Goodbye Allergy

Allergic rhinitis is sometimes called “hay fever” or “seasonal allergies,” although it can be caused by nonseasonal substances as well. Allergic rhinitis refers to inflammation in the nose (rhinitis) that occurs when you are exposed to a substance you are allergic to. The term “allergic rhinitis” does not refer to all kinds of allergies you may have. For example, food allergies and allergies to medications do not typically cause allergic rhinitis.

“Allergies” is a general term that refers to a reaction the body has to allergens. Allergens are substances that are generally not harmful to the body. However, if you have allergies, the immune system thinks allergens are dangerous and tries to fight them off like it would any other intruder, such as bacteria, viruses, and parasites. Having allergies, therefore, means the immune system is overactive. In other words, the immune system is doing something it is normally supposed to do but the reaction is exaggerated, unnecessary, and even harmful to the body. In medical terminology, this overreaction is called a type 1 hypersensitivity reaction.

There are many different kinds of allergies that differ based on the part of the body affected and the severity of symptoms. In some cases, allergies may cause a small rash or runny nose. In other cases, allergies can be life-threatening. Types of allergies include allergic rhinitis (inflammation in the nose), contact dermatitis (an allergic reaction on the skin), allergic asthma (a specific type of asthma), and anaphylaxis (a life-threatening condition that involves swelling of the airways).

Allergic rhinitis is typically caused by allergens that are airborne. These are roughly divided into outdoor airborne allergens and indoor airborne allergens. Common airborne allergens found outdoors include tree pollens, grass pollens, and weed pollens. Common airborne allergens found indoors include animal dander, dust mites, and mold.

Outdoor allergens are usually seasonal because plants release pollen at certain times of the year. Spring allergies are commonly due to tree pollens. Late spring and summer allergies are commonly due to grass pollens. Late summer and autumn allergies are commonly due to weed pollens, such as ragweed pollen. In fact, ragweed pollen is one of the primary causes of allergic rhinitis and 75% of people with pollen allergies are allergic to ragweed.

Indoor allergens may be present throughout the year. However, certain situations can make indoor allergies worse. For example, animal dander allergies may be worse in the winter because pets may spend more time indoors and there is less circulating fresh air. And mold allergies may be worse if there is a very rainy spring season.

Researchers aren’t sure why some people develop allergies and others do not. What we do know is that the tendency to develop allergies is genetic. This means if your family members have allergies, you are more likely to have them as well. Additionally, certain allergic conditions commonly occur together. Known as the “atopic triad,” these conditions are allergic rhinitis, eczema (also called atopic dermatitis), and allergic asthma.

Immunoglobulin E (IgE) is a type of antibody. Antibodies are proteins that the body forms to help fight invaders, known as pathogens. There are several kinds of antibodies that the body can make. IgA antibodies are typically found in mucous membranes, such as the mouth and the intestinal linings. IgA is also found in breastmilk and can transfer from mother to baby. IgD antibodies are less understood and signal certain immune cells to activate. IgM antibodies are the first antibodies the body makes when exposed to a pathogen. And IgG antibodies take longer to make but are the antibodies we typically think of that are associated with immunity to diseases.

IgE antibodies are normally beneficial because they help protect against parasites. However, IgE antibodies are also responsible for allergic reactions. When the body encounters an allergen for the first time, it develops IgE antibodies that are targeted against that allergen. The IgE antibodies then attach to the surface of immune cells called mast cells and basophils. The next time the body is exposed to the same allergen, the allergen links up with the IgE antibodies, beginning a series of events that result in allergy symptoms.

Histamine is an inflammatory chemical that is released by immune cells during an allergic reaction. The release of histamine is normally helpful because it can help fight pathogens that are affecting the body. However, during an allergic reaction, histamine is released when it shouldn’t be. Histamine is responsible for symptoms like watery eyes, runny nose, sneezing, and itchy skin.

Leukotrienes are inflammatory chemicals that are released by immune cells during an allergic reaction. The release of leukotrienes is normally helpful because it can help fight pathogens that are affecting the body. However, during an allergic reaction, leukotrienes are released when they shouldn’t be. Leukotrienes are responsible for inflammation and the production of a large amount of mucus.

