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If you're like me, you spend a part of your day rubbing your eyes and blowing your nose. It's fall, which means that ragweed releases pollen into the air – and people with ragweed allergies try to escape.
If you're like me, you think that by taking an antihistamine every day, you're doing everything you can to control your symptoms. But otherwise, you spend your time between your days, fabrics by your side, secretly hoping for a hard gel to kill all those pollen-producing herbs.
What else can you do?
Many, it is found. There are new treatments for people with seasonal allergies to ragweed and herbs (which release pollen in late spring and summer). And the relatively new advice on over-the-counter allergy medications. There are also reminders on how to avoid pollen or fight it after exposure.
I was happy to learn some of the latest solutions for my itching and sneezing. I was less than happy to learn that my allergies are likely to worsen with climate change.
"Botanists say that for birch and ragweed, with rising average temperatures, the amount of pollen produced increases," said Sandra Lin, otolaryngologist at Johns Hopkins University. (Birch pollen is an early spring allergen.) In addition, seasons of allergies are longer and the distribution of plants expands and moves north.
Over-the-counter drugs
At the pharmacy, the allergy aisle offers classic antihistamines, such as Benadryl and Chlor-Trimeton (doctors call them the first generation), which are effective in reducing the symptoms of allergy, but cause also an important sedation.
"Benadryl is really sedative," says Janna Tuck, an allergist and pediatrician in Santa Fe, New Mexico. "It inhibits superior cognitive function, which means it impairs your ability to work, think and drive."
The doctors' favorite drugs are the newest on the pharmacy market: nasal steroids, such as Flonase and Nasacort, approved for over-the-counter use in the last four years. Lin, who co-authored the clinical practice guidelines of the American Academy of Otolaryngology-Head and Neck Surgery in 2015, says that the most effective treatments against Moderate to severe seasonal allergies are the most effective. Used by spraying directly on the nose once a day, they are effective in reducing allergy symptoms during the pollen season, including runny nose, nasal congestion, sneezing and itching.
"You have to use nasal steroids every day," says Flavia Hoyte, an allergist and immunologist at Denver's National Jewish Health. "It takes time to work. Try for a few weeks before giving up.
Second generation antihistamines – such as Allegra, Claritin and Zyrtec – are almost as good and some people prefer to take a pill instead of spraying something on their nose. These medications do not reduce nasal congestion or other over-the-counter options. For this reason, most have a "D" version that combines the antihistamine with a decongestant pseudoephedrine. But decongestant means more potential for side effects, such as blood pressure problems, sleep difficulties, and urinary retention, Lin says.
When the number of pollen is high and your symptoms worsen, can you double these over-the-counter medications? You can do it, says Tuck, like taking a bedtime Benadryl to help you sleep despite a stuffy, runny nose. But most studies show that the combination of over-the-counter allergy medications does not usually give you more relief.
"Most people use their pills every day and use a nasal spray as needed. It's much better in reverse, "she says. This is because nasal sprays are more effective when used daily, they are more effective than pills and cover more symptoms.
In addition, Tuck adds, "If you take two medications a day, this is a sign that you should see a doctor. They may have a better solution for you. "
Prescription treatments
"If you're unhappy every fall, allergy vaccines can help," says Tuck. The more technical term is allergen immunotherapy, which involves an allergen exposure regime, which eventually alters the underlying immune response.
"Immunotherapy is the only treatment that alters the underlying immunology," Lin said. Pharmacy medications only treat symptoms.
The "new" novelty is tablet immunotherapy rather than injection therapy. Currently, four tablets have been approved by the Food and Drug Administration, says Hoyte, who co-authored a 2018 article on recent advances in the field. Two concern allergies to certain grass pollen, the other allergy to ragweed and the other allergy to mites.
"The big advantage is that you take them home," says Hoyte. "The shots must be done in the doctor's office."
A typical vaccination regimen is weekly for seven to eight months and then every month up to five years. With the tablets, the dose is much smaller – you take it daily – and the risk of reaction is very low.
"Local side effects can occur, such as itching or tingling in the mouth," says Hoyte. Hoyte administers the first dose at the office so that she can monitor the adverse reactions. And she sends patients home with an EpiPen, a device that delivers an injection to treat a possible reaction.
Another benefit is that you can use the daily tablets seasonally rather than throughout the year. It is recommended to start 12 weeks before the start of the pollen season.
But there are disadvantages. The tablets are so new that the insurance coverage is uneven. Doctors have less experience with them, so the effectiveness and side effects are still being evaluated. And tablets are not available for various allergies, such as mold, pet dander or tree pollen.
With allergy shots, a change is noticeable in the first year and can be maintained after three to five years of treatment. Hoyte says that not everyone responds to immunotherapy; about 85% of patients experience at least one improvement.
Avoidance
Avoiding pollen means keeping it outdoors when you are indoors. Close your windows and use the air conditioning in your home to filter the pollen. "For avoidance measures to be effective, you have to do several things," Lin says. You could also take a shower or at least change clothes when you come from the outside; wear a mask outside gardening or gardening; and if you have outdoor pets, keep them out of your bedroom.
Indoor air filters are not helpful with plant pollen, says Tuck. "The pollen is relatively big, so it falls on surfaces," she says. "Animal dander are different. It's pretty light (to float in the air), so an air filter helps. "
Rinse
Saline rinses are effective at preventing allergic reactions as they remove pollen from your nose.
"Saline is your friend," says Tuck, spokesperson for the American College of Allergy, Asthma & Immunology. "Use it when you come from the outside." She adds: "This can slightly decongest and it's pretty immediate."
You can create your own saline solution for use with a Neti pot or a small squeeze bottle. Instructions abound on various websites. The FDA has a version on its website. Go to fda.gov and look for neti pot.
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