Sunday, October 19, 2014

Allergy Treatment: Know Your Options

"As the allergy season goes on, your nasal passages become more and more inflamed from daily exposure to pollen," says Dr Dykewicz.

About 20% of Americans suffered from hay fever, which occurs when your immune system overreacts to pollen.  As the body attempts to neutralize the pollen, it releases histamines and other substances that trigger watery eyes, a runny nose, and congestion (which is caused by inflammation).

Research published in the February 2014 issue of the journal Otolaryngologic Clinics of North America shows that people with seasonal allergies have a 10-fold greater risk of developing asthma, and they may be more prone to sinus infections.



Avoidance of Pollens


The simplest strategy to fight allergy is—steering clear of pollen as much as possible.  Here are some tactics you can adopt:[23]
  • After spending time outdoors, pollen can be collected on your hair and clothing.  When returning home, consider:
    • Take off or change your shoes
    • Change your clothes
    • Take a shower 
  • Consider showering at night so that you don't transfer pollen to your bedding
  • Using a saline nasal rinse at the end of the day will help wash pollen out of your nose
  • On really high pollen days,[1,2] you might consider staying inside as much as possible.
  • Filter indoor air.
    • Consumer Reports recommends:[6]
      • 3M Filtrete Elite Allergen 2200 MPR
      • Whirlpool AP51030K
      • Hunter 30547

Allergy Medications


The best treatment for you depends on the severity of your allergies:[6]
  1. Your symptoms are annoying but tolerable.
    • Practice the avoidance tactics
  2. Your symptoms interfere with sleep or everyday activities
    • Consider OTC antihistamines in eye drops or pills
      • You have two choices in antihistamines:[5]

        1. The first-generation drugs
          • Including diphenhydramine (Benadryl Allergy and generic)
        2. The second-generation drugs
          • Including loratadine (Claritin and generic)
          • They are far more selective for peripheral histamine H1-receptors. However, they're more likely to cause drowsiness
          • All the second-generation antihistamines are equally effective[6]
            • So consider choosing by price
    • Antihistamines can be taken whenever your symptoms flare (they become effective in 1 to 3 hours) or daily if the pollen count is high or you're experiencing symptoms more than several days per week.
    • People respond differently to antihistamines, so if you don't get relief from one type, try another.
    • Try nasal sprays—they deliver antihistamines directly to nasal passage and they are said to have an anti-inflammatory effect.
      • Nasal forms work faster than oral decongestants (15 to 30 minutes) and may not cause as much drowsiness. However, they can cause dependency and rebound (see Warnings).
  3. You have daily symptoms and antihistamines aren't enough
    • Consider nasal steroid spray because it reduces inflammation, relieves watery, itchy eyes and helps stave off a congestion-related headache (see also Warnings).
      • For the best results, start using sprays at the beginning of the allergy season (as soon as the weather warms up).
      • The sprays take up to 12 hours to work, and you may not experience the full effect for a week.
  4. You have daily symptoms and no drug seems to help
    • Consider immunotherapy, also known as allergy shots.
      • They can eliminate the need for medication in some people, but they require a major time commitment.  (author's note: I have tried this and it didn't help me that much).
      • A standard course of immunotherapy—which is customized by the type of allergies you have—involves getting regular injections at a doctor's office for three to five years.
      • Soon there may be a more convenient alternative: sublingual immunotherapy
        • It involves placing purified allergens under the tongue to build up your resistance.
        • Some studies show they might not be as effective as traditional shots.  Plus, sublingual therapies contain single extracts, and people usually allergic to more than one.
      • Try the new therapy, known as sublingual immunotherapy, which does not require frequent doctors’ appointments or supervision.[29]

Alternative Treatments


There are a number of alternative remedies available that may help diminish the sneezing, coughing and irritation caused by allergies:[7-12]

  • Eating locally-produced honey
    • In a 2011 study,[8] which found that patients diagnosed with birch pollen allergy found significant relief when they consumed birch pollen honey daily from November to March. 
    • However, Dr. Mercola warns that:
      • Honey itself can also trigger in some cases severe allergic reactions, including anaphylactic shock. 
      • Honey is high in fructose, which, in excessive amounts, can exacerbate pre-existing insulin resistance and wreak havoc on your body.
  • Flushing your nasal cavity with a neti pot
  • Acupuncture[10,24]
    • A new study published in the Annals of Internal Medicine found that patients who received acupuncture treatment for seasonal allergic rhinitis reported improvements in symptoms and decreased use of medication compared to those getting standard treatment or sham acupuncture.
    • However, the effect only lasted as long as they maintained their treatments.
  • Treat your leaky gut syndrome
    • “Healing and sealing” your gut has been shown to help alleviate allergy symptoms.[7,12]
      • Consider fermented foods[16]
      • Consider probiotics and prebiotics[14,26]
        • “Not all probiotics work for allergies.” said Jennifer Dennis, the first author on UF’s latest study.  However, she and the other UF researchers found a combination of probiotics (i.e., lactobacilli and bifidobacteria) that does
  • Eating “right”
    • Patients with asthma and allergic rhinitis may benefit from hydration and:
      • a diet low in sodium, omega-6 fatty acids, and trans fatty acids
      • but high in omega-3 fatty acids (i.e., fish, almonds, walnuts, pumpkin, and flax seeds), onions, and fruits and vegetables (at least five servings a day). 
    • Avoid GMO and processed foods
      • Both GMO and food additives (in most processed foods) have been shown to cause food allergies. 
      • Both GMO and food additives decimate the beneficial bacteria in your gut, thereby having a negative effect on your immune system
    • Avoid junk foods
      • Recent research has also found that junk food increases a child’s risk of asthma and allergies.
    • Avoid foods that may worsen pollen allergies[11]
      • If you are allergic to ragweed, you may have cross-sensitivity to melons, bananas, tomatoes, zucchini, sunflower seeds, dandelions, chamomile, and Echinacea. 
      • If you have a grass allergy, you may also react to peaches, celery, tomatoes, melons and oranges. 
    • Consider "White Ingredients" (白色食材)[9,13]
  • Following Chinese traditional doctor's suggestions:[15]
    • Avoid eating sugary or icy foods.
    • When your allergy symptoms flare up and lose appetites, eat less and eat lighter foods. You can even consider skipping meals and drinking water only to give your body a break to recoup.
    • Try eating foods full of digestive enzymes such as pineapple (bromelain) and papaya (papain).  It may be more helpful eating them with an empty stomach.

