Hay fever season is here. For some people, their allergy symptoms are pretty obvious. As soon as the tree, grass and weed pollens appear, so do the itchy and watery eyes, runny noses and sneezing attacks.
For others, allergy symptoms are more subtle and difficult to figure out. Some people develop sinus congestion, which creates a feeling of pressure around the eyes. This can cause a persistent dull headache. Others develop post-nasal drip which causes throat irritation and a cough. Some people just feel itchy all over. Mild fatigue is another common symptom.
For most people with allergies to tree, grass and weed pollens, springtime is when their symptoms flare up. However, hay fever can be a year-round problem in mild climates where pollen is released during all seasons. Allergies to dust mites, mold, mildew, animal dander and cockroach droppings can also cause symptoms year-round. All of these things that can cause allergies are called "allergens."
Allergy symptoms start when the body is exposed to an allergen and the immune system overreacts. (This tendency for the immune system to overreact is genetic.) The body, in an attempt to protect itself from what it perceives to be a foreign invader, produces antibodies called immunoglobin E (IgE). This IgE then triggers the release of inflammatory chemicals such as histamine, cytokines and leukotrienes.
The histamine and other substances cause swelling of the nasal passages and an increase in mucus production. They make the eyes water and itch and can cause itchy skin.
Since too much histamine is the cause of these symptoms, it makes sense that the most common anti-allergy drugs are antihistamines.
Some antihistamines are sold over the counter. Diphenhydramine (the active ingredient in Benadryl® and other similar brands) is the most common type. It suppresses allergy symptoms but may cause drowsiness.
Prescription antihistamines have the advantage of not causing drowsiness, but they are more expensive. You've probably seen the ads on TV and in magazines for all the various brands: Zyrtec®, Allegra® and Clarinex®. Claritin® was formerly sold by prescription but is now over the counter.
Sometimes, antihistamines are combined with a decongestant, like pseudoephedrine. The combination of the two drugs may work well for people who have a lot of sinus congestion.
Another option for people with mild allergy symptoms, who don't want to take pills, are nasal sprays. Some, like cromolyn sodium and decongestant sprays are sold over the counter. Prescription strength nasal sprays contain topical steroids, and are very safe.
There are also antihistamine eye drops (both over the counter and prescription) that can help if your eyes are watery and irritated.
Anyone with severe allergy symptoms (ones that prevent you from functioning normally), or who wants to try a prescription antihistamine should see a health care provider. Prepare for your appointment by making a list of the symptoms that are bothering you and when they first started. Also make a note of any over-the-counter medicines or herbal supplements you may have tried.
Avoiding pollen is difficult. When plants are in bloom, pollen is airborne and touches just about everything. There are a few things you can do to minimize your exposure to pollen:
Keep the windows in your home closed, especially in your bedroom.
Stay indoors in the morning, when pollen counts are highest.
Stay indoors on sunny, windy days.
Consider wearing a mask designed to filter out pollen when outdoors.
Vacuum and dust your home often.
Clean your sheets, blankets and especially pillowcases frequently.
If you've been outdoors, shower and shampoo your hair before going to bed to rinse away all the pollen.
HEPA air filters can help filter indoor air.
Kathryn B. Brown is a family nurse practitioner with a master's degree in nursing from OHSU. Is there a health topic you would like to read about? Send your idea to firstname.lastname@example.org.