Warmth, yeah! Allergies, boooo!

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John Vaughn, MD, Director of Student Health
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Many of you have been dealing with allergies all your life. Some of you are new to the South and the abundant variety of plant life. You may find your face melting and your sinuses in revolt.

Welcome to allergy season.

What causes allergies?

Unfortunately, you have no one to blame but yourself.  Many different things (called “allergens”) can trigger allergies: pet dander, grass, trees, dust, mold.  But there is nothing inherently evil about any of these things.  It’s your immune system’s overreaction to them that causes all the problems.  For allergy sufferers, the immune system unfortunately perceives these benign things in the environment as a serious threat and activates a whole bunch of defense mechanisms to combat them.

What are the symptoms?

Sneezing, runny nose, stuffy nose, itchy nose, post nasal drip, cough, itchy eyes, watery eyes, fatigue, trouble concentrating, rashes, hives, itchy skin.  Basically, your head feels like it’s full of cement and getting tickled from the inside out.  You may have only some or all of these symptoms.  They can be mild or severe.

How do I know if I have them?

Allergies is a pretty straightforward diagnosis – one you can usually make yourself.  If you get any of the above symptoms whenever you are exposed to a specific allergen, it’s safe to say you are allergic to it.  For the majority of mild to moderate cases, the treatment is the same no matter what the trigger is (avoid the offending allergen and take some antihistamine medication), so we don’t usually jump to allergy testing right away.  However, if the symptoms are severe or you’re having a hard time figuring out exactly what the trigger is, you can see an Allergist who can test your immune response against a whole bunch of common and less common triggers.

How do I deal with them?

If you’re allergic to outdoor allergens (pollen, grass), you should keep an eye on the local pollen counts for the day (weather.com and accuweather.com) and avoid outdoor activities (like biking, hiking, running, etc.) at the height of pollen counts. If you really need to be outside, a face mask might help to prevent excessive pollen exposure (and make a daring fashion statement to boot!).

During the height of pollen season, you should try to keep the windows and doors of your living space and car shut.  Keeping the air conditioner on and using the “recirculate mode” in your car can also help.  If you have access to your AC unit, HEPA filters are effective at reducing and eliminating potential outdoor allergens.  Changing your outdoor clothes as soon as you get inside, putting them in a hamper or closet instead of throwing them on the bed or floor, and even taking a quick shower can also help.

If you’re allergic to pets, the best treatment is to avoid them.  If you just can’t bear to kick little Fido or Mittens to the curb, make sure you at least keep them out of the bedroom and off fabric covered areas, like couches.  Getting someone else to wash the pet frequently would help your allergies (if not your friendship) and using a HEPA vacuum and HEPA indoor air-purifier would also be beneficial.  If you can, removing carpeting in your living space also helps a lot.

For dust mites, it’s all about controlling the humidity in your living space.  Decreasing the humidity to less than 40% using a dehumidifier is key.  Wash and dry sheets and bedding on hot cycles.  Adding an extra rinse cycle during washing will also reduce allergen levels and detergent residue.  You can buy dust mite-proof bedding material at Bed, Bath and Beyond, Target, Amazon etc.

Humidity control is also important for managing mold allergies.  Using a dehumidifier will help, as will making sure any water leaks or moldy dry walls are corrected.  Doing any yard work, especially raking dry leaves and mowing grass, should be avoided to minimize outdoor mold exposure.

What about medications to help?

Luckily, there are good over-the-counter medications called antihistamines that are very effective at controlling allergy symptoms.  The 3 most common are Loratadine (Claritin),  Fexofenadine (Allegra) and Cetirizine (Zyrtec).  These are tablets that you can take once a day for allergy symptoms and are non-drowsy (for the most part – they can make some people sleepy, so don’t take them for the first time if you’re in a situation where you need to be alert).  Diphenydramine (Benadryl) is another effective antihistamine but it only lasts about 6 hours and it makes you very sleepy.

You can also use a nasal saline rinse to flush allergens and other gunk from your nose.  Since it’s just salt water, you can’t really overdo it and there shouldn’t be any side effects.  It has the added benefit of keeping the lining of your nose from drying out which minimizes the risk of nose bleeds.   

One word of warning.  You can buy an over the counter nasal spray that has decongestant medication in it called Neosynephrine (Afrin) but you should really try to avoid it.  It sounds crazy, but your nose can easily get “addicted” to it and before you know it, you’ll need to use it all the time to keep your nasal passages open.  If you feel you really need it, you should limit it to no more than a couple of days. 

When should I see my health care provider?

There are prescription medications that can be used in addition to the OTC ones to help control your symptoms.  You can discuss these medications with your primary health care provider.  For symptoms that are still difficult to control even with the first line prescription treatments, you may be referred to an Allergist for evaluation and management.  They may recommend allergy immunotherapy (“allergy shots”) for severe cases.

If you are worried that you may have allergies, or if you know you have them and need some help getting them under control, you can make an appointment at the Student Health Center.  Odds are, our health care providers can help you manage them, but if they can’t, we can send you to see one of the great Allergists affiliated with Duke.

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