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

Allergy Capitals

Allergy Capitals

Where you live has a huge impact on those who have outdoor/seasonal allergies. Certain places are notorious for having low allergy levels where as for others, places can be known as allergy capitals.

According to the Asthma and Allergy Foundation of America (AAFA) 40 million have hay fever/nasal allergies and 10 million have allergic asthma. Although not all of these people, and perhaps yourself, have outdoor allergies, a big chunk does.

Fall Allergy Capitals

If you happen to be one of these unfortunate souls you may wonder, am I living in the right place? Or is my residence one of the causes of my worsening symptoms.

The AAFA established the “Most Challenging Cities to Live with Fall Allergies” for 2011.

http://www.aafa.org/pdfs/Public%20LIST%20FALL_2011%20v2.pdf

 High on the list are 1. Knoxville, TN, 2. Dayton, OH, 3. McAllen, TX, 4. Jackson, MS,  and 5. Oklahoma City, OK. Other high contenders were scattered about the eastern states, south and southwest, and some west coast (mostly California).

So what do you do if you live in one of these places?

            If moving is an option and symptoms are severe, that is always a very valid choice. However this may not be ideal for everyone . The next best thing is avoidance. This could be staying indoors, using ventilation[HEPA filter]/ac instead of opening windows, using pharmacologic interventions, checking daily pollen counts (in your local paper or online). Other avoidance ideas are discussed in previous blog entries.

If you are interested in checking pollen counts online, such resources exist such as http://www.pollen.com/allergy-weather-forecast.asp . This website can be used to search different allergy triggers according to city/zip code.

http://www.pollen.com/allergy-weather-forecast.asp

So what are some of the best cities for the seasonal sufferer? This is more subject to change than the most challenging cities. According to the AAFA such “low allergy” cities include Canton, OH, Spokane, WA, Portland, OR, Springfield, MO, and Scranton, PA.

So unless your planning on moving or just trying to tough it out, no city is “free from allergies”, the best you can hope for is less. 

When to see a doctor

When to see a doctor

When starting to experience symptoms, questions generally arise about what’s causing this and what can be done to help. Or it could just be that you have had these symptoms for a while now and you just are tired of it. It seems that with a condition like hay fever you don’t necessarily need to see the doctor until you choose to. What may be some things to prompt you though?

One reason to see a doctor is if your hay fever is disrupting your quality of life. This can include a variety of things such as missing work or school, not getting enough sleep, or even just getting in the way of your favorite activities.

Another reason that you should see a doctor is for possible complications or exacerbations of other conditions commonly associated with hay fever. The most common are sinusitis, nasal polyps, asthma, and eczema.

       

     Sinusitis- an inflammation of the sinuses that is associated with infections that can either be bacterial, fungal, or viral. Symptoms are similar to that of the common cold that don’t reside or even worsen after 5-7 days. This can include loss of smell or taste, nasal congestion, headache, sore throat, nasal discharge, fever and fatigue

Sinusitis X Ray

     

    Nasal Polyps- inflammation of tissue lining the nasal passageway causing sac-like growths. Symptoms include similar feelings of a having a persistent cold (up to months or years), mouth breathing, nasal obstruction, loss of smell, runny nose.

Nasal Polyps

    Asthma- a condition where the airways of the lungs can become swollen and narrow, or bronchoconstriction. The most common symptoms are chest tightness, wheezing,  shortness of breath, and coughing. Depending on severity of symptoms, asthma can lead to an emergency situation and you must seek help immediately. 

Bronchiole- Normal vs Asthmatic

    

   Eczema- a hypersensitivity reaction on the skin resulting in itchy and/or scaly rashes.  Symptoms include skin changes resulting in blisters with oozing and crusting, ear discharge/bleeding, itchiness, skin color changes, skin redness/inflammation around blisters, and thickened or leather-like areas on the skin.

Eczema lesion on hand

On your visit…

Make sure you list your symptoms which includes ones that are old and new. Tell your doctor about lifestyle changes you had to make in order to accommodate these symptoms and what you have done to help alleviate. Make sure to include all medications (OTC, prescription, and even herbal remedies). Depending on severity and types of symptoms you may have allergy skin testing or even see a ENT (ear nose and throat) specialists. Also, make sure to write down questions you might have prior to your visit and don’t be afraid to ask. 

