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Aah-aah-aah-choo! That sound marks the time of year for stuffy noses and itchy, watery eyes. The best treatments are started early and used regularly. Here are some tips on natural, over the counter, and prescription relief, as well the closest thing to a cure for allergies.

Allergies are the result of pollen triggering the release of histamine by mast cells. Histamine will cause blood vessels to swell and leak leading to the symptoms of allergies. Histamine also triggers other chemicals that cause inflammation. Mast cells line the respiratory tract and are also found in the skin which explains why allergy symptoms present as sneezing, nasal congestion, itchy watery eyes, wheezing, hives and soft tissue swelling.

The best treatment is to avoid allergens altogether. Clearly moving to another environment is not practical but avoiding allergens is somewhat possible. Wearing a pollen filtering mask while mowing the yard or feeding hay to the livestock will keep down the load of inhaled pollen. Using a drum type HEPA filter in the home, especially bedroom, or using a whole house filtration system is very effective in lowering the pollen load while at home.

The different types of treatment work by:

  • Keeping mast cells from releasing histamine
  • Binding to histamine and rendering it harmless
  • Modulating the immune system
  • Suppressing the immune response

Mast cell stabilizers aim to keep histamine from ever being released in the first place. There are nasal sprays such as Cromolyn and eye drops such as Alomide available. These are best if used regularly before pollen is encountered.

Anti-histamines are the mainstay of allergy treatment and work by binding to histamine after its release and rendering it ineffective. The old diphenhydramine (Benadryl) type meds work fine but have sedating and drying side effects. The newer, mostly non-sedating meds such as Zyrtec and Claritin work better. Nasal sprays such as Astelin and eye drops such as Zaditor work well. Again, these types of meds work best if they are already in your system before pollen is encountered and histamine released.

Decongestants don’t really stop the allergy process – they tighten blood vessels and result in a temporary reduction in the swelling and congestion. Meds such as Sudafed can cause dry mouth and high blood pressure. Nasal sprays like Afrin and eye drops such as Naphazoline work well, but decongestants should be used sparingly and only as needed for temporary relief of symptoms since they can cause a “rebound” flare of allergy symptoms when stopping after using long term.

Steroids are the last line of allergy treatment and work by suppressing the immune response, especially after histamine has had a chance to really get the system riled up and secondary inflammation started from chemicals such as leukotrienes and prostaglandins. Due to serious side effects we try to avoid steroids altogether, use them for short periods of time, or use them locally in the form of nasal or bronchial sprays or eye drops.

Steroid nasal inhalers including Flonase or Rhinocort work very well and are relatively safe. Regular use during allergy season is successful for most people. Patients with wheezing/asthma do well with steroid lung inhalers such as Advair or Flovent. For severe cases we often prescribe a few days of oral steroids or administer a steroid injection that lasts a few weeks. Again, due to long term side effects we try to limit the steroid pills or shots.

Natural treatments work in a variety of ways to regulate the immune response to allergies or soothe the respiratory tract. I’ve had good luck with a product called Seasonal Freedom (caper, olive leaf, black currant, panax ginseng) that decreases response to allergens. Allerg-Ease is another product which is a formulation of naturally extracted, standardized Traditional Chinese Medicine herbs that act together to decrease IgE – the antibody which is related to allergies and triggers histamine release.

The Allergy Cure

Immunotherapy (IT) is recognized as the only curative treatment for allergies. By exposing the immune system to slowly increasing concentrations of an allergen it will eventually stabilize and regain control of the portion that is hypersensitive to the allergen.  Traditional “allergy shots”, known as Subcutaneous Immunotherapy (SCIT), work well about 50% of the time.  The problem with shots is they are dangerous, expensive and involve time consuming trips to the doctor.

Sublingual immunotherapy (SLIT) involves taking daily “allergy drops” under the tongue where the allergens are absorbed in the oral mucosa.  This is the preferred method worldwide, are just as effective as shots, yet are much safer, less expensive, and done at home.

I’ve done SCIT in my private practice for 25 years and honestly continue with it only because insurance covers it.  I predict SCIT will soon be a thing of the past other than for limited areas such as bee-sting allergies.  SLIT will replace SCIT in the mainstream, yet both are only about 50% effective and only used for environmental allergens.

My preferred and most used allergy treatment is Low Dose Immunotherapy (LDI) which we observe works about 90% of the time for environmental allergies.  We also use LDI for allergies to foods, chemicals, and molds.   LDI is similar to SLIT in that the allergen mixtures are given as under the tongue drops.   At first the drops are given every 2 months but typically patients will get relief for longer periods of time and eventually need the drops only a few times per year.


Author

Scott Rollins, MD, is Board Certified with the American Board of Family Practice and the American Board of Anti-Aging and Regenerative Medicine