Finally! It’s warmer, sunnier and you’re ready to play outside. A bike ride in the country, a golf game with friends, a poolside party. You’re having fun, then boom! Your eyes start to water. Your nose starts to run. Your allergies are in full bloom.
Who’s having fun now?
Edward Bolhofner and Rose McAndrew know what it’s like. “I’ve accepted allergies as a ‘fact of life,’” McAndrew said, who grew up in the country and battled allergies all her life. “It seems the older I get, the worse they become. Over-the-counter meds no longer help.”
Bolhofner, a semi-retired teacher, said his allergy and sinus issues were so severe that his energy level was low.
“I’d be too tired to even go out for dinner.”
McAndrew and Bolhofner were ready to put the fun back in summertime. So they became patients of Sunitha Sequeira, MD, an otolaryngologist at Missouri Baptist Medical Center.
What are Allergies?
“Allergies are an immune system reaction to substances, such as pollen, mold, and animal dander,” said Dr. Sequeira.
Seasonal allergic rhinitis, often called ‘hay fever,’ includes allergies to pollen and mold. The symptoms usually start when trees, grasses, and weeds release tiny pollen particles into the air, or when molds release their spores.
Visit the St. Louis County Pollen and Mold Center for St. Louis County pollen counts.
An estimated eight percent of the U.S. population 18 and older has seasonal allergic rhinitis, according to 2010 data from the National Health Interview. That’s some 2.5 million people suffering from itchy, watery eyes; runny noses and endless sneezes.
Some allergies affect people any time of the year and can be caused by pet, mold, and dust mites. As with seasonal allergies, your body’s immune system releases chemicals, including histamine, into the bloodstream. And that’s when the trouble begins: histamine causes swelling and further inflammation of your eyes, nose, throat, lungs, and/or skin.
As common as allergies are, sometimes there’s no common solution. For many, it’s trial and error to find which remedies will work best. But there are some general guidelines that can help:
- Lifestyle and environmental changes.
- Medications, including oral antihistamines, nasal sprays, decongestants, nasal irrigations, and eye drops.
- For more severe cases, you may need to explore allergy testing and shots.
Most of the patients Dr. Sequeira sees have already visited their primary care physicians and learned that over-the-counter remedies aren’t the answer. Plus, many patients come to her with more than one problem. “For example, inflammation and swollen mucus membrane linings from allergies may contribute to sinus symptoms,” she said.
Controlling the 'Achoos': McAndrew.
While McAndrew doesn’t know the exact cause of her allergies, she knows what aggravates them: being outdoors in springtime or around someone with heavy perfume. Then there are the “green mini balls,” as she describes them, which fall off trees in her yard. Her allergies are seasonal. “Spring is beautiful, but I usually look forward to hotter weather when I seem to have fewer problems,” she said.
Since using a prescription and following Dr. Sequeira’s suggestions, McAndrew has had success controlling her symptoms. Dr. Sequeira recommended a nasal irrigation system, such as a neti pot, which you can buy over-the-counter. Nasal irrigation systems use a special saline solution, which helps clean out the mucus and allergens, along with any bacteria or viruses.
There are various types of systems. Any of them are fine, according to Dr. Sequeira, with the squirt bottle easiest to use for many. Be sure to follow the manufacturer’s directions, unless instructed otherwise by your physician. “Besides the instructions that come with the kits, there are videos online that can show you how to use them,” said Dr. Sequeira.
McAndrew now uses a nasal irrigation system twice a day. Dr. Sequeira also prescribed a nasal spray, which includes both an antihistamine and steroid. “A topical nasal steroid spray is safer than oral steroids, since it is not significantly absorbed into the body. It helps reduce inflammation, thereby reducing nasal congestion and drainage, as well as itching and sneezing symptoms,” Dr. Sequeira said.
McAndrew, who is married and has a two-year-old, said she became smarter about recognizing what might trigger her allergies. “For example, I started changing the furnace filter before winter starts.”
What about Shots and Testing?
“Allergy testing and shots are not necessary if a patient is responding well to treatment,” Dr. Sequeira said. “A simple approach, such as avoiding the things that trigger your allergies is useful as a starting point. Sometimes these triggers are obvious, such as cutting the grass, sometimes not. It may be useful to keep a journal or log to see if there is a pattern. Part of a smart treatment plan is limiting your exposure to allergens. For example, on dry windy days, pollen can easily float through the air — closing car and home windows, as well as avoiding drying clothes outside can help.”
But if the simple approach doesn’t work, Dr. Sequeira said medications might be prescribed, and lastly allergen testing. There are a couple of types, such as skin testing, in which diluted allergen is injected under the skin to see if a small red bump, called a wheal or hive, develops. Another type is the RAST, a radioallergosorbent blood test. Allergy testing is helpful for planning immunotherapy, or allergy shots, which work by desensitizing a patient’s immune system.
Sinuses and Surgery: Bolhofner.
Bolhofner has chronic allergy and sinus problems, regardless of the season. He’s treated by several specialists — including Dr. Sequeira — for different but related problems, including asthma. Dr. Sequeira examined his nasal cavity using a small fiberoptic camera scope and ordered a CAT scan. She found, Bolhofner had nasal polyps and blocked sinus passages, resulting in sinus pressure, congestion, and reduced sense of smell. After medical treatments did not work, she recommended sinus surgery.
According to Dr. Sequeira, “Nasal polyps can happen as a response to inflammation, in some people. While most people with sinus and allergy problems don’t have polyps, people with polyps often have sinus and allergy issues.”
In January, Bolhofner had his polyps removed and his narrow sinus passages widened surgically, to help improve mucus drainage and improve airflow. (This surgery can help people with sinus problems without polyps, as well.) “Now, I am much, much better,” Bolhofner said. “Before, I was always tired. The surgery helped tremendously.”
“I’m not 100%. But, I have a lot of energy back and am doing pretty well.”
Sunitha Sequeira, MD, is on staff at Missouri Baptist Medical Center and a member of the BJC Medical Group. She received her medical degree from Washington University School of Medicine and completed her residency in otolaryngology at Washington University.