Say Goodbye to Hay Fever, Hello to Winter Allergies

Although allergies to pets, mold and dust last all year, they may be more pronounced in the winter when people spend more time indoors.

Depending on where you live, hay fever season might be coming to a close in a few weeks. That’s the good news, and it isn’t coming a moment too soon for the millions of people who suffer from weed pollen allergies. The bad news: with the approach of cold, wet weather, you’ll likely be spending more time indoors where a new set of allergens will step into the spotlight.

Mold, pet dander and dust mites can cause problems year round but when you’re cooped up with them, their effect becomes more pronounced. That head cold or “sinusitis” that just seems to hang around all winter … maybe it’s not a cold after all — it could be an allergic reactions to one of these common triggers. And those recurring ear infections your child gets — they, too, could be caused by allergies.

On the positive side, there are simple ways to fight at least two of these allergens. You can combat mold by keeping your kitchen and bathrooms dry. Be especially diligent about drying showers, where mold likes to grow in corners, and tile countertops where grout can soak up moisture.

Similarly, you can keep dust at bay by cleaning regularly and washing your bedsheets and pillow cases in HOT water weekly. Specialized covers over your mattress and pillows can help control dust mite migration. Dust mites also live in carpets, so vacuum constantly. In addition, dust clings to drapes, stuffed animals and other soft fabrics so make sure you wash them frequently in hot water if you plan to keep them around.

Pet dander can be harder to control if you have a pet, or visit homes with pets. Vacuuming helps if you do it often, but pet hair also sticks onto furniture, clothing and more. And if you let your pet lick you, you’re getting a full dose of allergen right to the face. But who wants to turn away their lovable friend when it’s showing affection? If you can’t keep up the rigid cleaning regiment, and/or don’t want to snub your pet, your best bet might be immunotherapy (allergy drops or shots).

Immunotherapy teaches your body to ignore allergens so allergy symptoms don’t develop in the first place. And both allergy shots, and allergy drops can help you overcome multiple allergies at once — for instance, pet dander, tree pollen and ragweed pollen — so you can resolve all of your allergy triggers with one form of treatment and enjoy the entire year allergy-free. To learn more about immunotherapy, click here.

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Allergy Perils Await Your Child This Fall – What to Watch Out For and What to Do

Back-to-school season can expose your child to a wide variety of allergens.

It’s almost September — time for school, football, cross-country, marching band and soccer. There are lots of allergy traps for your child out there. Read on to find out what to look for — and what to do about it.

At school, three immediate threats come to mind. Number one is dust. Most classrooms sit empty over the summer, giving dust plenty of time to settle on tables, books, window frames, etc. Dust mites find a way of hiding inside of window coverings and light fixtures and lurking deep in hidden corners. When teachers return to those rooms to prepare for a new crop of students, dust may be among the last things they consider — if they have time to think about it at all. Once activity returns to the classroom, that dust gets stirred up and fills the air, wreaking havoc for allergy sufferers.

The second potential problem is food allergies. Depending on the severity of your child’s allergies, simply sitting next to someone eating a peanut butter sandwich could be cause for serious alarm. And peanuts aren’t the only risky allergen out there; for some food-allergic kids, a trip to the cafeteria could be like walking through a mine field. While it may be simple to avoid a specific allergen that appears on a plate in its whole form, that same trigger could be an unsuspected ingredient in another dish. Or a trace amount in the kitchen from a previous day’s meal could wind up in the food by accident. The safest course to avoid problems for allergic children is to pack their lunch at home with known ingredients.

And last but certainly not least, there’s good old pollen. It can affect your child at school both on and off the sports field. Grass and weeds are the serious troublemakers in late summer and fall. Football players, runners, marching band members, and soccer players will spend a lot of time rolling around on — and kicking up — grass and weeds. Their parents, you, will likely find yourself at parks and fields for hours where mown grass will take to the air with the slightest breeze. Even the kids who plays sports themselves are surrounded by the allergens floating in the air and drifting off their classmates’ clothing. Aside from the sniffling and wheezing that affects athletic and musical performance, allergy symptoms have a significant effect on attention and concentration in school, and, consequently, on grades. Unfortunately, while antihistamine use may curb the symptoms, side effects from the meds also tend to negatively impact performance.

So what to do about it all? The first step is to take showers and/or change clothes after spending a lot of time outdoors. For the here and now, it may be necessary to take allergy medications to get a handle on immediate symptoms. But equally important, prepare for the next phase of allergen invasion (for instance, winter mold and spring trees) and get way ahead of the curve for next fall by teaching your children’s bodies to stop overreacting to environmental allergens. Immunotherapy is the only fix, and it is all natural with no medication. It trains your child’s body to ignore the allergens that trigger their symptoms so the allergies go into remission for many, many back-to-school seasons.

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When Allergy Season Peaks, Do You Have a Plan? My Tips for Your Worst Patients

With pollen counts skyrocketing, this could be the worst allergy season in years. Be prepared to help your patients.

