How Do You Know If You Have Allergies?
Written by Alexandria Yarborough, PharmD
As a community pharmacist, I am constantly asked for my opinion on how to prevent and treat multiple medical conditions. During the winter months, I’m asked about colds and the flu. During the spring and summer, seasonal allergies are one of the most common conditions sending all ages, including millennials, to my counter hopeful for recommendations and solutions.
According to the data from CivicScience, younger Millennials aged 25-34 tend to suffer the most. They are much more likely to classify their allergies as ‘severe.’ That severity also comes with a high price tag. In 2021, millennials spent an estimated $353 per year on allergy treatments.
What are allergies?
Allergies are very common. More than 50 million people in the United States have an allergic reaction each year. They’re the sixth-leading cause of long-term illness in the United States.
Allergies are your body’s reaction to a foreign protein. In most cases, these allergens are harmless. However, if you have an allergy to a particular protein in an allergen, your body’s immune system overreacts to its presence in your body causing symptoms from discomfort to extreme sickness.
Allergy Symptoms
Allergic rhinitis is a diagnosis associated with a group of symptoms affecting the nose. These symptoms occur when you breathe in allergens such as pollen. Symptoms of allergic rhinitis include:
Nasal stuffiness (congestion), sneezing and runny nose.
Itchy nose, throat and eyes.
Headaches, and sinus pain
Increased mucus in the nose and throat.
Fatigue
Sore throat from mucus dripping down the throat (postnasal drip).
Wheezing, coughing and trouble breathing.
What is an allergic reaction?
An allergic reaction is your body’s response to an allergen. If you have allergies, the first time you encounter an allergen, your immune system responds by creating antibodies to form immunoglobulin E (IgE).
IgE antibodies bind to allergy cells (mast cells) that live in your skin, respiratory tract and your gastrointestinal tract. The antibodies find the allergens in your body and help remove them by taking them to the mast cell where they attach to a special receptors and release histamine. Histamine is what causes your allergy symptoms.
It is important to note that an allergic reaction is different from an anaphylactic reaction. An anaphylactic reaction is a potentially deadly response to an allergen that results in the blockage of the airway tract and decreased oxygen. This reaction can only be reversed by injection of epinephrine.
Alexandria Yarborough, PharmD, is a Community Pharmacist and Pharmacist in Charge at Sam’s Club in South Carolina. She has almost a decade of experience in the field of pharmacy.
Types of Allergies
Allergies exist in many different forms. When talking about suffering from allergies, most people are referring to seasonal allergies, but the list is lengthy. There are food allergies, skin allergies, drug allergies, hay fever (allergic rhinitis), nasal polyps, and eosinophilic esophagitis. There are also people that are specifically allergic to one or a few things such as dust, cockroaches, pine trees, or latex.
Let’s review a few of the most common types of allergies:
Seasonal Allergies
If you sneeze, cough, and have itchy eyes during certain times of the year, you most likely have seasonal allergies. In many areas of the United States, spring allergies begin in February and last until the early summer.
Tree pollination begins earliest in the year followed by grass pollination later in the spring and summer and ragweed in the late summer and fall. The most common culprit for fall allergies is ragweed, a plant that grows wild virtually everywhere, but especially on the East Coast and in the Midwest. Ragweed blooms and releases pollen from August to November. In general, ragweed pollen levels are highest in early to mid-September.
While the timing and severity of an allergy season vary across the United States the following climate factors also can influence symptoms:
Tree, grass and ragweed pollens thrive during cool nights and warm days.
Pollen levels tend to peak in the morning hours when the majority of people are heading to school/work.
Rain washes pollen away, but pollen counts can soar after rainfall
Try not to rub your eyes; doing so will irritate them and make symptoms worse.
When the day is windy and warm, pollen counts surge; stay inside.
Allergic Rhinitis
Allergic rhinitis, also known as hay fever, is considered a multitude of symptoms affecting the nose. Please understand the name is misleading as hay doesn’t trigger the symptoms nor cause a fever.
Allergic rhinitis develops when the body’s immune system recognizes and overreacts to an allergen in the environment that typically causes no issues in most people. Allergic rhinitis has two categories: seasonal and perennial. Seasonal allergic rhinitis symptoms occur in spring, summer, and early fall. They are caused by allergic sensitivity to airborne mold spores or to pollens from trees, grass, and weeds. Perennial allergic rhinitis experience symptoms year-round. It is generally caused by dust mites, pet hair/dander, cockroaches, or mold.
Some unfortunate people experience both types of rhinitis, with perennial symptoms getting worse during specific pollen seasons. There are also nonallergic causes for rhinitis including irritants such as cigarette or other smoke, perfumes, cleaning products and other strong odors that exacerbate symptoms. Symptoms include: runny nose, itchy, puffy eyes, mouth or skin, sneezing, stuffy nose, and fatigue due to poor quality sleep as a result of nasal obstruction.
In addition to physical symptoms, allergic rhinitis can be associated with decreased concentration and focus, problems remembering things, and irritability. These problems can lead to sleep disorders, missed days of work/school, and more school/work injuries.
