Medications for Allergy

Allergies do not cause fevers.

True

In fact, allergies themselves never cause fevers. Then why, you might ask, does everyone use the term “hay fever“? It originated in the 19th century.

Dr. John Bostock, an English physician, suffered from severe summer allergies and found it interesting that his problem occurred during the English haying season.

So, in 1828, he came up with “hay fever.” Today, we know that hay has nothing to do with allergies, and that allergies don’t cause fevers. Instead of “hay fever,” medical professionals call the problem Seasonal Allergic Rhinitis.

“Seasonal” refers to seasonality of the symptoms; and rhinitis means inflammation of the nose. Rhinitis comes from the ancient Greek word for the nose.

Occasionally, you’ll hear other names including “rose fever,” “pollen allergy,” and “pollinosis.” The last two take their name from pollen, the major cause of seasonal allergic rhinitis in the United States.

Allergies are caused by viruses and bacteria.

False

Viruses and bacteria do create problems. However, we call these problems infections, not allergies. The two are closely related, but allergies mean something different. In short, they are a case of mistaken identity.

Here’s why.

Your immune system is a network of cells and organs that work together to defend your body against attacks by foreign invaders such as bacteria. The system recognizes these invaders and expels them. Sometimes, however, the system mistakes a harmless substance like pollen for an invader, and tries to expel it. That’s why you sneeze and cough; why your nose runs and eyes get watery. Your immune system is trying to expel the pollen from your body.

The medical name for substances mistaken as dangerous is allergen. The number-one allergen in the United States is ragweed pollen.

To the naked eye these microscopic grains look like dust. They function as the plant’s equivalent to sperm, carrying the male genetic code from a male ragweed plant to a female plant. They travel from plant to plant through the wind, which sweeps them into the air.

Pollination is the name of this process. To increase the chance of successful pollination, each ragweed plant produces about one billion pollen grains each season. So lightweight are these grains that they’ve been found 400 miles offshore and up to two miles in the atmosphere. So it doesn’t matter if there’s no ragweed growing in your backyard. You’re exposed to ragweed everywhere in the United States except for the arid Southwest and Southern California, where it doesn’t grow.

From a global perspective, ragweed is unusual since it’s found in high concentrations only in the United States. Most people who move here have never encountered it before. Many have not had allergies in their families for centuries. Yet, within two or three years of living here, they develop them.

When you breathe pollen-filled air the pollen grains, seen here through an electron microscope, land on the skin inside your nose. They release proteins which work their way into the lining of your nose where they encounter your immune system. This kicks off a chain reaction that results in sneezing and the other symptoms of allergies.

People are usually allergic to more than one thing.

True

In fact people are often allergic to several things. In addition to ragweed pollen, the #1 cause of allergies people are allergic to are an assortment of other weed pollens, as well as tree and grass pollens. They are also allergic to mold spores, dust mites, certain insect venoms, foods, medicines, chemicals, and metals, to name just a few.

Trees that cause allergies include common varieties such as oak, elm, maple, birch, ash, hickory, walnut, poplar, sycamore, cypress, pecan, box elder, mountain cedar, and Western red cedar. They shed their pollens in the spring. And that’s when you’ll feel their effects.

Although more than 1,000 species of grass grow in North America, only a few produce highly allergenic pollen. These include timothy, Johnson, Bermuda, redtop, orchard, sweet vernal, and Kentucky bluegrass.

Grasses shed their pollens in late spring and early summer. Weeds shed their pollens in late summer and in fall, until the first frost.

Ragweed is the major culprit, but others include sagebrush, redroot pigweed, lamb’s quarters, tumbleweed, Russian thistle, cockleweed, and English plantain.

Another important allergen carried by the wind are mold spores. Like pollen, spores serve a reproductive function, are very tiny, and float in the air. Found almost everywhere, in some places mold spores outnumber pollens. Fortunately, only a few dozen types cause allergies. People usually have symptoms from spring to late fall, with the peak of the season from July to late summer. Unlike pollens, molds may survive the first frost. Some can even grow at subfreezing temperatures, but most become dormant. Snow cover lowers the amount of mold in the air outdoors, but doesn’t kill them. After the spring thaw, they thrive on the vegetation that’s been killed by the winter.

