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Seasonal Allergies

Author: Dr. Matthew W. Kramer
January 05, 2020

Well, it’s that time of year again…….  runny/stuffy noses, sinus pressure, ear pressure, sneezing, itchy/watery eyes and the dreaded cough – especially at night.  Yes, it’s allergy season.  What I want to accomplish in this month’s blog is a better understanding of what are Seasonal Allergies?  A glimpse into the effect that Seasonal Allergies have on the health of the rest of the body.   A better look at knowing if I’m only dealing with my Seasonal Allergies or now do I (or my children) have an infection that is contagious.  Finally, what are some simple and straightforward strategies for managing Seasonal Allergies.  Let’s get started.

First things first, let’s address the question “Why am I or the members of my family miserable right now and many people I know are doing just fine?”  The answer is very simple, genetics.  Seasonal Allergies are an inheritable trait that sets the threshold for how aggressive a person’s immune system will be.  The more aggressive your immune system is, the lower your threshold is to handling allergens such as dust, pollen, spores and animal dander.  This is the reason you will see Seasonal Allergies follow a family’s line.  Anyone who has Seasonal Allergies almost always knows of a parent or perhaps grandparent that they can point to, in order to thank them for that little genetic gift.  Now what’s happening inside of you, is that when these allergens enter the sinus spaces, they bring with them DNA that is introduced to the immune system.  If your immune system is by their genetic nature very aggressive, it will be more likely to label that DNA as being viral, and then launch that all familiar anti-viral attack sequence.  The swelling of the sinus turbinates (the increased blood flow is bringing more soldiers to the battlefield) and the creation of more mucus (taking advantage of the fact that we are big and our enemies do not swim well).  This over time creates the beloved runny/stuffy nose and sinus congestion.

Now this is what sets the stage for the question “What effect does this have on my long term health?”  Initially, Seasonal Allergies are not much more that an annoyance. However, over time the continued “battle” that your immune system wages against the allergens reduces your bodies ability to defend itself against true viruses.  In fact, the very resources used to prevent you from getting a viral infection have been used on fighting dust, pollen, spores and animal dander. This is why during allergy season it seems that you catch any cold that’s going around the office or your kids are constantly getting colds.  After days to weeks of sinus congestion, runny nose, sneezing, itchy ears, itchy watery eyes or whatever combination is your allergy symptoms, these symptoms will suddenly worsen and then comes the sore throat, aching in your muscles/joints, fatigue, feeling feverish along with cold chills and from there it only gets worse.  Until eventually you see your Family Doctor, Urgent Care or Emergency Room Provider and get put on antibiotics and other meds.  Sound Familiar?  Well, the best way to treat this is to not have any of the above at all.  Is that truly possible?  The answer is, YES.  One thing I want to quickly mention before giving some techniques in managing Seasonal Allergies is to bring up some of the potential long-term effects that unfortunately, I don’t have space to go into right now.   Over time, a person with poorly controlled Seasonal Allergies can increase the overall reactivity of their immune system far beyond their initial genetic predisposition, this leads to a propensity in developing autoimmune diseases.  A short list includes developing a Reactive Bronchitis that can develop into Asthma, areas of Eczema that can develop into Psoriasis and also food sensitivities developing into Irritable Bowel Syndrome that over time can become Crohn’s Disease or Ulcerative Colitis.  I hope this puts into perspective that treating Seasonal Allergies is more than simply avoiding some annoying symptoms or the occasional cold.

So, “How do I know if I’m only dealing with Seasonal Allergies or have I developed a cold and now I am infectious?”.  Well this is tricky because as we’ve already discussed your immune system THINKS it’s fighting a virus, in fact by its very definition, that’s what a Seasonal Allergy actually is.  So many of the symptoms of Seasonal Allergies and a Cold do overlap, but here are a couple areas to focus on.  First of all, if your ears are itching on the inside, it is your Seasonal Allergy. That is the only way a person has itching inside their ears.  Also, focus on the throat.  If the throat is becoming sore and if you check either on yourself or your child and there is tenderness when pushing on the lymph nodes around the throat then chances are very high you (or your child) are now infected with a virus. Also fatigue, aching muscles/joints are classic symptoms of infection over being just Seasonal Allergies.