Using a Neti Pot for Hay Fever

Neti Pots

What are they?

Neti pots, or nasal saline irrigation is a system of cleansing out the sinus and nasal cavities. in order to help a range of nasal symptoms from colds, allergies, sinusitis or just for hygiene.  Although the idea of the Neti pot has been around for centuries but has recently been increasing in popularity.  This is especially true for those with hay fever because of it acts as effective maintenance of clearing out the allergens with minimal side effects. This especially applies for those year round hay fever sufferers.

How do they even work?

To understand how the Neti pot works, the anatomy and physiology of the sinuses needs to be stated.  Sinuses are air cavities in the cranial bones which help reducing weight of the skull, create resonance in the voice, and most relatable for this, for humidifying the air in the nasal passageway. The paranasal sinuses include the maxillary, frontal, sphenoid, and ethmoid. The body is constantly producing mucus in these cavities which normal works as a protective and lubricating barrier and should just go down the throat as a post nasal drip and be swallowed.  However if  infectious agents, allergens, dirt, dust or other particles are present this mucus can thicken up and have a harder time being removed. This build up causes pressure in the sinuses, worsening symptoms of nasal congestion and rhinitis, and even can lead to cough, sore throat, and hoarseness. With the Neti pot, the solution is designed to thin out the mucus and irrigate it through the sinuses and out the nostrils. Attached is a youtube video of a more in depth explanation.

So do they work?

Studies show that they do help in relieving symptoms. Ear nose and throat  [ENT] surgeons often recommend them to their patients after having nasal surgery because how effective their irrigation works. Research has backed up the claims of both companies and users of the Neti pot. However this may vary from person to person. Don’t start a new regime without constulting your primary care physician. 

My Personal Results

As a fellow hay allergy sufferer I decided to give this device a whirl. I bought the  Neil Med Nasal Flow one at Target for 17.99. When I first started it made my head feel full and I had to make sure my head was tilted just right over the sink otherwise I would taste the salty solution in the back of my throat. However, it didn’t take long and was painless- the best news is I saw results almost instantly. I physically saw mucus in the sink (gross I know, but better out of my sinuses than in!), also I felt better. I was able to breathe better almost instantly. There was the occasional trickle of solution for then next fifteen minutes but nothing bad. I did however feel a little lightheaded for about an hour. I have now tried this regime three nights in a row- deciding I would slow down as soon as I had a successful (little or no mucus left) go around. I have noticed have had little or no congestion in the morning and throughout the day and barely even sneezed. Personally I am loving the Netipot.

Attached are some links you may be interested in about the products.

Check out http://www.amazon.com/Himalayan-Institute-Ceramic-Neti-Pot/dp/B000WJIC3G

http://www.sinucleanse.com/netipotlanding.htm

http://www.neilmed.com/usa/adword_np.php

Allergy Skin Tests

Allergy Skin Tests

With hay fever, the most common thing you are told is to avoid your triggers. But what if you don’t know what the triggers, how are you supposed to avoid them? How do you find out what they are?

Allergy skin tests are designed to help expose whether or not a suspected allergen is actually what is causing the allergic reaction. To gather information on what could be a possible suspected allergen is through the medical history.  During the medical history some questions that may be asked include: How long have you had the allergy? Where do you live? How long do the symptoms last for? Where do you work or what are some environmental exposures?

After gathering the information, the suspected allergen will then be introduced in one of three ways- a skin prick test, skin injection test, and patch test.

            Skin Prick Test- is done with a lancet injected different allergens. The results usually come in about 15 minutes. It can be done with as many as 40 different substances to see if the allergies are from pollen, mold, pet dander, dust and even food allergies. If a skin prick test is positive, there will be a skin response This could be a raised, red itchy lump- somewhat like a mosquito bite.

            Skin Injection Test- a test that, like the skin prick, injects a small amount of allergen extract into your skin. The difference is that instead of a lancet, it is used with a needle to be a little deeper as an intradermal test. In about 15 minutes, there will be signs of an allergic reaction- this test isn’t very common for hay fever like the skin prick test, but more for allergies to venoms or specific medications.

            Patch Test- tests to see if there is an allergic reaction by not injecting an allergen, but instead applying it to a patch, which will be placed on the skin. Like the injection test, this isn’t very common for hay fever, but more for contact dermatitis, such as latex or preservative allergies. The patch will be worn for 2 and irritation will indicated a positive test.  

