Spring Allergies: Tips To Survive The Season
Dr. Maeve O’Connor from Allergy Asthma & Immunology Relief of Charlotte answers your questions about Spring allergies.
Spring means flower buds and blooming trees — and if you're one of the millions of people who have seasonal allergies, it also means sneezing, congestion, a runny nose and other bothersome symptoms.
On March 22, Charlotte Parent hosted a live Facebook chat with Dr. Maeve O’Connor of Allergy Asthma & Immunology Relief of Charlotte about tips on getting through the spring allergy season. Following are questions from Facebook users and live answers from Dr. O'Connor. (This transcript has been edited for clarity and grammar.)
Charlotte Parent: Welcome to our “Sidelining Spring Allergies” LIVE Facebook chat with Allergy Asthma and Immunology Relief of Charlotte. Today we'll be talking with Dr. Maeve O’Connor about tips on getting through the spring allergy season. Welcome, Dr. O'Connor. Onto our first question.
What advice do you have for parents going into this spring season? What should they have their kids avoid?
Dr. Maeve O'Connor: Spring is when tree pollen and molds are most abundant. I suggest visiting your pediatrician or allergist in February to determine best treatment options before the season begins, even before March 20, the fist official day of Spring. Even though it is tempting to open home and car windows after the cold winter, this invites allergens in leading to itchy eyes, runny nose, sneezing or wheezing. As pollen counts tend to be highest in the early morning hours, try to plan outdoor activities after mid-morning to minimize exposure. Remove pollen-laden clothes quickly and shower to rinse pollen from hair.
Is it possible to build up a slight immunity to spring allergies by taking an over-the-counter antihistamine consistently before allergy season starts?
Dr. O'Connor: Starting antihistamines early does not “build up immunity” like allergy shots per se. By taking medicine early, allergic inflammation is prevented from starting as these medications block the histamine receptors and the histamine binding to cells. If there is little inflammation, your child will experience diminished or no symptoms at all.
Dr. O'Connor: If treatment is started after allergy symptoms occur, the inflammatory process has already been triggered and can lead to complications such as sinus infections or an asthma flare. Parents should also be sure that kids take their medication regularly to prevent symptoms. If anti-histamines are taken two hours before going outdoors, symptoms are typically controlled. We want kids outside after all.
Cold or allergies? How do I know which it truly is, so I can take the right over-the-counter medicine to feel better?
Dr. O'Connor: Unlike allergies, a virus causes the common cold, while allergy symptoms are due to an immune response to allergens such as pollen and mold. Cold and seasonal allergy symptoms often overlap including runny nose, stuffy nose, sneezing, fatigue, and coughing. The best way to know what your child is suffering from is the duration of symptoms. A common cold lasts no longer than 10 days and tends to occur between winter and fall, while allergies can bother children for weeks and can occur seasonally or year-round. While cold and allergy symptoms may overlap, they should be treated accordingly based on proper diagnosis.
Dr. O'Connor: First-generation antihistamines, such as over-the-counter diphenhydramine, may make your child feel sleepy and typically offer relief for only a few hours. Side effects can include dry mouth/eyes along with abdominal pain and headaches. Second-generation antihistamines are less likely to cause these side effects. Each of the over-the-counter medications mentioned above are unique but none is “better than the other”— individual children respond differently. I suggest trying the one recommended by your allergist and continue the one that works best for your child. As an important point, nasal sprays are considered to be the most effective way to treat environmental allergies.
My son was prescribed FloNase by his pediatrician which we filled at the pharmacy, but I later saw FloNase on shelves in the store. So what is the difference if any?
Dr. O'Connor: There is no difference between the prescribed Flonase or the OTC one. They are the same nasal steroid molecule. The cost may be cheaper with a prescription, but this depends on your insurance plan.
Can kids who have never had seasonal allergies in years past can develop them?
Dr. O'Connor: Even a child who has never had seasonal allergies in can develop them. Seasonal allergies can start at almost any time, though they usually develop by 10 years of age and peak in the early 20s. Often, children will outgrow their allergies in adulthood, but it is important to note that allergies can appear at any age including in adults and seniors.
My daughter has taken a prescription allergy medicine for a couple of years, and I've noticed it's less effective now than it once was. Is it possible to develop a tolerance to an allergy medicine or is this a myth?
Dr. O'Connor: Although there were early studies citing that tolerance to therapeutic effects of antihistamines could occur, more recent data, especially studies involving antihistamines reveal that tolerance to these drugs does not occur. Variations in symptoms while on a single antihistamine more than likely are due to differences in the natural course of the condition rather than tolerance to the drug in question. Be sure to increase the dose as well as your child grows and weight changes with each season!
When it comes to infants, how do you determine if they may have allergies?
