“Did you ever wake up with two black eyes as a kid?” said one MedShadow reader and former allergy sufferer. “In addition to being miserable, I had to explain to people all the time that I wasn’t a fighter. You’d think weighing about 80 pounds ‘til high school would make that obvious.”
March 21, the equinox, marks the official first day of spring. Along with the season of rebirth, growth, and warming temperatures, with the equinox comes something slightly less pleasant than spring. According to the Asthma and Allergy Foundation of America, for over 50 million U.S. residents, the season also means seasonal allergies.
Many Suffer from Seasonal Allergies
“I used to wake up and look like I’d fought Muhammad Ali,” further explains Jason, who said his symptoms often left him looking like he had black eyes. Now, age 38, he and his parents spent years of his childhood trying to find a solution.
“I was around12 when I started getting shots,” Jason says. “Before that, there were months that I couldn’t spend any real time outdoors. I was a pale kid, and my sunken, itchy eyes were a scary sight.”
Jason says that he spent many springs with what looked like black eyes. His symptoms, he adds, would cause drowsiness, itchy, watery eyes, sunken and darkened skin around the eyes, and nasal discharge.
Another reader, Helen, echoes Jason’s sentiments. Unaware of, and later unable to afford, the shots to alleviate her symptoms, Helen continues to sneeze through her toughest weeks.
“I just brace myself come spring,” says Helen, who has suffered from seasonal allergies for as long as she can remember. Now, 46, she says, it is just a fact of life she tries to deal with to ease her comfort. “I try to avoid medications as much as possible. When that time of year rolls around, I simply know to stock up the tissues, avoid too much time outside, and grin and bear it.”
Depending on what you are most allergic to, the “when” of your allergy season may vary. Your symptoms will also sway depending on your location.
“Tree pollen season is usually at the beginning of spring in March, April, and the first half of May while the grass pollen season is typically mid-May through early-to-mid-July,” he said in the article. “And the ragweed season is usually from mid-August until that first frost.”
Those in the southern states may find that pollen seasons start as early as January, as the growing cycle (and warmer temperatures encouraging budding) emerge earlier in areas closer to the equator.
Climate change may also be impacting the timing of seasons.
“Tree pollen typically pops up in early to late March, and climate change may lead to earlier and longer pollen seasons,” Dr. Aaron Westreich, told MedShadow in a recent press release. Westreich is a fellowship-trained allergist/immunologist at ENT and Allergy Associates, LLP.
Types of Allergies
Westreich said not all allergies are the same. Timing of the worst of the impacts vary by far more than where you call home.
“There are two types of allergies: perennial and seasonal,” he said. “Perennial allergens can affect people all year round, whereas seasonal allergies occur during particular seasons such as spring or fall.”
When triggers impact you most varies depending on what precisely the trigger is.
The typical triggers for perennial allergies are dust mites, mold, and pets, while pollen is the primary trigger for seasonal allergies. Both conditions typically involve similar symptoms.
Some call a third type of allergy, or those that suffer from both perennial and seasonal together, “hayfever.” Though the name is misleading, and those that suffer do not have to be exposed to actual hay, as the name implies.
Still others may call the same ailments a more technical term known as “allergic rhinitis.” All of the names boil down to one thing for those suffering: a rough start to the spring season!
The American College of Asthma, Allergy, and Immunology (ACAAI) notes that, despite the various triggers or timings, many of the symptoms sufferers experience are similar.
Symptoms typically include (listed in order of most reported to least):
- Runny nose
- Itchy eyes, mouth or skin
- Stuffy nose due to blockage or congestion
- Fatigue (often reported due to poor quality sleep as a result of nasal obstruction)
Common Allergy Triggers
Symptoms typically peak at the time of exposure to triggers, or to those things in which the person is allergic. Typically, triggers include:
- Outdoor allergens, such as pollens from trees, grass, weeds, and mold spores
- Indoor allergens, such as pet hair or dander, dust mites, and mold
- Irritants, such as cigarette smoke, perfume, and diesel exhaust
How Do I Know If I Have Allergies?
Allergy testing with a medical professional is the most accurate way to identify your allergies, according to Westreich. Skin-prick testing, and sometimes blood tests, will help your physician determine what your precise allergies are.
Skin testing often requires small rollers to be pressed lightly into the skin in order to prick or scratch the surface. Small drops of specific allergens are placed on the points to monitor your reaction. Often the spots will be circled, if necessary, to view the precise point of application. Reactions can be hive-like, with red, itchy bumps occurring in spots of application.
“Correctly identifying allergy triggers is a key component of effective management,” says Westreich. “Treatment options for allergies can vary, but the most common treatment options are environmental control, medications, and immunotherapy via allergy shots or sublingual tablets.”
