In my ‘neck of the woods,’ to use a colloquial phrase, the ‘woods’ have caused quite the havoc with runny noses this year. It is not the woods alone, of course. Pollen fills the air from the literal myriad of plant species, along with varying temperatures and periodic winds. Add that to the 3 other major culprits: dust mites, mold and animal dander, and “allergies” become a favorite topic of health. I suffered along with many neighbors, friends and folks I met on the street, where sneeze greetings were common this spring.
Ignore It.
Many of us ignore the symptoms, since often they are indeed ‘ignorable.’ You may see the occasional finger blot at the eye, tissue at the nose or hear the frequent ‘ah-hem’ to clear the throat, but most times it stops there. We don’t always medicate or treat the indications. I was on the ‘Ignore team’ for many years, sniffling and sneezing a lot but only complaining when the sinus drip led to a sore throat.
Ignoring persistent symptoms can wear us down and may keep us from feeling like we are truly Aging with Pizzazz. Further, allowing mucus accumulation or tissue swelling from allergies to continue can get a bit out of hand and progress to blocked Eustachian tubes and then inner ear problems. Thus, ‘ignore’ is its own decision scenario.
Not Ignoring
So, what about when we can’t stand it? Then what? Choices abound.
Displaying one of my bad habits of frequently eating dinner while watching TV, I’ve witnessed the lineup of commercials and comments about the common pandemic of our allergies. The other night, on the sitcom Big Bang Theory, a forlorn comic book shopkeeper lamented never receiving gifts. When offered the chance to choose one, he whined, “well, you can never have too much Claritin.” Yikes, never too much? Guess he made his choice. What about us? That brings me to our options. What are the over-the-counter and alternative choices, or prevention steps?
Different treatments and brands run together. The TV plays numerous ads each night focused toward capturing the money of allergy suffers. It gets difficult to separate them. With this post, I want to offer a general summary of the categories to consider. It’s not meant as a treatment suggestion because of course we must leave that to your Doc, and secondly because you can (and should) always search out product details online. [For a short primer on what causes Allergies, see the reference section at the end.]
Take Your Pick.
OTC — Physical — Natural — or Combo
There are several ways to approach allergies and none are right for everyone. So you must determine where your allergies stem from, the severity of them, and then what is the best course of action for you. Let’s start with Over-the-Counter Treatments
Over the Counter (OTC)
Decongestants
Since nasal congestion is a common problem, it makes sense that often people start with an anti-congestion approach, what we call decongestants. I have a personal animus toward them, but for quick, temporary relief of nasal or sinus congestion, I guess they are a consideration.
Why my animus? In college, I was obligated to take vocal lessons and participate in performing groups. After some issues, a doctor suggested Afrin (oxymetazoline), which is one of two major decongestant types; the other being tetrahydozoline (Tyzine). He did not emphasize “short-term.” If anything has ever allowed me to feel the power of addition, this was it. I know now that this is called “rebound congestion.” At the time, all I knew was that it was getting worse and worse. The hours between use, less and less. I was addicted to being able to breathe. And it was difficult to stop the cycle. Nowadays I keep a tiny-sealed sample (at this point probably an antique and brittle bottle) in my cabinet just as a no-no reminder.
How they work. The scoop is that a decongestant restricts (or shrinks) blood vessels to decrease congestion. It’s response can be almost instantaneous, which also contributes to its addictive nature. The common ingredient is pseudoephedrine, and when you see other allergy remedies with a “D” after their name (such as Zyretec-D, Allegra –D, or Claritin-D) it means this ingredient has been added as a decongestant. Sudafed, a strong decongestant was placed behind the counter in 2006; as its pseudoephedrine was being used to create the illegal drug methamphetamine, aka ‘crystal meth.’ It can be purchased with identification; but I personally wonder, “why bother.”
Side-effects. Decongestants with pseudoephedrine have notable side effects. They can cause insomnia, changes in heart rate, increase high blood pressure, as well as irritability and headaches. They are not recommended either for pregnant women (not my biggest audience here) nor for those with hyperthyroidism, diabetes, high blood pressure, cardiovascular disease or glaucoma. Clearly, its litany of side-effects become more familiar and relevant to the vocabulary as we age.
Anti-Histamines
These days it is popular to say there are 3 generations of Antihistamines. I suggest that while the difference between the 1st and 2nd generation is substantial, I am uncertain about the 2nd and 3rd generation degree of differences.
