How Do You Fight Back?
Do you feel like your allergies are getting worse? They may be. New research published by the National Academy of Sciences shows that pollen seasons start 20 days earlier, are 10 days longer, and feature 21% more pollen than in 1990. The researchers suggest that this is due to climate change. Therefore, it will likely get worse. It is often recommended to start taking allergy medication at least two weeks before seasonal symptoms typically appear. That means treatment for spring allergies will now begin around Valentine’s Day!
Allergies affect many organs in our body. Otolaryngologists specialize in managing allergic disease of the ears, nose, and throat. The most common allergy symptoms within the head and neck region are nasal congestion, rhinorrhea (a runny nose), postnasal drip, itchy nose or throat, sneezing, and a cough. The most common allergic condition seen in my clinic is allergic rhinitis. This is inflammation of the inside of the nose caused by pollen, dust, mold, or other irritants.
Allergic rhinitis is very common. It affects up to 50% of the population worldwide with the highest frequency in children. More worrisome is that up to 30% of patients with allergic rhinitis develop asthma. Allergic rhinitis is also associated with chronic sinusitis, eustachian tube dysfunction, atopic dermatitis, and sleep disturbance.
There are treatment options available. The first step is either an allergy test or, if possible, avoiding or controlling exposure to allergy-causing irritants.
If needed, there are three first-line medical therapies that are all intranasally delivered: corticosteroids, antihistamines, and saline.
Intranasal corticosteroids (nasal sprays sold under the brand names of Flonase, Nasocort, Rhinocort, Nasonex, Omnaris and Q-Nasl) should be used at least daily. At most they can be used twice a day, and they take about six to eight weeks to have an effect. The most common side effects are dryness, burning, stinging, and nosebleeds. To avoid nosebleeds, these nasal sprays should be used in an “opposite hand, opposite nostril” technique, using the right hand to spray into the left nostril, and vice versa. This allows the tip of the spray bottle to be directed up and outward towards the ears and sides of the face.
Intranasal antihistamines are usually prescribed in combination with intranasal corticosteroids. There are two formulations available over the counter, Azelastine and Olopatadine. These medications are typically better tolerated than the steroid sprays, except they taste bad. If you have ever been prescribed Dymista, this is a combination spray that includes Flonase and Azelastine in one bottle. Unfortunately, without insurance Dymista often costs over $200, and therefore these sprays are generally prescribed separately.
The final first-line therapy is intranasal saline, typically in the form of salt rinses or irrigations.
If a patient fails standard medical therapy, second-line treatment options include allergen immunotherapy, biologics, and possible surgical evaluation.
Immunotherapy (also known as allergy shots) usually involves 3-5 years of repeated injections. The goal is to change the immune system’s response to certain allergens. Biologics are a newer class of drugs that target specific components of the allergic pathway. These drugs are also injectable but can be costly.
Finally, while surgery cannot cure allergies, some surgical options may improve certain symptoms. A septoplasty can ease nasal obstruction if it is caused by a deviated septum. That is the structure which separates the right from the left nasal cavity. Inferior turbinate surgery also improves nasal obstruction by reducing the volume of turbinate tissue. These are the tiny structures in your nose that clean, heat and humidify air as it passes through the nasal cavities. Lastly, treatment of a nerve in the back of the nose has been found to relieve rhinorrhea.
With summertime allergies starting earlier and earlier, it’s a good idea to talk with your primary care doctor. If necessary, you can be referred to the Saint Alphonsus ENT, Hearing & Balance clinic in Boise for additional evaluation.
