Pharmacological Therapy with Lifestyle Changes

Hay fever, the chronic condition that affects millions worldwide, is characterized by the hypersensitivity reaction to airborne allergens and the inflammation associated. This inflammation of the upper respiratory tract leads to symptoms of nasal congestion, sneezing, watery itchy eyes, and rhinitis. These symptoms plague those who suffer from this illness seasonally, perennially, or both. Standard treatment implemented on patients usually consists of pharmaceutical interventions in combination with lifestyle changes. With information used from this blog and through the website www.RateADrug.com, I was able to compare the medications evaluated to see effectiveness of hay fever management. The top five drugs evaluated for the indicated use of hay fever were Dimetapp Allergy, Benadryl Allergy Sinus, Vick’s Children’s NyQuil, Allegra, and Zyrtec. All of these drugs had high ratings for effectiveness and generally low side effects. The last three medications had the most side effects with overall theme being drowsiness. Through these evaluations, it should be recognized that all medications were either had an antihistamine as an active ingredient. This makes sense for the fact that one of the main components of the hypersensitivity reaction in hay fever revolves around the mast cell degranulation and histamine release. Through this mechanism of action, the risk of having many harmful side effects is low. Other medications, which was discussed in previous blogs, include decongestants, LTRAs, corticosteroids etc. Many of these are not as easily accessible because medications such as these usually either need to be bought through the pharmacy or through a prescription. Although these medications do appear to work well for those suffering, lifestyle changes a considered to be the first line defense. This is done primarily through avoiding the specific allergy triggers. Avoiding triggers has also been discussed in previous blogs with information regarding frequent dusting, using the air conditioning as opposed to keeping windows open etc. The reasoning for these interventions to help with the management of hay fever symptoms relates to the basic pathophysiology of the condition. By preventing the allergen, or antigen, from entering eyes and nasal passageway, the body would not produce the inflammatory effects. However this is easier said than done, that's why medication therapy is implemented in order to make up for what can be avoided. The use of these lifestyle changes also benefit the quality of life work optimally by creating a balance of the pharmacological therapies.  Although hay fever tends to be undertreated or self-treated by the patients, it is the goal for the health care providers to find a balance between this in order to promote better health and a better quality of life. 

Spring Allergies vs Fall Allergies: Which is Worse

For those who suffer from seasonal symptoms of hay fever, there always seems to be that time of the year that is absolutely dreaded. For some it includes the spring, and for others it’s the fall. Seasonal allergy sufferers may also suffer from both or even more seasons, but one will usually dominate. So which is worse? Well, it depends on the specific allergen and when it is most abundant in the regional area at a specific time of the year.

Spring Allergies- Spring appears to be the time of the year when trees release the most pollen. Some of the top trees responsible for this abundant pollen release are Oak, Sycamore, Maple, Elm, Birch, Walnut, Hickory, and Cypress. The warming of the weather still accompanied by heavy winds also aggravates these allergens. Mold is still a prime allergy source in the spring, however it will worsen in the fall.

Oak Tree

Fall Allergies- The biggest culprit during the fall season is ragweed. Ragweed begins to pollinate in August normally, which makes it stay in the air and “attack” those for the following months. It’s also a very light particle that travels well in the wind. This allows it to act as an allergen to many nationwide, even if you don’t live near growing ragweed. Also in the fall, mold proliferates the most. Although mold is stated to be a major contributor to spring allergies, fall has higher levels because of the increase in spore release. The release of these mold spores also wreaks havoc to those susceptible to mold allergies. Another additional burden that fall allergies do play is with children. Because it is the start of the school year children will begin to have more exposure to certain school time activities, which may aggravate their allergies even further. This appears to be correlated with children asthma attack spikes in the fall as well.

Ragweed

So which one is worse? Well, of course, it changes for each individual because allergies are triggered by different allergens. For both spring and fall allergies, the best defense is avoiding the triggers in combination with medication in order to manage symptoms. These options were discussed in previous blogs.

The Typical Costs of Treatment

Depending on the severity of your condition, Hay Fever may end up being a relatively expensive disease with its chronic nature and pharmaceutical symptom management.

Let’s say you take a daily Claritin, Loratadine, 10mg 24 hr antihistamine is taken daily. For a box of 30 tablets, the regular price ranges about $19.89 at Target (and most drug stores). We can round this to about $20 a month for just a daily Claritin tablet and $240 a year.

Now let’s say you have multiple members of the family also taking this medication for their symptoms as well, this price will only go up and possibly double. But of course no medication is perfect and works for anyone. If you have congestion and decide that regular Claritin is sufficient and you need a decongestant, Claritin-D may be a more suitable choice, but with an added price. At Walgreens you can buy Claritin-D (120mg pseudoephedrine with 5mg loratadine antihistamine) 12-hour decongestant with 30 tablets for $29.89. The rounded cost for a day’s use of this drug will then be about $2. This would be $60 a month, and $720 a year if used two times a day, every day of the year.  Claritin-D, and other decongestants, such as Sudafed and Allegra-D are pose additional obstacles because you have to buy it over the counter which is an inconvenience.

