It’s spring-time again and all across the country, people with allergies are sniffling, sneezing, and generally suffering from a surfeit of spring allergies. This year, Michael W. Smith, MD, chief medical editor at WebMD, sat down with nationally acclaimed allergist Jordan S. Josephson, MD, to get the latest news on causes, treatments, and home remedies for allergic reactions. Josephson, author of the recently published Sinus Relief Now: The Groundbreaking 5-Step Program for Sinus, Allergy, and Asthma Sufferers, is the director of the New York Nasal and Sinus Center and attending physician at Manhattan Eye, Ear, and Throat Hospital/Lenox Hill Hospital.
A: Absolutely. What starts as simple itching and sneezing can turn into something much more serious. As your allergies worsen, your nasal passages and sinuses become swollen and congested. This can lead to a sinus infection. The infected mucus draining from your sinuses can drip into your stomach and, if you have gastroesophageal reflux disease (GERD), cause symptoms to act up. And if this mucus drips down the trachea into your lungs, it can irritate your lungs and your airways.
If you have asthma, it can flare up and lead to bronchitis. If the mucus drips over your Eustachian tube, the tube that connects your middle ear to the outside of your head, the tube becomes clogged and you can’t equalize the pressure in your ear. This can lead to ear problems, such as decreased hearing from excess pressure in the ear, ear pain, or even ear infection.
Sleep apnea, caused by a blockage anywhere from the tip of the nose to the back of the throat, is another complication of allergies or sinus problems, leading to sleep deprivation and chronic fatigue. Sleep apnea can cause heart disease if it’s not treated; in fact, it’s the No. 1 cause for heart attack and stroke while sleeping.
Bottom line: Allergies, although usually a quality of life issue that makes us feel lousy, can also be very serious. People have anaphylactic reactions to both environmental and food allergies, and you can end up with a really bad asthma attack and possibly die. It’s much more than a stuffy nose, and if the symptoms are not improving with simple measures, you should see a board-certified sinus and allergy specialist.
Q: What’s new in allergy treatment that excites you?
A: Eastern and Western medicine are joining forces. So now, irrigation with neti pots and hydrating irrigating units (devices that deliver pulses of drug-free irrigation solution) and squeeze bottles are becoming more mainstream. This is really important because all these wash out the allergens that get in your nose. Also exciting are new intranasal antihistamines, such as Astelin, that work unbelievably well. They can be used in addition to oral antihistamines as well as nasal irrigation and nasal steroid sprays. Also, the newer-generation antihistamines have nondrowsy formulations and are therefore better for those who need them at school and at work. The older versions tend to make most people sleepy.
Q: What about air purifiers? There’s been some controversy about whether they really help people with allergies. What’s your take?
A: I think air purifiers are great. But you have to understand that if you have an air purifier in the bedroom, it’s only going to clean the air around a perimeter of a few feet, and you still have to deal with the air when you leave your house, which is polluted. However, for bedrooms and work areas, patients find them very effective. Don’t forget that it is important to regularly change the filters.
Q: The rates of both allergies and asthma have climbed in recent decades. Does current research tell us why?
A: All upper and lower respiratory tract diseases are increasing. One reason is that global warming is causing allergens to peak, so pollen counts are higher each year as a result. People who are sensitive to pollen will have worse allergies.
Another reason is that “super infections” are on the rise because people take antibiotics when they don’t need them or don’t finish all their prescribed antibiotics. The result is more resistant organisms that cause worse sinus infections -- you have these super organisms, as they call them.
We also have an increase in pollution, with so many more cars on the road and so many more factories. Pollution doesn’t cause allergies, but it does cause inflammation and swelling in the nose and sinuses, and worsens allergy symptoms. Common irritants include cigarette smoke and burning coal in addition to car and factory exhaust.
Q: Some research suggests that early exposure to infections and germs may help protect against allergies and asthma. Do you agree with this so-called hygiene theory?
A: I do think there might be some merit to it, yes. So exposing young children to potential allergen sources that may bother them, such as dogs, flowers, grasses, and so on, may help build up their immunity -- both against infections and for allergies. As you build immunity to different things, it also helps fight things you haven’t been exposed to. The best scenario? Probably having a balanced exposure to everything is the best way to go. Not too much exposure but certainly not a sterile environment.
Q: The American Academy of Allergy, Asthma, and Immunology estimates that some 40% of all American children suffer from allergic rhinitis. What are some of the special concerns about children with allergies?
A: Certainly children are most affected by seasonal allergies, so if your kid has allergies, be sure to take care of it early on. Kids can suffer from stuffy noses, postnasal drip, coughs, hoarseness, headaches, sore throats, and clogged ears and ear infections. Often these are written off as normal, but they are not and need to be cared for before the situation worsens. Should the obstruction get really bad, children can suffer from breathing problems and sleep apnea; both can cause significant fatigue and lead to other conditions if left untreated, such as heart disease.