Now that we know that Seasonal Allergies cause you and your loved ones to get sick much more often and Seasonal Allergies also have the potential to create much more serious autoimmune disorders, how do we get them under control?  The answer is through a combination of allergen load reduction and medications, with the eventual goal of taking you off all your allergy medications. Allergy medications are greatly varied in their strength and effectiveness in different situations and conditions that require some tailoring by your Physician to your needs. However, some generalities toward medications are this:  Fluticasone and Mometasone are by far the strongest Seasonal Allergy medications. They are both nasal sprays and are generally safe both in the short term and long term.  Pregnancy is a condition that changes the circumstances and would require a conversation with your Physician.  Both should be used with one spray in each nostril twice daily, and they work best if used following nasal saline spray.  So, this leads us to discussing Allergen Load Reduction. Allergen Load Reduction involves decreasing the amount of allergens (dust, pollen, spores and animal dander) that your immune system is exposed to on a regular basis.  Here are a few of the “most bang for your buck” techniques of lowering your overall Allergen Load.

Nasal Saline Spray:  The number one method in reducing your allergen load is to spray nasal saline spray up your nose, then blow your nose twice daily…..  every day of your life.   The temptation is to manage your allergies only during allergy season or when symptomatic, but you will be doing that the rest of your life and with a strong potential for everything to get worse over time.  Saline is a hygenic method of managing allergens.  What you are doing is blowing out a portion of all the allergens that you have breathed in over the past 12 – 24 hours BEFORE they began to dissolve and expose their DNA to your immune system.  This only works if it is done regularly and routinely.  In the same way we don’t brush our teeth only when we find out we have a cavity.  In fact, we brush twice a day to PREVENT the cavity.  So the proper routine for allergen management, is to brush your teeth and clean your nose twice a day, everyday.  

AC/Furnace Filters: Your AC filter reduces the amount of allergens in your home.  If you look on the side of the filter, it will say to change them every 3 months.  This is too long for people with Seasonal Allergies. I recommend purchasing the cheapest of the pleated AC filters.  Then changing them every 4wks.  So the reason for not buying the absolute cheapest filters should be obvious – they let too many allergens pass through, but why not by the expensive filters that advertise how well they reduce allergens?  Well two reasons.  One, they are expensive.  I already don’t like them because of that and on a practical level, a high cost also means that you are less likely to keep up with them regularly.  Second, they have such a tight weaving that it is very difficult for your Air Handling Unit to pull air through them and you will burn out the motor of your Air Handling Unit, and now we are talking thousands of dollars.  So the cheap but pleated filter is the good compromise and to change them more frequently, every 4wks.  (remember to set a reminder on your smart phone, don’t lie to yourself and think that you will just remember to do this)

Air Purifying Fan: Your bedroom is the Allergen Load “Golden Space”.  You cannot control the the amount of allergens outside, at work or at school but you do have some control of the allergen load in your home (AC/Furnace filters are an example).  Even then though your influence is limited, however your bedroom is the “prime real estate” as you spend at least 6-8hrs of every 24hr day in that one room.  An air purifying fan can be very helpful running CONTINUOUSLY in your bedroom.  When looking online or at the store, I recommend a fan that moves a lot of air and has a reusable filter (for example the hepa-type).  Although the true HEPA filter is the best overall filter, every 6-8wks it needs to be thrown away and at $30+ dollars per filter your motivation to keep up with this will decrease over time.  Fans with a hepa-type filter are vacuumed off every 4wks (same time as changing the AC/furnace filter) and ours has lasted about 11 years.  Cost is between $70 to 130 dollars, and yes there are much more expensive fans – I have not had personal experience to know if they are worth the cost.  A DIY on a shoestring budget option would be to have a box fan running in your bedroom, then wherever you are purchasing the AC/furnace filters for your home, you can buy 20x20 inch filters that fit exactly the size of a box fan.  While the fan is running the filter will be suctioned to the back of the fan and now your fan is helping in cleaning the air.  Keep these fans in bedrooms, they are not powerful enough to make a significant difference in the air quality of the house at large.  Speaking of the bedrooms, all “fur babies” need to be kept out of bedrooms.  I know, I’m a dog lover myself and I know how much you love your animals.  However, you will be much healthier (side note, an animal in the bedroom is the #1 cause of poor sleep in the United States) and you will find that your relationship with the animal you love will be better having the established boundaries.

I know I’ve thrown a lot of information out there, believe me when I say that we have only scratched the surface regarding Seasonal Allergies, but I hope this blog entry has been educational and helpful.  I intend on writing on a topic each month. I would love to hear your input on topics you would like to see added to the blog content.