Symptoms of allergic rhinitis have other causes as well, the most known being the common cold -infectious rhinitis. Most infections are relatively short-lived, with symptoms improving in three to seven days versus the weeks to months long symptoms of allergic rhinitis. Most people have recurrent or chronic nasal congestion, excess mucus production, itching and other nasal symptoms similar to those of allergic rhinitis. In those cases, an allergy may not be the cause, but a viral infection.
Allergic Rhinitis and Seasonal Allergies Treatment
The most helpful advice when dealing with any type of allergies is to avoid triggers by making changes to your home and to your behavior. Helpful tips include:
Keep windows closed during high pollen periods.
Wear glasses or sunglasses when outdoors to keep pollen out of your eyes.
Wash your hands after petting any animal, and have a nonallergic person help with pet grooming, preferably in a well-ventilated area or outside.
To limit exposure to mold, keep the humidity in your home low (between 30-50 percent) and clean bathrooms, kitchens, and basements regularly. Use a dehumidifier in damp, humid places, and empty and clean it often.
Many allergens that trigger allergic rhinitis are airborne and are nearly impossible to avoid. If your symptoms require medication, there are many options and come in many different forms. Some medications may have side effects, so discuss these treatments with your allergist, primary care doctor, or pharmacist.
Antihistamines
Antihistamines are commonly used to treat allergic rhinitis. These medications counter the effects of histamine, the chemical released within your body when an allergic reaction takes place. Antihistamines are found in eyedrops, nasal sprays and, most commonly, oral tablets and syrup. They help to relieve symptoms such as sneezing and an itchy, runny nose, eye itching, burning, and itchy skin, hives and eczema.
There are multiple antihistamines; some are available over the counter, while others require a prescription. Examples include Benadryl, Zyrtec, and Claritin. Benadryl is best for anaphylactic reactions, insect stings, and food allergies. Zyrtec, Claritin, and Allegra are an excellent choice for daily use to prevent allergy symptoms when known triggers are present. These three are also considered non-drowsy. I always remind my patients that you can build a tolerance to them, so it’s best to alternate between the three every 2-3 years.
Decongestants
Decongestants help relieve the stuffiness and pressure caused by swollen nasal tissue. Oral decongestants are available as prescription and nonprescription medications and are often found in combination with other medications.
It is not uncommon for patients using decongestants to experience insomnia if they take the medication in the afternoon or evening.
Patients with high blood pressure or heart disease should check with their doctor before using. Examples include Sudafed PE and Sudafed. This medication is available over the counter but you must show an ID to purchase as the government has limited the amount any one person can purchase each month.
Nasal Sprays
Nonprescription saline nasal sprays will help counteract symptoms such as dry nasal passages and/or thick nasal mucus. Unlike decongestant nasal sprays, a saline nasal spray can be used as often as it is needed. Sometimes an allergist may recommend washing the nasal passage. There are many OTC delivery systems for saline rinses, including neti pots and saline rinse bottles/sprays.
It’s important to note that although this is technically saltwater, do not make your own at home. Purified, distilled water is necessary to use in neti pots and the main ingredient in the pre-packaged sprays. Using tap water can cause your symptoms to become even worse!
As a pharmacist, I always encourage intranasal steroids as a first- line therapy in combination with an antihistamine (mentioned above) for prevention of moderate to severe allergy symptoms.
Leukotriene Pathway Inhibitors
Leukotriene pathway inhibitors are prescription-only medications that block the action of leukotriene, a substance in the body that can cause symptoms of allergic rhinitis. These drugs are also used to treat asthma and are only available by prescription. Examples include Singulair. Singulair used to be very costly but the generic is available and usually has a very affordable price tag of less than $10 for a month’s supply.
Immunotherapy
Immunotherapy may be recommended for people who don’t respond well to medications or who experience side effects from medications or who desire a more permanent solution to their allergies. Immunotherapy can be effective in controlling allergic symptoms, but it doesn’t help nonallergic rhinitis.
Two types of immunotherapy are available: allergy shots and sublingual tablets. Allergy shots typically require three to five years of injections of a diluted allergen administered frequently in increasing doses until a maintenance dose is reached. Immunotherapy helps the body build tolerance to the effects of the allergen, reduces the intensity of symptoms caused by allergen exposure and sometimes can make skin test reactions disappear. As tolerance develops, symptoms should improve.
Sublingual tablets involve placing dissolvable tablets under your tongue several months before allergy season begins to benefit from year-round treatment. Treatment can continue for as long as three years. Only certain grass /ragweed pollen and house dust mites can be treated now with this method, but it is a promising therapy for the future.
Intranasal Corticosteroids
Intranasal corticosteroids are the single most effective drug class for treating allergic rhinitis. They can significantly reduce nasal congestion as well as sneezing, itching, and runny nose. These sprays are designed to avoid the side effects that may occur from steroids that are taken by mouth or injection. The most common side effects are local irritation and nasal bleeding. They are available over the counter. Examples include Flonase and Nasacort.
Allergy Diagnosis
Occasional allergies aren’t just something you have to live with. Consulting an allergist is the best way to diagnose and treat allergic rhinitis symptoms and help you find relief. Your allergist may recommend a skin test, in which small amounts of suspected allergens are introduced to your skin. Skin testing is the easiest, most sensitive, and generally most cost effective way of identifying allergens.
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