There may still be patches of snow smothering your crocuses, but believe it or not, springtime allergy season is only about 10 days away – and for some poor souls it’s already begun.
But you may be able to head off trouble before it starts.At least that’s the current thinking of allergy specialists, who say that if you’re among the 26 million Americans likely to get allergic rhinitis, or hay fever, consider calling your doctor now to start taking medications before symptoms get bad.
There’s also another reason to attack allergies before they attack you. The medications are getting better – and we’ll get to the newest ones in a minute.
Allergies, miserable as they can be, simply mean that “the body is making an inappropriate immune response” to specific triggers, or allergens, in the environment, says Dr. Marshall Plaut, chief of the allergic mechanisms section at the National Institute of Allergy and Infectious Diseases.
Altogether, about 50 million of us are allergic to something – either seasonal, outdoor things like trees and grasses, or year-round indoor things like mold, dust or cats. Or both.
In the spring, the big culprit is pollen – a packet of male genetic information that trees and grasses release into the air to be carried to female organs in the same plant or one nearby.
Right now, it’s pollen from elms, willows, poplars, and maples that is likely to cause the most grief. By May, it’ll be the oak, birches, and beeches. By June and July, grass pollen will be the culprit; and by Labor Day, ragweed.
Depending on your genetic makeup, pollen from a particular kind of tree, say a birch, may cause an immune reaction – release of a type of antibody called IgE. This antibody sits on the surface of mast cells – immune cells that line the nose, throat, gastrointestinal tract and skin.
The next time this pollen enters your system, it combines with these antibodies, causing the mast cells to release histamine and other chemicals that trigger an allergic reaction. These chemicals make blood vessels dilate and leak proteins into tissues, causing swelling – the stuffy noses of allergy sufferers – or hives on the skin.
Usually, this is just annoying. But allergies are also the leading cause of asthma, an inflammation of the bronchial tubes. Like colds, allergies can also trigger sinusitis, an inflammation of the sinus cavities around the eyes and nose.
The basic problem is that “allergies can swell your nose internally,” says Dr. Marvin Fried, chief of ear, nose and throat medicine at the Beth Israel Deaconess Medical Center and Brigham and Women’s Hospital.
Once the sinuses become blocked, mucus cannot drain properly, which means that any virus or bacterium can “set up shop in this nice warm environment,” he says. Infected mucus then drips into the lower respiratory tract, where it can cause bronchitis and asthma. It can also seep into the eye or brain, where, in rare cases, it can cause life-threatening infections.
So what can you do?
“Call the doctor now. Get a jump on the allergy season. If you wait until Memorial Day and you’re feeling miserable, you’ll need even more powerful medications,” says Dr. Julian Melamed of Allergy and Asthma Specialists in Chelmsford.
And if you’re discouraged because medications you’ve tried in the past haven’t worked or caused too many side effects, call anyway, because there are new products available this spring.
These include Astelin, a recently-approved antihistamine nasal spray that should not make you sleepy because it acts only in the nose, not throughout the body; Nasalcrom, an anti-inflammatory spray once available by prescription but now available over the counter; and Allegra, an antihistamine pill that does not cause drowsiness or heart rhythm disturbances, as its more famous, soon-to-be-banned cousin, Seldane, does.
The main preventive measure to start now, says Melamed, is an anti-inflammatory nasal spray. One choice is Nasalcrom, a safe drug that does not contain steroids but that is relatively weak and does not work for everybody.
You could also try one of the more powerful prescription corticosteroid sprays, such as Vancenase, Beconase, Flonase or Nasacort . These can be very effective, but can also cause nasal dryness and in large doses over many months can irritate the eyes. In children, they may intefere with growth, but only at high doses.
These medications, which keep down swelling in the nose by damping down the inflammatory response, usually take a number of days to begin working. So if your doctor agrees, you may want to start taking them soon so they will have kicked in by the time the trees and grasses start pollinating.
Antihistamines, which act through a different mechanism to block release of histamine, usually work faster than the anti-inflammatory drugs. Talk to your doctor about what antihistamine to use and when to start using it.
Traditionally, the over-the-counter formulations have worked well but also caused drowsiness. “In recent years, the big advance has been development of nonsedating antihistamines,” says Dr. Paul Chervinsky, president of the New England Research Center in Dartmouth, a private group that tests allergy drugs. But these drugs are available only by prescription.
