Allergy Symptoms Shouldn't Be Ignored

From the WebMD Archives

March 17, 2000 (Atlanta) --Pollen season is blooming across the U.S. This year, will more sneezing, coughing, undiagnosed allergy sufferers take their problems seriously -- and see a doctor?

Maybe, if their quality of life is at stake. "Hay fever causes sleep disturbance. People can be tired, they have headaches, they don't feel well. They take over-the-counter medications that interfere with driving, with learning," Gary S. Rachelefsky, MD, past president of the American Academy of Allergy, Asthma, and Immunology, tells WebMD. "They need to be asking their doctors for nonsedating antihistamines or, if that doesn't work, go to topical nasal steroids [sprays]."

Not only that, symptoms that look like allergies might turn out to be something else.

"Only half my patients turn out to be truly allergic," Mandel Sher, MD, tells WebMD. "They may have other problems with adenoids, their septum is deviated, they have chronic sinus infection -- all these other causes for chronic stuffy nose. Only half my patients turn out to be truly allergic."

And that's in sunny Tampa Bay, where allergy season lasts at least half the year -- starting in January. Sher is an allergy/immunology specialist and clinical associate professor of medicine and pediatrics at University of South Florida College of Medicine. "You really know when you're there because people are miserable, absolutely miserable, with itchy, watery eyes, post-nasal drip, fatigue," Sher says. "I call them the canaries in the mines. We're right in the middle of it in the last two or three weeks."

Diagnosis of allergies is difficult, says Rachelefsky. "Allergic rhinitis is also associated with sinusitis, ear disease, and asthma," he tells WebMD. "With someone who has asthma, doctors should always check the allergic component. With someone who always seems to have a cold, it may be a sinus infection. But if you treat the sinus infections and don't treat the allergy, then you're chasing your tail."

In the upper Midwest, Iowa City allergist John Weiler, MD, has not yet seen crowds in his waiting room. "It's still early," he says. Weiler says he worries about those who hit the road after taking over-the-counter (OTC) allergy products without realizing their side effects. His research, published recently in Annals of Internal Medicine, showed that standard doses of the antihistamine diphenhydramine, contained in Benadryl and many similar medications, had a greater effect on driving ability than alcohol.

"It's scary," he tells WebMD. "The magnitude of the effect was pretty significant. I think the problem is, not all medications are available OTC, so they're really limiting themselves. But if they visit a doctor, they can get a treatment with less side effects."

Children's hay-fever allergies are often underdiagnosed and undertreated, Houston pediatrician Stuart Abramson, MD, PhD, tells WebMD. "Some people just think the kids are getting colds all the time, or that kids should have snotty noses all the time, that it's just part of being a child. Children who have allergic rhinitis that's not controlled can have problems with sleeping because their nose is obstructed, there's snoring, and if they don't sleep well, then they may not perform well in school. There also may be excessive mouth breathing." Abramson is assistant professor of pediatrics, microbiology and immunology at Baylor College of Medicine.

A simple allergy skin test takes about 30 minutes and will tell your doctor whether you have an allergy and exactly which allergens, such as seasonal tree or grass pollens, produce your symptoms.

Treatment revolves around the key allergy-triggering agents: the immune molecules, called IgE antibodies, that cause your body to respond to allergens; and the chemical histamine, which is released during this process. Antihistamines block the action of histamine, the chemical that is responsible for symptoms such as sneezing and runny nose. Nasal steroid sprays deliver a fine mist to the nose's lining and also suppress the allergic response.

Prescription antihistamines and nasal sprays work best, without side effects, says Weiler. "Nasal steroid sprays are often thought to be most effective treatment for the congestion and some of the runny nose, but they don't work quite as well for itching. Antihistamines work best for itching. The upside of OTC drugs is that they're cheaper, but the downside is that they have more side effects, are more likely to cause drowsiness and jitteriness."

Those who have severe seasonal allergies for which nothing else works can get long-term relief with allergy shots. A recent study published in TheNew England Journal of Medicine showed that allergy shots have long-lasting effects, boosting the body's immune system for three years or more.

The best advice, Weiler says, is to talk to your doctor. "It sounds real simple to just pick up an OTC drug from the pharmacy, but that doesn't work for many people. ... They're really limiting themselves. There are much better treatments available with less side effects."

Vital Information:

  • As allergy season approaches, sufferers may experience coughing, sneezing, sleep disturbances, and headaches, but many will forgo a visit to the doctor.
  • A skin test that takes about 30 minutes can determine whether a patient has allergies, and exactly what he or she is allergic to.
  • It's important to talk with a physician about allergy medications, such as prescription antihistamines and nasal steroid sprays, which work well and have few side effects.
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