In warmer parts of the country, however, molds thrive throughout the year, and can cause allergies year-round. We call this problem perennial allergic rhinitis. In addition, molds grow indoors where they can provoke allergies year-round, even in the coldest of climates.

Another major cause of perennial allergies comes from dust mites. These microscopic beasts survive in house dust by eating the scales of skin each of us sloughs off daily. The mite itself doesn’t cause allergies; rather, its feces does. The fecal balls are sticky, heavy proteins that bind to carpeting, bedding, and upholstery; and can be seen floating, along with dead mites, in a shaft of sunlight. All temperature climate areas in the world have dust mites. Outside of North America, they’re the #1 cause of allergies. The feces of cockroaches is also very allergenic.

Animals are a third major source of perennial allergies, particularly household pets. At one time, we thought that the fur and dander on cats and dogs provoked allergies. Dander is the word for scales of skin.

But we’ve learned that the real allergens are the proteins in the animals’ saliva. When they preen themselves, the fur becomes coated with saliva which becomes airborne when it dries. Since cats preen themselves more than dogs, they win the allergy prize. But dogs can still be a major problem.

Some rodents, such as guinea pigs and gerbils can also cause allergies. Their urine contains the offending allergen.

One more source of perennial allergies deserves mention, and that’s feathers. Down pillows and comforters are the main culprits.

So let’s sum up. The major cause of allergic rhinitis, the allergies that afflict the eyes, nose, and throat, are airborne particles.

The major seasonal sources are pollens and outdoor mold spores. The major perennial sources are indoor mold spores, dust mites, animals, and feathers.

We’ll talk about allergies caused by food, medicines, chemicals, metals, and insect venom in the next part of the program. But for now, know that people are frequently allergic to more than one of these allergens.

Flowers cause allergies.

False

It’s common to hear people say that they’re allergic to colorful or scented flowers like roses. In fact, only florists, gardeners, and others who have prolonged, close contact with flowers are likely to become sensitized to pollen from these plants. Because butterflies and bees carry this type of pollen, rather than the wind, most people have little contact with the large, heavy, and waxy pollen grains of many flowering plants.

Emotional problems can cause hay fever.

False

As we noted earlier, there is an emotional side to the problem of allergies. But emotions don’t cause an allergic response. Rather, emotional problems can be a consequence of the chronic physical symptoms of allergies.

Allergies are an incurable and untreatable problem that you just have to live with.

False

It’s true that, as yet, we have no cure for allergies. But let’s be certain that you and I mean the same thing when we say “cure.” You’ll recall that allergies are a case of mistaken identity. Your immune system mistakes something harmless for something dangerous, and goes on the attack to expel it from your body.

A true cure would prevent your immune system from making this mistake. Like giving it a pair of glasses, so it can see what’s dangerous and what’s not. Thus far, medical science hasn’t found this cure. But research continues.

Nevertheless, most allergies are treatable. In fact, the treatments available today have dramatically improved the relief available to you.

In general, therapy for allergies consists of three basic tactics: avoidance, medications, and immunotherapy. Immunotherapy is the medical term for allergy shots. Avoidance means just what it says: Avoiding the allergens that give you trouble. Obviously, some allergens are easier to avoid than others.

For some allergies complete avoidance is the primary treatment, is practical to do, and often must be done. These include foods, drugs, chemicals, metals, animals, and feathers.

When partial avoidance is practical, as with dust mites, indoor mold, and insect stings, you should combine avoidance with medications. In a small number of cases, immunotherapy is needed.

To completely avoid pollen or mold means moving to a place where the offending substance doesn’t grow. But even this extreme solution may offer only temporary relief since you may develop allergies to the allergens of your new home. For this reason, allergy specialists don’t encourage this approach.

Nonetheless, selected avoidance of pollens and outdoor mold has a valuable role. For example, air conditioning filters pollen and mold spores out of the air.

You can use air conditioning in your home, workplace, and automobile to reduce the pollen in the air you breathe.

When possible, avoiding allergens is the best choice. But to the degree that we can’t , medications can help. To understand the differences between medications, I need to give you a little more detail about the allergy process.

The immediate cause of sneezing and itchiness is the stimulation of nerves in the nose, throat, and eyes.

