Winning the War Against Allergies-- Paul Enright -- 03/11/04

By Paul Enright
WebMD Live Events Transcript


The official start of spring is right around the corner, but for many allergy sufferers the sneezin' season has already begun. Learn what you can do to reduce allergy attacks from WebMD's own in-house expert, Paul Enright, who joined us to discuss prevention and treatment options for seasonal allergies.

The opinions expressed herein are the guest's alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

Moderator: Welcome to WebMD Live, Dr. Enright. After a couple of years of big changes in drug treatments for allergies (along with a flood of TV commercials), with the nondrowsy antihistamines becoming widely available, things seem pretty quiet from a health consumer point of view. Are seasonal allergies considered conquered by doctors such as you?

Enright: I am personally very happy to see loratadine now available for $.10 a pill instead of $1 per pill, since I take it every day myself. It certainly is a wonderful opportunity to effectively treat allergic rhinitis without seeing a physician.

Member question:
I thought it would be a good thing when Claritin became over the counter, but it's so horribly expensive I can't afford it! Will other brands be coming on the market soon to help drive down the cost? 

Enright:
Over six months ago generic Claritin became available and you can try Wal-Mart and Sam's Club to find a six-months supply. I paid $20.00 last month.

Member question: Since I get runny nose, watery eyes, and congestion every spring I think I have some allergies. Is it OK for me to just get Claritin OTC on my own or do I have to go to the doctor just to hear I have spring allergies and that I should get the same meds?

Enright:
I'm a biased observer in this case. As a physician, I generally recommend that people obtain a diagnosis before they begin treatment, but I understand that many people in the United States without universal health care coverage cannot afford a physician's office visit. The symptoms you describe seem so typically of hay fever that the purchase of at least two weeks' worth of generic Claritin sounds like it's worthwhile, since the side effect rate is very, very low.

Member question: Does the over-the-counter allergy medicine work as well as the prescription medicine? Weren't some over-the-counter meds only available by Rx not so long ago? How do I know what to get?

Enright: Buy loratadine, period. If your symptoms do not resolve within a few days of taking loratadine, then consider seeking a prescription nondrowsy antihistamine, since a few people with hay fever respond well to one antihistamine but not to another.

Member question: I take my Claritin only when symptoms are present yet someone told me that I should take them all the time to build them up in my system is this so?

Enright: Good question. Antihistamines prevent the release of histamine, which causes the itchiness, sneezing, and other hay fever symptoms, so ideally it's taken before the exposure occurs. So I personally recommend to my family and patients that they begin taking Claritin every day during the season when they know they have hay fever symptoms.

Member question: My daughter's only symptom is chronic sneezing; she doesn't seem to have any other trouble. Should I still seek medical advice? I don't like her taking drugs of any sort.

Enright: I agree that medications, both obtained from a health food store and obtained from a physician, should generally be taken only when necessary to treat disease, meaning something that's causing a reduction in your quality of life. So there is no evidence that lack of treatment of hay fever leads to any permanent problems in the subsequent years.

Member question: I am a severe asthmatic. One doctor wants me to try immunotherapy; the other says it's too risky as I also suffer anaphylaxis. Would I likely get any asthma improvement from immunotherapy? Should I stay away from it?

Enright: Please ask that question on the asthma forum on WebMD, where I may give you a more detailed response.

Member question : I recently tested positive for allergies to pollen, dust mites, grasses, etc. My symptoms don't include the running nose, sneezing, etc. that I thought were allergy symptoms. I have fullness in my ears, headaches, sore throat, and some sneezing. I just started taking Zyrtec. Will this work right away or will it take awhile?

Enright: Zyrtec is a prescription non-sedating antihistamine, perhaps stronger than Claritin. You should experience relief of the symptoms of itchy eyes and sneezing within a couple of days of starting Zyrtec. However, your headaches may be due to sinusitis, which is a side effect of severe hay fever, where the drainage tubes from sinuses become clogged up. It may take weeks to months of additional therapy to successfully treat sinusitis once it has become established.

Member question: Do allergies from the seasonal changes increase in severity over time or can they remain a mere nuisance?

Enright: People who have genetic tendency to develop allergies may develop new ones to their environment throughout life. Therefore, new exposures, such as in the workplace or to a new home or a new pet or with new landscaping, may worsen the symptoms compared to previous years. Moving to a new location, on the other hand, may lead to reduced exposures to the allergens to which you have become sensitized in your old location; therefore, you may experience a "honeymoon" period of one to two years in the new location.

Member question: Why is it I've gone through life (I'm in my 40s) allergy-free, only to develop allergies in the past two years? I can tell you exactly when the scotch broom is starting to bloom by the onslaught of symptoms (runny nose, watery eyes, sneezing).

Enright: Adult onset of allergies and/or asthma is unfortunately rather common. It can often be caused by workplace exposures to chemicals and allergens?

Member question: Is there an actual link between allergies and asthma, i.e. does one often lead to the other, or do people with one simply tend to have the other?

Enright: Good question. About half of patients with asthma also have allergic rhinitis, and about one-third of patients with allergic rhinitis (hay fever) have a tendency to develop asthma at some point in their life. The connection is usually a genetic predisposition (a poor choice of parents).