How they work. “Allergies” or allergic reactions are directly connected to our immune system. Everything we eat, breathe, drink or come in contact with affects us. Our immune system works to maintain “hemostasis” – keeping us in balance. Our antibodies help. But when we get overloaded, things go wrong. Our bodies ‘over-adapt.’ One way they over- adapt is to produce excessive histamine. Fighting off foreign agents is the job of histamine, but sometimes it works overtime. Too much histamine. So medications that function against histamines knock down the response somewhat. Voila, anti-histamine.
All three-generation antihistamines reduce itchy /water eyes, stop a runny nose, ease swelling, and relieve other symptoms related to allergies. The differences are where they work, how fast, how long, and their side effects.
First Generation Antihistamines
In this group, we find the inexpensive, good ol’ Benadryl (diphenhydramine) and its generics, and the less common Chlor-Trimeton types (Chlorpheniramine) Both of these are relatively short-lived, about 4-6 hours.
How they work. These drugs affect histamine receptors in the brain, as opposed to the next generations, which affect histamine solely in the body. Like any drug, either of these can result in serious allergic reactions (see last section), but the common complaint is that they cause drowsiness and sleepiness. Diphenhydramine (Benadryl) has other common and annoying (or worse) reactions. Along with fatigue and dizziness, it often activates headaches and frequently causes dehydration. Especially if taken multiple days in a row, dehydration takes its toll with dry mouth, difficult urinating, related enlarged prostate, or constipation. [I even linked dehydration to increase risk for Benign Paroxysmal Positional Vertigo – BPPV.]
Jokes are often made about giving kids Benadryl to put them to sleep. But this ubiquitous, inexpensive drug should be used with serious consideration for both children and older folks. True for the latter group perhaps specifically because the chemical functions more in the brain than just the body.
2nd and 3rd Generation Antihistamines
These later antihistamines are much less likely to cause drowsiness. Some of the recognizable brands are:
- Cetirizine (Zyrtec Allergy)
- Desloratadine (Clarinex)
- Fexofenadine (Allegra Allergy)
- Levocetirizine (Xyzal)
- Loratadine (Alavert, Claritin)
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Side effects. Second generations (such as Claritin) work well and are less expensive, but on occasion may cause drowsiness in some people. [Some in the holistic industry claim that no antihistamine, despite its generation, is non-sedating for everyone.] Third generations (such as Allegra) claim not to cause fatigue or drowsiness (period), and to improve clinical efficacy. No surprise, they tend to be more expensive – significantly so.
[A 2011 New England Journal of Medicine Journal of Allergy and Clinical Immunology notes that fexofenadrine (Allegra) is most consistently non-sedating of the later generation antihistamines. This includes generics of fexofenadrine.]
While allergic drug reactions are not that common, neither generation is immune to them. They can also cause headache, dry mouth or fatigue. Third generation fexofendadine, for all its glowing reports can, on occasion, cause otitis media (an ear infection) in some people.
Nasal spray-types of antihistamines also relieve most of the same symptoms. The sorts mentioned here can still be fatiguing and may leave a bitter taste in the mouth. Still, their convenience makes them a contender for some med users.
- Azelastine (Astelin, Astepro)
- Olopatadine (Patanase)
Antihistamines are frequently used in a combination to produce eye drops (especially for itchy and swollen eyes). These can cause headache and (counterintuitively) dry eye. Nevertheless, they are used as medicated drops to accompany other meds for more protection. Some of the brand names include Visine-A, Pataday, Alaway Emadine, and Optivar,
You can check out your own antihistamines here.
Most reliable sources say there is little difference between brand names and generics.
Corticosteroids
How Corticosteroids (CS) work. They reduce symptoms by decreasing or suppressing inflammation stemming from allergic reaction. Oral CS, used for other conditions also, tend to have more related side effects than nasal sprays or inhalers. Pills and liquids (for example Prednisolone or Prednisone) used over a long term can cause osteoporosis, cataracts, gastric ulcers, or muscle fatigue, as well as exacerbating diabetes and hypertension.
