Every year millions of Americans, both children and adults, develop cold-like symptoms during the spring and fall. Many of these individuals think that these symptoms are secondary to a “head cold,” but in reality, they are caused by allergies.
Allergies have plagued man throughout recorded history. Archeologists have unearthed a report of an Egyptian Pharaoh who died from an allergic reaction after being bitten by an insect in ancient Egypt. In medieval Spain, the philosopher/physician Maimonides wrote the first papers on the treatment of asthma. But it wasn’t until the early part of the 20th century that physicians realized that many individuals develop symptoms including head and chest congestion after exposure to pollens, animal dander, dust, and molds. These individuals were classified as being allergic.
Allergic Rhinitis is known by many other terms including Pollinosis, Hay Fever, and Rose Fever. Approximately 40 million Americans experience allergic disease with a large number of them being children. Allergies unlike many other illnesses tend to be most severe in late childhood and early adult life — times when individuals are expected to be the most productive. Because of this, the economic costs of allergies are quite high, exceeding five billion dollars each year.
Rhinitis is the inflammation of the nasal membranes. Individuals who have inflammation caused by allergies are diagnosed as having Allergic Rhinitis. Individuals with seasonal allergic rhinitis experience symptoms when the outdoor pollens are most elevated — usually during spring and fall. Others will have their symptoms year around and are known as having Perennial Allergic Rhinitis. Seasonal allergens include trees, weeds, and grasses. Perennial allergies include animal dander, molds, and dust.
Symptoms of Allergic Rhinitis include nasal irritation and itching, rhinorrhea or nasal discharge, nasal congestion, and post nasal drip. Other symptoms seen with allergic rhinitis includes sinusitis, headaches, eye irritation, and pharyngitis as well as asthma.
Environmental control in which the patient attempts to avoid exposure to those allergens which lead to a flare-up of symptoms is of paramount importance. Such measures include avoiding yard work and even staying indoors when the outdoor pollens are high. Indoors, a thorough house cleaning may be of benefit. Other preventative measures include the removal of old pillows which may be dust collectors, replacing the air-conditioning filter, and the purchase of an air-filtration device. If the individual with allergies is allergic to animal dander, the removal of the family pet from the family sleeping quarters may also be beneficial.
Patients with severe allergies will not have their symptoms adequately controlled by these measures. These individuals may benefit from the use of medications. The drugs of choice for the treatment of allergic rhinitis are antihistamines. In the past, antihistamines would cause undesirable side effects such as sedation. The newest classes of antihistamines such as loratadine, desloratadine, fexofenadine, and certirizine are quite effective for the control of allergies, yet cause minimal if any negative side effects.
Nasal steroids may be the most effective medications for the treatment of the patient with allergic nasal symptoms. New preparations on the market include mometasone, fluticasone, budesonide, and triamcinolone.
Other medications which may be helpful include nasal cromonlyn, nasal decongestants, and topical eye drops for the individual with allergic eye disease.
Unfortunately, many people with allergic disease will require more aggressive therapy than environmental control measures and medications. These patients may benefit from immunotherapy or allergy injections. Immunotherapy is the administration in small doses of those allergens to which the patient is sensitive. By administration of such allergens, the person will then build up a tolerance resulting in a reduction of symptoms.
The Allergist can perform a series of tests including skin test and RAST analysis which will enable the physician to determine to which allergens the patient is sensitive. The Allergist can then prescribe those medications which will best control the patients’ symptoms and set up a treatment plan which will include environmental control measures. If allergy injections are indicated, the Allergist’s office is skilled in the preparation and administration of immunotherapy.
Allergies, especially allergic rhinitis, can result in a significant amount of misery and loss of school and work time. But with proper recognition and treatment, people who suffer from allergies can have their symptoms brought under excellent control.
By Steven Rosenberg, M.D.
Steven Rosenberg, MD, FAAP, FAAAAI, has been practicing medicine in the Central Florida area for over 20 years, specializing in the area of Allergy, Asthma, and Immunology. He received the Doctor of Medicine from the State University of New York, Downstate Medical Center. Dr. Rosenberg completed a residency in Pediatrics at the State University of New York at Buffalo and a Fellowship in Allergy, Asthma, and Immunology at the University of Pittsburgh. Dr. Rosenberg has held positions as President of the Central Florida Pediatric Society, at the Florida Allergy, Asthma, and Immunology Society, and on the medical staff at Florida Hospital. In addition, Dr. Rosenberg has held the position of Chairman, Department of Pediatrics at Florida Hospital and is a member of many local and national societies which include the American Academy of Allergy & Immunology, the Florida Allergy and Immunology Society, Florida Hospital Kid’s Docs and the Central Florida Pediatric Society. He holds faculty appointments at the University of Central Florida Medical School and the Florida State University School of Medicine. For additional information please contact him at 407.678.4040 or firstname.lastname@example.org