Hay fever slams us every spring: Can't breathe; can't think; can't even hear very well. Do you call in sick or drag your fuzzy-brained self to the office? Or do you simply pop an allergy pill and get on with your day?
Either way, American workers have long waged a battle with hay fever. Hay fever is the fifth most common chronic disease -- topped by orthopaedic problems, sinusitis, high blood pressure, and arthritis, according to the National Academy on an Aging Society.
Ten years ago, nearly 7 million workdays were lost because of hay fever allergies, either through absenteeism or "presenteeism" -- when workers show up but are less productive. The total cost to employers was more than $600 million in lost productivity because of allergies and taking sedating allergy medications at work.
"At that time, the nonsedating antihistamines were prescription drugs, and oftentimes expensive, especially for people without drug coverage," says Ron Z. Goetzel, PhD, director of the Institute for Health and Productivity Studies at Cornell University Institute for Policy Research.
"That has changed over the last few years, now that Claritin -- and now the generic loratadine -- are available over the counter and less expensive," Goetzel tells WebMD. "For people with hay fever who get the right medicine and the right dosage, the amount of lost productivity has dropped to almost zero. But if you're not taking medication -- or taking the wrong medication -- there will be lost productivity."
For employers, the message is clear: They need to educate workers on allergy treatments, says Goetzel. Also, employers should make sure health plans cover prescription medications if people don't benefit from over-the-counter allergy drugs."
After all, for hay fever sufferers, the symptoms are no small matter. "If you don't have allergies, you don't realize it -- but hay fever is more than just a stuffy nose," says Karin Pacheco, MD, an allergist at the National Jewish Medical and Research Center in Denver. There are whole-body effects that make it hard to function," she tells WebMD.
Allergies Can Hit Hard
What we know as "hay fever" is known medically as allergic rhinitis. Over the spring and summer, trees, grasses, weeds, and ragweed release their pollen. If you're sensitive, your immune system will send an army of histamines on attack. Histamines are chemicals that trigger inflammation in the sinuses, nose, and eyes.
It's a downward spiral into fits of sneezing, congestion, postnasal drip, runny nose, and itchy eyes. You may feel worse on some days than on others -- depending on what's blooming, the pollen count, and your sensitivities.
"What slows people down is the fuzzy feeling in your head ... which makes you feel disoriented, disconnected, makes it hard to focus," Pacheco says.
Pollen on the Rise
Hay fever is a public health problem that is only getting worse, as the sheer volume of pollen in the air is increasing, Pacheco tells WebMD. "With global warming, ragweed and other allergenic plants are producing more pollen -- especially in urban areas," she tells WebMD. Also, there is some evidence that air pollution (especially diesel pollution) could cause more people to develop hay fever and other allergies.
Yet only 50% of people with allergies consider it a serious medical condition, one poll showed. Less than one-third consulted an allergist or doctor the last time their symptoms acted up. Also:
- 43% said that allergies affected their productivity at work.
- 50% said their ability to concentrate was impaired.
- 68% had trouble getting a good night's sleep.
OTC vs. Prescription
"While drugstore shelves are loaded with over-the-counter (OTC) allergy treatments, it's often hard to figure out what you need. A lot of people take Sudafed for allergies, but it's not an antihistamine," Pacheco says. "It helps partially, but not completely because it doesn't block histamine. It's a decongestant, so it will open up your nose, but it doesn't really treat allergies very well."
"Claritin, Claritin-D (with decongestant), plus generic forms of Claritin are very cost-effective and nonsedating," says Sharon Horesh, MD, instructor of clinical medicine at Emory University School of Medicine in Atlanta. Also, there's Mucinex for drainage and postnasal drip that causes coughing.
"For many people, these OTC medications can take the edge off allergies and they can function just fine," Horesh tells WebMD. "The drugs are safe for long-term use, with very few exceptions."
A few caveats: The decongestant in Claritin D can raise blood pressure, so if you have high blood pressure, ask your doctor. Uncommonly, Claritin can cause drowsiness. Also, Claritin can cause excessive drying in a relatively small number of people.
"Hay fever is not a good reason to stay at home, especially with these good products available now," Horesh says.
If you don't get relief from OTC products, see a primary care doctor, she says. "You probably need a prescription antihistamine, which is stronger than Claritin." You may also need a prescription steroid nasal spray like Flonase, Veramyst, Nasonex, Nasocort, or Rhinocort to get better control of nasal congestion or postnasal drip. Some people need prescription eyedrops for itchy eyes.
She gives her patients samples of several brands of antihistamines to try, since some people respond to one but not another. "One person does great with Allegra; for another, only Zyrtec works," she says. "There's an element of trial and error in finding the right one. If you've tried one and it hasn't worked, it's worth trying an alternative. Try one for a week, and if you get no response, move to another."
If you've tried everything with no relief, see an allergist. "If allergy symptoms continue, despite these measures, you probably are highly allergic to multiple things," Horesh says.
Pollen Patrol in Your Environment
Avoiding contact with allergens-- like pollen -- is the tried-and-true advice that allergists give to patients. You can control your exposure to pollen at home, in the car, and outdoors. Here are a few suggestions:
- Keep windows closed and use air-conditioning.
- Cover air-conditioning vents with cheesecloth to filter pollen.
- Use high-efficiency particulate air filters (HEPA).
- Clean air filters frequently and air ducts at least once a year.
In the Car
- Keep windows closed.
- Set the air conditioner to use recirculated air.
- Minimize walks in wooded areas or gardens.
- Stay indoors as much as possible on hot, dry, windy days when pollen counts are highest.
- Stay indoors between 5 a.m. and 10 a.m., when pollen counts are usually highest.
- Wear a mask when mowing the lawn or gardening.
- Don't hang linens or clothes out to dry.
In a modern office building, you won't likely encounter pollen, says Pacheco. "Pollen isn't sticky like cat or dog dander is. It doesn't stick to your clothes. You don't track it into your office. Once you're inside, you're not exposed to it."