All of these tests are used in order to pinpoint what your allergies are in order to avoid them. This means may not be necessary for everyone, but more for those who really need to know, are more susceptible, and have very severe allergies. Talk to your doctor about if this interests you to see when/how you can receive this testing. 

Cold or Allergies

Cold and Allergies- How do I tell the difference

It’s that time of the year where everything is seeming to bloom and be harvested, but it is also the time where there seem to be more sick friends and coworkers poping up as well. As you start to sneeze and your congestion builds up that tickle in the back of your throat keeps you wondering- am I sick? Or is it just allergies?

Colds are infections caused by viruses and the classical symptoms of the cold are caused by the immune system attack on the contagious pathogens. These symptoms are the occurring because the body is doing what it should be to get rid of this harmful organism invaded.

Allergies on the other hand, and as explained in previous posts, are the body’s hypersensitive response to a harmless stimulus, or allergy, which the immune system recognizes as a danger. Allergies are not contagious and continue as long as the allergen is present.

So how do we know the difference? 

If you are still not sure what you have don’t hesitate to call a physician to check it out. Also, try to avoid possible allergy triggers to see if symptoms improve.  This can even be taken a step further by taking an allergy medication, such as a Claritin to see if symptoms are alleviated. Do you have a history of allergies? Have you had allergies before and does this feel similar or different? These may be signs that you are the allergy sufferer. On the other hand if nothing seems to be helping, the cold is the more likely cause. For colds, also think about anyone you know who has recently fallen ill or that anyone you associate with has after you. Do you work in a place with children, sick people, or just a high volume of public exposure?

Either way symptom relief is the treatment you are most likely to go with for either way. If you suspect a cold, and for just regular health promotion, make sure to wash your hands often, cover your mouth when you sneeze or cough, and carry hand sanitizer around. Also for a cold, get adequate rest, drink plenty of fluids, and possibly try some OTC medications for symptom relief. As for allergies symptom relief can be taken from a variety of medications and avoid the allergy triggers. Make sure that you talk to a doctor before you start any medication regimes or plans. 

Alternative Therapies- Butterbur, Honey, and Acupuncture

Alternate Therapies-

Complementary alternative medicine (CAM) is any healing practice that isn’t part of the practices of conventional medicine. It can range from receiving acupuncture to taking herbal supplements. Because it is alternate however, there is not sufficient evidence to back these treatments as certified but many people vouch for effective results none the less.

Like most conditions, there are “alternate therapies” for Hay Fever. Some of the most common ones include rinsing sinuses (nasal irrigation), which will be discussed in a later blog. Also, common herbal therapies include butterbur, Tinospora cordifolia, cat’s claw, choline, goldenseal, belladonna, bromelian, and honey. Alternate therapies also include hypnosis, acupuncture, and probiotics.

This blog entry will be discussing butterbur, honey, and accupuncture

For information on the other alternative therapies check out http://nccam.nih.gov/ and http://www.rateadrug.com/ for more information and to evaluate your own experiences with these treatments.

Butterbur- (Petasites hybridus) Extracts taken from this shrub-like plant have been used as medicine for for migraines, stomach cramps, coughs, allergies and asthma.

Although how it works is unknown, butterbur is believed to block the action of histamine and leukotrienes resulting in a decrease in inflammatory reactions. There have been studies involving participants with hay fever taking doses of butterbur which had a greater relief in symptoms than those with the placebo. However no studies have been conclusive to classify this as an effective treatment. Side effects include indigestion, headache, fatigue, nausea, vomiting, diarrha, and constipation and is not intended for those who are pregnant, children, and with renal or liver conditions.

Butterbur - Petasites hybridus

Honey- Honey has been studied as a potential therapy for those with pollen senstitive patients. The idea behind it is that the traces of pollen inside the honey desensitizes the body to honey, therefore reducing the hay fever symptoms. This idea is a much like that of immunotherapy.

Honey

Acupuncture- a Chinese healing process which has been practiced for thousands of years, has been studied for the benefit of many diseases. As for hay fever, research suggests that those who receieved accupuncuture with Chinese herbal tea noticed a lessening of hay fever symptoms. But like the other alternate treatments, the study isn’t conclusive.

