One of the most common conditions seen in both children and adults is allergic rhinitis, though you usually see it referred to as “hay fever.” You may suffer during the different seasons, or year-round with sneezing, itchy nose, runny nose and congestion. Is there anything new about this ailment that you should know?
The American College of Allergy, Asthma and Immunology, along with the American Academy of Allergy, Asthma, and Immunology, recently published a practice guideline for allergists and other health care workers about the latest understanding on this disease. Let’s look at some of the highlights, which you can use in caring for your allergic rhinitis.
While we’re all familiar with the classic symptoms of allergic rhinitis, there’s another common symptom many of us don’t think about, and that’s a cough. The guideline emphasizes that cough is commonly seen in allergic rhinitis. As we’ve learned, cough is also one of the main signs of COVID-19. We need to remember that among those with hay fever, cough may not be due to the coronavirus.
To determine what they’re allergic to that’s causing nasal allergies, patients routinely undergo allergy testing. The guideline strongly emphasizes that food allergy testing should not be performed in the routine evaluation of allergic rhinitis. The reason is that food allergies do not cause nasal symptoms. Typically, food allergies show up with the onset of hives, swelling, trouble breathing, vomiting and anaphylaxis after ingestion of the allergic food. Testing for hay fever should include sensitivity to pets, dust mites, trees, grasses, weeds and mold. These are the most likely triggers for nasal allergies.
ACAAI recommends against using a first-generation antihistamine and is in favor of a second-generation antihistamine when taking an oral medication for the treatment of allergic rhinitis. First-generation antihistamines, including diphenhydramine (Benadryl) and chlorpheniramine (ChlorTrimeton), can cause drowsiness and symptoms such as dry eyes, dry mouth, constipation and urinary hesitancy and retention. You should take a low or non-sedating agent such as cetirizine, levocetirizine, fexofenadine or loratadine instead.
Intranasal corticosteroids (fluticasone, mometasone, budesonide, triamcinolone) are the preferred treatment if you suffer from persistent allergy symptoms, especially if they’re interfering with your quality of life. These are the most effective treatment for hay fever and may even help control allergic eye symptoms.
Oral decongestants are frequently used for stuffy nose. There are some important facts about these treatments that you need to know. The most effective of these medications is pseudoephedrine. Unfortunately, this is also the main ingredient in making methamphetamine (commonly known as “meth”) and is only available by prescription or by specially requesting it from the pharmacist, depending upon the state where you live. People should be aware of the numerous side effects of pseudoephedrine. These include insomnia, loss of appetite, irritability and heart palpitations. If you have high blood pressure, this drug can increase it. Also ask your doctor about using this medicine if you have cerebrovascular or cardiovascular disease, hyperthyroidism, closed-angle glaucoma, bladder outlet obstruction and Tourette syndrome, as it may worsen these conditions.
One last serious adverse reaction with pseudoephedrine: If it is taken during the first trimester of pregnancy, there is a possibility that it will cause gastroschisis in the unborn child. This is a birth defect of the abdominal wall that allows the baby’s intestine to protrude outside the baby’s body. Consider instead using an oral decongestant like phenylephrine, which you can buy right off the pharmacy or grocery store shelf. Unfortunately, this medication has not been shown to be effective for nasal congestion in the doses available without a prescription. Don’t waste your money.
And how about alternative treatments for nasal allergies, such as acupuncture and herbal medications? The allergy organizations did an extensive review of medical studies that had examined their efficacy and safety. They concluded that they cannot make a recommendation for or against the use of these treatments for allergic rhinitis as, to date, there is a lack of adequate studies.
Lastly, when should allergen immunotherapy or desensitization be considered in allergic rhinitis? The guidelines suggest that subcutaneous injection (allergy shots) or sublingual tablets should be offered through shared decision making with you if you have moderate/severe hay fever that is not controlled with allergen avoidance and/or medications. Another reason for choosing immunotherapy is to prevent or reduce the severity of additional existing conditions like asthma. If this sounds like you, discuss with your allergist. You don’t have to suffer with hay fever.
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