By Mary Jo Rolfes-Lo, MD
Spring has finally arrived, along with warm sunshine, green grass, tree foliage and blooming flowers. The change is welcome – unless you are one of the millions of people who suffer from springtime allergy symptoms.
Nasal congestion, a runny nose, sneezing, post-nasal drainage, nasal itching, sinus headache and allergic eye symptoms come with the change of seasons and can interfere with day-to-day activities, sleep and quality of life.
Ocular allergy symptoms that affect the eyes include itching, tearing, eyelid swelling, redness, morning crusting, swelling, and darkening of the skin under the eyes, sometimes called allergic shiners. Chemosis, or swelling of the conjunctiva or outer surface of the eye, can also be a symptom of allergies.
Spring allergens can also trigger vernal keratoconjunctivitis (VKC), an uncommon but severe form of ocular allergies. VKC can cause damage to the surface of the eye. It can lead to corneal scarring and vision loss if not treated properly.
Signs of VKC include sensitivity to light, thick mucus discharge, tearing, burning, foreign body sensation in the eye, blurred vision and eye pain. A child or adult who has VKC symptoms should be seen by an allergist and also evaluated by an ophthalmologist, or eye specialist.
Ocular and nasal symptoms are the most common signs of spring allergies. However, additional seasonal symptoms can include ear itching, fullness and discomfort; throat and palate itching; and sore throat, cough and hoarseness due to post nasal drainage.
Spring allergens can also trigger asthmatic symptoms of cough, wheezing, shortness of breath and chest tightness.
Tips to reduce seasonal symptoms
The first step in controlling symptoms caused by pollens and outdoor molds is to limit exposure to allergens. The following tips can help:
Stay indoors, especially during early morning hours when pollen counts are high. Windows and doors should be kept closed.
Wash your hands and face after being outside.
Machine dry sheets, blankets, towels and clothing. Pollens and outdoor mold spores can stick to fabric.
Shower before bed to remove outdoor allergens from your skin and hair and prevent pollens from getting into pillows and bedding.
Tie back long hair, as pollen settles in hair and can touch your face.
If allergen avoidance does not decrease ear, eye, throat or nasal symptoms, over-the-counter medications may help.
Oral antihistamines are first-line therapies. Long-acting, non-sedating over the counter antihistamines are recommended. Examples include loratadine, cetirizine, levocetirizine and fexofenadine.
Nasal steroid sprays are the next line of defense. Sprays are best started before the allergy season and need to be used regularly to provide relief.
Steroid sprays do not act quickly. Most patients will need to use them consistently for a few weeks to realize a benefit. Examples of over-the-counter nasal steroid sprays include fluticasone, budesonide and triamcinolone.
Decongestants such as Sudafed can be used as needed to help with congestion. They can cause side effects including elevation in blood pressure, palpitations, insomnia and urinary retention.
Nasal decongestants containing oxymetazoline and phenylephrine are generally not recommended for treating allergic disease. They should not be used for more than two to three days.
Sinus rinses may provide relief
Sinus rinses are a non-pharmacologic way to remove allergens from the sinuses and prevent symptoms. They can be used once or twice a day, depending upon the severity of symptoms and individual tolerance for daily rinses.
A squeeze bottle, nasal syringe, or small neti pot and premixed, low-cost salt packets can be obtained from the pharmacy. Be sure to keep the neti pot clean and follow storage recommendations for the salt.
To make your own sinus rinse, use distilled, sterile, or boiled and cooled water. For every quart of water, add 1 teaspoon of baking soda and 1 to 1.5 teaspoons of canning or pickling salt. Do not use regular table salt, which contains other chemicals that can be harmful.
Allergy testing can be helpful in identifying the allergens responsible for symptoms. Testing helps your physician develop a plan for medical therapy and allergen avoidance.
Immunotherapy or allergy shots can be very effective in relieving allergy symptoms, especially for patients who do not like to take medications or when other treatments do not provide adequate relief or cause side effects.
Patients with asthmatic symptoms should be evaluated by a board-certified allergist to help identify triggers, provide information on avoidance of allergen triggers, and evaluate the need for asthma medications. Several new advances are available in asthma treatment, including the use of injectable biologic medications and new inhaler technologies.
Seasonal allergies can be challenging, but they can be reduced and treated. Ask your doctor about any symptoms you experience that may be related to allergies.
Mary Jo Rolfes-Lo, MD, is certified by the American Board of Allergy and Immunology. She sees patients at the ProHealth Medical Group clinics in Hartland, Muskego and Waukesha.
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For more than a century, ProHealth Care has been the health care leader in Waukesha County and surrounding areas, providing outstanding care across a full spectrum of services. The people of ProHealth Care strive to continuously improve the health and well-being of the community by combining skill, compassion and innovation. The ProHealth family includes ProHealth Waukesha Memorial Hospital, ProHealth Oconomowoc Memorial Hospital, ProHealth Rehabilitation Hospital of Wisconsin, ProHealth Medical Group, the UW Cancer Center at ProHealth Care, Moreland Surgery Center, ProHealth AngelsGrace Hospice, ProHealth Home Care, ProHealth West Wood Health & Fitness Center and ProHealth Regency Senior Communities. Learn more at ProHealthCare.org.