Acupuncture

Keep in mind with all of these that it is CRUCIAL that you discuss this with your doctor before starting treatment. Herbs and alternative therapies may be harmful to other predisposing medical conditions, need to be taken cautiously, and need to be monitored. Make sure you tell your doctor if you are taking any because although they are not classified as a convention treatment there is still a physiologic impact on the body. Also make sure to by your herbal remedies from safe sources. Herbals are not FDA approved therefore not regulated so doses may be misleading. 

Immunotherapy- A Medication Alternative

Immunotherapy- The Medication Alternative

Pills aren’t working? Are those alternate therapies not doing the trick? Or are you just sick (physically and mentally) of your symptoms being so intense and irritating every day or allergy season?

These are just some of the reasons why many patients venture to the care and treatment of hay fever through immunotherapy.

What even is immunotherapy though?

Immunotherapy is treatment targeted often to type I hypersensitivity, which uses desensitization therapy. Also, usually works best with hay fever patients. How it works is through the involvement of environmental control of external allergens in addition to the titrated pharmacologic exposure to them as well. With environmental control, a plan has to be made to decrease the exposure to the specific allergen(s). The pharmacologic desensitization process involves injections of the allergen (antigen) regularly through a course of time. This usually will last anywhere from months to years depending on the extent and progress. Throughout the time period, the dosages of allergen will be increased as tolerated. This will hopefully cause a change in the immunoglobins so that there will be an increase of IgG and IgA blocking antibodies as opposed to the abundance of IgE..

However immunotherapy doesn’t always work and may not be a complete treatment to allergy symptoms.  Also it has been reported that the relief to certain grasses and pollens usually last about 4-5 years.

Some considerations before getting involved

If you are thinking about getting immunotherapy keep a couple of things in mind. Such as the commitment it will take -the years of having to come in for the shots. Also it is an expensive process- you must weigh the costs of this with the costs of the medications you normally use.  Immunotherapy is not a definitive treatment and does not yield the same results for everyone.  Age is an important consideration- immunotherapy shots are usually not given to children under five and to older adults (65+ depending on medical status). Lastly, there are some medication conditions that may be present to prevent you from receiving immunotherapy. These include immunodeficiency diseases, recent heart attack or unstable angina, current use of beta blockers. 

Remember if you are considering this to ask your physician about any concerns or questions you may have. 

Prevention

Are taking medications not working or just not your thing? What else can you do if the symptoms of hay fever still haunt you? 

For those who are the seasonal allergy sufferers have it easier in the sense that symptoms only last a couple weeks or months. However, prevention of these seasonal sniffles is much harder to avoid, or fix. 

Because seasonal allergies primary cause is pollens the key concept is to stay indoors. It is advised to keep all windows and doors closed and use the air conditioner to stay cool. This also applies for while driving as well; but make sure that the car is in the “recirculation” mode. It’s also important that the air conditioner has a good air filter, which is to be washed weekly during high pollen season. Another thing to keep in mind is to keep in mind is to not have plants indoors.

As for the year round hay fever sufferers, prevention gets a little more difficult. Also, there are a lot more possible sources/causes of the allergens. The most common, which I will focus on are dust, dust mites, pet dander, and mold. For household dust, it’s beneficial to not have carpet and instead have a smooth surface, such as hardwood flooring. This allows dust to settle on top and be cleaned much more effectively and easily. If you are unable to get rid of carpet use a mask while vacuuming. Also limit surfaces, and furniture, for dust to settle on. Clothing could be a big issue when it comes to dust because it’s fabric, has a lot of surface area, and is normally stored in the bedroom. It is advised that clothing be kept out of the bedroom and/or in airtight vinyl clothing bags. Some other small changes that could be made are to use blinds instead of drapes, to keep the air conditioning vent closed in the bedroom, and to make sure there is a clean filter on the air conditioning unit. As for dust mites, these changes also apply in addition with some new ones. It’s key to wash bedding weekly in hot water (at least 130 F). It’s also important to not sleep/lie down on upholstered furniture and to keep the home cool and dry. As for pet dander, the most effective solution would be to remove the pets from the home. This could be keeping them outside or the better solution (in the mindset of relieving hay fever symptoms) is to get rid of the pets altogether. However this is easier said then done, so the next best thing is to make sure to get the home cleaned thoroughly and often, keep the pet out of the bedroom, and make sure that it gets groomed elsewhere regularly.