It may be common for similar symptoms to appear with the common cold or the flu. To find out if they are allergies, more accurate testing would be required.
Treatment for Allergies
As Westreich noted, depending on the type, severity, and life impact of the allergies, there are multiple options for treatment. Some sufferers, such as Helen, noted they simply prepare their environment for the seasonal impacts of her allergies. Others seek more medically focused approaches.
If you’ve turned on a television lately, you’ve likely seen countless advertisements for both prescription and over-the counter allergy medications. Even without a prescription, there are many options allergy sufferers can turn to during the worst of their symptoms.
When most people hear “allergies,” they immediately think of the tiny pink pills sold under the brand name of Benadryl (diphenhydramine). These antihistamines are taken orally and generally bring about drowsiness for many. These medications are often called “first-generation antihistamines.”
The newer products on today’s market are being called “second-generation antihistamines,” which include name brands such as Claritin, Allegra, Zyrtec, or Xyzal. These tend to cause low or no drowsiness, which is a major side effect complaint of users of its predecessors.
How Do Antihistamines Work?
Histamine is a naturally occurring chemical in the human body. It serves a number of purposes.
“Histamine is an important chemical that has a role in a number of different bodily processes,” said a 2020 Cleveland Clinic article reviewed by its medical staff. “It stimulates gastric acid secretion, plays a role in inflammation, dilates blood vessels, affects muscle contractions in the intestines and lungs and affects your heart rate. It also helps transmit messages between nerve cells and helps fluids move through blood vessel walls.”
So, how does blocking these histamines help in combating allergies? Histamine released if your body encounters a threat from an allergen. Histamine causes vessels to swell and dilate, leading to allergy symptoms. For example, when your body encounters an allergen, histamines flood that area. If you breathed the allergen through your nose, your nostril may fill with mucus. If your site is the skin in the case of a mosquito bite, histamines may cause a red, itchy bump. The histamines cause that “exposed” tissue to swell. If the tissue in your nose swells, it can be harder to breath, which is why you feel stuffy.
Over-the-counter medications such as Benadryl and Allegra are an antihistamines, meaning they block or prevent the histamine from reacting.
“Antihistamines block the effects of a substance called histamine in your body,” reads the United Kingdom’s National Health Service (NHS) website. “Histamine is normally released when your body detects something harmful, such as an infection. It causes blood vessels to expand and the skin to swell, which helps protect the body.”
In the case of those suffering from allergies, the body thinks that a trigger is actually a real threat.
“But in people with allergies, the body mistakes something harmless – such as pollen, animal hair or house dust – for a threat and produces histamine,” said the NHS site. “Histamine causes an allergic reaction with unpleasant symptoms including itchy, watering eyes, a running or blocked nose, sneezing and skin rashes.”
To prevent such a reaction, an antihistamine can act in one of two ways.
“Antihistamines help stop this [threat detection from] happening if you take them before you come into contact with the substance you’re allergic to, or they can reduce the severity of symptoms if you take them afterwards,” explained the NHS site.
Common Side Effects of Antihistamines
In addition to the aforementioned drowsiness many people experience with antihistamines, there are still more side effects to consider. Most reported symptoms such as:
- reduced coordination, reaction speed, judgment
- dry mouth
- blurred vision
- difficulty peeing
Even the newer generation of antihistamines, designed to avoid the drowsy side effect, still comes with risk. Side effects of non-drowsy antihistamines can include:
- dry mouth
- mild drowsiness
As with any medication, it is best to read all packaging and warning labels before consuming the treatment. Be sure to take a recommended dosage and reach out to a doctor or pharmacist if you have questions.
Antihistamine Drug Interactions
In addition to side effects, all medications also come with a risk when it comes to combinations. Intermixing medications can often cause unintended side effects or harm.
If you are take antihistamine, use caution and do not mix them with the consumption of:
- Stomach ulcer medications
- Cold medicines also containing antihistamine
Many nighttime cold and cough medications use antihistamines to purposefully cause drowsiness. Many find that it is difficult to get rest and sleep with a troublesome cough or stuffy head, and the drugs are designed to allow you to sleep for recovery.
However, combining an antihistamine with another antihistamine can lead to an overdose of the drug, which can be fatal.
According to the Royal Children’s Hospital of Melbourne, an overdose of these medications can cause side effects, and even death.
An overdose of antihistamines can cause:
- Increased drowsiness
- Blurred vision
- Increased heart rate
- Loss of balance
Even the non-drowsy antihistamine (second generation), can cause harm if you take too much at one time. These medications often lead to dizziness, headache, drowsiness, and agitation if you take more than the recommended dose. Even tachycardia (when a resting heart rate is over 100 beats per minute) can occur.