Vitamin D is necessary for the normal functioning of several bodily processes. One study on overweight men who had a vitamin D deficiency found that after a year of supplementation with vitamin D, testosterone levels increased. Another small study found that supplementation with vitamin D was associated with increased testosterone levels and improved erectile function. However, vitamin D has not been evaluated by the FDA as a treatment for low testosterone and further studies need to be done to better understand the effects and optimal dosing of vitamin D.

1. The first time the body is exposed to an allergen, it responds by creating antibodies known as immunoglobulin E (IgE).
2. IgE antibodies attach to the surface of immune cells called mast cells and basophils.
3. The next time the body is exposed to the same allergen, the allergen links up with the IgE antibodies. This prompts the mast cells and basophils to release inflammatory chemicals, including histamine and leukotrienes.
4. The release of histamine and leukotrienes causes the symptoms that are typically associated with allergies. Histamine is responsible for watery eyes, runny nose, sneezing, and itchy skin. Leukotrienes are responsible for inflammation and the production of a large amount of mucus.

Azelastine works by blocking the H1 receptors on cells, which are receptors that are normally activated by the chemical histamine. When the body is exposed to an allergen, immune cells (called mast cells and basophils) release histamine. Since azelastine blocks histamine from activating the H1 receptors, the symptoms that are typically caused by histamine are lessened. Azelastine also has anti-inflammatory effects and reduces congestion.

Researchers are not entirely sure how fluticasone propionate works but it is known to have a wide range of effects on different immune cells and chemicals that cause inflammation, including mast cells, histamine, and leukotrienes.

Levocetirizine works by blocking the H1 receptors on cells, which are receptors that are normally activated by the chemical histamine. When the body is exposed to an allergen, immune cells (called mast cells and basophils) release histamine. Since levocetirizine blocks histamine from activating the H1 receptors, the symptoms that are typically caused by histamine are lessened.

Montelukast works by blocking cysteinyl leukotriene receptors, which can be activated by the chemical leukotriene D4. When the body is exposed to an allergen, immune cells (including mast cells and basophils) release leukotriene D4. Since montelukast blocks leukotriene D4 from activating the cysteinyl leukotriene receptors, the symptoms that are typically caused by leukotriene D4 are lessened.

Yes, azelastine may make you drowsy. Azelastine is a type of medication known as an antihistamine. One of the common side effects of antihistamines is drowsiness. As such, azelastine may make users drowsy after use. Users should exercise caution when taking azelastine and should be aware that mental alertness may be decreased. This can impact the ability to drive or operate machinery.

No, fluticasone propionate should not make you drowsy. Antihistamines are a group of medications that are commonly used to treat allergies and one of the side effects of antihistamines is drowsiness. However, fluticasone propionate is not an antihistamine. It is a type of medication known as a glucocorticoid. Therefore, fluticasone propionate does not typically cause drowsiness as other allergy medications do. That being said, the Prescriber’s Digital Reference (PDR) for fluticasone propionate does list fatigue as one of the many possible side effects of taking the medication.

It is possible levocetirizine will make users drowsy but the exact answer is unclear. Levocetirizine is a type of medication that is sometimes referred to as a third-generation antihistamine. It is derived from cetirizine (brand name Zyrtec), which is a second-generation antihistamine. The third-generation antihistamines are a new type of drug class that is believed to cause less drowsiness than the second-generation antihistamines. However, the exact extent of this difference is unclear. As such, while it is possible that levocetirizine is less sedating than cetirizine, it still may cause drowsiness. Users should exercise caution when taking levocetirizine and should be aware that mental alertness may be decreased. This can impact the ability to drive or operate machinery.

No, montelukast should not make you drowsy. Antihistamines are a group of medications that are commonly used to treat allergies and one of the side effects of antihistamines is drowsiness. However, montelukast is not an antihistamine. It is a type of medication known as a leukotriene receptor antagonist. Therefore, montelukast does not typically cause drowsiness as other allergy medications do. That being said, the Prescriber’s Digital Reference (PDR) for montelukast does list fatigue as one of the many possible side effects of taking the medication.