Mold is perhaps the most potentially dangerous out of the year round hay fever causes.  The three D’s: dampness, darkness and drafts are key to the growth of mold. Therefore the best way to avoid mold is to avoid those three things; however it may be too late and the growth as already begun. Make sure rooms have good ventilation by opening doors and windows. Put lights in dark places, like small closets and the basement. Also avoid places of high humidity. This can include green houses, barns, laundry rooms etc. Because mold can be potentially dangerous to ones healthy it is very important to get the mold checked out by a professional. They may be able to help remove the mold (or at least part of it) regardless of the danger as well.

So overall, what’s the best way to prevent the symptoms of hay fever without medications (or in addition to)? AVOIDANCE. Avoid as much as you can and you will start to feel better.

Some of the Meds

Treatment

How do these medications work?

As stated before, the most common medications used for hay fever are antihistamines, mast cell stabilizers, intranasal corticosteroids, leukotriene receptor antagonists LTRAs and decongestants.

Antihistamines: There are two type of antihistamines which are classified in first generation (sedating) and second generation (non sedating). Common first generation antihistamines are azataine (Optimine), brompheniramine (Dimetane) and diphenhydramine (Benadryl). Common second generation antihistamines are loratadine (Claritin), centirizine (Zyrtec), dexofenadine (Allegra), and desloratadine (Clarinex). Both generations work by binding with the Hò receptors on target cells thus blocking the binding of histamine. Second generation agents have a decreased attraction for the receptors in the brain, which makes them preferable with the less sedating side effects. http://www.claritin.com http://www.benadryl.com

Mast cell stabilizers: The most common use of this is seen as a nasal spray, or cromolyn spray known as NasalCrom. Recall in a previous entry the physiologic process about how mast cells degranulate resulting in the histamine release? Mast cell stabilizers inhibit this degranulation in the first place of these sensitized mast cells. Medications like NasalCrom have minimal side effects, besides occasional nasal irritations however it is important to start treatment regimens prophylactically. This includes 2 weeks before the allergy season or 15 minutes before exposure to a specific allergy, such as a dog. http://www.nasalcrom.com/

Intranasal Corticosteroids: The primary corticosteroids used for hay fever come in the form of nasal sprays. Some of the common medications include budesonide (Rhinocort), ciclesonide (Omnaris), and mometasone (Nasonex). These work by being a locally used corticosteroids for the nasal passageways. Corticosteroids work by inhibiting the inflammatory response- thus decreasing the symptoms that go along with hay fever. Like the mast cell stabilizers, there is just minimal nasal burning or stinging and it should be started 2 weeks before the allergy season. However, because corticosteroids work by surpressing the immune system the body is at risk for increased risk for infections, such as Candida Albicans (a fungal infection where white patches will appear in the mouth and tongue). Also it is to be used on a regular basis, not just as needed. http://www.nasonex.com/nasx/index.jsp http://www.omnaris.com/

Leukotriene Receptor Antagonists (LTRAs): The most common LTRA is montelukast (Singulair). This works by antagonizing or inhibiting leukotriene activity. Normally when leukotrienes are released, they cause a slow-reacting substance of anaphylaxis (SRS-A) leading to many of the respiratory symptoms. These include narrowing of airway and increased edema in the airway. By inhibiting these to be released, these symptoms are able to be avoided.  Unlike many of the other medications listed here, there are many side effects that go along with the use of LTRAs. These include from a range of headaches, and dizziness to altered liver function tests. Therefore it is important to monitor liver function, take on an empty stomach, and not be be used for acute attacks of symptoms. Also, medications such as singular are more common for chronic respiratory conditions such as asthma. This would not be a first round choice for those with hay fever especially with just mild to moderate symptoms. http://www.singulair.com/montelukast_sodium/consumer/asthma/asthma-medication/index.jsp

Decongestants: Perhaps with the antihistamines and intranasal corticosteroids, decongestants are a very popular choice for hay fever, especially for those who have a little more severe sinus/nasal symptoms. The most common decongestant is pseudoephedrine (Sudafed). These decongestants can also be recognized for being added to other medications with the addition of a “D” to the name. Ex: Claritin D. These work by stimulating adrenergic receptors on blood vessels causing them to constrict. As a result congestion decreases from the reduced nasal edema and rhinorrhea. Because it acts on the adrenergic receptors some side effects are from the cardiovascular system such as increased blood pressure, increased heartbeat and excitation/irritability. Another important thing to keep in mind with decongestants is that you have to buy them from the pharmacy counter and purchases marked through your driver’s license. Why? The key ingredient in these decongestants (ephedrine or pseudoephedrine) is used in the production of meth. http://www.sudafed.com/

If you have any questions about what medications you should be taking or about any of the side effects make sure to talk to your doctor and pharmacist. Also check out www.rateadrug.com to evaluate your treatments. Also use it to read about other people’s questions or input on medications you may be taking or thinking about taking.