Dr. O'Connor: It is more difficult to determine if an infant is suffering from allergies, as we don't want to subject them to too many invasive tests. I use the history and physical exam first as well as my experience with allergies in this age group. Avoidance of common allergies such as pets and pollen may shed light if symptoms improve with avoidance. I also check response to a short course of medication. Allergy testing can be done but I prefer to do limited skin testing in these young ones and direct testing to what the infant actually has exposure to.
I really suffer from spring allergies and almost prefer to stay indoors until it passes. This isn’t too realistic because I have a toddler who loves being outside. What’s the best way for me to cope?
Dr. O'Connor: Be sure you know your triggers. See a board-certified allergist to properly diagnose your allergies. Obviously with pollen visible to the naked eye here in Charlotte, (that “yellow stuff” that seems to be everywhere) this can be difficult. Pre-medicate with an over-the-counter antihistamine or nasal spray, use nasal saline to rinse out the nasal passages two or three times a day when allergy symptoms are most bothersome. Wash hands, hair, change clothes from those exposed to pollen quickly, and if necessary, wear a mask. If symptoms persist, consider desensitization immunotherapy (allergy shots or allergy drops/tablets) to allow you to be exposed to pollen without symptoms and minimizing medication exposure.
My 7-year-old is not sneezing but usually develops a cough at allergy time, no wheezing and lungs are clear. Should I start her on allergy meds now or wait for the cough to start? I have suffered with allergies but found that eliminating dairy and wheat during allergy time really helps too.
Dr. O'Connor: If your child coughs routinely every spring season, this could be post nasal drip, itching in the throat or a first sign of asthma. I would suggest starting allergy meds and if the cough does not respond, see your pediatrician or allergist to be sure it is allergies and not the first sign of asthma or an infection. If the cough has responded in the past to allergy meds, you may be able to control this on your own.
Are allergy shots painful?
Dr. O'Connor: Allergy shots can cause mild discomfort but they are not very painful. In fact, children often get used to them quickly. The needle used is very small. After a few shots, most kids become "champs" especially as their allergy and asthma symptoms improve!
How do allergy shots work and how often must they be administered?
Dr. O'Connor: Allergy injections work by causing changes in your immunologic system. These changes occur gradually over a period of many months. Injections begin weekly and then progress to bi-weekly and, finally, monthly injection intervals. Injections begin with extremely dilute doses and then progress in a stepwise fashion until a concentrated therapeutic dose is achieved. Low-doses are initially necessary since very strong doses could provoke an allergic reaction to the treatment itself. Improvement in fewer than six months should not be expected. The FDA has approved three sublingual (under the tongue) tablets to be used daily for immunotherapy as well. These are a good option for grass- and weed-allergic children. Although not FDA approved yet, sublingual daily allergy drops are another safe and effective way to desensitize children to most allergens. These are currently under review by the FDA and are offered by cutting-edge board certified allergists and some ENTS as well.
Is there any truth to probiotics being helpful to people with seasonal allergies?
Dr. O'Connor: Researchers from Vanderbilt University Medical Center examined 23 studies involving a total of 1,919 people with allergies The researchers say 17 of the studies showed that people with seasonal allergies seasonal allergies who took probiotics had some improvement in at least one aspect — such as milder symptoms or better quality of life — compared to people who had allergies but were given a “fake” probiotics. Researchers can’t yet recommend probiotics to treat seasonal allergies because the studies used different probiotic strains and different study groups. More research is needed. There are many studies currently examining gut health, the microbiome and the increase in allergies. PREbiotics and PRObiotics show promise but need stronger data for a firm recommendation from the FDA. I often suggest them with success for allergy patients suffering from gut issues, food sensitivities or chronic GI complaints.
Any suggestions to combat itchy, watery, sometimes swollen eyes, due to pollen?
Dr. O'Connor: Relief Itchy water eyes can be particularly troublesome especially for children. A natural remedy is washing the face (and hands since pollen can be trapped between fingers and under nails and kids love to scratch their eyes!) and rinsing the eyes. There are also many eye drops that contain antihistamines and are safe for children. Kids typically don't like getting eye drops but my trick is to do this after the fall asleep — not as hard as it sounds — and also putting them in Mommy's eyes first to show them that they aren’t so bad. After a few times, kids usually adapt especially when the symptoms go away — they often ask for the “magic drops!”
What's the best remedy for itchy eyes for contact wearers?
Dr. O'Connor: Put eye drops in 30 minutes prior to putting contact lenses in or put the eye drops in at night before bed when your contacts are not in.
What are some natural remedies for pollen allergies, that don't involve taking any kind of medicine?
Dr. O'Connor: Natural remedies include avoidance of known triggers- sometimes easy but not always. Also slain irrigation of the nasal passages to clear away secretions as well as allergens in the nose that can become lodges. I also recommend natural supplements with antihistamines properties such as quercetin and stinging nettles. Lowering stress can be very helpful as can maintaining a healthy organic diet rich in fruits and vegetables. Air filters can also help minimize allergens in the air.