Most sources claim those risks are not present (or greatly reduced) in aerosols. Nasal sprays can stop sneezing and a runny nose as well as prevent stuffy congestion, although they are a bit slower taking effect than some allergy meds. Complaints sometimes include unpleasant taste and smell, irritation of nasal cavity and nosebleeds. Examples include:
- Budesonide (Rhinocort)
- Fluticasone furoate (Flonase Sensimist, Veramyst)
- Fluticasone propionate (Flonase Allergy Relief)
- Mometasone (Nasonex)
- Triamcinolone (Nasacort Allergy 24 Hour)
- Beclomethasone (Qnasl) aerosol
- Ciclesonide (Zetonna) aerosol
One site reviewing products preferred Triamcinolone, stating it is effective in treating inflammation in the nose, doesn’t affect adrenals nor cause dizziness, is water-based, and “easy on the wallet.”
Some inhalers use CS with medications for asthma.
Tip on Nasal Spray
Take applicator in opposite hand from nostril;
hold upright and
aim at ear of same nostril.
[This may reduce nosebleeds and be more effective.]
One source mentioned corticosteroids topical creams (like hydrocortisone) for skin reactions should be used for short periods of time to avoid thinning of skin or other reactions. We should consider other remedies than these OTC types if needed more than 14 consecutive days.
Other treatment for skin reactions can include dupilumab and secukinumag (Cosentyx), both which can be administered by injection and contain more active ingredient than typical topical creams.
Mast Cell Stabilizers
These meds block chemicals produced by the immune system after an allergic reaction. Considered safe, but perhaps slower. These days they are often used if antihistamines are not working. The most common OTC spray is cromolyn. There are many eye drops in this category as well.
Leukotriene Inhibitors
Generally this is ‘on script’ (although see natural section for Butterbur). They too act by blocking a chemical (although this time, leukotrienes), which cause symptoms. The one commonly used in the typical medical industry (allopathic) is montelukast (known as Singular).
Allergen Immunotherapy
The theory behind this is almost like a vaccination (although less painful), or even a bit like homeopathy. It gradually exposes the body to allergens while training it not to respond to them.
Immunotherapy is NOT OTC. It starts with skin or blood tests and advances to treatment via injection (not in muscle, so supposedly little pain), or sublingual tablets. The series of shots can often take up to 3 years, but has the potential to ‘cure’ the situation.
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Physical Approaches
Prevention is always a moderate, modest approach with a possible big pay-back. If you are an allergy suffer, these are probably just reminders – but time-tested ones with an excellent ROI.
1. Air Purifier. This may be new information. Evidently, some air purifiers can make allergies worse. Types which rely on negative ionic filters, or those that release ozone (also a common allergen) can make matters worse for some suffers. HEPA filers (trapping pollen and animal dander) are perhaps still the best.
2. Dander is ubiquitous in a house with a pet. At the least, keep pets off the bed.
3. Not my favorite, but some people choose to cover the bed mattress in plastic.
4. Vacuum regularly and weekly. [Okay, I ask that friends who know me well not laugh.]
5. Test house for mold if you have even the slightest concern.
6. In high pollen season, sleep and drive with windows shut.
7. When working outdoors or in a garage, use both mask for mouth and nose AND googles for your eyes. Hopefully no one will call in an E.T. alien invader alert – either way it’s worth it.
8. Acupuncture works for relief of symptoms for some people (including children).
9. Nasal irrigation – my favorite Neti Pot. Finally, I am able to say that both holistic and allopathic industries have come to recognize its value. There is clear evidence that this ancient treatment of nasal passage flushing actually does flush out pollen and allergens, and helps reduce (sometimes relieve) allergy symptoms. I laugh at some of the intricate explanations of ‘formulas’ to use. Don’t fret. Just use sea salt in tap water as hot as you can stand it. It should ‘taste like your own tears’ as I was taught at the Himalayan Institute. Use half of your neti pot in one nasal passage and the other half in the second. [It may be slightly uncomfortable until you understand the feel – and flow – of it.] When blowing your nose afterward do NOT close off one side; blow with both passages into tissue.
[Saline spray is fine for travel, but I don’t think it holds a candle to the neti pot.]
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Natural Approaches
In the allopathic world, the advice on using natural or alternative allergy remedies is similar to claims for every other condition – not enough research, evidence unclear, long-term effects inconclusive. Partly, I agree (not as much research as I would like). Yet, even when evidence is clear, the same ‘party line’ seems to continue.
When it comes to natural remedies, especially herbal supplements (versus food) the remedies for allergies are good, but not necessarily great. Perhaps their best advantage point is that they aren’t as ‘un-natural’ as many chemicals. If you rely on them alone for allergies, you may be unsatisfied unless you make every effort at starting early, and thinking of them as prevention. Along with that, making beneficial gut (and thus diet) changes is often recommended. For people who fall into the category of ‘ignore’ symptoms (due to a wish to avoid chemical use), then these would be a wise alternative. However, with some natural remedies if you use them in conjunction with chemical medications or especially as prevention before problems arise, they can provide an even greater advantage.
