FAMILY MEDICINE® COLUMN

By John C. Wolf, D.O.Associate Professor of Family Medicine Ohio University College of Osteopathic Medicine

'TIS THE SEASON TO BE SNEEZIN'

Question: I have trouble with allergies at this time of year. I think I'm allergic to ragweed. I get fair relief from allergy medicines from the drug store, but they make me sleepy. Would allergy shots be a good choice for me?

Answer: Allergies are a very common problem. Between 15 and 20 percent of the population suffers from them. The typical symptoms are some combination of nasal congestion, itching eyes and nose, sneezing and a runny nose. These usually begin as soon as 30 minutes after exposure to the offending allergen, and the overall allergic response may persist for several days. Of course, repeated exposure to the irritating substance just perpetuates the condition.

Ragweed is a common plant that grows well in most parts of the U.S. and southern Canada. It is in the family Asteraceas that contains several members, the most common of which are common ragweed and giant ragweed. All Asteraceas, unfortunately, are prolific producers or pollen. The pollen is not only abundant, but it is also very small and light so that it is easily blown about by the wind. Pollen production doesn't begin until the plant is mature and the amount of daylight drops to 14.5 hours or less. In most northern latitudes this occurs in August or September. So you are probably correct in assuming that your fall seasonal allergies are due to it. Sensitive individuals have allergic reactions when they come in contact with an irritating substance that is called an allergen - in this case, ragweed pollen. This "allergic response" is actually the result of an inappropriate immune system reaction to an otherwise harmless substance. Inhaling the offending allergen -- typically pollen, mold, animal dander or insect remains -- triggers the allergic response. In addition to the usual nasal congestion and itchy eyes, exposure to an allergen can trigger asthma, headaches or produce a rash.

The best treatment for allergies is avoidance of the offending substance. Unfortunately, this is often an impractical solution for ragweed allergy sufferers. There are some things you can do to help reduce the amount of pollen you are exposed to, however. The release of pollen is greatest first thing in the morning, so staying inside until 10 in the morning helps. (Nice try, but no, you still must go to work or school!) Air-conditioning and or a HEPA air filter is a good idea as is wearing a particle mask when cutting grass, gardening or doing other outdoor activities. It is also a good idea to reduce the amount of pollen on you after working outside by bathing and changing clothes as soon as you come inside.

Antihistamines, both the prescription and non-prescription types, are good choices for controlling allergic symptoms, and they are usually the first type of medicine to try. The non-prescription antihistamines are effective, but they also cause drowsiness for many users - like you. Fortunately, there are a number of additional treatment options for allergies.

Nasalcrom is a non-prescription allergy nose spray that can be added if antihistamines alone fail to give relief. The next escalation of the attack against allergies is the use of a prescription nose spray medicine that contains a topical steroid.

When the previous combination of treatments has been unsuccessful, or when there is accompanying asthma, allergy shots should be considered. First, allergy testing is necessary to determine the ingredients in your specific desensitization shots. Then, allergy shots are given on a regular schedule. The drawback to "allergy shots" is that they are expensive, time consuming, take weeks to months to work, and don't always give good relief. Your doctor will help you choose the best treatment(s) for you.

"Family Medicine" is a weekly column.

To submit questions, write to: John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.

Past columns are available online at http://www.FamilyMedicineNews.org.