Friday, October 14, 2011

Dealing with allergies

St. Luke’s Health Watch

By Dr. Julie Lyons

Ahhchew! It's that time of year again: allergy season. Each year during the spring and fall, our clinic sees a burst of patients suffering from typical allergy symptoms: itchy nose, eyes and throat, sneezing and wheezing, cough and fatigue. As a sufferer myself, I know just how burdensome allergies can be.

Allergies are common in the United States; up to 40 percent of children and 10-30 percent of adults suffer from them. In Blaine County, the common culprits are sagebrush, which blooms in the fall, ragweed, which blooms in the late summer and fall, and willow, which blooms in the spring. Some exotic and invasive grasses also cause our residents trouble. Indoor triggers include dust mites, animal dander and mold spores.

There are several known risk factors that predispose us to developing allergies. These include family history of allergies, male sex, early introduction of food and formula, birth during pollen season, early use of antibiotics, smoking exposure during the first year of life and firstborn status. Allergies are less common in children under 5, and become more common as children start to enter school. In early adulthood, we also see a rise in allergy prevalence.

The more you are exposed to an allergen, the more sensitive you become. Over time, less allergen is needed to cause significant symptoms, and the nose becomes more sensitive to all sorts of substances, including tobacco smoke, perfumes and chemicals. Allergies can significantly decrease a patient's quality of life. Children with allergies may have more fatigue, decreased test scores during allergy season, higher rates of attention-deficit disorder, poor concentration and lower self-esteem. In adults with allergies, work productivity is decreased and patients have higher rates of anxiety and depression.

So how can allergies be treated? The first step is to accurately diagnose the disease. Sometimes your primary care provider can do this based on history alone; do you sneeze every time you play in a sage field in the fall? Then maybe you have allergies. If the diagnosis is not clear, or a patient is not getting better with routine treatment, then skin testing may be helpful. Skin testing is the most convenient and least expensive screening method to detect allergic sensitization. Blood tests (traditionally called RAST testing) provide similar information as that obtained with allergen skin tests, though they are more expensive and less sensitive for the diagnosis of allergy to inhalant allergens.

Once a diagnosis is made, there are three main components of treatment. The first is to avoid allergens. For some of us, that may be difficult; maybe we don't want to give away the family dog or perhaps we work outside near sagebrush. The second part of treatment is pharmacotherapy (using drugs). The most effective single therapy is intranasal glucocorticoid sprays (like Flonase). Over-the-counter antihistamines can also help some patients with mild symptoms, but the older ones, like Benadryl, can cause significant sedation. Antihistamine nasal sprays are sometimes prescribed when other medications are ineffective. Steroid shots are no longer indicated for the routine treatment of allergies due to their potential for harmful side effects.

For the patient with severe allergies that does not respond to traditional treatments, immunotherapy is available. Gradual administration of increasing amounts of allergens over time helps to decrease immune response and alleviate allergic symptoms, but this takes one to two years of frequent shots to become effective.

Dr. Julie Lyons is board certified in family medicine. She is seeing patients at St. Luke's Clinic in Hailey.

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