ALLERGIC RHINITIS - WHAT YOU NEED TO KNOW
Sneezing, itchy eyes, runny nose, congestion, post nasal drip, cough, itchy ears….. Sound familiar? You might have allergic rhinitis! For some people, triggers for allergies are very obvious - you are around a cat and within minutes your eyes are itchy, your nose is runny, and you can’t stop sneezing. Or, in the summer, you sit down in the grass and after a few minutes the skin on your legs is itchy and red and your nose is going crazy! For some people, the symptoms are more constant or variable and the triggers are not as obvious.
Is it allergies? Or is it something else?
The best way to find out for sure is to have skin prick testing!
In the U.S. approximately 8% of the adult population and 9% of kids have allergic rhinitis. Worldwide the numbers are closer to 10-30% and on the rise!
If you are diagnosed with allergic rhinitis (allergies or hayfever), what can you do?
Basically there are just 3 options: you can avoid what you are allergic to, you can block your symptoms with medications, or you can desensitize to what you are allergic to with immunotherapy (SCIT, known as allergy shots OR SLIT known as sublingual IT).
Let’s talk a little more about these three choices:
1. Avoidance: Avoiding the substances to which your body is allergic effectively reduces symptoms. For some kinds of allergies this is both practical and possible. For instance, if you are allergic to animals, avoiding contact with them can greatly reduce uncomfortable symptoms. For many common allergens, though, it is both difficult and impractical to completely avoid contact. There are some things that can help.
For indoor allergies such as dust mite and animals - START IN THE BEDROOM! Completely encase mattresses and pillows in dust mite-impermeable covers. Close bedroom doors to keep animals out. Install a HEPA air purifier in a space that you can enclose (such as a bedroom w/a door). For even better control, talk to an HVAC profession about indoor air quality options.
For outdoor allergies such as grass and trees - try to avoid HIGH exposures such as sitting in grass, mowing the lawn, playing in hay, touching your face or eyes after touching trees and grass. Mitigate the effects of high exposure by showering after being outside, rinsing out your eyes w/ saline eye drops, rinsing your nose with saline nasal rinse. Remember, though, that pollens float in the air for miles and miles. It’s impossible to completely avoid pollen exposure. And it doesn’t really matter what tree is growing in your neighbor’s yard. During tree season, tree pollens are present and high in the entire Willamette Valley.
2. Medications: There are several classes of medications available to help control the symptoms of allergic rhinitis including antihistamines (OTC), nasal steroid sprays (OTC) eye drops (some OTC some rx), antileukotriene blockers (rx) nasal antihistamine sprays (rx) and asthma meds (if needed). For someone with moderate to high allergies, it is important to remember that ONE medication alone is unlikely to be enough to block the intensity of the allergic reactions that you experience There are two important things to understand about using medications to block your allergy symptoms.
Medications are only blocking your symptoms related to allergy so that you can enjoy life unhindered by annoying symptoms. They are not a cure. So when you stop medications, the symptoms are free to recur when you are exposed to the allergen.
It will take more medicine to get your symptoms under control after you are flared up then it will to keep them under control once they have calmed down. Starting your meds after your symptoms are out of control is like closing the barn door after the animals are out! It takes a lot more effort to get the mayhem under control than if the barn door had just stayed closed. Similarly, it may take more medicines and higher doses to get a flare under control than it will take to keep symptoms at bay. This is especially important when you think of pretreating for a “pollen season” or for exposure to animals, etc. Start your medication regimen as directed by your doctor just prior to the start of your allergy season or allergy exposure BEFORE you are in a huge allergy flare.
Avoidance and environmental control is a great way to reduce your need for medication or improve how effective your medication regimen is. However, if you have moderate to high allergies, it’s unlikely that you will be able to completely control your symptoms with avoidance alone. What else can you do?
3. Immunotherapy: Allergy shots are an immune treatment designed to “teach” your immune system to tolerate the allergens to which you are allergic. Skin testing would be required to determine which allergens you are sensitized and how severely. We then use concentrates of these antigens and create a unique formula to you. This serum is diluted down to a low level that your body can tolerate and then injected into the subcutaneous area of your upper arm. Each visit, the dose is increased as tolerated (like climbing a ladder). There is a certain number of steps you must take to reach a level that basically matches the level of allergens you are exposed to in life creating a tolerance. So the more regularly (1-2x per week) that you come in for an allergy shot during the “building” phase, the faster you will get to a level that will noticeably reduce your symptoms. After the building phase, you reach the “maintenance” phase. The “top” dose is maintained with a shot every 2-4 weeks for a period of time until your body has learned to tolerate exposure to these allergens in your life. Three to five years at maintenance is generally recommended before immunotherapy is discontinued.
Studies have shown that 80% of people who complete this program reach 80% or better symptom control for at least 5-10 years, and often longer. Although this treatment option is more labor intensive, it is an immune treatment that is likely to reduce or eliminate your need for medication over time and effectively “cure” your allergies.
In recent years, the FDA has also approved SLIT, or sublingual immunotherapy, (an under-the-tongue dissolvable tablet) for grass, dust mite, and ragweed. These therapies have proven to be be effective, though they do not necessarily create the long term desensitization that can be obtained with allergy shots.
The benefit of SLIT includes the ability to take this treatment at home (after an in office observation visit for the first dose) and a lower risk of serious side effects. The downside of SLIT is that you are only treating ONE allergen with each tablet. So, if you are allergic to many different trees, grasses, weeds, and animals, treating just one of these with a sublingual tablet may not provide much noticeable benefit. Allergy shots could be a better option since more than one allergen can be desensitized through the immunotherapy process.
So even though there are only a few proven and effective treatment approaches for allergic rhinitis, there is a wide variety of choices WITHIN the three methods. The key to managing your allergies is to educate yourself, be proactive, and stay ahead of your reactions! Make an appointment with one of our providers today to tailor a regimen that works best for you.