Control Your Spring Allergies

WebMD Live Events Transcript

Has spring lost its splendor because you're too busy sneezing and wheezing? We learned how to control spring allergies when Pamela Georgeson, DO, from the American Academy of Allergy, Asthma, and Immunology joined us on April 13, 2005.

The opinions expressed herein are the guests' 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. Georgeson. Thank you for joining us today. How bad do you expect the allergy season to be this year? Or does that depend on where you are?

GEORGESON:
The anticipation of how bad an allergy season will be does depend on what part of the country one lives in. Depending on whom you speak to and what you read, there will be conflicting recommendations in reference to whether or not a severe winter contributes to a bad allergy season or a mild winter contributes to an allergy season.

The best source for determining how much pollen and mold are in the air is to check pollen counts performed in your area. The best source to obtain these is the AAAAI web site at www.aaaai.org. That stands for the American Academy of Allergy, Asthma and Immunology. The higher the pollen and mold counts the more severe the allergy season will be for those patients who suffer from allergic rhinitis.

MEMBER QUESTION:
I've heard that certain cities are worse than others for allergies. Is central Ohio known to be bad? The reason I ask is that my three school-aged children have developed seasonal allergies (like this season) and neither my husband nor I have any allergies whatsoever.

GEORGESON:
Yes, certain parts of the country can be more allergy prone than the others and the Midwest -- including central Ohio -- would be an area with high pollen and mold counts.

It is true that allergic rhinitis runs in families; however, if neither parent suffers from allergies it is still possible for their children to develop allergies. It is very possible that there are other family members who do suffer such as grandparents, aunts and uncles which could contribute to the heredity of your children.

MEMBER:
Actually there are no family members on either side with allergies, distant or close. And the funny thing is that all three kids developed new allergies two springs ago: two kids with apparent tree allergies and one with what I suppose is more of a grass allergy. Her allergy kicks in when the grass goes to seed.

GEORGESON:
It still is possible for her children to develop allergies without any known family history of allergic disease. It would be best to have her children evaluated and tested by an allergist to determine whether or not her children truly are allergic.

"It is always a good thing to know what one is allergic to, as avoidance is the mainstay of allergy therapy."

MEMBER QUESTION:
How can I tell if my symptoms are an allergy or just a spring cold?

GEORGESON:
The symptoms of allergies are very similar to that of a cold. They include sneezing, runny nose, congestion, and overall fatigue. One way to distinguish between the two is a person who suffers from the common cold often has an accompanying low-grade fever and the symptoms usually improve within seven to 10 days. A patient with allergies will have symptoms that persist longer than seven to 10 days and also often have associated itching of their nose and eyes, watery eyes, itchy ears and/or itchy scratchy throat.

MEMBER QUESTION:
Do I need to get tested to determine if I have allergies? My doctor just said, "Yes you have allergies" and gave me some medicine, but did no testing.

GEORGESON:
If a patient has typical allergy symptoms which are controlled with allergy medications, there isn't a need to be tested. However, if her symptoms persist and are not responding to medication therapy, then skin testing and an evaluation by an allergist would be indicated.

Another reason to identify one's specific allergies would be in those patients who also suffer from other associated illnesses, such as chronic asthma, recurrent ear infections and/or chronic sinusitis.

MEMBER:
I thought it would be good to get tested so I would know what to avoid.

GEORGESON:
It is always a good thing to know what one is allergic to, as avoidance is the mainstay of allergy therapy. If the symptoms are mild and well controlled with medications, skin testing would be optional. However, if they would like to visit their local allergist for skin testing he or she would be very happy to test them and provide them with that information.

MEMBER QUESTION:
That brings up an interesting question. If you have one child tested and treated by an allergist who says she is allergic to trees, and you notice identical symptoms that start at the exact same time, is it safe to not bother with testing? The pediatrician prescribed Zyrtec and Patanol and they seem to be working fine.

GEORGESON:
I suppose in that situation I would agree with the family pediatrician.

I think it would be best to discuss at this time when it is appropriate to refer a patient for evaluation by an allergist. Patients who have persistent allergic symptoms, including the nasal and eye symptoms previously discussed which are not well controlled by avoidance and medications, should also see an allergist. If they also have chronic asthma, that is not well controlled and recurrent ear or sinus infections, those individuals should also be evaluated by an allergist.

In the case of this second child previously discussed, that child's symptoms are well controlled with Zyrtec and Patanol eye drops; there is no need to be evaluated by the allergist at this time.

An exception to this is if eye symptoms persist for several weeks or the patient is intolerant of eye drops, (many of them burn when instilled in the eye); then allergy testing would be appropriate in that situation. Allergy eye symptoms are the most difficult to control medically and with avoidance measures and that will often bring a patient to an allergist's office, because of persistent eye symptoms.

MEMBER QUESTION:
Are over-the-counter
eye allergy drops as effective as those like Patanol?