Some of the Physio

As mentioned before, the overall concept of hay fever is caused by the bodies sensitization to a specific allergen. But how exactly is this caused?

Our immune system is made up of several structures; this includes skin and mucous membranes, the mononuclear phagocyte system, the lymphoid system, and bone marrow which all have different types of white blood cells, also known as leukocytes. Leukocytes help protect the body through inflammation and immunity.  T Lymphocytes (or T cells) are the mediators of specific immunity which act by reacting to the presence of a specific antigen (marker of a foreign substance) body and stimulates B Cells to make antibodies, a protein complex which react to the antigen.

In hay fever this antigen is caused by the presence of an otherwise substance that isn’t harmful. This is an allergen that after repeated exposure causes a hypersensitive reaction. The primary antibody responsible for mediating this reaction is immunoglobin E, or IgE. The IgE binds to receptors on other cells in the immune system known as mast cells. This IgE Mast Cell complex can bind to passing antigens (the specific allergen) and create a crosslink (when two antibody ends attach to an antigen) therefore causing an increase of intracellular calcium in the mast cell. This increase causes local mast cell degranulation resulting in the symptoms of inflammation. This may cause other inflammatory cells, and as for the case of hay fever, basophils to also release chemicals. The primary receptors to these are histamine. (That is why a lot of allergy medications are classified as antihistamines). Histamine causes a variety of symptoms, which may vary in severity. Some of the effects of histamine include bronchoconstriction, vasodilatation, increased mucus secretion, and pruritus (itching).

This however depends how the allergen entered the body and how much. For those with hay fever the most common is the allergic rhinitis (because the allergen enters through the nasal passageway). These symptoms also occur only when the allergen is present (or in high enough levels) for the antibodies to react. That is why for those with seasonal allergies they vary on location and pollen levels and for those with chronic have to make lifestyle changes depending on the cause. 

What is Hay Fever?

Hay Fever- you or someone you know probably suffers from this condition. For most people, the feeling comes every spring. Do watery itchy eyes, congestion, nonstop sneezing, or just that constant tickle in your throat haunt you as the flowers start to bloom. As unfortunate sounding as this may be, the seasonal hay fever sufferers have it easy compared to the who suffer from perennial, or year round, allergies.  As a fellow "allergy sufferer" I can relate to having the constant wad of tissues secured in my pockets or purse for both the exacerbations in spring and having to be in the presence of mold year round.

However these symptoms are very well known, but the confusion begins with what Hay Fever really is. Hay Fever, or sometimes known as allergic rhinitis, occurs when the presence of an allergen which would be completely harmless, is perceived as being just that opposite and triggers an immune response. This allergen could be from pollen, mold, dust mites, pet dander, cockroaches etc. (The in depth pathophysiologic explanation will be brought up in a future post). The higher levels of these allergens cause a more intense response and sensitization with exposure- that's why for seasonal sufferer's, the very high levels of pollen in the spring can leave some feeling miserable.

The most common symptoms experienced by hay fever include the initial sneezing, watery itchy eyes, altered smell or taste, thin watery nasal discharge, sustained nasal congestion. Throughout chronic exposure there may be headache, congestion, pressure, nasal polyps, post nasal drip (which will exacerbate a cough). The constant congestion may also lead to snoring and daytime drowsiness from difficulty sleeping.

So what can you do? There are plenty of OTC medications (which will be explained more in a future post), such as antihistamines, mast cell stabilizers, intranasal corticosteroids, and leukotriene receptor antagonists (LTRAs). These are all triggered at symptom relief because there is no real "cure" once the antibodies have been made to the specific antigen- however immunotherapy (or allergy shots) can be used if trigger is identified and if medications are not effective. People often do nasal rinses or other alternative methods. The main thing that can be done is to identify the allergen and avoid it.