It's time to talk about fall allergies. I know it seems early, with daytime temperatures over 100 degrees. However, fall allergy season starts in the last half of August. If you have family members with allergies, it is time to prepare.
The best way to deal with allergies is to prevent a reaction. This is done first by avoidance. Don't go out into fields, if you have a lot of fall allergies. That makes sense, but some people are not able to do that. These individuals can lower their risk of an allergic reaction by taking antihistamines and by keeping their homes as allergy free as possible.
Keeping your home allergy free is not easy if you have multiple allergies. For seasonal allergies, it is important to keep your house closed up. Resist the temptation to open the windows and turn off the air conditioning as temperatures drop. If you also have food allergies or indoor allergies, you may have to be more vigilant during this time. Exposure to multiple allergies can add up and make you really miserable.
Let's talk a little bit about antihistamines. I realize that much of this information may be review for some people. Antihistamines block histamine. Histamine is released by our immune systems in response to a trigger. Some people react to one trigger, and some to another. Some people's trigger setpoints are more sensitive than others. Since antihistamines work by blocking release of histamine, they work best when taken before the allergic reaction starts. For the fall allergy season, that means taking medication from August 15th until the first hard frost. (Where I live, the first hard frost happens sometime between Halloween and Thanksgiving). That seems like a lot of medication for a long period of time. I agree. Clearly, not everyone with fall allergies has severe enough symptoms to warrant this regimen. However, if you have allergies that trigger asthma or eczema, this can be life-changing. The newer nonsedating antihistamines (eg. fexofenadine, loratidine) allow us to treat you for extended periods of time without drowsiness. Diphenhydramine is more effective in many people, but is also associated with drowsiness in most people. Grade schoolers given diphenhydramine at bedtime showed an inability to concentrate that lasted until about 3:00 pm the following day. Many pediatricians are getting away from it's use for this reason.
For individuals with moderate to severe allergies, this may not be enough treatment. If you continue to have itchy eyes, stuffy nose and sneezing despite the above advice, there is more you can do. For itchy eyes, there are several over the counter (OTC) eye drops that are very effective. Follow all instructions on the label and do not use for more than 1 week without your physician's input. Nasal steroids can help with nasal congestion and sneezing. Like antihistamines, they work best if started prior to allergy season. They can be associated with headaches, nosebleeds and colds, so do not take them without first talking with your provider. However, they can be very helpful in individuals with asthma triggered by allergies. We know that if we control the upper airway (nose), it is easier to control the lower airway (lungs).
Some people take drugs called "mast cell" inhibitors, such as montelukast. There seems to be a lot of confusion about when and how to use these. To explain this, I would like to back up a bit. The allergy response (an allergic reaction) is called a cascade. This is because it is a series of chemical reactions that in turn cause more allergic reactions. A good visual is to think about playing pool. When you "break" in pool, the cue ball hits one or two balls, which each hit 2-3 balls, etc, scattering all the balls over the table. A cascade is similar in how one reaction causes several other reactions. Antihistamines work on 2/3 of that cascade, and mast cell inhibitors work well on the other third. Because of this, mast cell inhibitors should always be used with an antihistamine, and never instead of an antihistamine. Do you follow? I hope I made that clear. It's a difficult concept.
In summary, fall allergy season will be starting soon, and there is much you can do to relieve symptoms. Avoidance is the best treatment. Don't open up the house when the weather cools off, as this introduces allergens into your home. Antihistamines and other medications work best if taken before the allergic reaction starts. Medications may need to be taken from August 15th to the first hard frost. I hope that you have a better understanding of how and why certain medications are used. More importantly, I hope you have a happy and healthy fall season. For more questions, contact your Personal Medicine provider.
Nanette Nuessle, MD, FAAP
House Call Pediatrician, Overland Park, KS
State of the art care for your child in your home.
http://FiresidePediatrics.com
http://www.PersonalMedicine.com
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