A severe allergic reaction is known as anaphylaxis. Mahimo does not offer treatment for anaphylaxis. If you are experiencing a severe allergic reaction (or even if you just think you might be in trouble), call 9-1-1 immediately and seek medical help. The symptoms of a severe allergic reaction include itching of the mouth and lips, swelling of the airway, tongue, and lips, flushing, hives, decreased blood pressure, difficulty breathing, confusion, and loss of consciousness. These symptoms may occur rapidly and are life-threatening, requiring emergent treatment.

If you have a history of anaphylaxis or are at risk of developing anaphylaxis, your healthcare provider may have prescribed you a medication called epinephrine. You should carry this medication with you at all times and should give it to yourself (or have somebody else give it to you) in the event of a severe allergic reaction without delay.

Yes, you need a prescription from a healthcare provider to obtain azelastine nasal spray. The medication comes in several doses and is normally available as the generic or as the brand name, Astelin. Mahimo only offers the generic form, which will be prescribed to you if your Mahimo-affiliated physician believes it is appropriate for the treatment of your allergic rhinitis.

No, you do not need a prescription from a healthcare provider to obtain fluticasone propionate nasal spray. This means you can get the medication either with a prescription or over-the-counter. The medication is normally available as the generic or as the brand name, Flonase. Mahimo only offers the generic form, which will be prescribed to you if your Mahimo-affiliated physician believes it is appropriate for the treatment of your allergic rhinitis.

No, you do not need a prescription from a healthcare provider to obtain levocetirizine. This means you can get the medication either with a prescription or over-the-counter. The medication is normally available as the generic or as the brand name, Xyzal. Mahimo only offers the generic form, which will be prescribed to you if your Mahimo-affiliated physician believes it is appropriate for the treatment of your allergic rhinitis.

Yes, you need a prescription from a healthcare provider to obtain montelukast. The medication comes in several doses and is normally available as the generic or as the brand name, Singulair. Mahimo only offers the generic form, which will be prescribed to you if your Mahimo-affiliated physician believes it is appropriate for the treatment of your allergic rhinitis.

Yes, you can take azelastine as-needed for symptom relief. Azelastine is rapid-acting and typically starts working within 15 minutes. Taking azelastine as-needed will lead to a temporary improvement in sneezing and itchy and runny nose. However, the effects of the medication will wear off after 12 hours, so if you need continuous symptom relief it is recommended you take the medication twice daily. Using azelastine twice daily may also lead to an improvement in overall congestion.

Yes, you can take fluticasone propionate as-needed. However, if you do so, you may not experience the medication’s maximal effectiveness. Fluticasone propionate normally starts working after 12 hours but it may take 10 to 14 days of continuous, daily usage to see the most improvement in nasal congestion.

Yes, you can take levocetirizine as-needed for symptom relief. Levocetirizine is fast-acting and typically starts working after 1 hour. Taking levocetirizine as-needed will lead to a temporary improvement in sneezing, runny nose, and itchy eyes. However, the effects of the medication will wear off after 24 hours, so if you need continuous symptom relief it is recommended you take the medication daily.

No, it is not recommended that you take montelukast as-needed. Montelukast may start working after the first dose in some users. However, to experience maximal improvement in nasal congestion, it should be continued for several days.

Fluticasone propionate is a type of medication known as a glucocorticoid. Glucocorticoids are corticosteroid hormones that are effective at reducing inflammation. Corticosteroid hormones are not the same thing as anabolic steroids, which are the steroids commonly associated with athletic enhancement.

Using fluticasone propionate as prescribed for the treatment of allergic rhinitis is generally not considered dangerous. However, chronic overuse may cause specific signs and symptoms. Using greater than what is recommended by your physician can lead to trauma and irritation of the lining of the inside of the nose, which can lead to nosebleeds. Long-term use of high levels of corticosteroid hormones can cause other symptoms such as thinning skin, changes in body fat distribution, blood sugar problems, bone loss, and increased acne or facial hair. If you are experiencing worrisome symptoms, contact a healthcare provider.

Besides medication, there are many other things you can be doing to treat your allergic rhinitis. One of the most important things is called allergen avoidance. This involves successfully staying away from the things you are allergic to. Some tips for how to avoid allergens include:

• If you have pollen allergies, you may benefit from staying indoors during certain times of the year or avoiding freshly cut grass. You can also keep your windows closed at home and in your car to avoid airborne exposure.
• If you have animal dander allergies, you may not want to own a pet or visit the homes of friends who have pets.
• If you have dust mite allergies, you may want to purchase a hypoallergenic mattress cover and pillow covers for your bed. Weekly washing of your bed linens will also help decrease the level of dust mite exposure.
• If you have mold allergies, you may benefit from staying out of places where mold commonly grows, such as basements. Molds thrive in warm, damp areas, which also includes showers and bathrooms. Keeping your bathroom well ventilated or dry (with a dehumidifier) can help keep mold levels to a minimum.