GEORGESON:
Over-the-counter eye drops can be as effective as prescription products. Most of the eye products were prescription products and have subsequently become OTC (over-the-counter) medications. If at some point in time the OTC eye drops are not effective, the next step would be to see your doctor for a prescription eye drop.

MEMBER QUESTION:
What is the best medication to combat fatigue when dealing with allergies?

GEORGESON:
The fatigue is generally associated with the symptoms of allergies, primarily congestion, so it's best to treat the allergy symptoms with topical nasal steroid sprays, which are prescription, and/or oral antihistamine and decongestant medications. Once an allergy patient's symptoms are controlled the associated fatigue will improve.

"Once an allergy patient's symptoms are controlled the associated fatigue will improve."

MEMBER QUESTION:
I have been taking Clarinex and Nasonex for about a week and have still been congested. Could this be a side effect of either medication?

GEORGESON:
No. Missing from her treatment regimen is an oral decongestant, such as Sudafed. You can supplement your treatment regimen with Sudafed OTC or contact your physician to see if she or he will prescribe a combination product such as Clarinex-D or Allegra-D or Zyrtec-D.

MEMBER QUESTION:
Is there a best time to take allergy medication, such as nasal steroids?

GEORGESON:
No. It would be best, however, to take the medication the same time each day.

MEMBER QUESTION:
Do you think it would be beneficial for a child with known hay fever who is experiencing trouble breathing while running (what I assume is exercise-induced asthma) to be seen by an allergist? The pediatrician is trialing Singulair but it doesn't seem to have much effect. We'll go back to the pediatrician of course, but I just wonder if it would be better to try an allergist or pulmonologist to really prove if it's asthma.

GEORGESON:
This parent's suspicion is most likely correct. Forty percent of patients who have allergic rhinitis will also have asthma. There are many triggers of asthma, including allergies, exercise, infections, laughter, crying, sinus infections, and weather changes. If the patient is not responding to Singulair, the patient should also be prescribed an inhaler, which is a bronchodilater, such as albuterol. If the pediatrician is unwilling to prescribe an inhaler for the child, the child should see an allergist.

Since the patient has a history of hay fever and/or allergies an allergist would be a better specialist for him to see as allergists are also asthma specialists and understand the relationship between allergic disease and asthma.

MEMBER QUESTION:
Can postnasal drip be a result of allergies? I wake up in the morning with globs of mucus that drop down my throat but I don't have itchy/ watery eyes or a runny nose.

GEORGESON:
The simple answer is yes. Postnasal drainage can be a symptom of allergies, as well as sinus disease, and not every patient will have sneezing and itching and teary eyes. Each patient's allergy symptoms can differ from person to person.

Postnasal drainage can also be a symptom of a condition called nonallergic rhinitis, which is a condition often seen in adult patients that don't have allergies as a trigger. The best way to make this diagnosis is for a patient with rhinitis symptoms to have negative skin tests.

MEMBER QUESTION:
Is it fact or fiction that eating local honey can actually build my immune system against the pollens that affect me the most in my area?

GEORGESON:
It's fiction.

"A resource would be the AAAAI web site. Information with a map of the country is available that will identify when and where the different pollens will be present."

MODERATOR:
What are the most common allergens that affect people in the spring?

GEORGESON:
In the spring the first pollens that appear are trees, and depending on what part of the country you live in, determine what time this occurs. In the Midwest and Northeast the trees start pollinating in late March, early April. In the Central Southern states they'll start in January.

The next pollen to follow the trees are the grasses. After the grasses will start weeds, and then in the end of the summer, mid-August through fall, where there is a good killing frost, there will be ragweed, which is commonly referred to as "hay fever."

A resource would be the AAAAI web site. Information with a map of the country is available that will identify when and where the different pollens will be present. The official web site is www.aaaai.org. There's a lead article on the home page called Topic of the Month, April 2005, Staying Ahead of Spring Allergy Season .

MEMBER QUESTION:
We never had a killing frost this winter. In fact it was so mild, my geraniums stayed over winter. Does this mean it will be an especially hard spring for allergies?

GEORGESON:
I don't really know, to be honest.

MEMBER QUESTION:
How long does it take for nasal steroids to be effective?

GEORGESON:
There are recent studies that show nasal steroids can begin to improve symptoms within 12 to 24 hours. However, maximal effectiveness will be seen within 10 to 14 days.

MODERATOR:
So you should start those allergy meds a couple of weeks before the season is supposed to hit?

GEORGESON:
I would agree with that.

MEMBER QUESTION:
I always believed mold is a problem in just the summer. Is this true?

GEORGESON:
I live in Michigan and currently our mold count and tree pollen count is very high. So the mold, again, depending on the climate you live in, can be around starting in the spring, summer or fall. In climates that experience frost and snow, this cold will eliminate mold for the winter season. In areas where there isn't a frost, mold may persist all year round if it is a wet/damp climate.

