdose of medication.

Eye Drops

Eye drops can help alleviate eye symptoms.

They are available both as over the counter allergy drops and as prescription allergy eye drops. If over the counter drops fail, make an appointment to discuss if a prescription might help better.

Most insurance companies don't cover prescription allergy eye drops well, so you might want to check your formulary before asking for a prescription. This is usually available on your insurance website after you log in.

If your child resists eye drops

Tips to administer eye drops include washing hands before using eye drops, put the drop on the corner of the closed eye (nose side) and then have the child open his eyes to allow the drop to enter the eye.

Montelukast

Singulair (Montelukast) works to stop histamine from being released into the body. It can help to control both allergies and asthma, but the FDA now advises using it only when other treatments fail.

Montelukast is only available with a prescription. Talk to your prescriber to see if it’s right for you.

Steroids

Steroids decrease allergic inflammation well. These include both oral steroids for severe reactions (such as poison ivy on the face or an asthma attack) and inhaled corticosteroids for the nose (or lungs in asthma).

The nasal steroids are discussed above and are highly recommended for kids and adults who tolerate putting a spray in their nose.

Other steroids require a prescription, so a visit to your provider is recommended to discuss proper use.

What if all of the above isn't helping to control allergies?

Maybe it's really not allergies.

There are many things that can seem to be allergies but aren't. If proper treatment is not working, reconsider the diagnosis.

It's possible that the allergy treatment is working, but you caught a cold on top of the allergies. Both are common, so they can occur together.

Allergies to things other than foods are rare before 2 years of age. If you're treating allergies in an infant or toddler, be sure to keep your pediatrician in the loop.

I've known people who are treated for years by an allergist for allergies, but when they're tested due to a poor response, they have no allergies. They might have frequent infections or are exposed to other irritants, like smoke or poor air quality.

Learn to control these issues too, starting with good hand washing, avoiding touching your face, and avoiding smoke.

Allergy testing

Allergy testing is possible by blood or skin prick testing, but can be costly. Not to mention the fact that kids tend to not like needles, which are used with most testing.

Allergy testing isn't recommended for most allergy sufferers. It can be used to guide allergy immunotherapy, which involves routine allergy shots. Most suffers don't need allergy shots, but if you think your child would benefit (and allow them), talk to your doctor.

In most cases I don't find test results very helpful for environmental allergens because you can't avoid them entirely. You can limit exposures as discussed above, regardless of test results.

Tracking patterns and symptoms to identify allergies

By tracking seasonal patterns over a few years can identify many of the allergens. You can still treat as needed during this time.

Rather than testing, note animal exposures and household conditions and any symptoms seen with exposures.

Write symptoms and exposures weekly (or daily). It often doesn't take long to see patterns.

Testing is important if allergy shots are being considered, but most of the time it won’t change how you manage allergies if you learn general risks and precautions.

Wrong medicine or wrong dose.

Some people have more severe allergies and need more than one treatment. I personally use eye drops, nasal spray, and an oral antihistamine in addition to daily nasal rinses and hair and face washing when my allergies flare.

Switching types of medication or adding another type of medicine might help. If you need help deciding which medicines are best for your child, schedule an office visit with your prescriber for an exam and discussion of symptoms.

Some kids outgrow a dose and simply need a higher dose of medicine as they grow. Talk to your pharmacist or prescriber to decide if a higher dose is indicated.

Is Nothing working?

Consider allergy shots (immunotherapy) to desensitize against allergens if symptoms persist despite your best efforts as above.

Schedule an appointment with your pediatrician to discuss if this is an option for your allergy sufferer.