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Davis Square Family Practice
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Friday
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Deborah Bershel, MD
Michelle Clark, NP
Carmen Phillips, NP
"Call our office to receive logon credentials."
Barbara Kaplan, LICSW
Christopher Mulvey, NP
Allergic Rhinitis
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What You Should Know About Allergic Rhinitis

"Allergy" is the potential for your body's immune system to react in a strange way to substances in the air that are usually harmless. There are many of these substances. Some of the most common ones found in the environment you live in are pollen, mold spores and animal dander. The substances that make you react are called "allergens." "Rhinitis" is an inflammation of the lining of the nose. So "allergic rhinitis" means: that you develop the symptoms of a runny nose, congestion, sneezing, and/or itching in response to certain allergens.

Not all rhinitis is caused by allergies. An infection, medications, other diseases, chemicals, even sudden changes in air temperature or other irritants in your environment call cause rhinitis. You can inhale them or they can be in your food and medications. Rhinitis can also be a result of your hormones or the use of the illegal drug cocaine. If you have more than one type of rhinitis causing your symptoms, you are said to have mixed rhinitis.

The symptoms of allergic rhinitis are annoying and can severely interfere with your daily routine and quality of life. But they don't have to. Many effective strategies are available to lessen or eliminate symptoms, and you've taken the first and most important step by visiting your doctor.

AVOIDING TRIGGERS
One of the most important and effective ways to alleviate symptoms is to avoid the allergens that cause them. While this is not always realistic or practical, the following information will teach you how to decrease your allergen exposure:

Pollen
Wind-pollinated trees, grasses and weeds are among the most common allergens. Since peak pollination seasons vary widely throughout the United States, be sure to check local authorities in your area or go to
www.pollen.com to find out when pollen counts are at their highest. Generally, trees pollinate in early to mid spring, grasses in late spring and early summer, and weeds in late summer and early fall. The hours between 11:00 am and 3:00 pm are usually the worst. Keep windows closed and use air conditioning on the "indoor" cycle (ie, vents closed) during peak hours. Avoid using window and attic fans that pull pollen indoors. Avoid outdoor activities as much as possible, and shower after being outdoors to remove pollen from skin and hair. Dry laundered clothes in a vented dryer, not outside.

Molds/Fungi

Outdoor mold spore counts are generally highest in late summer and early fall. Avoid walking through uncut fields, working with compost or dry soil, and raking leaves. Stay indoors during and immediately after rain and during other periods of high humidity. Use cleaning products containing bleach on sinks, shower stalls, and garbage pails, where mold is likely to grow. Avoid humidifiers, vaporizers, damp basements, attics, and crawl spaces, and bathrooms and kitchens without vents or windows. Check air conditioners, coolers, refrigerator drip pans, moist wall spaces, carpet backing, and other areas where mold may grow.

Dust Mites
Dust mite feces (waste) are an important allergen in all but the driest climates. It is primarily found in bedding, upholstered furniture, carpeting and stuffed animals. If you are allergic to dust mites, avoid carpeting, especially where you sleep. Wear a face mask while cleaning the house and for about 15 minutes after. Use a vacuum cleaner equipped with a double-filtration system or at least a high-energy articulate air (HEP A) filter. Encase mattresses and pillows in zippered, allergen-proof covers. Wash bed linens in water heated to a minimum of 130"F at least every two weeks and dry them in a hot dryer. Choose plastic, leather and wood furniture instead of pieces covered in fabric.

Animal Dander
While cats are the most common culprits, dogs, birds, rabbits and rodents can all cause allergic rhinitis. The only totally effective way to eliminate symptoms is to remove the pet or pest from the home or consider confining the pet to a room with a HEPA or electrostatic air purifier. Keep the pets as far from your bedroom as possible, and keep the door to your bedroom closed. Bathing pets weekly may help.

Cockroaches

Look for roaches in all living areas of your home, not just in kitchen and dining areas. Pesticides work, but the problem will reoccur unless food and garbage are packaged appropriately and removed from your home often. Boric acid traps and hydromethanon are effective, but should be used with extreme caution around young children. Do not store newspapers, paper bags or cardboard boxes.

Please take these environmental adjustments as suggestions. I do not expect people to ‘stop there lives’ because of allergic rhinitis. If environmental modification doesn’t seem to be working then go easy on yourself and call us.

DRUG THERAPY
If avoidance is impossible or doesn't completely eliminate your symptoms, it may be time to think about a medication. Your clinician is not likely to prescribe an antibiotic because the cause of your symptoms is not an infection; it is a reaction in your body to something in your environment.

Antihistamines Versus Decongestants
Many products are available at the drug store for the symptoms of a runny or stuffy nose, sneezing, itching and watery eyes. Most of them contain an antihistamine, a decongestant, or both. Antihistamines should help the symptoms of itching, sneezing, and a runny nose, but generally won't help a stuffy nose or congestion. They also may cause drowsiness, so do not plan to drive a car or operate heavy machinery. Also, do not drink alcohol. Newer antihistamine products, including Allegra, Claritin, Clarinex and Zyrtec are just as effective as older agents and cause little or no sedation.

If your primary symptoms are a stuffy nose and congestion, then choose a product containing a decongestant, such as pseudoephedrine. Unlike antihistamines, these products may make you jittery, so you may not want to take them right before bed. If you have hypertension, heart disease, an arrhythmia, glaucoma, or prostatic hypertrophy, check with your clinician before taking a decongestant. If you suffer from all of the above-mentioned symptoms, then look for a product that contains both an antihistamine and a decongestant.

Some decongestants are available as nasal sprays. Do not use these agents for longer than the label suggests. They can actually make your rhinitis worse.

Inhaled (intranasal) Corticosteroids and Inhaled (intranasal) Antihistamines
Steroid nasal sprays are becoming quite common in the treatment of allergic rhinitis and are highly effective at relieving all the symptoms of the condition. These agents are not the steroids that weight lifters take to build muscle, and they do not have any of the terrible side effects you hear about. Steroid agents are highly safe and usually do not cause side effects other than nasal irritation (although there may be a slightly increased risk for cataracts/glaucoma with chronic use). Nasal antihistamines (Astelin and Patanase) are also effective and do not run the risk of cataracts/glaucoma. Both inhaled corticosteroids and inhaled antihistamines are proven to work better than oral antihistamines for treating your symptoms. As inhaled antihistamines do not come in generic form, they will usually be more costly than inhaled steroids.

IMMUNOTHERAPY (Allergy ‘Shots’)

When your allergic symptoms don’t respond adequately to environmental adjustments or medications or you have symptoms that ‘bring you down’ for too many months of the year, then immunotherapy or allergy ‘shots’ may prove useful. The ‘shots’ will hopefully desensitize you to the allergens. We would refer you to an allergist for skin testing and they would decide upon a formulation. The formulation contains very weak amounts of the irritant. By administering the allergens under the skin your body will slowly get adjusted to a mild exposure and over time to stronger and stronger doses of the allergen. The downside to immunotherapy is that you may need 3-5 years of weekly or twice-monthly office visits to get full desensitization.

As of this writing in Jan. 2010, there is some news out of Europe that suggests that oral desensitization is possible (working on a principal that is similar to homeopathy).

Last screened by Dr. Bershel in 1/2010
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