It’s happening already: TV stations, newspapers and radio are hyping the severe spring pollen season ahead. As we know, long winters with lots of snow are springboards for high pollen counts. Every year when spring arrives my office phone starts ringing and patients can’t wait one day to be seen. My new patients, that is. I’ll explain the difference below. These new patients’ developing allergy “emergency” can be handled effectively with proper management, but more importantly, the crisis can turn into an opportunity to make sure these patients can enjoy spring without interruption next year. Here’s what I’ve learned about allergy peaks over the past 20 years…

They bring a lot of allergic inflammation! Patients come in with their eyes and noses red and swollen. They’ll tell you they feel miserable – like they have a terrible cold. They’ll also tell you they’re tired but can’t sleep at night. Many will complain that their head feels so heavy and their sinuses so painful. These are the ones with the self-diagnosis of “sinusitis.” And they’re right —their sinus passages ARE definitely inflamed. While we know from our training that the inflammatory process is often the result of allergic response, many patients equate sinusitis with infection. And all of them want solutions. So what should you do?

You reach for your prescription pad to put out the fire. But before you do that, it’s critically important that you make a definitive diagnosis. Allergy skin testing is the gold standard for diagnosing IgE mediated allergic disease. When skin test is contraindicated, IgE blood test is an acceptable alternative. Once you know what you’re dealing with, you can begin the management process. Of course, a positive skin or blood test doesn’t rule out infection but if you know there’s an underlying allergic process, you can’t go wrong by attacking it from that angle. Only a sinus tap confirms infection but if you clear up the inflammation, you can bet that this will rarely be necessary.

The medicine that works best in acute inflammatory situations isn’t the antibiotic that the patient often desires. And once your patient sees and feels the results of an allergy test, he/she will understand this concept. Many of us go straight to oral cortisone because it’s effective! However, there’s an art to prescribing oral cortisone so that it works while minimizing side effects and patient concerns. I’ve found Prednisone at a low dose is the key to quick relief. The dosage is weight-dependent but, as a general rule, 20mg is an effective therapeutic dose for adults and children over 60 lbs. You could increase that for patients over 170 kg, but higher doses usually aren’t necessary. Prednisone, like all oral cortisone, should be taken in the morning to synchronize with the patient’s circadian rhythm. It should always be taken with some food to minimize gastrointestinal upset.

One week of Prednisone is usually enough to quell the acute allergic inflammation caused by the eosinophils in the tissue. This gets the ball rolling to reverse patients’ most severe symptoms but you should complement it with topical sustainable medications as well. For nasal congestion, sneezing and rhinorrhea, there is nothing better than topical cortisone nasal spray. Nasacort is the first one of these sprays available over-the-counter. Your patient can use the 24 hour preparation once each morning.

What the patient may not capture from their over-the-counter purchase is the understanding that correct administration technique is vital for effectiveness and safety. It is important that you and your staff demonstrate and educate on the cross-hand technique; show patients how to spray one pump at a time into the lateral aspect of the nostril using the opposite hand.Using opposite hand makes it easier to avoid accidentally spraying medially towards the septum, which diminishes effectiveness, potentially inspires a bloody nose, and ultimately puts the patient at risk for long term septal damage. Nasal steroids are proven superior to antihistamines in terms of both symptom relief and side-effect profile in head-to-head comparison studies.

Many patients don’t like nasal sprays or worry that they’ll “get hooked” on them. My answer: They work. And, no, you don’t get addicted to cortisone nasal sprays as you might after weeks of consecutive use of decongestant sprays like Afrin. That said, decongestant sprays can be incredibly useful for short term treatment of acute inflammation and can sometimes forestall the need for Prednisone.

Eye symptoms such as redness, itching and tearing can be very debilitating. The best short term treatment for acute allergic conjunctivitis is topical antihistamines. I have several favorites in this area, but you need to check with your patient’s insurance coverage. I’ve had patients call up in a panic that the antihistamine eye drop I prescribed cost over $100 for a tiny bottle. I call them “liquid gold” because they’re very effective but the cost is sometimes precious-metal caliber. A nice trick for enhancing relief is storing the eye drops in the refrigerator to ease the burning sensation. Most eye drops should be administered twice each day. Instruct your patients not to use the typical red-out over the counter eye drops. They contain decongestants which may indeed get the red out but also prove quite addicting. Finally, even while using the Prednisone and topical treatments, I recommend my patients take an antihistamine at night. I prefer Allegra(fenofexidine) or Zyrtec (cetirizine) equivalents because they last for 24 hours and are generally more effective and often less sedating than Benedryl (diphenhydramine).

Now that we’ve successfully weathered the initial storm, it’s time for education. This reminds me of an age old saying: “Never waste a good crisis.” In medicine, I take this to mean that when the patient is really suffering, you have an opportunity to explain that they can avoid this same scenario next year with proper diagnosis and treatment! Sometimes it’s necessary to wait for the crisis to pass before definitively diagnosing. This happens when a patient is too symptomatic and miserable to undergo the test. Either way, once we obtain positive results, I explain that allergen immunotherapy — shots or drops — is the only way to minimize or eliminate their regular allergy crises.

No other tools in our bag can actually change the course of the disease. Keep in mind that symptom treatment must continue and even increase in the early weeks of immunotherapy ramp-up, but at the first quarterly visit you’ll discuss tapering meds -for good! For most patients, the choice is simple: a lifetime of meds with side effects and potential interactions vs four years of using elements from the environment to teach the immune system not to overreact to nature. Imagine if we had such a solution for diabetes or hypertension!

In the end, patients relate well to successful results. It brings a smile to my face when I tell the acute patient: “my waiting room used to be filled with sniffles and watery eyes just like yours. Now I have a waiting room mostly full of patients feeling great and just stopping by to pick up their allergy drops.”

– Dr. Dean Mitchell