The immediate cause of a runny, congested nose, and watery eyes, is increased leakage of tiny blood vessels. The fluid they leak out is the watery stuff of runny noses and watery eyes. The fluid also makes your nasal tissues swell, causing congestion. Overproduction of mucus by the mucous glands in your nose also makes it runny and congested.

Chemical stores in your eyes, nose, and throat kick these processes off. As a group, these chemicals are called mediators. The most famous, and most prevalent in allergies, is histamine. The mediators are stored in mast cells and white blood cells called basophils.

Mast cells are concentrated in those places that are exposed to the outside world, the skin, the linings of the nose and lungs, the gastrointestinal tract, and the reproductive system. They defend the gateways into the body from invaders. Basophils circulate throughout the body in the blood.

Attached to the surface of mast cells are proteins called antibodies. They’re like a lock on a door. When you put a key into them, they unlock the mast cell, which releases its histamine. The key to these locks is the protein on the surface of the pollen grain we told you about earlier. When the pollen grain lands inside your nose, it sends its own protein down into the tissue where it bumps into the antibody sitting on the mast cell, and unlocks the cell. Basophils work the same way.

Here’s the whole process. A pollen grain lands in your nose and releases its protein. The pollen protein bumps into a matching antibody and unlocks the mast cell, which releases its histamine and other mediators. The histamine stimulates the nerves, makes the blood vessels leaky, and the mucous glands overproduce. The nerves make you sneeze and itch; the fluid that leaked makes your nose run and become congested, and your eyes watery; and the glands help plug you up with extra mucus.

The idea behind medications is to interrupt this process at some point along the way. There are five types of therapy: antihistamines, decongestants, mast cell stabilizers, topical corticosteroids, and immunotherapy. As is true of all medications, be sure to check the labeling for limitations that may apply to you and talk to your doctor if you are using prescription medications.

Nasal polyps are a complication of hay fever.

False

Nasal polyps are enlargements of the inner lining of the nose, what’s called the mucosa. For many years, they were considered to be a complication of allergic rhinitis. Today, our thinking is different. We believe polyps are rare in patients with allergic rhinitis, but common in patients with asthma and sensitivity to aspirin.

For mild allergies, different drugs should be used than those for severe allergies.

False

All of the antihistamines, mast cell stabilizers, and topical corticosteroids we’ve reviewed in this program are appropriate for treating allergies that vary in severity. Severity of symptoms does play a role in making the choice. Other factors that do guide choice are how well a person tolerates side effects; whether a person is comfortable with the form of medication, that is, pills or spray; and whether a person will take the medication as directed.

Allergies are a serious enough problem for a visit to the doctor.

True

Let’s put allergies in a little perspective. Do you go to a doctor for a sore throat or the flu? The symptoms of allergies are just as troublesome. What’s more, if your flu or sore throat is caused by a virus, there’s no medication a doctor can give you that helps. But doctors can guide you to medications for allergies.

Your doctor might also help you understand a problem in ways you hadn’t expected. For example, you may be having trouble sleeping at night, but don’t know why. Your doctor could help you figure this out, and the answer may be that you have allergies.

Going to the allergist means shots; there are no other options.

False

Allergy shots are the third basic tactic a doctor will consider. In general, doctors recommend them only to patients with severe year-round allergies that can’t be treated in any other way.

Doctors play a guessing game about allergies; they really can’t help.

False

Because there is no 100% reliable allergy test available, doctors must rely on the information you give them to diagnose the problem. This is an imprecise process, since you could be exposed to many allergens and may not be certain about your exposure to them. But it’s superior to currently available skin and blood tests. You can test positive for an allergen, but show no symptoms. There is a proper role for these tests, however, and that’s confirming what the doctor learns from the patient history you provide.

Finding the best choice of medication for you is an imprecise process, too. Some trial and error may be involved. But you’ll learn more from the errors, and make the most of what you have learned, if you work closely with a physician with whom you have a good relationship.

Allergies take time to master. It’s frustrating. But teaming up with your healthcare professional can help you get there quicker.

The only allergy medications available are the ones sold on the shelves in the drug store.

False

Prescription medications are also available for each of the categories mentioned. See your doctor for more information.