While rare, death can occur via overdose. Studies show that less than 0.1% of overdose deaths are due to antihistamines alone. While they may be present in other drug overdose cases, it is typically not the leading cause.
If your symptoms include itchy, watery eyes, or eye irritation, over-the-counter eye drops may offer relief. No prescription is needed for this treatment option, but that doesn’t mean it is risk-free..
These eye drops, sold under the drug named “ketotifen,” (which contain antihistamines) work much in the same way that other antihistamines do, by blocking the impacts of histamine swelling. Drops may also come in prescription strength.
“They may not relieve all symptoms, though, and prolonged use of some of these drops may cause your condition to worsen,” warns the ACAAI’s website.
The side effects mimic many of the symptoms of allergies, so they may not be a helpful solution for all patients.
Side Effects of Eye Drops
Common side effects for allergy eye drops include burning, stinging, or eye irritation, headache, stuffy or runny nose, a bad taste in your mouth, or an increased sensitivity to light.
Those that wear contact lenses should consult their doctor about their use during your medical need. Depending on your contacts, a doctor may recommend not using them in conjunction with the drops, may recommend waiting 10 minutes or more before putting them in following the drop use, or no changes at all.
Many allergists recommend using an over-the-counter intranasal steroid. These medications are available without a prescription, with some offering immediate relief. Sold under brand names such as Rhinocort, Nasacort and Flonase are intranasal steroids are sold at your local drugstore.
“Intranasal steroids are the most effective medication for dealing with allergies,” says Lang.
How Do Nasal Sprays Work?
Nasal sprays are not an antihistamine, and thus work in a different manner. Steroids are a man-made version of hormones normally produced by the adrenal glands, which are two small glands above the kidneys.
“When sprayed into the nose, steroids reduce inflammation (swelling),” explains the NHS site. “This can help relieve symptoms such as sneezing and a runny or blocked nose. It can also help to reduce the size of any swellings (even polyps) in your nose.”
The reduced swelling—and more open nasal passages—provide the user with a sense of nasal openness and easier breathing.
Nasal Spray Side Effects
Common reactions to such sprays include nostril irritation, dry nose, throat irritation, itchy nose, unpleasant taste, or bloody nose. Unlike oral steroids, the traditional side effects (such as insomnia, mood swings, increased appetite, face-flushing, or weight-gain) of nasal sprays are mitigated by their method of administration. The NHS site, however, warns that long-term uses of nasal sprays can increase the risk of the side effects.
Immunotherapy for Allergies
The “shots,” previously noted by reader Jason, are called immunotherapy in the medical circles. These treatment options expose a allergy sufferer to small doses of their trigger, hoping that their bodies will develop immunity to the allergen and, over time, stop overreacting to it.
Though such treatments can take years to become effective, many opt for this treatment as it is viewed as a “cure” for the allergic reaction. The therapy does take long periods of time to work, but if successful, would potentially eliminate the need for other allergy treatments.
According to the Mayo Clinic’s website, typical immunology treatments include a “build-up phase” which can be three to six months. During this period of time, shots are given from one to three times a week, typically in the upper arm.
Following this more intensive phase, a “maintenance phase” can take an additional three to five years, though injections during this time typically happen only once per month.
Immunotherapy Via Injections
“Allergy shots are regular injections over a period of time — generally around three to five years — to stop or reduce allergy attacks,” said the Mayo Clinic Staff article seen here. “Allergy shots are a form of treatment called immunotherapy. Each allergy shot contains a tiny amount of the specific substance or substances that trigger your allergic reactions.”
But, how do you know when this intensive level of treatment is required? Lang said that it depends on the severity of your symptoms, most often.
“If you’re experiencing a level of symptoms that interferes with your desire to pursue activities or your symptoms are interfering with work or school performance, causing sleep disruption or sleep impairment despite avoidance measures and regular medications, you should see an allergist,” he says.
He also adds that allergy shots, called allergen immunotherapy, are also an option for some patients. Speaking to your doctor about your unique case is best to find your ideal solution.
“The allergy shots offer the potential to affect the underlying allergic potential that drives symptoms,” says Lang.
Immunology may be the answer for you, but it may not be. Sometimes, it is a mix of over-the-counter, prescription, or environmental options that works best. Lang encourages patients to seek out ”the right combination of remedies that can help them, including seeing an allergist.”
“We frequently see patients who are suffering needlessly and [allergists] can help,” says Lang.
Sublingual Immunotherapy Allergy Tablets
For those not ready to have frequent trips to the doctor’s office or have a fear of needles, there is another method to obtain immunotherapy: sublingual tablets. Sometimes abbreviated as “SLIT,” these tablets are designed to work much in the same way as the injections.
