Allergies Affect You More Than You Realize

By Rebecca G. Piltch, MD

It's spring in the Bay Area and that means high pollen counts and allergies. At the same time, the economic situation is tenuous and everyone is trying to budget wisely. While allergies may not seem as dramatic as some other medical conditions, the impact on quality of life and career can be significant. Knowing the consequences of untreated allergies and the options for reclaiming wellbeing while living with allergies can help a great deal.

This article combines information from a talk Dr. Don Buckstein recently gave at the Allergy, Asthma and Immunology Foundation of Northern California's Annual Educational Symposium with my thoughts and experiences as a locally practicing allergist/immunologist. (Dr. Buckstein is the Director of Allergy and Asthma Research at Dean Medical Center in Madison, Wisconsin and a nationally known figure in the field of Allergy & Immunology.)

Allergic rhinitis is one of the most common chronic medical conditions in the United States today. It is responsible for 10 million doctor's office visits, 800,000 missed workdays and 2,000,000 missed school days. In one study, allergic rhinitis was responsible for more lost and unproductive time than migraine, depression, arthritis, diabetes or high blood pressure. In another, bank employees' productivity dropped as ragweed pollen counts rose. Direct and indirect costs are estimated in the billions of dollars.

Another survey found that over half of people with allergic rhinitis sometimes or frequently feel irritable, tired or miserable. Embarrassment (>20%) and feeling depressed or blue (>30%) during allergy season are also fairly common.

Children may have trouble doing well in school. Measures of learning are lower when children have allergy symptoms. Moreover, allergic rhinitis has been linked to lower test scores during allergy season.

Inadequately treated allergic rhinitis can lead to sinus headaches, ear infections, sinus infections, worsening asthma, fluid in the ears (which in turn can cause decreased hearing), poor quality sleep, fatigue and even migraines.

For some people with allergies, over-the-counter medications are enough to control symptoms and improve quality of life. However, this is not the case for many others. Over the counter medications can help with some symptoms, but not others. Also, many over-the-counter medications contain sedating antihistamines; these have been linked not only to poor work performance, but impaired driving. Decongestants are not recommended for young children and can have significant side effects for people of all ages.

The good news is that there are a number of ways to manage allergic rhinitis effectively. From a specialist's point of view there are a few guiding principles to managing allergic rhinitis:

• Identify what is causing the allergy (allergens) and minimize exposure. Allergy skin testing can help identify the allergens responsible. Modifying lifestyle and one's environment can be very effective approaches.
• Control symptoms with medications. Which medications are best and how long they should be taken differs from person to person. Different kinds of medications address different symptoms. Some people experience relief with complementary or alternative therapies as well. (Note: remember to discuss the risks, benefits and expected effects of any therapy you are considering—alternative or conventional—with your health care provider.)
• Consider changing the way the immune system reacts with immunotherapy ("allergy shots"). Immunotherapy teaches the immune system to ignore the allergen. While not for everybody, immunotherapy is an effective treatment and may decrease the chance of developing new allergies or asthma.
• Knowledge is power. When I work with patients, we spend a lot of time talking about what is going on in the body and the options for maintaining or regaining wellness. When discussing the options, we discuss the pros and cons as well as what to expect.
• Have a plan. Sometimes referred to as the "Allergic Rhinitis Lifestyle Plan," these are individualized roadmaps for getting the allergies under control and keeping them under control. Such plans can include lifestyle, environmental modifications, medications, other strategies for controlling symptoms, complementary/alternative therapies and allergen immunotherapy. If medications are part of the plan, "step up" and "step down" the intensity or number of treatments with time and/or changing circumstances.
• Re-evaluate the plan and adjust or change it as needed. The time frame for this depends upon the individual circumstances.

Springtime in the Bay Area is a beautiful time of the year and the heart of pollen season. Both tree and grass pollens are in the air. With the right approach, most people with allergies and their families can enjoy the best of the season!

Resources:
Pollen counts can be found at www.aaaai.org. Pollen count predictions (analogous to a weather report) can be found at www.pollen.com.

Please remember that no article is a substitute for a physician's evaluation and care. Content is for informational purposes only and should not be used as a substitute for medical care or for diagnostic purposes.

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