By Omar H. Ahmed, MD
With summer here, many people are looking forward to enjoying the great outdoors.
However, for those with seasonal allergies, the great outdoors can trigger some not-so-great symptoms.
If you are one of the nearly 50 million people in the United States who suffer from seasonal allergies, see your doctor for help. Various treatment options are available so that you can find relief.
Inflammation and Other Symptoms
Seasonal allergies, also known as hay fever or allergic rhinitis, are caused by the body’s immune system overreacting to pollen or mold spores in the air.
This overreaction leads to the release of histamines and other chemicals, causing inflammation of the nasal passages, which can lead to dryness, irritation and congestion as well as other symptoms such as:
- Sneezing.
- Itching that affects your nose, eyes or roof of your mouth.
- Runny nose.
- Watery eyes.
- Coughing.
- Post-nasal drip.
In more severe cases, symptoms can include difficulty breathing due to swelling around the throat and chest area, and asthma attacks.
Primary Culprits
During summer, the primary culprits for allergic rhinitis are pollens from grasses, trees, and weeds. Ragweed pollen, in particular, is notorious for causing severe allergic reactions and tends to peak in late summer and early fall.
Moreover, increased outdoor activities can lead to higher exposure to other allergens like mold spores, which are prevalent in warm, humid conditions.
Allergies and Sinus Disease
Seasonal allergies and sinus disease, also known as sinusitis, are closely related, often coexisting with and exacerbating each other.
Sinusitis involves inflammation or infection of the sinus cavities, which are air-filled spaces in the skull that produce mucus.
Inflammation associated with allergies can extend from the nasal passages to the sinuses, leading to swelling and blocking of the sinus openings. When the sinuses are blocked, mucus cannot drain properly, creating a breeding ground for bacteria and viruses, which can result in sinus infections.
Additionally, allergies increase mucus production as the body tries to flush out allergens. This excess mucus can become trapped in the sinuses, contributing to congestion and infection.
Persistent inflammation from ongoing allergic reactions can lead to long-term changes in the sinus linings, making them more prone to chronic infections and polyps.
Chronic sinusitis symptoms can mimic those of allergic rhinitis but last much longer and may require different treatment approaches.
Diagnosis
Diagnosis of allergic rhinitis typically involves a complete medical history and physical examination. Your doctor will review your symptoms and their frequency as well as potential triggers.
In many cases, allergy testing will be recommended. Allergy testing, which can include skin prick tests or blood tests, helps identify specific allergens responsible for the symptoms.
Skin prick tests involve exposing the skin to small amounts of potential allergens and observing for reactions, while blood tests measure the presence of allergy-causing antibodies in the bloodstream.
Your doctor may also refer you to an ear, nose and throat specialist for further assessment and evaluation.
Treatment and Management
Treatment and effective management of seasonal allergies involves a combination of avoiding allergens, medication and in some instances, immunotherapy.
There are several types of allergy medications available to help manage seasonal allergies. These medications can be used alone or in combination, depending on the severity of symptoms and individual preferences.
- Antihistamines work by blocking the action of histamine. They can help relieve sneezing, itching, and watery eyes. Cetirizine, fexofenadine, and loratadine are three popular over-the-counter antihistamines.
- Decongestants. Decongestants help to reduce nasal congestion by narrowing blood vessels in the nasal passages. They can be taken orally or as a nasal spray. Over-the-counter decongestants include pseudoephedrine and phenylephrine.
- Leukotriene modifiers. Leukotriene modifiers are prescription medications that work by blocking the action of leukotrienes, chemicals that contribute to inflammation and allergy symptoms. Montelukast is an example of a leukotriene modifier.
- Nasal steroids. Nasal steroid sprays function by diminishing inflammation within the nasal passages. They prove effective in alleviating issues like nasal congestion, sneezing, and itching. Well-known examples of nasal steroids are fluticasone and triamcinolone.
- Immunotherapy. Allergen immunotherapy involves the administration of small amounts of allergens to help the body build a tolerance to them. Administered through injections or through small tablets under the tongue, allergy immunotherapy is a long-term treatment approach that can help reduce the severity of allergy symptoms and potentially provide long-lasting relief.
In severe cases, especially when allergies and sinus disease occur together, minimally invasive surgery such as turbinate reduction, may be recommended.
Turbinate reduction involves reducing the size of the turbinates (the ledges or appendages that hang down on each side of the nose) by surgically removing excess tissue or using radiofrequency ablation to shrink the tissue. Often, both techniques are used in combination.
The in-office procedure is performed endoscopically through the nasal passages with local anesthesia and takes approximately an hour.
For patients whose symptoms are linked to a deviated septum, surgery to straighten the septum (septoplasty) may be recommended. This surgery is performed in the operating room while the patient is under general anesthesia.
The goals of both turbinate reduction surgery and septoplasty are to reduce nasal congestion, help alleviate runny nose and post-nasal drip and prevent sinusitis.
Coping Tips
Though it may be difficult to prevent allergies completely, here are some tips to help you cope when the pollen counts are high:
- Rinse nasal passages. Using saline sprays or a neti pot to rinse nasal passages can help clear allergens and reduce symptoms.
- Use an air purifier. Air purifiers can help reduce the presence of allergens and maintain optimal indoor air quality.
- Keep the windows closed. Whether in your house or your car, keeping the windows closed or rolled up can help keep the pollen out.
- Change your clothes. When you come in from outside, change your clothes. Better yet, take a shower first.
Don’t let seasonal allergies spoil your summer. Consult your doctor or an ear, nose and throat specialist for help managing your symptoms so you can enjoy the great outdoors sneeze free.
To find a physician affiliated with Penn Medicine Princeton Health, call 1 (888) 742-7496, or visit www.princetonhcs.org.
Omar H. Ahmed, MD, is a board certified otolaryngologist and head and neck surgeon. He is a member of the medical staff at Penn Medicine Princeton Health.
