June 6th, 2013

The first three steps of allergy treatment

woman-with-allergiesThis time of year, a lot of patients are asking me about seasonal allergy remedies. They are surprised when I tell them that medications such as Reactine or Aerius are Step 3 in the treatment protocol. Step 1 is allergen avoidance and Step 2 is allergen removal. I must mention at this point that for those with serious symptoms, such as bacterial sinusitis or allergic asthma, please see your doctor.

Step 1—Allergen Avoidance
How can you avoid allergens in the air? Allergen loads are highest pre-dawn, so if you have allergies, try not sleeping with the windows open overnight will be a great help. Also, if you can control your schedule, don’t go out first thing in the morning. If you can’t change your schedule, plan to arrive a little earlier so you can splash some water on your face to remove any allergen particles.

Step 2—Allergen Removal
Allergen removal is just as important as a choosing an antihistamine. After outside activities take a shower to wash the pollen out of your hair, eyebrows and eyelashes. During your shower, let the water briefly run over your eyeballs so that it can rinse out any pollen. Don’t forget to blow your nose after the shower, as well.

If you can’t have a shower, at the very least carry around some artificial tears (such as Blink or Systane) and instill into the eyes a couple of times while you are out. Also, carry around some physiologic saline (such as London Drugs Saline 0.9%) or a nasal lubricant such as Rhinaris Nasal Spray. These artificial tears and nasal sprays will also help maintain mucosal health (important when the eyes and nose are irritated).

Step 3—Allergy Treatment
If you are stringent with Steps 1 and 2, your antihistamine will appear to work that much better. Benadryl is the gold standard, but it causes drowsiness in a lot of people. If this is you, Reactine and Aerius is a good first choice; they are at least as potent as Benadryl, but it does not cause drowsiness in the vast majority of people, and they are both sufficiently long lasting that they only need to be taken once per day.

Be weather aware
The above measures are usually enough for most people, but pollen loads wax and wane. The Weather Network posts its pollen index for various pollens in your area. When the pollen load is particularly high, performing sinus lavages with the Neilmed Sinus Rinse Kit or HydraSense may be necessary. The lavage has enough volume to flush out the sinuses; the saline/lubricant nasal sprays do not have enough volume to serve as a lavage.

Even with the above, seasonal allergic symptoms can still progress and be bothersome. That is why nasal corticosteroids (e.g. Nasonex), ophthalmic antihistamines (e.g. Patanol), orally inhaled corticosteroids (e.g. Flovent), leukotriene receptor antagonists (e.g. Singulair), and desensitization shots exist. But you’d have to see your doctor for those.

Keith Ma
Tillicum, Victoria
Pharmacy manager

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