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Spring allergies - The care and feeding of Margie's nose - (3/27/2018)

By Dr. Ron Gasbarro

Margie came into the pharmacy looking miserable. “Help me! I feel like I am drowning. These allergies will be the end of me,” she said to the pharmacist. Margie and anyone else who has spring allergies know the drill: runny, stuffed, itchy nose, post nasal drip, scratchy, watery eyes. In those who also have asthma, one can get the typical asthma symptoms like shortness of breath, wheezing, and cough. All of these symptoms make it difficult to work, sleep, drive, and to, basically, exist. 

While many people blame their spring allergies on flowers, trees are responsible for most of the early season’s allergies. Birch is one of the most common offenders in northern latitudes, where many people react to its pollen. Other allergenic trees include cedar, horse chestnut, willow, and poplar.

Margie mentioned that she gets similar symptoms from eating certain foods. The pharmacist explained that eating some nuts, fruits, and vegetables could worsen symptoms. If one has nasal allergies to certain trees, that person can you have a higher risk of allergic symptoms from some of these foods. For example, if one is allergic to birch trees, that individual may get itchiness or swelling in the mouth or around the face after eating almonds, apples, carrots, celery, cherries, fennel, hazelnuts, kiwi, peaches, pears, or plums.

Tree pollen allergy symptoms can be treated with over-the-counter or prescription drugs. For example, antihistamines relieve many symptoms by blocking the histamine the body releases in the allergy battle. Histamine can produce symptoms of sneezing, itching, watery eyes, and runny nose. Examples of histamine blockers include cetirizine (Zyrtec®), loratadine (Claritin®), and levocetirizine (Xyzal®). 
 
Oral decongestants such as pseudoephedrine (Sudafed® and its generics) can provide relief from nasal stuffiness by lessening the swelling of the nasal tissues. Decongestants also come in nasal sprays, such as oxymetazoline (Afrin®) and phenylephrine (Neo-Synephrine®). Only use nasal decongestants for a few days in a row. Longer-term use of decongestant nasal sprays can actually worsen symptoms (rebound congestion). Some allergy medications combine an antihistamine with a decongestant, such as loratadine plus pseudoephedrine (Claritin-D®) and fexofenadine plus pseudoephedrine (Allegra-D®).

Cromolyn sodium nasal spray (NasalCrom®) can control the nose problems associated with seasonal allergy. Cromolyn acts by inhibiting the release of histamine. The drug is very safe and does not cause drowsiness or rebound nasal congestion the way OTC nasal decongestants can. It is most effective when used before symptoms begin. Some people may experience temporary sneezing, nasal burning, or a bad taste in their mouth. Another disadvantage is that nasal cromolyn must be used at least 4 times a day to reel in symptoms. Nasal corticosteroids, such as fluticasone (Flonase®), decrease the swelling in the nasal tissues. Ideally, people who use fluticasone should note when they start experiencing symptoms during the spring and then start using the spray regularly 2 weeks prior to that time. Do not use it on an “as needed” basis. Plain saline spray (Ayr®, Ocean®) will wash out any pollen in the sinuses and can be used as often as needed. 

Margie, grateful for the pharmacist’s advice, purchased several allergy items. She then sniffled and sneezed her way out the pharmacy door. 

Ron Gasbarro, PharmD, is a registered pharmacist, medical writer, and principal at Rx-Press.com. Read more at www.rx-press.com 

 


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