The initial star in this category was Seldane, but in January, the US Food and Drug Administration announced its intention to withdraw approval of Seldane because it has contributed to cardiac arrhythmias in people who were also taking certain antibiotic or antifungal drugs.
Besides, the FDA reasoned, there is now a better alternative: Allegra, which was approved last summer and, like Seldane, is made by Hoechst Marion Roussel.
Other nonsedating antihistamines that may help are Claritin, the biggest seller, and Zyrtec, which can cause some drowsiness. There’s also Hismanal, which is still on the market but has been linked to the same cardiac problems as Seldane.
But you may have to fight for these drugs. Some cost-conscious managed care plans ask doctors not to precribe nonsedating antihistamines, which can cost roughly $ 60 a month.
In addition to antihistamines, which relieve runny noses, sneezing and watery eyes, decongestants like Sudafed can help with other symptoms, notably a stuffy nose, by constricting blood vessels. The oral decongestants can raise heart rate and blood pressure and contribute to insomnia, so you may want to avoid them at nighttime.
The decongestant sprays like Afrin and Neo-Synephrine cause fewer of these problems, but they can cause stuffiness to “rebound” if used for more than three days.
If all else fails, you may need allergy “shots,” a series of injections that can train your immune system not to overreact every time a speck of pollen comes along. But this treatment can take months to complete, so you probably can’t count on it for this year’s allergy season.
And if your allergies seem to be evolving into asthma or sinusitis, it’s all the more reason to call the doctor.
“In the middle of it, it’s hard to tell” whether you’ve got a cold, allergies or sinusitis, says Fried of Beth Israel. But the American Academy of Otolaryngology now offers some rules of thumb for sorting it out.
With allergies, for instance, the nasal discharge is usually clear, thin and watery. But it turns thick and yellow-green, or you develop a fever, bad breath, pain in your upper teeth and you feel quite sick for 10 to 14 days, you may have a bacterial sinus infection.
The usual treatment for that is a long – three to six weeks – course of antibiotics, though a recent study in the medical journal Lancet questions how effective such treatments are.
If sinusitis becomes a chronic problem, as it does for about 35 million Americans, you may also consider endoscopic surgery – in which doctors insert instruments through the nose to make holes for better drainage of sinus cavities.
The procedure is not without risk, says Fried, a pioneer in the method, because probing the sinuses brings surgical instruments close to the eyes and brain. But the safety of this procedure, now done 250,000 times a year, has improved considerably with imaging techniques that allow a surgeon to “see” exactly where the instruments are.
And if your allergies bring on significant coughing or trouble breathing, you may have asthma.
“Asthma is a major sequel of allergies,” says Melamed of Chelmsford. In fact, allergies are the most common cause of asthma, which, though treatable, kills 5,000 people a year.
The cornerstone of asthma treatment is still inhaled steroids to dampen down the inflammatory response, but two newly approved drugs – Accolate and Zyflo – may also help by blocking the chemical chain reaction that sets off the asthma response.
“If you have asthma, it’s even more important that you treat allergies,” says Plaut of the allergy institute. There is even some evidence that children who get allergy shots may be less likely to develop asthma later, though this is unproved.
The take-home message, he says, is that “while allergies cause a lot of discomfort and can cause significant illness, there are treatments that can improve your quality of life.”
Telling symptoms
It can be hard to determine if you’ve got a cold, allergies or sinusitis. Colds get better by themselves, but allergies and sinusitis persist and often need medical treatment. Here are the distinguishing symptoms.
Symptom Sinusitis Allergy Cold Facial pressure/pain YES Allergy Sometimes Cold Sometimes
Duration of illness Sinusitis More than 10-14 days Allergy Varies Cold Less than 10 days
Nasal discharge Sinusitis Thick, yellow-green Allergy Clear, thin, watery cold Thick and whitish or thin and watery
Fever Sinusitis Sometimes Allergy NO Cold Sometimes
Headache Sinusitis YES Allergy Sometimes Cold Sometimes
Pain in upper teeth Sinusitis Sometimes Allergy NO Cold NO
Bad breath Sinusitis Sometimes Allergy NO Cold NO
Coughing Sinusitis YES Allergy Sometimes Cold YES
Nasal congestion Sinusitis YES Allergy Sometimes Cold YES
Sneezing Sinusitis NO Allergy Sometimes Cold YES SOURCE: American Academy of Otolaryngology.