Don’t let allergy season catch you off guard

The woman next to me in the checkout line looked upset. Her eyes were red and her nose was running. My first thought was to give her privacy, until I saw her shopping basket filled with supplies to fight allergy symptoms, and then our eyes met. “I can’t believe how bad my allergies are this year!” she said, exasperated.

My fellow shopper isn’t the only one suffering. “Warm weather and a mild winter, as we’ve experienced this year, can stimulate trees to pollinate. The southern U.S., which has a warmer climate, is particularly susceptible to earlier allergy seasons. Other climate factors — such as cool evenings, wind, and rainfall — can also lead to surges in pollen counts, which can exacerbate the impact of the early allergy season,” says Dr. Ahmad Sedaghat, an ear, nose, and throat specialist at Harvard-affiliated Massachusetts Eye and Ear Infirmary.

Treatment challenges

Waiting until allergens are in the air is a losing strategy in the allergy war. Once spring pollens — typically from oak, elm, birch, poplar, or maple trees — float through the air and reach your nose, the body can overreact. Mast cells in the lining of the nose may mistake the harmless tree particles for dangerous invaders, and summon help by releasing chemicals such as histamine and tryptase, which then recruit more immune system cells to the battle. Those chemicals also trigger watery eyes, a runny nose, sneezing, coughing, and a sore throat.

A better defense

It’s best to turn off your body’s defenses well in advance of the pollen party. This is because some drugs, such as corticosteroid nasal sprays, take a few weeks to become fully effective. It’s also because the reaction to even a few allergens has a snowball effect. “Once it starts, it’s hard to stop,” Dr. Sedaghat explains. “More inflammatory cells are recruited to the nose and sinuses, symptoms become more severe, and it’s difficult to treat them.”

Blocking the reaction before it begins prevents symptoms or lessens their severity, and keeps irritation from progressing to sinusitis or an asthma flare-up.

Choose your weapons

Only certain allergy medications should be used in advance, such as:

  • a corticosteroid nasal spray, such as mometasone furoate (Nasonex) or fluticasone propionate (Flonase). Many of these sprays are now available over the counter (OTC). Use the spray every day while allergy season lasts, starting a month in advance of when you expect to get allergy symptoms.
  • an OTC oral antihistamine, which counteracts the effects of histamine. Some antihistamines, such as diphenhydramine (Benadryl), can cause drowsiness, leading to falls. Fexofenadine (Allegra) or loratadine (Claritin) are less likely to cause drowsiness.
  • prescription antihistamine sprays, such as azelastine (Astelin) and olopatadine (Patanase), may help prevent the symptoms of sneezing and a runny nose while minimizing side effects like drowsiness.
  • antihistamine eye drops, such as ketotifen (Zaditor), available over the counter, and olopatadine (Patanol), available by prescription, can be used to prevent watery eyes.

Other medications

Decongestant pills, such as pseudoephedrine (Sudafed), help reduce nasal congestion, but they can cause problems for people with high blood pressure or heart problems and should not be used to manage allergies. Decongestant sprays such as oxymetazoline (Afrin) should not be used for more than a few days, since long-term use can make congestion worse.

Another option is allergy shots to help reduce allergic symptoms, but that approach can take three to five years to be fully effective.

What you should do

Work with your doctor to develop a pretreatment strategy, including how far in advance you should use medications.

And what if you, like my shopping buddy, were caught off guard with this early allergy season? Dr. Sedaghat recommends medical strategies, such as:

  • irrigating the nose with salt water (saline)
  • using antihistamines and intranasal steroid sprays, both of which are now available over the counter, under the guidance of a physician.

Dr. Sedaghat also suggests environmental strategies to reduce pollen exposure, such as:

  • keeping windows closed
  • using an air cleaner with a HEPA filter
  • changing clothes immediately upon getting home
  • frequently washing clothes in hot water
  • wearing a mask for outdoor yard work
  • avoiding going outside when pollen levels are highest.

And by all means, prepare for next year’s allergy season before it strikes, especially if a mild winter precedes it.

Bible verses for today’s meditation and inspiration: Matthew E. McLaren

Mark 1:1-45 The beginning of the gospel of Jesus Christ, the Son of God. As it is written in Isaiah the prophet, “Behold, I send my messenger before your face, who will prepare your way, the voice of one crying in the wilderness: ‘Prepare the way of the Lord, make his paths straight,’” John appeared, baptizing in the wilderness and proclaiming a baptism of repentance for the forgiveness of sins. And all the country of Judea and all Jerusalem were going out to him and were being baptized by him in the river Jordan, confessing their sins. …

Psalm 103:1 Bless the LORD, O my soul, and all that is within me, bless his holy name!

Psalm 119:1-176 Blessed are those whose way is blameless, who walk in the law of the LORD! Blessed are those who keep his testimonies, who seek him with their whole heart, who also do no wrong, but walk in his ways! You have commanded your precepts to be kept diligently. Oh that my ways may be steadfast in keeping your statutes! …

Psalm 4:6-7 There are many who say, “Who will show us some good? Lift up the light of your face upon us, O LORD!” You have put more joy in my heart than they have when their grain and wine abound.

1 Corinthians 6:19-20 Or do you not know that your body is a temple of the Holy Spirit within you, whom you have from God? You are not your own, for you were bought with a price. So glorify God in your body.

John 3:16-17 “For God so loved the world, that he gave his only Son, that whoever believes in him should not perish but have eternal life. For God did not send his Son into the world to condemn the world, but in order that the world might be saved through him.

Proverbs 8:1-36 Does not wisdom call? Does not understanding raise her voice? On the heights beside the way, at the crossroads she takes her stand; beside the gates in front of the town, at the entrance of the portals she cries aloud: “To you, O men, I call, and my cry is to the children of man. O simple ones, learn prudence; O fools, learn sense. …

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