Allergic Rhinitis: Weathering the Perfect Storm

James Thompson, MD Health Pro September 04, 2012
  • Seasonal allergic nasal problems have soared this year as a result of high temperatures in late winter and early spring. Tree pollen exploded into the air in February, at a time when most people in the Midwest are concerned about restocking their driveway salt. The warm February transitioned into a hot March and subsequently long and drawn out tree and grass pollen season. Mold spores have had all spring and summer to build up momentum despite the lack of rain in many areas of the country. The damaged crops, fallen trees (from disease, draught and fire) have enhanced the mold generation, primed to peak as fall season rolls in. In my area of the country (Chicago) poor air quality has contributed to the plight of my patients because of the multitude of sunny and hot days combined with fossil fuel emissions and ground level ozone which is typically problematic during summer months.

     

    Ragweed season jumped on the bandwagon two weeks ago and hasn’t let up. As the mold counts expectantly continue to rise, allergy symptoms will again skyrocket and boost the number of sick days around the region.

     

    Many allergy medications are available without prescription which I have found to be a double edged sword. On the one hand, people with allergy nasal problems can walk into any pharmacy and purchase a long-acting, non-drowsy antihistamine (Claritin, Zyrtec or Allegra for example) and allergy eye drops without the added delay and expense of seeing a doctor. This works well for people with mild seasonal allergic rhinitis. On the other hand, people with more moderate to severe seasonal rhinitis or perennial rhinitis (symptoms year round) often require more than what an oral antihistamine and/or eye drop can provide. The small number of pills or drops available over the counter usually lasts for one to two weeks but allergy seasons are often 2-4 months in duration. This disconnect in availability versus need can lead to gaps in treatment and subsequent failure of allergy management.

     

    What Can You Do?

     

    Discuss unmet needs with your doctor and pharmacist. Did you know that a prescription from your doctor requesting a month supply of allergy medication may allow you to get multiple packets or bottles of medicine at one time? The increased number of pills or syrup may come with a discount (but not always).

     

    If daily antihistamines don’t adequately reduce your nasal symptoms you may need a prescription nasal spray. Nasal steroids have been most effective in controlling the symptoms of rhinitis over the past several years. These include: Flonase, Nasacort AQ, Nasonex, Rhinocort AQ and others. Generic forms of Flonase and Nasacort AQ are available which may reduce medication expenses. I’ve found most people have poor orientation on how to use these nasal sprays. For this reason many don’t get the desired benefit from them. Ask your doctor to take you through a step by step tutorial on how and when to use your nasal spray.

     

    Two new aerosol based nasal steroids have emerged and may be ordered by your health provider. QNASL became available earlier this year. Kathi MacNaughton  gave an incisive report on QNASL months ago. ZETONNA was recently released by Sunovion Pharmaceuticals in recent weeks. QNASL and Zetonna are the first available (in the U.S.), aerosol nasal sprays since the ban on CFC (chlorofluorocarbon- propellant) containing inhalers and nasal sprays.

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     People annoyed by the several minutes of drainage down the back of the throat, associated with taking the water based nasal sprays (practically all prescription allergy nasal spray available prior to these are water based) may appreciate the new dryer aerosols. One drawback is the force of the spray as it jets up the nasal passage, which may already be sensitive due to inflammation. The most reported side effects of both nasal sprays are: nasal discomfort, headache and nose bleeding. They are indicated for seasonal and year round nasal allergy symptoms in adults and children who are 12 years or older.

     

     

    Anyone who is missing nights of sleep, missing work or school or suffering from rhinitis complications which include recurring sinus infections, ear infections, cough or poor asthma control should see an allergy specialist. It is important to identify whether allergy triggers are part of the problem, how to avoid them, as well as how to avoid irritant triggers. It is essential to be advised in how to best utilize medication. When this approach fails other alternatives, for example allergy shots, or procedures done by an ENT specialist may be of help.

     

     

    This has been a particularly bad year for a lot of people. Are you one of them?

     

    What adjustment has been most helpful for you?