Purchasing a High-Efficiency Particulate Air (HEPA) filter can also help protect against airborne allergens.

Another way to improve nasal symptoms is to perform nasal saline irrigation.

Nasal saline irrigation is a practice that involves flushing the nasal passages with a large volume of a saline solution. It is highly recommended that everybody with airborne allergies irrigates their nose at least once a day (but ideally twice) per day. If you have airborne allergies, irrigating once before going outside and once when you come home is extremely helpful to clear the nose of the allergen particles that are causing your symptoms. Numerous companies sell devices that can be used for nasal saline irrigation, such as the neti pot or the Neil Med irrigation bottle.

Nasal saline irrigation can cause an unusual sensation that might be uncomfortable at first. It should always be performed with a warmed solution that is intended for nasal irrigation and not with fresh water. If you are mixing your own solution, it is extremely important that you do NOT use tap water, as this could be contaminated with organisms. Instead, make sure you only use water that has been distilled, sterilized, or boiled. If you use boiled water, do not mix the solution or use the water until it has cooled down to room temperature.

There are many other oral and nasal medications that can be taken for allergic rhinitis. There are also eye drops that can be used to treat itchy eyes. Some of these other medications include other antihistamines, other corticosteroids, decongestants, cromolyn sodium, and ipratropium bromide.

While it is safe to combine some allergy medications, certain combinations may be dangerous or may cause excessive drowsiness. Therefore, it is always important to talk to your healthcare provider about what you are taking, including over-the-counter medications. Do not start any new medications in addition to the treatment you have been prescribed here without first talking to a healthcare provider.

It is hard to say whether your allergies will ever go away. Certain allergies tend to be more common in children and many patients may find that their allergy symptoms improve with age. However, it is also possible to develop new allergies as an adult. You may also become more aware of certain allergies if you change your surroundings, such as if you move to a new city and are exposed to new pollens.

Allergy shots, also called immunotherapy, are a type of long-term treatment for allergies. Allergy shots are given on a weekly basis for several months. It may take up to a year to see any improvement in symptoms. Allergy shots can then be given every few weeks for approximately 3 to 5 years.

Prior to beginning allergy shots, an individual is tested to determine his or her specific allergens. The individual is then injected with small and increasing amounts of those allergens. By injecting the individual with allergens, his or her immune system is slowly retrained, becoming desensitized to those allergens. This means that when the individual is exposed to the allergens in the real world, he or she mounts less of a reaction to them. Allergy shots can potentially trigger anaphylaxis, so they must always be given in a healthcare provider’s office under supervision.

Allergy drops are also known as sublingual immunotherapy. The idea behind allergy drops is the same as allergy shots and involves gradual desensitization to certain allergens. Allergy drops are placed under the tongue daily and do not require administration in a healthcare provider’s office. However, there are not many allergens that are currently FDA-approved for allergy drops. Additionally, since allergy drops are newer, their long-term efficacy is unknown.

Remedies that have shown some efficacy in treating allergic rhinitis include the following:

• Acupuncture and acupressure
• Ayurvedic medicine, including a mixture of seven Indian herbs (Albizia lebbeck, Terminalia chebula, T. bellerica, Phyllanthus emblica, Piper nigrum, P. longum, and Zingiber officinale)
• Herbal therapies, including butterbur, Tinospora cordifolia, a mixture of cinnamon bark, Spanish needle, and acerola, Benifuuki green tea, Yupingfeng granules, ginseng, and Tonggyu-tang
• Topical treatments, including capsaicin, cellulose powder, and a petrolatum-based allergen-absorbing ointment

Remedies with less strong evidence include the following:

• Herbal therapies, including quercetin, stinging nettle, Perilla frutescens, steamed eucalyptus, menthol, Ginkgo biloba, milk thistle, and grape seed extract
• Laser therapy