We are all familiar with the phrase, “April showers bring May flowers.” I this year’s case, it was, “Winter showers bring February, March, April and May flowers.” All kidding aside, this spring pollen season has truly been historic in that it began several weeks earlier than normal (in early February), and has produced some of the highest pollen counts on record. In fact, some of the areas of the southeast (such as Atlanta) record high pollen counts that actually doubled previous highs!
All of this has resulted in not only a more prolonged season, but also a more severe season. Allergists all over the country have had their offices packed with patients suffering from sneezing, stuffy nose, post nasal drip, coughing, and in some cases, wheezing and other breathing problems. Pollen grains, in susceptible patients, set up an allergic immune response, or a “chain reaction” that results in symptoms as well as persistent inflammation.
There are several over-the-counter antihistamines such as fexofenadine (Allegra), loratadine (Claritin), and cetirizine (Zyrtec) that are either non- or low-sedating products, and can be given generally once a day in liquid or tablet form. Nasal saline sprays are also quite effective measures. We suggest to our patients that they avoid more sedating antihistamines such as Benadryl or chlorpheniramine for regular use because of their sedating qualities. Prescription antihistamines that may be considered are levocentirizine (Xyzal) or desloratadine (Clarinex). Medications with decongestants added (Allegra D, Zyrtec D, or Claritin D) are frequently helpful, but we caution patients that this can cause palpitations, jitteriness and elevations in blood pressure and heart rate in susceptible patients.
If eye drops are needed over-the-counter, either Liquid Tears or ketotifen (Alaway or Zaditor) can be helpful. Frequently, more severe patients need treatments with prescription nasal sprays that contain systematic corticosteroids (Flonase, Nasacort AQ, Nasonex, Veramyst, Omnaris, fluticasone propionate, and QNASL) to use on a maintenance basis to control these symptoms. There are antihistamines available in prescription such as Patanase, Astepro and azelastine which can be used either alone or in combination with intranasal corticosteroids.
Environmental control is more difficult in patients with pollen allergy. We recommend not leaving windows open during pollen season, and changing air filters more frequently. Prior to going to bed, we suggest patients bathe and wash their hair to remove pollen.
Finally, many patients with more moderate to severe symptoms—especially that require more than antihistamine therapy to control—are great candidates for allergy vaccines (immunotherapy or “shots”). These are given on a schedule over a 3 to 5 year period, and can result in significant improvement in symptoms.