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    Managing Fall Allergy Season

    Jason White, MD Deaconess Clinic Allergy & Immunology 08/12/2020
    As we head into the autumn season, people who haven’t had any sneezes and sniffles all year may begin to experience allergies. 
    Weeds—especially ragweed—pollinate in late summer and early fall.  In most areas of the country, the ragweed season is now August through mid-October. 
    And there’s really no way to physically escape ragweed allergies.  A single ragweed plant can release a billion pollen grains over the season, and these grains are tiny and light, floating easily in the air. Ragweed pollen has been detected as far as 400 miles off-shore.
    Also in the fall, mold allergies can be problematic.  Mold grows on crops, and is stirred up during harvesting; mold also thrives in fallen leaves and dying vegetation.  Until the weather gets really cool, and we have a freeze or two, mold will be a problem. 

    So if you are prone to seasonal allergies, there are some things you can do to help reduce your suffering. 

    If you find that medication helps with your allergies, you should start taking the medication as soon as you notice the first symptom.  Some medications take time to become effective, and it’s also easier to prevent symptoms than to treat symptoms that are out of control. Let me give you some information about various medications, and how they work.
    • Antihistamines can be very effective at decreasing the runny/itchy/sneezy/drippy symptoms, but they will not help with congestion.  Antihistamines can be non-sedating, and don’t have to make you tired in order to work.  They are generally convenient, because they are pills or liquids and only need to be taken 1-2 times per day.  There are a number of inexpensive options--even generics--that are helpful to many people.
    • Nasal sprays can decrease inflammation in your nose and sinuses.  These are generally prescription medications, but our first over-the-counter nasal steroid has become available this year.  Triamcinolone nasal spray can now be found at many pharmacies.  It is not habit forming, and should not be confused with some other non-prescription nasal sprays that can be habit forming.  Much better nasal steroid medications are available by prescription, and are generally very safe.
    • Decongestants are harder to get and must be signed for at the pharmacy.  However, they do help relieve sinus congestion and pressure inexpensively.  They may cause insomnia and agitation in some people who may be sensitive to certain ingredients.

    While I know it’s tempting to open all the windows and enjoy the fresh air, if you suffer from allergies, that will allow all the outdoor pollens to come inside, which means you don’t ever get away from them and you increase your exposure.  Remember, keep the outside OUT. You should also shower before you go to bed, to remove invisible pollen and mold spores from your skin and hair.  You do not want to sleep with allergens all night long.  (For example, if you have a lot of hair, you’ll get pollen and spores all over your pillow, and then will be rubbing them in your face all night!) Something that many pet owners don’t think about is that your beloved dog or cat that goes outside will come back inside covered in pollen and spores.  So when you pet Fifi or Fido, you’re getting exposed to a lot of allergens.  Because it’s not a good idea to bathe your pet daily, you need to wash both your hands and face after cuddling your pet, but also, you need to keep them out of your bedroom.

    Air Filtration
    Air filtration can be effective at removing allergens from an immediate area, such as your bedroom.  You have to make sure to not use any electrostatic air filters because they can create ozone as a by-product, which is an irritant and can make your breathing and nasal symptoms worse.  No ozone alerts in your bedroom!

    I do recommend HEPA filtration air purifiers, where a fan pulls in dirty air, and then pushes it through a filter, creating clean air.  A mid-priced model can be appropriate, such as $50-125, for a room-sized system.  And if you’re only going to buy one, you should absolutely place it in your bedroom.  That’s where you spend the most time in one room, and can result in better sleep, as well.

    Nasal Irrigation
    Nasal irrigation can be very effective and helpful in treating and preventing allergy symptoms.
    Some people use a neti pot, others use a sinus rinse kit that is sort of a more forceful “squirt” bottle.  There is also a nasal mist.  They all have the same function, in that they help remove pollen and other allergens from nasal passages and sinus cavities.
    Here are some tips for you:
    • You can’t use table salt, so I recommend that you purchase the non-iodinated/buffered salt packets, available at the pharmacy.
    • Use distilled or bottled water so you don’t introduce contaminants from unclean water directly into your sinuses.
    • Use clean water with every dose.   Don’t “save” the leftovers from an earlier rinse.
    • I recommend using a nasal irrigation system each night before going to bed, to help remove the allergens you’ve breathed in all day.
    • Whichever system you use is a personal preference.  Some people prefer the more passive neti pot,  which works basically with gravity.  Others like the squirt bottle because they feel like they can control the flow and direction better.   Whichever one you use, follow the directions carefully.
    • I can also endorse nasal irrigation for helping to clear infected sinus passages.
    • Once you get the hang of using whatever technique you choose, you’ll feel so much better after using it.

    Allergy Testing & Shots
    If your allergies aren’t always manageable through medications and avoidance, a next step may be allergy testing and shots.

    Allergy testing is a way for you to determine what you are allergic to so you can focus on avoiding those specific allergens. It’s normally done with a skin prick test. For this test, your inner arms are poked with drops of liquid that contain allergens, and your individual reaction to each drop is monitored. A bump and redness are indicative of an allergic reaction.

    The test takes about 30 minutes to complete. After testing, you and your allergist can discuss if you may be a good candidate for allergy shots, also known as immunotherapy.  Allergy shots are a way to make you less allergic to certain allergens. They are custom-made to a particular patient based on their skin testing results.

    We start off with an extremely low dose of what the patient is allergic to, and give the injection into the back side of the upper arm. It is not an intramuscular shot, so it doesn’t hurt like many shots do. Each week, the patient receives an increasing dose of their allergy vaccine, thus making them tolerant to these allergens.

    The shots start out weekly, and after about 8 months, are spread out to monthly shots. Patients receive monthly injections for 4-5 years.

    Some Sneezing & Sniffles….What’s the Big Deal?
    Some people try to “power through” their allergy symptoms, thinking of them as more of an annoyance or nuisance than a real problem. But allergies can take their toll on your overall health.

    They can impact your sleep, which leads to poor concentration at work or school. Sinus infections can result when the sinuses are constantly inflamed, which allows a sinus infection to set in. Asthma can also be the result of allergies.

    Plus, just being that miserable can put you in a bad mood and affect your quality of life—as well as the moods and quality of life of people around you!

    So if you’ve really been suffering, talk to your allergist, or if you don’t have an allergy specialist, talk to your primary care doctor about a referral.
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