‘Tis The Season To Be Sneezy, Fa La La La La, La La Achoo!

While coronavirus has been the non-stop topic for nearly all of us for the last couple of months, today we switch gears a bit to discuss seasonal allergies.  The last couple of weeks has brought with it the dawn of the seasonal allergy season, and with it, plenty of sneezing, stuffy noses, itchy throats, asthma exacerbations, and eyes reminiscent of Rocky Balboa after going 15 rounds with Apollo Creed.

Seasonal allergies are quite common, affecting roughly one in five children and adults in the United States.  Seasonal allergies are caused by immune responses to allergens.  As with all immune responses, there has to be a trigger.  Here on Long Island, the classic seasonal culprits are tree pollens in April and May, grasses during May, June, and July, and weeds in September.  Because you have to be exposed to and generate an immune response to an allergen to have symptoms, seasonal allergies are uncommon prior to two years of age in children.  The frequency with which allergy symptoms are present (prevalence) increases with age, with a peak during early adulthood.  There is some improvement when you get old, primarily for the same reason you are more prone to infections when you are old – your immune system starts to weaken.

Seasonal allergies affect each person differently, and many have other conditions that go hand in hand with allergies.  While many individuals will often have just nasal symptoms (sneezing, runny nose, congestion) or ocular symptoms (red, itchy, and/or watery eyes), more than half will have both.  In addition, allergies often trigger worsening of other conditions such as asthma or eczema.  Asthma, eczema and allergies are often known as the “Allergic Triad” for that reason.

How you manage symptoms primarily depends on which symptoms are present and how severe they are.  Some simple modifications in the home environment may assist those with seasonal allergies.  Keeping windows closed at home (and in the car) and using air conditions to filter the air is recommended.  Minimizing outdoor exposure will help, but clearly it is not expected nor recommended that you keep children indoors during an entire allergy season.  Showering and changing into clean clothing after being outside will help remove allergens before contaminating furniture (especially bedding).  Saline nasal sprays can be of benefit after exposure as well as they rinse away the allergen from the nasal passage.

The primary starting point for medicinal treatment of allergies is oral antihistamines.  There are several options available at the pharmacy without a prescription.  Cetirizine, fexofenadine, and loratadine are generally preferred and are available as tablets, liquids, and chewable tablets.  Other options, such as diphenhydramine, are available but are associated with increased side effects, need to be given more frequently during the day,  and thus are not recommended as initial therapy.  Dosing for all is usually clearly stated on the packaging for each age group.  You can also find dosing on our website in the “Self Help” section by using the medication dosing pull down menu.

When treatment with oral antihistamines alone is not sufficient, there are other options to assist and are often used in combination with the oral antihistamines.  To assist with both nasal and ocular symptoms, steroid nasal sprays are often used, and many are available without a prescription.  Mometasone, fluticasone, and triamcinolone are among those approved for children over two years of age for this purpose.   There are also antihistamine nasal spray options for older children such as azelastine (>5 years of age) and olopatadine (>12 years of age).   Lastly among nasal sprays are cromolyn nasal sprays.  While they work, they need to be frequently dosed and that inconvenience alone leads to their limited use.  For those who need extra help with ocular symptoms, there are many antihistamine ophthalmic (eye) drop options to assist.  These include ketotifen, epinastine, azelastine, emedastine, and olopatadine.  Some of these are available without a prescription, others require one.   Again, there are cromolyn eye drops to assist.  They are best used prior to exposure and need frequent dosing which again makes them a less favorable option for most.

For some folks, all the above listed options are still not sufficient, and that brings us to the domain of an allergy specialist.  An allergy specialist is capable of testing for specific allergens and offering treatments to desensitize against the offending agent.  Desensitization can be done via injection (“allergy shots”) or in some cases sublingually (tablets that dissolve under the tongue).  There is little role for testing for specific allergens prior to reaching this stage primarily because knowing which tree is causing the issue would not have helped you treat the allergy.  It is illegal in the United States to go Link and cut down every oak tree in the woods.  For those that don’t quite know what that refers to, go find a retro Nintendo system and get the Legend of Zelda game.  You will find it can occupy many hours of your time in quarantine.

As always, if you have any questions or would like your child evaluated, please call the office and we will be happy to assist you!