David C. Leopold, MD, Integrative Medicine expert from California explained to WebMD that not everyone is able to control allergies with supplements alone. Some can, some can’t. But even if we aren’t able to fully treat ourselves (or be treated) with allergy supplements, such alternatives can be a good addition. He explains:
“By adding on a supplement like quercetin or butterbur,
you might be able to take a lower dose of the prescription drug while getting the same benefits.
And by keeping the medication at a lower level, you decrease the side effects.”
Whether you are in the ‘some can’ camp or not, some natural preparations may be of help. Let me hit on just a few, and offer a reminder that if you chose alternative remedies, the advice is often to consult your physician. That’s fine – that’s wise. However, I would add to research it fully yourself as well. Physicians cannot know every contraindication of pharmaceuticals, let alone pharmaceuticals and botanicals.
Quercetin is a natural antioxidant, helps to reduce inflammation, and is a bioflavonoid found in wine, fruits and vegetable. It may work (as with some chemicals above) in helping to stabilize mast cells to block the release of histamine. It’s an herbal equivalent to cromolyn (found in NasalCrom). Using it 4-6 weeks before allergy season hits may work best to prevent allergy symptoms. While I mentioned it is in foods, it is one of those botanicals in which it’s difficult to get enough in your diet alone to make the difference. [If you have liver problems, talk with your doctor and explore this more, especially if you plan on taking it for a long pre-and-present allergy season. Studies look good for quercetin, and it’s tolerated by most people, but the exact mode of its behavior is not totally understood.
Butterbur may have the best research and appears to act as a leukotriene inhibitor, blocking certain swelling triggers as does Singulair (mentioned above). Extract of butterbur root (which is dangerous if eaten raw) is found in studies to be as effective as Zyrtec or Allegra in relieving nasal symptoms. It does not cause sleepiness. For seasonal allergies, professionals generally suggest 50-75 mg 2x/day; believed to be safe up to 12 weeks. For best results, some sources also push to purchase a product certified as UPA-free (meaning free of unsaturated pyrrolizidine alkaloids, which the label will most definitely tout).
Sinupret, a European combination of sorrel, elderflower, cowslip, verbena and gentian root is used for acute and chronic sinusitis, as well as bronchitis.
Nettle Leaf (aka Stinging nettle) is another histamine blocker. It contains vitamin K, quercetin (as above) and carotene. There is not a lot of research, but a long history of its use anecdotally. This botanical can be used in combination with other herbs for allergy relief (like red raspberry or peppermint leaf). Using capsules makes it easier to control dosage, compared to tea or tincture. The root is used to treat other problems, but for allergies it is important to purchase Urtica dioica – the leaf.
Probiotics. While there is a great deal of hype these days regarding gut health (balancing gut bacteria) and allergies, it can be a long fix to approach the problem in this way (although it may offer other advantages). However, the presence of friendly, beneficial gut bacteria can help reduce allergy symptoms. Additionally, taking a strong quality probiotic capsule is a plus to digestive health. I have used several, but currently am happy with Nature’s Bounty Probiotic 10 (ultra-strength 20 billion live cultures) purchased at Costco. They aren’t cheap, (approximately $20 for 140 capsules when not on sale). However, if you wish to take them for any other reason and then find a complimentary action of allergy relief, then it’s a real bonus.
Phleum pretense and Tinospora cordifolia. I have no personal knowledge or experience with the substances, but several studies have shown these products to be effective. The first is extracted from pollen and suggested for eye irritation, asthma and ‘hay fever’ (an older term for seasonal allergies). Tinosporaceordifolia is an herbal remedy from India used to relieve sneezing, itching and nasal passage discharge. Both appear safe, with studies behind them and may help reduce the dose of allergy medicines.
Other items are used for allergies, but truly don’t have enough research to promote. However, if something works for you, then you probably don’t care about the research. Some of these include: Echinacea, local honey, filtered apple vinegar, the 2 antioxidants grape seed extract and pycnogenol, cat’s claw, goldenseal, and spirulina. [Not to forget turmeric – great for inflammation.] However, if you don’t use them for something else, you might find them less-than-effective for acute allergy issues.