Allergies that lead to chronic sinusitis and possibly swollen tonsils and adenoids also need to be addressed. In my experience, if you treat the sinus infections and the tonsil and adenoid infections aggressively with antibiotics and even sometimes steroids and irrigation, typically both will shrink and you will spare your child having to have an operation.
Q: What’s the first step for parents who think their child may have allergies?
A: Start by making an appointment to see a board-certified sinus and allergy specialist. Saline irrigation is the easiest treatment, either with a neti pot, squeeze bottle, or irrigating system. Antihistamines are also very helpful. But, if possible, parents can also take up the carpeting in their child’s room and replace with wood, linoleum, or tile floors. Also, remove dust-catching drapes from their children’s room. If their kids have been outside and rolling around in the grass, take their clothes off before they reach their bedroom, and give them a bath. Certainly use air conditioners and purifiers. And, again, be sure to clean the filters.
Q: What about decongestants? Parents have so many concerns about medicating their children. What does the research show about what’s safe -- and not safe -- to give children with allergies?
A: There are now new warnings on decongestants, and since long-term usage may cause problems, even heart problems, I recommend parents use decongestants very sparingly because they can have significant side effects.
As far as antihistamines go, several on the market are nonsedating and don’t cause fatigue; I think those are good for children. They can play an important role in controlling allergy symptoms. I think allergy shots are great for kids. You’re going to need a commitment -- even a year, maybe two or three -- and you’ll need to be followed closely by an allergy specialist. I’ve seen kids do very well. When they’re first allergic, they’re miserable. But two or three years later, they are feeling terrific and come allergy season, they’re just not feeling it. Again, getting to the problem early helps thwart allergies.
The benefits are there for adults, too. There are drawbacks -- some people don’t have the time for the weekly shots; others are afraid of needles. In Europe, doctors are giving drops under the tongue, but that’s not FDA-approved here yet, even though several studies do show they are effective.
Q: One of the toughest situations that comes up when kids are diagnosed with allergies is the recommendation to reduce exposure to allergens by giving away the family cat or dog. What is your position on this?
A: It’s a question of working with people’s lifestyles. If you take 10 people who are avid golfers and tell them they have to quit because of their allergies, 10 out of 10 are going to tell you to take a walk.
You have to give people treatment choices that they can actually work with and that are going to work for them. You can’t tell someone who has had a dog for 10 years and just had a kid to get rid of the dog. That dog has been their kid longer than the kid.
So you make certain changes in the home: keep the dog, have the child irrigate. You can use saline nasal spray and saline drops even on infants, which can be very helpful. And certainly keep the animal out of the baby’s room -- put up a gate if you have to. Put an air filter in the baby’s room. All these things can really help.
Q: As you’ve mentioned, another lifestyle approach is to “irrigate” the sinuses -- as some cultures have practiced for centuries -- but it tends to turn some people off. What’s the benefit of this homespun remedy? You must get a lot of resistance when you first recommend it to patients.
A: I think neti pots are probably the best thing out there for people with sinus problems and allergies and even colds. You can also use a pulsating nasal irrigator or a squeeze bottle. All are easy to use, and the risks are almost zero. It’s kind of like taking a shower when you get home.
Patients always ask me, How long do I have to do this? and I ask them, How long have you been taking a shower? And they say, My whole life. Well, that’s the answer. You’re cleaning out the dirt in your nose and sinuses; why not wash that out?
At first some people are a little afraid, and some people think it’ll be too cumbersome. But almost all of my patients come back very positively and say it makes a difference. My 6-year-old is doing it, my 5-year-old is starting, and we’re trying to get our 2-year-old to do it. Whether you’re 2 or 92, this is good for everybody.
Q: What promise do alternative and complementary therapies hold for those who have spring allergies?
A: Besides irrigation, acupuncture seems to work well for some people through the rebalancing of chi (the energy forces in the body), which can help fortify the immune system to help alleviate the symptoms of sinusitis, allergies, and asthma.
Some of my patients want to try homeopathic remedies, so I send them to doctors who do integrative medicine. A very diluted amount of a particular medicine or combination of medicines is given on the theory that it will boost the immune system. The treatment is individual; each patient is carefully evaluated and receives a specific combination of homeopathic ingredients.
Q: Recent research shows that even mild stress or anxiety can worsen allergy symptoms.
A: It’s true: Mild stress or, in today’s economy, major anxiety weakens your resistance. So that does worsen allergies and leave you more susceptible to infections. It’s well known that stress has a relationship to your body’s immunity.