“Sublingual immunotherapy (SLIT allergy tablets) is another form of allergy immunotherapy and involves administering the allergens under the tongue generally on a daily basis,” explains a drug guide issued by the American Academy of Allergy, Asthma, and Immunology.
Currently, however, there are only oral extracts for three of the common allergy triggers:
- House dust mites
- Short, ragweed pollen
However, the tablets have a versatility that offer patients a potentially more efficient solution.
“They address a broader range of airborne allergens and are customized for each patient,” said Howard Boltansky, MD, an allergy expert at Johns Hopkins Medicine website. “Based on the patient’s allergy test results, the physician can formulate a mixture that can include such allergens as:
- Weeds, including ragweed
- Cats and dogs
- Dust mites
Shots or Drops: Which Are Better for My Allergies?
Oftentimes, depending on your doctor’s availability, your insurance coverage, and your own personal preference, both options may work for you.
“Shots are somewhat better than drops for treatment of allergic rhinitis and asthma, with laboratory tests more likely to show favorable immune changes compared to drops,” said Boltansky.
He said those that are fearful of the treatments’ potential side effects may prefer shots, as they are administered by a healthcare professional.
“Allergy shots must be given in a doctor’s office under observation so that possible adverse reactions can be treated,” says Boltanksy. “Allergy shots are the right choice for many people, but for others, sublingual immunotherapy offers more comfort and convenience, as well as greater flexibility to travel without the need to return to the clinic for shots.”
Side Effects of Immunotherapies
According to Boltansky, most side effects to these immunology treatment options are mild. The worst risk would be anaphylaxis, though no deaths have ever been reported with the SLIT tablets, according to Johns Hopkins.
Most allergists will recommend having an Epinephrine injection (Epi-Pen) on standby, especially when you begin your first treatments. Doctors also recommend that those with mouth ulcers or cuts inside their mouths or gums not take an under-the-tongue SLIT tablet as it may cause the medication to enter the bloodstream too quickly.
More moderate side effects of immunology that have been documented include:
- Lip, mouth and tongue irritation
- Injection site reaction (swelling, pain, or irritation of skin)
- Nausea, vomiting, abdominal cramping and diarrhea
- Itching or redness of the eyes
- Nasal symptoms (sneezing, itching or congestion)
- Wheezing or difficulty breathing
- Increased severity of asthma symptoms
- Skin reactions (hives, itching or swelling)
Another rarer side effect is an allergic reaction in the esophagus — the tube between the mouth and the stomach. This problem (eosinophilic esophagitis) can feel like heartburn or difficulty swallowing.
Anaphylactic reactions, which can be life-threatening, often occur within 30 minutes of an injection. Most doctors will monitor new allergy patients at least this long, especially during the first few shots.
Anyone experiencing mild side effects should reach out to the prescribing doctor as soon as possible. If you have more severe reactions such as trouble breathing, hives, are unable to swallow, sensations of throat closure, immediately use an Epi-Pen and call 911.
Non-Medicinal Allergy Treatment Options
Not every treatment for allergies includes a medication or doctor office treatment. Instead, sometimes simple lifestyle changes or environmental options may work to alleviate your symptoms.
According to Westreichome non-medical options to treat allergies may include:
- Try staying indoors when possible, especially when pollen counts are high or at their peak.
- Keep windows of your home, workplace, and car closed during peak pollen seasons.
- Use air conditioning whenever possible. Replace filters each month.
- Wash your hands and face to remove pollen.
- Shower and shampoo your hair at bedtime to wash off accumulated pollen.
- Wear glasses or sunglasses when outdoors to minimize pollen getting into your eyes.
- Wash bedding once a week using hot water.
Additionally, some sufferers turn to nasal washes for clearing out pollen and debris in the nose’s air passageways. Small teapots, sold under the brand name of Neti-Pot, can help to flush the nose. The U.S. Food and Drug Administration (FDA) warns patients to use proper techniques with such products to avoid complications.
Typically, these products use saline or distilled water to flush out the nose. They are not medicated solutions and may be a safer option for those seeking a non-medicinal route. Caution is required, as unique infections or bacteria can enter via the nasal passages should distilled water or saline not be used.
One Florida case, for example, exposed a patient to a brain-eating amoeba. Health experts speculate that the use of tap water caused the exposure and ultimate death of the person. The person used a nasal wash with amoeba-laden water. While consumed via tap water (drinking it) is harmless to humans, allowing the amoeba to enter via the nose can cause death.
Other allergy symptoms may be alleviated without the use of medication through the use of an N-95 mask that is snuggly fit to your face. Such protection covering the mouth and nose can prevent some allergy trigger particles from entering your system in the first place.