Like I said before, Claritin or Claritin-D may not be the drug of choice for a particular user, others may prefer Allegra, Allegra-D, Zyrtec, and generic brands. However these are usually range around the same prices give or take a couple dollars.

Not only can these medications be expensive, but the other interventions taken by many allergy sufferers add up as well. These include things such as immunotherapy and lifestyle changes.

Immunotherapy prices tend to range on a variety of factors. These include length of therapy, type, and whether or not insurance will cover it. In the US, the average cost for immunotherapy ranged from $1,480-$2,500 for six years of therapy. This averaged to about $800 for the first, and most expensive year of therapy, and then dropped down to about $200-$300 dollars a year after that. This is an interesting consideration considering the outcomes of therapy hopefully mean eliminating drug usage for several years and when comparing this to some of the prices above this may be the more fiscally favorable choice.

Lastly, lifestyle changes do have a great financial impact on the hay fever sufferer as well. In previous entries. This includes using the air conditioning instead of opening windows, use of more cleaning products, and a higher quality of filtration system which may all increase electricity and gas bills. A common recommendation to those with hay fever is the use of a HEPA filter. The Envion Therapure Air Purifier for a Medium Room (26x8”) at target is sold online for $139.99. This only works for a room that is about 100-300sq ft. room, which means that multiple may need to be purchased to fulfill the needs of an individual with multiple rooms.

In conclusion, Hay Fever can add up to be a pretty expensive condition to have and something to keep in mind when choosing treatments.  However a combination of one or many may be necessary in order to ensure an improved quality of life which is priceless.

How Big of a Problem is Hay Fever

It’s pretty obvious that Hay Fever is a big problem that affects many people worldwide. We know that it happens to children and adults and that we probably have a little of it (or a lot) ourselves. But really who all is suffering?

According to the CDC, the United States has had 17.7 million adults newly diagnosed with hay fever within the past 12 months and another 7.1 million children have reported having hay fever. The Revolution Health Group reports that hay fever causes about 14 million doctor office visits, 90% of which are seasonal and 70-80% have perennial as well. By the age 6-19, 17% of all children have an allergy to some environmental factor, and the severity and occurrence tend to greatly increase with age with no apparent discrimination to race or gender. Most importantly, the rates in the U.S. have been rising dramatically for unknown reasons.

So what does this even mean? That a significant number of people are suffering from hay fever and that this is an increasing problem. It appears that by this data alone that quality of life for these individuals is also affected. For example; for the doctor’s visits alone take into consideration the time, money (co-pays, medications, transportation etc.) and overall hassle of even getting the visits. This does not even include the symptomatic burdens associated with this chronic condition. Also, because having hay fever puts you at a higher risk for other hypersensitivity conditions from an overactive immune system, there is the increase for food/drug allergies, asthma, and other types of hypersensitivity reactions and the other issues that go along with them.

The most interesting thing about this condition is that even though it affects so many people, leads to so many undesirable effects, symptoms, medication usage, and even possible complications, there is no cure.

http://www.cdc.gov/nchs/fastats/allergies.htm

http://www.revolutionhealth.com/conditions/allergies/allergies-basics/introduction/the-demographics-of-allergies

The Hay Fever Diet

For everyone, especially those will an illness or aliment, it seems as if the doctor will often state the importance of an appropriate diet and frequent exercise. For some things, this can be a very specific diet, such as the DASH diet for those needing to lower blood pressure and the BRAT diet for many pediatric patients. But is there a diet, or any dietary recommendations to help alleviate the symptoms of hay fever.

The Hay Fever diet-

Also derived as the Mediterranean diet because, as will be stated, the diet consists of many fresh fruits and vegetables, fish, nuts and other high antioxidant loaded foods.

Dig In

 Because hay fever is results in inflammation, it is advised to eat foods that have anti –inflammatory properties.

            Nuts- With a high amount of magnesium and vitamin E, nuts can help improve lung function, which is especially beneficial to asthmatics as well. Also because Vitamin E boosts the immune system, it can help the body fight against URIs (upper respiratory infections), and from damaging free radicals, which also cause inflammation.

             Apples, Oranges, Tomatoes, and other Vitamin C fruits- Because Vitamin C is an antioxidant, has many of the properties like Vitamin E such as protecting the body from free radicals thus reducing potential oxidizing tissue inflammation and damage.

Grapes (Red with skins)- Grapes are also filled with antioxidants, but also have resveratrol, which is the same chemical in red wine that gives it some healthy heart benefits when taken in moderation.  Resveratrol works not only for Hay Fever by reducing inflammation, but can also lower LDLs, the “bad cholesterol”.

