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Four Surprising Allergy Mistakes
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By Stacey Colino
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MDminute Allergies Spring 2008
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 The door has barely closed on cold and flu season when spring ushers in another wave of sneezes and sniffles. This time, the likely culprit is seasonal allergic rhinitis, or hay fever. The condition afflicts some 40 million Americans, and that number is growing: The National Institute of Allergy and Infectious Diseases reports that the prevalence of allergy in the U.S. is increasing “for reasons that are still unclear.” With all kinds of allergies on the rise, it’s more important than ever to avoid making the following mistakes.
When a hay fever sufferer is exposed to pollen—those tiny, powdery particles released into the air by trees, grasses and weeds—immunoglobin E (igE) antibodies are produced, which attach to the body’s mast cells (a type of white blood cell). Then, each time the person is re-exposed to pollen, these antibodies trigger the mast cells to release histamine and other inflammatory chemicals, causing the irksome symptoms associated with allergic rhinitis.
“Antihistamines block the histamine receptors in the eyes, nose and skin, thus preventing histamine from binding to these receptors in the first place,” explains Mark C. Jacobson, M.D., president of the Illinois Society of Allergy, Asthma and Immunology. “The earlier you start antihistamines—ideally, before the histamine has even been released—the more likely you are to prevent symptoms of itching, swelling and increased mucus production.”
Nasal corticosteroids, which relieve congestion as well as other hay fever symptoms, are also best started before you notice problems, since they may require three to seven days to take effect. That’s why allergists recommend starting allergy meds a week or so before you typically begin getting symptoms.
Seasonal allergies more than triple your risk of asthma and, if not controlled, can increase your risk of sinus infections, nasal polyps, migraine headaches, sleep apnea, conjunctivitis (pink eye) and ear infections. People with allergies and asthma may also be more susceptible to other medical conditions, including atherosclerosis, according to research at Innsbruck Medical University in Austria. In children, allergies can impair learning and lead to dental problems.
“Allergic disease has been trivialized, but it’s not a trivial disease,” notes Jonathan Bernstein, M.D., professor of clinical medicine at the University of Cincinnati College of Medicine and a partner in the Bernstein Allergy Group/Clinical Research Center. “It can lead to many complications that could be avoided.”
The bottom line: Get allergy symptoms under control through a combination of environmental/lifestyle modifications, medication and, if indicated, allergy shots. If one treatment doesn’t help, continue trying others under your doctor’s supervision until you find an approach that effectively relieves your symptoms.
There’s no truth to the notion that you can build up tolerance to antihistamines, says Sandra Gawchik, D.O., co-director of the division of allergy and immunology at the Crozer Chester Medical Center in Chester, PA. “If antihistamines stop working,” she notes, “it’s usually because the person has stopped the medicine or isn’t taking it regularly, and is still exposed to the allergen—or a new allergen has been introduced, such as a cat or dog.”
Remember, too, that antihistamines may not be fully effective for more severe hay fever symptoms. If you’re not responding sufficiently, you may need a nasal steroid and an antihistamine, says Jacobson. If not treated properly, hay fever can also lead to sinus infections, which could require other medications such as antibiotics. In any case, lack of response to antihistamines warrants further investigation by your doctor. Just don’t blame “antihistamine tolerance” in the meantime.
If you or your spouse suffers from allergies, your child has about a 50 percent chance of following in your footsteps, according to Dr. Jacobson. If you both have allergies, your child’s risk jumps to about 70 percent. But this doesn’t mean you and your child will be allergic to the same things.
“A child inherits the tendency to develop allergies, but not the parent’s specific allergenic profile,” says Ernest Charlesworth, M.D., clinical associate professor of medicine at the University of Texas Medical Branch at Galveston. So if you’re allergic to grasses, your child could develop an allergy to cats—or vice versa.
If you suffer from allergies, be on the lookout for signs that your child may be developing allergies as well, such as frequent colds, a constantly drippy or stuffy nose, rubbing or scratching of the eyes or nose, frequent ear or sinus infections, and snoring. In addition, eczema could be a sign of possible allergies down the road.
Sources: National Institute of Allergy and Infectious Diseases; Archives of Internal Medicine, November 28, 2005.
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