On the same topic, we wondered about acupuncture as a holistic approach.
Dr. O'Connor: The best evidence comes from a single study published in 2013. Three groups of pollen allergic patients were divided into three groups: one received 12 acupunctures, plus antihistamines, one group received sham acupuncture (meaning that the needles were placed randomly rather than at appropriate acupuncture points) plus antihistamines, and the other were allowed only antihistamines. Seventy-one percent of the patients who received real acupuncture reported improvement in their symptom. Fifty-six percent of the patients in the "sham" acupuncture group also reported improvement — possibly a strong placebo effect is at work. It is my opinion that acupuncture is an excellent and safe treatment option for seasonal allergies but more research is needed.
My friend swears by her Neti Pot this time of year. Does that really help "wash" the pollen out of your nose?
Charlotte Parent Magazine: Oooh, yes. Can't forget about the spring tradition of breaking out the Neti Pot!
Dr. O'Connor: Keep some nasal saline around to rinse out your child’s nasal passages two or three times a day when allergy symptoms are more active. Many people have discovered that sinus drainage and congestion is greatly reduced by once or twice daily nasal rinses with saline. Use distilled or sterile water. Wash and dry your hands before using a nasal-rinsing device, and check that it is clean and completely dry. Follow the manufacturer’s directions for use. Wash the device with distilled or sterile water then let it air dry. Nasal-rinsing devices can be used on children as young as age 2, however they might not tolerate the procedure well. Practice makes perfect!
How do you know when it’s time to move from over-the-counter antihistamines and get a prescription?
Dr. O'Connor: For most children, avoiding the allergen and using over-the-counter medications can control symptoms. I tell parents to try one or two over-the-counter meds such as an antihistamine or nasal spray for a week or two. If still suffering, it is wise to see your allergist to assess your child’s symptoms There are other types of medications such as antihistamine nasal sprays and leukotriene modifiers that can be prescribed to help bring your child relief. Allergy shots, may be recommended for children who don’t respond well to treatment with medications, experience side effects from medications, have allergen exposure that is unavoidable or desire a more permanent solution to their allergy problem.
Is honey helpful for combating allergies? If so, does it matter if it's local honey or will generic honey from the grocery store work just as well?
Dr. O'Connor: There is a widespread belief that eating local, unprocessed or "raw" honey can help allergy symptoms by regularly exposing you to pollen - not unlike the concept of how allergy shots work. Allergy injections help desensitize pollen-allergic people by exposing them to a specific pollen at regular intervals. An important difference here is that the pollen amounts in allergy injections are known. The amount of allergenic pollen in the honey is typically very small. There is no scientific proof that eating local honey will improve seasonal allergies and in extremely sensitive individuals, the ingestion of unprocessed honey can result in an immediate allergic reaction involving the mouth, throat, or skin or even anaphylaxis.
If we have pets that spend time outside, can they carry allergens into the house? Would it help at all to wipe them off when they come inside?
Dr. O'Connor: If your furry family members enjoy being outdoors, be sure to brush them off, wipe them off or even rinse them off to prevent pollen from being tracked in by them. This will minimize pollen from entering your home and keep kids from having an increase in allergy symptoms from outdoor allergens while indoors. Pet stores even carry a special glove to use to wipe down pets to minimize pollen and even dander.
What could happen if allergies go untreated? Is there a real danger there?
Dr. O'Connor: Seasonal allergies are rarely serious or life threatening, but studies have shown that untreated allergies can make kids miserable. Yes, miserable. I can assure you I do not want my 4-1/2-year-old to ever feel miserable. So, for quality of life, yes you should treat your child’s sinuses and allergies. What can occur? Chronic sleep troubles and fatigue. Sinus congestion, sneezing and nasal itching and twitching can disrupt sleep which can turn into chronic insomnia over time. Poor focus: It's hard to concentrate on school work when you're constantly blowing your nose and feeling unwell. Ongoing symptoms and a lack of sleep may also trigger irritability and mood disorders, such as anxiety and depression. Uncontrolled allergy symptoms could open the door to more serious inflammatory problems down the road, such as eczema, sinusitis or even asthma.
What’s the best way to treat my 2-year-old? So many over the counter medicines are not age-appropriate for him and he hates the saline nasal spray.
Dr. O'Connor: This is such a common problem. The best and easiest thing to do is avoid known allergy triggers. We know, however, that it is nearly impossible to avoid pollen. Speak to your pediatrician and/or allergist about weight-appropriate dosing of oral antihistamines — they are safe if dose is correct. I do not suggest topical or oral decongestants in this age group. Many of my patients’ parents have learned the art of using nasal spray while toddler is napping or distracted with another activity.