MEMBER QUESTION:
My physician has me taking Qvar 80 for asthma, and I am wondering if the newer medication out there may work better. I am also concerned with side effects.

GEORGESON:
Patients with persistent asthma should be on a daily controller medication. The NHLBI (the National Heart, Lung, and Blood Institute) guidelines for the treatment and diagnosis of asthma recommend inhaled corticosteroids as the preferred drug of choice. Qvar is one of several inhaled corticosteroid medications available.

The side effects from inhaled corticosteroids are very similar between the different products available. If this patient's asthma is well controlled on Qvar I do not see a need to switch medications. It is important, however, for all persistent asthmatic patients to be evaluated every six to 12 months to determine if their treatment is adequate and/or whether or not changes in their treatment is necessary.

"The results of the skin test will help the physician counsel the patient on further treatment options based on the skin test results."

MEMBER QUESTION:
When I visited Atlanta I saw lots of powder from the trees. It really irritated my eyes. My doctor says it is an irritant, not a true allergy. Can you explain the difference between an allergen and an irritant? Does it really matter which it is if they both make me uncomfortable?

GEORGESON:
In patients with allergies who develop eye symptoms, the allergen (the substance which causes the allergic reaction) can be an irritant. In this case, when the patient went to Atlanta the powder in the air was very likely tree pollen and it would also be likely that this was an allergic response. The only way to determine this would be to skin test this patient to pollens that are prevalent in the Atlanta area. Other "irritants" which can cause eye symptoms can be things like smoke, strong odors and wind, which are not typical allergens.

MODERATOR:
We've been talking allergy testing. Can you explain what is involved and what can be learned?

GEORGESON:
Allergy testing consists of two parts. The first is the scratch or prick skin test, where dilute amounts of allergens are "pricked" onto the skin on a patient's back. If the scratch tests are negative, intradermal tests are often done as a confirmatory test. An intradermal test is performed with the injection of a tiny amount of the allergen just beneath the skin surface on a patient's arm. The allergens generally used for testing are those pollens as well as indoor allergens, such as animals, dust mites, and indoor molds that are prevalent in the area where a patient lives. In general, if the skin tests are negative, it is unlikely that they are allergic to something that was missed on skin testing.

Positive and negative controls are also placed as part of the skin test procedure. This allows us to know of the validity of our tests. The results of the skin test will help the physician counsel the patient on further treatment options based on the skin test results.

MEMBER QUESTION:
Are bee and hornet venoms in the standard battery of skin test allergens?

GEORGESON:
Typically bee and hornet and wasp venom are performed at a separate skin test session, but to be sure they should ask the allergist if they are included in their general battery of skin tests. In Michigan, the standard of practice is to test patients for venom allergy only in those patients with a history of a severe reaction to a venom sting, and these are done in a session separate from pollen or indoor allergen skin testing.

MEMBER QUESTION:
Would you recommend skin testing for a patient who had a very severe reaction (cellulitis on the entire arm) to a flying insect (insect unknown) bite?

GEORGESON:
If the only reaction was a severe large reaction with cellulitis the answer is no. The indication for venom skin testing is if an individual has had a systemic reaction, including generalized hives, shortness of breath, wheezing, dizziness, and/or severe respiratory distress. Patients with large local reactions are not at any greater risk than that of the general population for having a life-threatening insect-sting allergy.

Typically patients who are stung by a honeybee will have a stinger left at the sting site. Patients who are stung by wasps or a variety of hornets will not have a stinger left behind and those are the bites that frequently become infected and develop cellulitis, which often require antibiotic and/or oral steroid therapy. The hornets and wasps are scavenger bugs and therefore often cause infections once they've stung a person.

"As the allergy season has started for patients who have persistent symptoms that are not controlled with over-the-counter medications, I would encourage these patients to see their physicians for further evaluation and treatment."

MEMBER QUESTION:
Can allergies cause irritability and trouble with concentration?

GEORGESON:
Yes. If you are congested and your nose is constantly running and your eyes are itchy you will be irritable and therefore somewhat distracted. This is why it's important, particularly in children, to identify their allergies and treat them appropriately.

MODERATOR:
Dr. Georgeson, we are almost out of time. Before we wrap things up for today, do you have any final words for us?

GEORGESON:
As the allergy season has started for patients who have persistent symptoms that are not controlled with over-the-counter medications, I would encourage these patients to see their physicians for further evaluation and treatment. I would also like to refer them back to the AAAAI web site for information regarding allergies and other allergic-associated diseases.

I thank you very much for the opportunity to speak with you today and I wish everybody a good day.

MODERATOR:
Our thanks to Pamela Georgeson, DO, for joining us today. And thank you, members, for your great questions. I'm sorry we couldn't get to all of them. For more information, please visit the AAAAI web site at www.aaaai.org.



©1996-2005 WebMD Inc. All rights reserved.

Health Solutions From Our Sponsors

Last Editorial Review: 4/22/2005