When You Worry About Pollen As Much as Potholes
Right now, I’m sitting on my couch with a left eye ball that feels like it’s being sand blasted and that looks like a tomato that has been out all night drinking. With everything in bloom, and the wind gusting for the past two days, my face is suffering from a blitzkrieg of pollen.
Allergies has been one of my life long pains, right up there with mosquitoes, taxes, and John Mayer. While pollen is plenty annoying on a day to day basis, it can be downright disastrous on race day. Fortunately, the treatment of allergies is getting better and better and as luck would have it, the most recent issue of American Family Physician has an update on allergic rhinitis. I figure this is perfect time to spread some knowledge wealth.
Briefly, allergic rhinitis is an immunoglobulin E-mediated process that occurs after exposure to a variety of allergens. Allergens can include just about anything, but some of the popular ones are mold, pollen, and animal dander.
A whole slew of medications, both prescription and OTC, are out there for you to spend your good money on. Lets take a Tour De Med…
While most people turn to Benadryl, Claritin, or other pills for treatment, the American Academy of Allergy Asthma Immunology currently recommends intranasal corticosteroid sprays as first line treatment.
Yup, those prescription sprays your all freaked to snort are the mainstay of treatment. These bad babies work by inhibiting the release of cytokines in the nasal mucosa, thereby reducing inflammation. It takes about 30 minutes for the effects to start, but it can take several hours for full effect to be reached. Getting the maximum effectiveness takes weeks of use. Regarding symptoms, the nasal sprays take care of runny nose, sneezing, itching, AND eye symptoms. Current studies do not show that one intranasal steroid spray is more effective than another. However, some of the sprays have different FDA approvals. Rhinocort is safe for use during pregnancy and Nasonex is the only one recognized for ease of use in arthritis patients.
In regard to side effects, corticosteroids can cause headache, throat irritation, nose bleeds, stinging, burning, and nasal dryness. Despite concerns, the nasal steroid sprays have not been shown to have systemic effects significantly. Flonase has been shown to reduce normal steroid secretion, but no noted effects have been found.
So what happens if your nasal dose of steroids isn’t covering you? That’s when anti-histamines such as Claritin come in handy. There are different generations of antihistamines. Good old Benadryl is a first gen anti-histamine. Anyone who has ever taken Benadryl knows why there are now 2nd gen anti-histamines. Benadryl can cause so much sedation I don’t recommend driving or working while on it. Studies have shown first gen antihistamines are associated with poor school performance, motor vehicle accidents, and work injuries.
Whats the difference between the 1st and 2nd gen antihistamines? The 2nd gen antihistamines don’t cross into the brain as easily as 1st gen drugs; thus they don’t cause as much sedation or other mental status changes. The only odd ball of the 2nd gen antihistamines is Zyrtec. It still crosses into the brain easily and causes significant sedation.
Regarding symptom control, 2nd gen antihistamines are good at alleviating all symptoms except for nasal congestion…which the nasal steroids take first place. Despite being second line, their quick onset (15 minutes) and their good safety profile from patients six months and older make them good for those with “moderate” allergies needing only intermittent relief.
With the success of intranasal steroids, it was inevitable before intranasal antihistamines came along. There are two sprays on the market now, Astelin and Patanase. Both medications start in about 15 minutes. While effective, these medicines are limited to third line therapies due to their adverse effects and cost.
This includes products such as good old Sudafed and Afrin. These meds work by causing vasoconstriction in the nasal mucosa and thus reducing inflammation. These guys can have a boat load of side effects, including elevated blood pressure. In addition, prolonged use can lead to rebound congestion. Remember, just because its over the counter doesn’t mean its not dangerous.
If the above usual suspects don’t get your symptoms under control, don’t wrap yourself in a biohazard suit yet. There are a couple of other unique meds, like Atrovent, Singulair, and intranasal cromolyn still available.
In addition, there are some alternative options, like herbs and even acupuncture out there. There’s not much evidence for such treatments yet, but you never know…..
Hope this helps my fellow pollen warriors. May the only watery eyes you have be on the podium!