Allergies: Give Me Flonase or Give Me Death

It's spring time! The flowers are blooming and the sun is shining. Have you stopped to smell the roses? Or are you too busy sneezing and chasing after your runny nose? Before you run your runny nose to the nearest urgent care, let me give you a quick Allergy 101 course.

Allergies are hypersensitive responses from your immune system to a substance that has either entered or come into close contact with your body.  

So what the hell does that mean? It means that your body has become overly sensitive to a particular allergen, like dust mites, dander, pollen, grass, mold, food or chemicals. Then, when your body encounters the dreaded allergen, it produces awful symptoms that make you miserable.

These symptoms include:

  • Sneezing
  • Runny nose
  • Stuffy nose
  • Sinus congestion
  • Itchy nose
  • Cough
  • Fatigue
  • Itchy ears
  • Itchy, watery eyes

In medicine, we call this whole collection of symptoms ALLERGIC RHINITIS, even if you only have 2 or 3 of them.  

And yes, these symptoms are very similar to cold symptoms. In fact, most of my patients come to see me because they THINK they have a cold. Because allergy symptoms can be so severe that it makes you feel like you have a cold or even a sinus infection. How do you know if you're sick or have allergies?  Generally, cold symptoms have fever, chills, and body aches, whereas, allergies symptoms have sneezing, itchy, watery eyes with a post nasal drip.  See chart above!


Treatment for Allergic rhinitis:

Allergy treatment depends on the severity of your symptoms

Mild symptoms:

In my practice, the first thing I would recommend for a patient with mild symptoms would be a steroid* nasal spray, like Flonase or Nasacort. They are the single most effective medications for allergy symptoms and usually offer fair relief within a few hours. The main side effect of steroid nasal sprays is dryness or burning in the nostrils or throat and maximum relief can take up to 3-4 days of use.

If you don't like squirting things in your nose or you can't tolerate the side effects of the steroid nasal spray, you can take a once daily over-the-counter antihistamine (ie:Claritin, Zyrtec or Allegra). The main side effect of these medications tends to be drowsiness. They do have non-drowsy formulas but these have pseudoephedrine in them, and shouldn't be taken by kids, elderly adults or people with high blood pressure. Sorry to sound like a disclaimer on the end of a tv commercial but it's super important to know!

All of these medicines also come in generic formulas which tend to be much cheaper and are just as effective. Also, if nasal congestion is your biggest complaint, the steroid nasal spray is the way to go.

Treatment Options for Allergic Rhinitis

* Not all nasal sprays are steroid sprays. There are saline nasal sprays, which are ok for almost anyone to use, including babies and pregnant and breastfeeding women. If you use it to rinse out the yucky, crusty snot in your nostrils before using steroid nasal spray, it will help the steroid nasal spray work even better! There are also decongestant nasal sprays, like Afrin. This type of spray can only be used short term, no more than 3 days, and can make symptoms worse after you stop taking it. It's best to just stay away from it.

Moderate symptoms:

Use a steroid nasal spray AND a daily over the counter antihistamine together. It's a great combination and takes care of most allergy symptoms.

Severe symptoms:

If your allergy symptoms are still out of control, despite using a steroid nasal spray and a daily antihistamine, you may need to see your provider.  She may prescribe you a combination of nasal sprays, oral medications and allergy eye drops. The most severe allergy cases often require a referral to an Allergist for skin testing and/or monthly allergy injections.


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