Warnings


Antihistamines sometimes cause dry mouth, headaches, and drowsiness, but a bigger drawback is that they tend to become less effective with long-term use.

The major hazard with nasal-delivery decongestants, particularly long-acting forms, is a cycle of dependency and rebound effects.[3] The 12-hour brands pose a particular risk for this effect.
  • With prolonged use (more than 3 - 5 days), nasal decongestants lose effectiveness and can cause swelling in the nasal passages.
  • The patient then increases the frequency of the dose. As the congestion worsens, the patient may respond with even more frequent doses.
  • This causes dependency and increased nasal congestion.

The following precautions are important for people taking nasal decongestants:
  • When using a nasal spray, spray each nostril once. Wait a minute to allow absorption into the mucosal tissues, and then spray again.
  • Do not share droppers and inhalers with other people.
  • Discard sprayers, inhalers, or other decongestant delivery devices when the medication is no longer needed. Over time, these devices can become reservoirs for bacteria.
  • Discard the medicine if it becomes cloudy or unclear.
  • DO NOT USE NASAL DECONGESTANTS FOR LONGER THAN THREE DAYS.

Also be warned that improper use of a steroid spray can cause harms:
  • The side effects include nasal dryness and irritation, sore throat, headache, and bleeding sores in your nose.
  • Improper use can lead to a hole in your septum in rare cases, and long-term use may increase the risk of cataracts or glaucoma.  
    • Always consult your family doctor if you're using an over-the-counter steroid spray for more than a month, you have side effects, or your symptoms don't improve.

Photo Credits


References

  1. National Allergy Forecast Map
  2. NAB Pollen Counts
  3. Allergic Rhinitis (The New York Times)
  4. Allergy medications: Know your options
  5. H1 antagonist
  6. Consumer Reports Best Buy Drugs
    • Cetirizine 10 mg tablets
    • Loratadine 10 mg tablets (see side effects here)
    • Loratadine dissolving 10 mg tablets
    • Loratadine liquid 10 mg
    • Alavert dissolving 10 mg tablets
  7. How to Address Allergies and Asthma Symptoms as “Worst Allergy Season Ever” Begins
  8. Allergy Remedies: Fact or Fiction
  9. 咳傷身！白色蔬食有助呼吸道保養、修復
  10. Acupuncture May Help Seasonal Allergies, Study Finds
  11. Foods That May Worsen Pollen Allergies
    • Check here for the list of foods to avoid if you are allergic to:
      • Ragweed
      • Birch pollen
      • Grass
      • Latex rubber
  12. Leaky Gut Syndrome and Autoimmune Disease
  13. 白色食物除秋燥
    • 中醫師陳旺全提及，在五色中，白色入肺，這也是一般常聽到秋天可以多吃一些白色食物來滋養肺部的關鍵。
  14. Do I need to include probiotics and prebiotics in my diet?
  15. 過敏？吃鳳梨、木瓜消炎！｜台灣好食材
  16. Health Benefits of Eating Fermented Foods (Travel to Health)
  17. Allergy Capitals
    • The top 5 cities for 2015 are:
      1. Jackson, MS
      2. Louisville, KY
      3. Oklahoma City, OK
      4. Memphis, TN
      5. Knoxville, TN
  18. How to Survive Springtime Allergies
    • Omega-3s
    • Stinging Nettle
    • Butterbur
    • Neti Pots
    • Flavonoids
  19. The 15 Sneeziest, Wheeziest Cities in America
  20. Pregnancy and asthma: Managing your symptoms (Mayo Clinic)
    • Some concerns have been raised about the use of systemic glucocorticoids during pregnancy, which has been linked with an increased risk of infant oral clefts, premature birth, low birth weight and preeclampsia.
  21. The global pollen problem is getting worse and worse
    • Allergies in general are on the rise possibly because of:
      • Hygiene hypothesis
      • Rising carbon dioxide levels, which has caused plants producing more allergy-causing pollen
      • Climate change has increased the potency of pollen (i.e., ragweed pollen)
  22. How honey kills bacteria
    • High concentrations of the antibacterial compound methylglyoxal (MGO) were found specifically in Manuka honey
  23. Your guide to surviving allergy season
  24. Acupuncture and Herbs Relieve Hay Fever
  25. Pollen Allergy (video)
  26. Allergies? Probiotic combination may curb your symptoms, new study finds
  27. Health Benefits of Omega-3 Fatty Acids (Travel and Health)
  28. Asthama (Wikidoc)
  29. A new Could Allergy Drops Be the Key to Allergy Relief?
  30. Allergy or Intolerance: How Can You Tell the Difference?
  31. Respiratory and allergic diseases: from upper respiratory tract infections to asthma
  32. Food Allergy Tests for Kids: What You Need To Know
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