Member question: My husband's asthma is always exacerbated by spring allergies. Any suggestions? He controls his asthma fairly well at other times.

Enright: It's wonderful that you are utilizing your computer to help improve your husband's health. I recommend that he talks with his physician treating his asthma at the beginning of the allergy season, so that his asthma controller medication can be "stepped up" to better control his asthma during this season. There are many different ways to improve asthma control. See the WebMD asthma board and asthma page for more details.

Member question: What allergy medicine can I take that won't make me drowsy? I'm presently on Zyrtec.

Enright: Of the three non-sedating antihistamines, Zyrtec is more likely to cause drowsiness than the other two. Many people starting Zyrtec have fewer side effects, such as drowsiness, after taking the medication for about two weeks (they become tolerant of the side effects.) Have you tried over-the-counter generic Claritin?

Member question: Do you know if they will come out with an OTC Zyrtec?

Enright: Probably not for more than 10 years, because the 17-year patent that the drug company enjoys would have to expire for them to give up such a large profit margin.

Member question: What's your opinion on OTC Vs Rx allergy meds?

Enright: I love the over-the-counter medications and take them myself.

Member question:
How can I tell if it's a cold or allergies?

Enright: Allergies tend to recur upon re-exposure, whereas colds are just one time, and stop Also, allergies run in families, and allergies are more likely to cause itchy eyes and itchy throat than a cold.

Member question: How can my doctor tell if I have allergies without running tests? I don't want to get stuck by all those needles!

Enright: Ask the doctor to order specific IGE testing, also called RAST, and then you only get stuck once.

Member question: I always thought that airing out the house in the spring was a good thing. Now I hear that I shouldn't because it lets in the pollen. Advice?

Enright: It depends on which allergens you've become sensitized to. If you respond to outdoor allergens, such as grasses, trees, wheat, and other pollens, then opening your windows to the outside will naturally make your symptoms worse, but if you have become allergic to indoor allergens then opening the doors and windows will tend to dilute those allergens, since they originate inside your house.

Member question: My wife and I love to sleep with the windows open in the spring. Where we live there's such a short time when it's not too hot or too cold! But I have bad spring allergies and I'm sure it makes it worse to let all of that junk blow in on me and my bed. Are there window filters or some other product that can let me sleep with fresh air but without the pollen? What about air purifiers? Would one of those help?

Enright: Yes, there are filters, much like air conditioner filters, that you can place in an open window, available for about $20.00 on an internet sites. However, they dramatically reduce the amount of air that will naturally blow into your bedroom.

Air purifiers will reduce the number of pollens in your bedroom air with the window open, but be sure to purchase a large HEPA unit that is quiet and not an ionic, or "ironic" as I like to call them, breeze unit. 

Member question: Are certain times of day worse for pollen?

Enright: Yes. In many communities it's the noon to afternoon when pollens are more readily released with the warmth of the sunlight. Also, after thunderstorms and after any windy periods the pollen counts are more likely to become much higher.

Member question:
What's the difference between an allergen and an irritant? And does it really matter when either one makes me miserable? Will it affect my treatment?

Enright: Yes. The difference is the allergens are proteins derived from plants and animals, and the irritants are chemicals, such as sulfuric acid, ammonia, and formaldehyde. The treatment for allergen exposures can include antihistamines and allergy shots, but these are not effective for irritants, which must be avoided. However, nasal corticosteroid sprays are effective for both, but require a prescription from your physician.

Member question: Do you have any recommendations for things other than pills to help with allergy symptom relief?

Enright: Yes. Nasal lavage can be very effective, which is washing your nasal passages with saline solution, which, with the correct concentration of salt, does not cause burning of your nasal passages. See my WebMD message board for details. Also, nasal corticosteroid sprays, such as Flonase and Rhinocort, can be very effective for treating nasal congestion caused by allergens.

Moderator: What about prevention methods, such as nonmedicine preventions for when you are outdoors in the spring, for instance

Enright: Although it may look rather funny, HEPA filter masks are very effective at preventing the inhalation of allergens when exercising outdoors.

Member question: Because of the medicine my son takes for his ADD, he cannot take anything with Sudafed, because it can make him excited and jumpy. Are there antihistamines that don't have the side effect of making him jumpy?

Enright: Yes. There's a big difference between decongestants, such as Sudafed, and antihistamines, such as Claritin. They are an entirely different class of medications with entirely different potential side effects. Antihistamines do not raise the blood pressure and do not cause nervousness or excitement.

Member question:
I used to love Asiatic lilies and grew banks of them in my garden. Now I have to have someone dig them out of my garden before they come up. I have a strong reaction to them. Is there any way I can be desensitized to them so I can grow them again?

Enright: That's an excellent question, and I'm clueless. Please consult the best allergist in your community. I'm unaware of allergen immunotherapy for that plant; however, it may be available.

Moderator: We are almost out of time. Do you have any final words for us, Dr. Enright?

Enright: Allergic rhinitis and sinusitis are very common, and the treatments for them are very effective. So don't continue to suffer from them. Seek medical advice and get good ideas from fellow sufferers on the WebMD Message Board.

Moderator: Thanks to Paul Enright, MD, for sharing his expertise with us today



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