Written by Steven Burns
From his column To Your Health
Are you sneezing? Runny nose? Watery eyes? Are there foods you can’t eat because they make your mouth itch, or cause hives? Then most likely you are one of over 50 million Americans with allergies. Allergic conditions range in severity from minor nuisance (mild hay fever) to life-threatening (anaphylactic shock), and they are the sixth leading cause of illness in the United States.
Respiratory allergies, such as hay fever and asthma, can make life miserable during seasons of high pollen and mold counts. Most hay fever sufferers know which seasons are worst for them, and testing often confirms that certain trees, weeds, and grasses are triggers for their allergy flares. Allergies to pollens and mold spores occur when the particles land on mucus membranes in the lining of the nose, throat, and respiratory tract. For most people, there is no reaction, but for others, a cascade of events occur.
For those with allergies, when a pollen grain lands inside the nose, the body views it as a “foreign substance” that may be dangerous. In response, sensitized mast cells start releasing chemicals, such as histamine, that cause the mucous membrane cells to swell and become itchy. They then produce a large amount of mucus, which, along with irritation, can cause us to sneeze or travel down the back of the throat. As the irritating chemicals spread, we experience itching and swelling in the throat and, for some, in the trachea and bronchi. Asthma can have many triggers, but this type of allergic reaction is one of the most common. The reaction can continue for a few hours, days, or even months, depending on how much pollen is in the air and how sensitive we are to it.
Anaphylaxis is a much more dangerous form of allergic reaction with complex cell mechanisms that are not thoroughly understood. It involves a massive release of mast cell chemicals that cause blood vessels to dilate rapidly, and all sorts of lining cells in the body to swell—all at once. An anaphylactic reaction causes shortness of breath, with swelling of the airways. Blood pressure drops, and a person can become unable to breathe, sometimes resulting in death. You’ve probably known people who carry an epinephrine pen injector in case of bee sting or contact with certain foods, such as shellfish and peanuts. When someone experiences the beginning of anaphylaxis, they have only a short time to inject epinephrine to avoid a severe and possibly life-threatening reaction.
Treatment of allergies can include several types of medications. The most common, a type most of us have in our medicine chests, are antihistamines. They block the effects of the chemical histamine. Most are very effective and available over the counter. Loratadine, fexofenadine, and cetirizine are relatively non-sedating, compared to diphenhydramine. Such drugs are generally safe; however, they can interact with other medications, and with certain conditions. For instance, antihistamines can cause problems with blood pressure and with one type of glaucoma. They can also worsen memory problems in those who are starting to have such difficulties.
Other options are prescription drugs, such as prednisone and other steroids, mast cell stabilizers, and leukotriene inhibitors. Beta adrenergic medications such as albuterol can help with asthma. Also, for severe allergies, newer types of injectable meds are available. These are of a type called monoclonal antibodies. For those with severe allergies, they can be life-changing. Individuals can also see an allergist for testing and immunotherapy (“allergy shots”). Immunotherapy is effective in about 7 of 10 people who receive the shots.
If you suffer from minor allergies, you can treat them with either over-the-counter medications or by avoiding the allergen, whether pollen or food. For instance, if certain times of the years cause hay fever, wear a mask (remember them?) when outdoors to prevent allergic responses. For more severe allergies, see your primary care provider. He or she can help you determine the best treatment to keep you healthy and breathing free.
Steven C. Burns, MD, is board-certified in family medicine and has been in practice for more than 30 years.