Monday, July 22, 2024

It's allergy season


Yesterday morning I woke up feeling under the weather. Stuffy nose? Check. Runny nose? Check. Sinus pressure? Check. Sneezing? Check. Is it a cold? That's not likely, since I have allergies to some of the plants blooming right now.

Airborne pollens can stick to the inside of your nose and throat, triggering an allergic reaction. This used to be called “hay fever” because doctors associated it with plant pollens like hay. Another name for it is allergic rhinitis, which is inflammation of the nose from an allergy.

Allergic rhinitis can be either seasonal or perennial (year-round). Seasonal allergic rhinitis is usually triggered by plant-based pollens, usually identified by the time of year your symptoms flare. Year-round allergic symptoms are often from molds or pet dander.

Grasses and trees like birch, oak, elm, and maple release their pollens in the spring and early summer, while weeds like ragweed produce their pollen in mid to late summer into early fall. I’m not alone in my allergy to ragweed. Ragweed is one of the most common seasonal allergies. Related to marigolds, chrysanthemums, and daisies, ragweed creates fine powdery pollen that can be carried for hundreds of miles on the wind.

I treat my allergy by the symptoms which are most bothering me. Sometimes, only my eyes are affected, becoming itchy and watery. My nose is the most severely affected. Allergies cause it to run constantly, called rhinorrhea, and be congested. This year, I’m experiencing sneezing, nasal congestion, and rhinorrhea.

Allergic rhinitis is triggered by a chemical called histamine. Your body stores histamine in special cells called mast cells. When your body recognizes a particular pollen or pet dander as something you are allergic to, the mast cells in your nose open up and release histamine, creating the misery of an allergic reaction. 

Medicines called mast cell stabilizers can BLOCK this chain reaction by keeping histamine safely locked inside your mast cells. If my eyes are itchy and watery, my favorite remedy is prescription-strength over-the-counter (OTC) ketotifen eye drops.

Ketotifen works not only as a mast cell stabilizer but also as an antihistamine, allowing it to prevent and relieve allergic reactions. Once sold as the prescription drug Zatidor®, ketotifen is available both as generic and Alaway® eye drops.

Steroid nose sprays decrease inflammation and are the most effective way to treat allergic symptoms affecting your nose, like sneezing, sniffling, and stuffiness. There are several products available without a prescription, like Nasacort® and Flonase®.

Oral antihistamines can be used with or without eye drops and steroid nasal spray to relieve allergic rhinitis symptoms. Diphenhydramine (Benadryl®) is one of the most effective antihistamines available OTC (over the counter). It has to be taken every 6 hours and causes drowsiness in most people. If you need a medicine that won’t cause drowsiness, try loratadine (Claritin®) or cetirizine (Zyrtec®), which lasts all day.

Because my nose can be both running and congested simultaneously, I prefer an older combination of antihistamine and decongestant called Actifed®. Actifed® contains triprolidine plus pseudoephedrine (the original formulation of Sudafed®) and has been available as a generic. Triprolidine dries up my watery eyes and runny nose without causing drowsiness, and pseudoephedrine eases my stuffy nose. 

5 Tips on Taking Allergy Medicine:

1.           Try an OTC steroid nose spray first.

Nasacort Allergy 24-Hr® (triamcinolone), Flonase Allergy Relief® (fluticasone), and Rhinocort® (budesonide) help relieve runny nose, stuffy nose, and sneezing. Be patient because it may take several days to get complete relief. Until then, try taking an oral antihistamine along with the nasal spray.

2.           Ketotifen or olopatadine eye drops relieve itchy or watery eyes.

Ketotifen (Alaway®, Zatidor®) and olopatadine (Pataday®) work as antihistamines and mast cell stabilizers. They are available without a prescription and can be used safely in children as young as 2 or 3.

3.           If you have a runny nose, avoid oral decongestants.

A decongestant relieves a stuffy nose but often makes a runny nose worse. Instead, use an antihistamine, combination antihistamine/decongestant purchased from the pharmacy counter, or steroid nasal spray.

4.           Don’t waste your money on phenylephrine.

Phenylephrine has only 1/3 the effectiveness of pseudoephedrine. That’s due to having severe side effects, like stroke at an equivalent dose. Pseudoephedrine is only available from the pharmacy counter.

5.           Use decongestant nose spray sparingly.

Avoid using any decongestant nasal sprays like Afrin® for more than 2-3 days at a time to avoid triggering rebound (worsening of your stuffy nose) symptoms.

Dr. Louise Achey, Doctor of Pharmacy, is a 43-year veteran of pharmacology and author of Why Dogs Can’t Eat Chocolate: How Medicines Work and How YOU Can Take Them Safely. Get clear answers to your medication questions at her website and blog,

Ó2023 Louise Achey


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