            

            Fish- Cold-water fish, algae, and supplements, have high amounts of the omega-3 fatty acids DHA and EPA, which are believed to reduce inflammation in the body. Some of the popular fish diet options include salmon, mackerel, trout, herring, sardines, and albacore tuna. Fish oil or omega-3 supplementations are also believed to be as beneficial.

            

           Tea- Especially a hot tea with lemon or honey is usually recommended for those with hay fever first thing in the morning. Some anti-inflammatory compounds in teas, flavonoids, work along with boosting immunity as well. Tea also works by “waking up” the cilia, the tiny hairs in the nasal passageway, to sweep out the pollen and dust. This will also allow mucus to flow more naturally therefore decreasing stuffiness or the morning sneeze attacks. 

Proceed with Caution

Spicy foods work well by be easing congestion and thinning mucus, but can be harmful by irritating the throat which may cause even more excessive mucus and cough. These include; Cajun spices, Garlic, and Horseradish

Steer Clear

Margarine is made of artificial unhealthy fats, which boost inflammation. A diet high, or even containing margarine, is stated to increase the risk of having allergies and respiratory wheezing.

Is Hay Fever the same as other kinds of allergies?

The term allergies seem to be thrown around a lot. But how do you know the differences between the two and how are they related?

All allergies are technically hypersensitivity reactions in the body. As previously described in the blog entry http://hayfeverinfo.blogspot.com/2011/08/some-of-physio.html it is described that in Hay Fever, the body interprets an innocent particle, such as pollen or dust, as a harmful substance. As a result, the body recognizes the antigen at every exposure and causes an unnecessary immune reaction in order to “defeat” the invader. For nasal allergies, such as Hay Fever, the route of exposure is primarily through the respiratory tract; hence the respiratory symptoms such as nasal congestion, runny nose, and sneezing.

Food allergies, and other forms of allergies (ie drug or insect bites/stings) are also caused by the basic concept of hypersensitivity in the body. They also have varying degrees and severity depending on the body’s amount of exposure and how it interprets the threat. For example, the bee sting. The bee sting’s route of exposure is through a superficial sting, which can actually enter the blood stream. The antigen is first seen through the skin and the hypersensitivity reaction may include symptoms such as pain, swelling, and redness at the site of entry. For those with more severe allergies it can even reach the point of anaphylactic shock which is a life threatening condition where vasodilatation can cause an unsafe drop in blood pressure and airway constriction can inhibit breathing resulting in the body’s loss of oxygen.

The treatment for both of these types of allergies is through the same mechanisms usually centered around anti-inflammatory and antihistamine medications. So if you do suffer from hay fever then you may expect to take a diphenhydramine (Benadryl) for the hay fever symptoms and/or if a bee stung you it would also help in suppressing symptoms of the event.  However not all treatments work the same and this would not be sufficient for an anaphylactic emergency.

Because both of these conditions are both correlating around the body’s hypersensitivity, having one may put you at a higher risk of obtaining more allergies. For concerns feel free to contact a doctor and be aware of what allergies you may have. 

Children and Hay Fever

Hay Fever is a condition that can affect everyone, even the children. Although there are many similarities between children and adults in regards to hay fever, the differences are very important to be aware of, especially if you're a parent. 

So what's similar? 

Well, children often have similar presenting symptoms (rhinitis, sneezing, stuffy nose, sore throat etc). Another thing very important to keep in mind is the similarities of the triggers. For children, often triggers include dust, pollen, mold, pet dander and more. Therefore treatment in avoiding these triggers is the same as for an adult. (for more information on this please see previous blog entry). Pharmacological treatment is very similar as well and most of the same medications have indications for children doses on the backs of the packaging. Common medications recommended for children allergy relief include Claritin and Singulair. Keep in mind that it is important to discuss new medications for a child with a doctor and to ensure accurate dosage.

So what is different?

Many children are often predisposed to other conditions, ie asthma and eczema. Therefore hay fever symptoms may often exacerbate the symptoms of these conditions. This could be especially dangerous with asthma because inadequate oxygenation may occur.

Also, children are at a higher risk for otitis media, also known as a common ear infection. This occurs from the congestion in the sinus passageway. The reason that children have a higher risk of this is because of the passage (Eustachian tube) connects into the nasal passageway. In younger children the tube in more horizontal as opposed to the more diagonal route of an adult Eustachian tube. As a result, it is easier for it to become infected and inflamed.

Lastly, because the development of a child is crucial and much of this is done at school, it is important to address the symptoms of hay fever in a child. Not only are the symptoms bothersome, but also it can actually impede in the learning process and worsen attention. Hay fever can even decrease self-esteem with the constant concern about how their symptoms are affecting their schoolwork and it’s affect on the body.

Final Notes

Like all hay fever sufferers, it is important to address the symptoms and take care of them. With children these this need even increased. Make sure if you think your child has hay fever visit your doctor to have him/her evaluated and see what treatment is appropriate.  

Check out http://www.keepkidshealthy.com/welcome/commonproblems/hayfever.html