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Friday, November 28, 2014

Dr. Pegs Prescription

Manage allergies with behavior changes, medications or herbal remedies

It’s that time of year again. Winter turns to spring — and back into winter again. The sun shines, the wind blows, the pollen flies and the rain falls. You might have heard the saying: “March comes in like a lion and goes out like a lamb.” In New Mexico, the lion sticks around well into April. The only thing you can reasonably predict about this season is that the pollen count will rise as surely as the sun.

Allergies tend to be bad here because our climate is dry, meaning the pollen doesn’t get washed out of the air. Add to that our famous spring winds, and the result is a noseful. If you never had seasonal allergies anywhere else you lived, you have a better chance of developing them here. The major offenders in the spring are trees, such as juniper and mulberry. In the summer, grass is the worst, and in the fall it is weeds.

Symptoms of seasonal allergies include itchy and watery eyes, runny nose, sneezing, coughing, wheezing, headache and itchy skin. Some people get wheezy lungs, too, and many feel draggy and fatigued. Sound familiar?

All is not lost, however. There are things you can do. In order of increasing technical difficulty, here they are.

Avoid the allergens. An allergen is whatever you’re allergic to.

Now, obviously you have to breathe, and you have to be outdoors sometimes, so you can’t completely avoid pollen. But you might be able to stay indoors when the wind and pollen counts are really high, or you can wear a dust mask if you’re desperate.

Get the allergens out of your environment. If you have indoor-outdoor pets, wipe them down when they come in. Even if you can’t see it, they are covered with dust and pollen. A damp paper towel will work. Wash your pillowcase often so you don’t inhale deposited pollen particles while you sleep. Close your windows at night. Trees drop most of their pollen in the wee hours, so don’t leave an open invitation, so to speak. Consider an air filter if it gets really bad.

Get the allergens off of you. Wash or rinse your hair before bed, and don’t sleep in your day clothes. Shower off after you spend time outdoors. Wash your itchy eyes with refrigerated artificial tears. Dare to try a sinus rinse. To do this, you use a squeeze bottle or teapot-like item called a neti pot that you fill with distilled salt water and pour up your nose to rinse out your sinuses. Follow with a quick gargle. Not only does this wash the pollen and other allergens from inside your nose and throat, it also loosens the mucous and makes it much easier to clear. I have some patients who do a sinus rinse twice a day and don’t have to do anything else or take any meds for their allergies. It may sound gross, but once you try it, you just might love it.

Take allergy medicine. From topical to oral, from over-the-counter to herbs to prescriptions, there are lots of drugs that block the allergic response or treat the symptoms. As with any medication, I recommend starting low and going slow. Try OTC eye drops and nasal sprays first, then OTC pills. Antihistamines are the class that blocks the allergic response. You can get all available antihistamines over the counter, including the non-sedating types.

Other useful drugs are cough suppressants, decongestants to decrease the swelling in the nose and expectorants to help loosen mucus. If OTC remedies fail, see your health care provider for a prescription. If you start wheezing or have asthma with your allergies, you should see a medical provider. Remember, all drugs have potential side effects and interactions with other drugs.

If you are the herbal type, the following substances are rated as “possibly effective” by the Natural Medicines Comprehensive Database: Pycnogenol is a natural antihistamine made from the bark of the French marine pine, and shows some promise, especially if you start it before allergy season. Lots of people use stinging nettle for allergies, although the research is a little slim.

Still, it’s likely safe unless you’re on Coumadin, a blood thinner. Quercetin, a compound found in tea, is also popular, and better absorbed if taken with bromelain. Butterbur root or leaf is effective, but make sure that you get the kind that is UPA-free.

Phleum pratense, otherwise known as Timothy grass, an expensive race horse delicacy, works for some humans, as does Tinospora cordifolia, or heart-leaved moonseed. But be careful of that last one if you’re diabetic.

Allergy shots are the last resort of the desperately, miserably allergic whose symptoms don’t respond to all the other measures above. If this is you, you need to see an allergist and get skin testing to see exactly what you’re allergic to. The allergist will then formulate a special serum made up of minute amounts of your unique allergens and give them to you by injection several times a week for a few years, until you are no longer allergic. This is expensive, time-consuming and not always successful, but worth trying if you have tried everything else and are still really suffering.

Lastly, remember the words of the very wise man or woman who said, “This too shall pass.” Nothing is permanent. Life is always changing, and the pollen will eventually subside.

Gesundheit!

Peggy Spencer is a student-health physician. She is also the co-author of the book “50 ways to leave your 40s.” Email your questions directly to her at pspencer@unm.edu. All questions will be considered anonymous, and all questioners will remain anonymous.