The more effective a drug is, the more severe its side effects.

False

This may be true of some medications, but not all. In fact, the opposite may be true. Some of the most effective medications may have the least side effects. You should consult your doctor for more information.

Prescription drugs are only for those with severe allergies.

False

Both over-the-counter and prescription medications may be appropriate to use for allergies regardless of the severity of your symptoms.

You can increase the amount of over-the-counter allergy medication you take without problems.

False

This is simply false. You can hurt yourself by taking over-the-counter medications more frequently or in larger amounts than directed by the labeling or your doctor. This is true of all medications.

You’re more likely to build a tolerance to a medication if it lasts 24 hours.

False

There’s no relationship between the dosing of allergy medications, that is, how often you’re directed to take it, and the likelihood of tolerance.

A medication that treats more than one symptom isn’t strong enough to treat any one symptom well.

False

Not true. Let me explain with an example. Blocking histamine from acting on the nerves, blood vessels, and glands will result in the reduction of more than one symptom. No medication is perfect. But its imperfections are not a result of the number of symptoms it affects.

Prescription drugs are more prone to dependency than over-the-counter drugs.

False

As concerns allergy medications, this isn’t true.

The larger the number of milligrams, the more powerful the medication.

False

There’s no relationship between the two. The action of each medication is different, so it’s like comparing apples to oranges. Ten milligrams of one medication may be needed, where 100 of another is appropriate. The exact way the medication works determines the amount. There’s no basis for comparing quantities.

Drug companies are interested in treating symptoms, not the cause.

False

Drug companies are pursuing every available idea for the creation of allergy medications, including ways to get at the root cause of allergies, to “correct the vision” of the immune system so it doesn’t mistake pollen and dust for something dangerous.

Allergies are not strictly a physical problem.

True

Allergies are a chronic disease. This means they’re an ongoing problem, one that doesn’t go away after a relatively short period of time. And like all chronic diseases, allergies have both a physical side to them, and an emotional one.

The emotional side of allergies consists of two major issues. How you feel about having an ongoing problem with allergies. And how your allergies affect your relationships with other people.

A mistake people often make is letting themselves think that allergies are no big deal. Even if they feel absolutely terrible, some will say allergies aren’t a significant medical problem. For some reason, and I can assure you that it’s not a medical reason, our culture doesn’t recognize allergies as a disease on par with diabetes, arthritis, or even the flu.

Letting yourself believe that allergies are a significant medical problem means that you may deal with them differently. You’ll let yourself spend time and energy to find and study information about the problem, to change things in your household to make it less allergenic, or to seek help from medical professionals. If you don’t believe allergens are serious, you probably won’t have the motivation to do these things and others that can help you.

In short, your own feelings about having allergies can have a tremendous influence on what you do about them. It’s very important not to sell yourself short.

Being clear with yourself about allergies enables you to manage your relationships with other people more successfully. For example, you won’t doubt yourself when negotiating for some changes around the house. You’ll be generally more confident in dealing with those who are skeptical about your problem. You’ll know, in your heart, what the real medical story is. It’s a matter of bringing the other person up to speed on the facts.

Obviously, these kinds of situations require good communication skills. You need to listen carefully to what people say. Confirm that you understand what they’ve said by repeating it back to them. Use the phrase, “If I understand you correctly,” to feed back what you think they’ve told you. Ask them to do the same; to tell you what they think you said. You’d be amazed at how much we all miscommunicate.

And be sure to explore people’s feelings when you talk. Ask them how your illness makes them feel. Bringing feelings into the open in a mature way gives you the opportunity to address issues and find your way to agreeable compromises. It may reduce the stress allergies put on your relationships and, as a result, reduce the stress allergies put on you.

You are forced to do whatever your doctor tells you to do.

False

The ultimate decisions are always yours. Your doctor is there to help you, but you should never feel out of control of the situation. So don’t let yourself feel pressured. Ask questions. Express your point of view. Don’t be afraid to ask your doctor about his or her feelings. Your doctor knows that you’ll only do what you want to do. He or she would rather have an honest discussion with you that produces an agreement that you’ll follow, rather than an empty talk about something you won’t do. Your health is ultimately your responsibility. Your doctor is there to help you with it.

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