Doctors' Notes: New medications make seasonal allergies nothing to sneeze at
Republished from the Toronto Star's Doctors' Notes
After what feels like a long wait, most people are relieved about the arrival of spring weather. But if you’ve got seasonal allergies, warmer conditions also mean the eventual return of pollens, mould spores and other allergens.
As an allergy specialist, I generally think it’s best to minimize exposure to the things that bother us where possible. But, when it comes to seasonal allergies, this is easier said than done. And ultimately, we want to be able to go outside and enjoy spring, summer and fall.
Thankfully, there are some new medications available to make the allergy season more bearable.
If your symptoms are fairly mild, one option is over-the-counter (OTC) antihistamines. I recommend avoiding the older ones since they have a lot of side effects like dry eyes, mouth or nose. As well, they can also lead to pressure changes within our eyes, especially in people who have glaucoma.
The older drugs can also cross the barrier from the blood stream into the brain. This means these medications have a sedative effect and can impair your performance at school, work or behind the wheel.
These kinds of drugs are widely available and fairly affordable, but they aren’t very effective so I don’t think there’s any need for them these days.
Additionally, these kinds of pills have some other significant unintended side effects. Common first-generation (i.e. older) allergy medications are also part of a class of drugs known as anticholinergic medications, which block the action of a substance that transmits messages in our nervous systems. Recent research suggests a link between long-term, frequent use of anticholinergic medications and premature cognitive impairment. Benadryl is the most commonly used medication.
There are some newer, second-generation OTC antihistamines that won’t make you sleepy or impair your ability to function. But it can be hard to identify them, so ask the pharmacist or your doctor for some guidance.
One question people often ask me is whether there’s anything else they can do to help manage their allergies. Saline rinses can help flush allergens out of the nasal cavity and sinuses and help get rid of thick, dried or crusty mucus in your nose. Look for a high-volume rinse — whether you choose to use a squeeze bottle or netti pot is up to you.
There are also prescription medication options to help you manage your symptoms. Generally, my preference is to recommend these new pills, eye drops and nasal sprays because they work well with minimal or no side effects. The great thing about topical remedies like eye drops and nose spray is that when you use something topically, you’re putting all the medication where you want it, and little is absorbed elsewhere.
If you’ve tried these things and still struggle with symptoms, pre-seasonal vaccines may help, too. These can be effective against a variety of allergens including tree, grass or ragweed pollens as well as other year-round allergens like pet dander or dust mites.
In this case, you’ll need to have an allergy test done so that your doctor will know which vaccine — or combination of vaccines — is the best fit for you. Some are given by injection, others are given as drops or tablets that dissolve under your tongue.
The sublingual vaccines that dissolve under your tongue have been used for several years in Europe. They’re very convenient — people can use them at home instead of having to visit their doctors’ offices. But for optimal effectiveness, you have to use them every day for several months before allergy season hits.
Vaccine (immunotherapy) injections have to be given at the clinic, but you only need between four and seven of them to be protected for the season. They can also be combined with other medications.
Some people may also benefit from allergy vaccines year-round, if for example, they have symptoms all the time or allergic asthma.
It’s impossible to predict how mild or difficult any allergy season will be.
Spring’s first allergens usually come from trees, which tend to pollinate one species after another before the grass pollens start.
But when we have a long winter like the one we’ve just finished, things can heat up very quickly and the trees can pollinate all at once instead of sequentially, setting the stage for a nasty season.
Thankfully, with the help of your doctor and the right treatment strategy, you don’t need to stay cooped up indoors just because you’ve got allergies.
Dr. Peter Vadas is the Acting Director of the Division of Clinical Immunology and Allergy at the University of Toronto’s Faculty of Medicine. He is also Head of the Division of Allergy and Clinical Immunology and Medical Director of the Regional Anaphylaxis Clinic at St. Michael’s Hospital. Doctors’ Notes is a weekly column by members of the U of T Faculty of Medicine.