Note: Decongestant properties of Bitter orange (citrus aurantium), should be used with care. It may increase high blood pressure, cardiac incidents and chance of stroke.
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ALL TREATMENTS
The case of anaphylactic shock in a nutshell
General Caution
Remember that any drug or substance, food or drink, can cause an allergic reaction. It is possible for these to be deadly. If you have ever wondered what to look for, here are some of the signs & symptoms of a bad reaction.
Trouble breathing
Tightness in chest
Constriction of throat
Difficulty swallowing or talking
Hoarseness
Swelling of mouth, lips, tongue, face or throat
Hives or rash
Itching (eyes or skin)
Skin reactions (red, swollen blisters, peeling)
Wheezing
Emergency epinephrine shots
If such a reaction occurs, you may be in an ‘anaphylaxis’ state and in need of immediate attention. Anaphylaxis can come on suddenly and is extremely serious or even life-threatening. You may need a shot of epinephrine. If you know you are allergic to something in this way (like peanuts or bees), you probably carry an auto injector. Still, it is vital to call 911 immediately as well.
Perhaps what you haven’t done is practice the steps for using an injector – a dry run. The directions are always given in great deal in the box. While you don’t want to open the tube top, you can practice the other motions. It will prepare you while you are calm, not in a stressful and fearful situation.
Examples of these medications include:
- Adrenaclick (Read about my personal experience buying an Adrenaclick
- Auvi-Q
- EpiPen
- EpiPen Jr.
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This article is certainly not inclusive of all treatment and remedies; and possibilities show up on the horizon frequently. In the meantime, if we are sniffling, sneezing and coughing a great deal (especially in spring) it’s good for us to understand our options and what they mean.
If you want to soothe yourself a bit more during high seasons – just hum to yourself. Maybe an old ditty from the Allergy Asthma and Immunology Society:
Blowin’ in the Wind by Peter, Pollen and Mary
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References:
Primer on Allergies.
Clemens von Pirquet first coined the term allergies in 1906, and at that time it seemed ridiculous that ‘antibodies’ – protectors of our health – could conversely create havoc and ill-health.
These allergic disorders were described as “abnormal adaptive immune responses.” So what exactly happens? The body reacts to a substance we generally recognize as harmless, but that is not how the body is seeing it. The body increases IgE (Immunoglobulin antibodies), which are attached to the mast cells as well as Type 1 T-helper cells (Th1). Within minutes, the body responds in a diseased type way, with mucus secretion, constriction of bronchial tubes and ‘vascular permeability.’ If the trigger continues after the body’s first response, there is an even greater response with activation of Type 2 helper cells (Th2) along with leukocytes. How ‘strong’ the responses are depend on a multitude of things: diet, environment, genetics. The person sitting next to you may not react similarly to the same environmental ‘invasion’ as you do.
We are more familiar with typical outward responses (signs and symptoms) than the internal workings. They include runny nose, itchy eyes, nasal congestion, fatigue, sometimes digestive disturbances, nasal drip, asthma, skin eczema, or even severe anaphylaxis.
The Europe PMC 2008 journal article, Development of Allergic Inflammation explains how this inflammatory response becomes chronic with repeated exposure:
“Persistent inflammation induced by prolonged or repetitive exposure to specific allergens,
typically characterized not only by the presence of large numbers of innate
and adaptive immune cells (in the form of leukocytes)
at the affected site but also by substantial changes in the extracellular matrix
and alterations in the number, phenotype and
function of structural cells in the affected tissues.”
*Butterbur info https://wholehealthchicago.com/2010/02/14/butterbur/
**Furrie E. Probiotics and allergy. Proc Nutr Soc. 2005;64(4):465-9.
*Individual antihistamines at: https://www.drugs.com/drug-class/antihistamines.html
*Galli, S. J., Tsai, M., & Piliponsky, A. M. (2008). The development of allergic inflammation. Nature, 454(7203), 445-454, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3573758/
*Wallace DV, Dykewicz MS, Oppenheimer J, Portnoy JM, Lang DM. Pharmacologic Treatment of Seasonal Allergic Rhinitis: Synopsis of Guidance From the 2017 Joint Task Force on Practice Parameters. Ann Intern Med. 2017;167(12):876-881.
Note: A reminder than none of this information is intended to diagnose, prevent, treat or cure your aliments or allergy symptoms.
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Title Picture credit: Allergy Potpourri via Pixabay. Thanks to artists clkir-free-vector, Jojpe, Moigram and digital Artist.
