Update: What You Need to Know About 2021 Spring Allergies

 Update: What You Need to Know About 2021 Spring Allergies

A practice guideline points to new recommendations for managing hay fever

Allergic rhinitis, more commonly called “hay fever,” has been around for hundreds of years, and the misery it causes has been around just as long. Occasionally, there is new information to be passed along regarding how to manage the symptoms that come with hay fever -- namely sneezing, itchy nose, runny nose, and congestion.

Recently, the American College of Allergy, Asthma and Immunology (ACAAI) took part in publishing a practice guideline for allergists and other healthcare workers about the latest developments in understanding allergic rhinitis.  

The guideline highlights the fact that cough is a common symptom of hay fever.  Many people aren’t aware of that, and especially as we face another spring with COVID-19, people should be aware that a cough isn’t necessarily a COVID-19 symptom – it can just be part of allergies. 

Four additional recommendations highlighted in the guidelines included: 

  1. Avoid first-generation antihistamines – If you plan to take an oral medication to treat your hay fever, think twice before using first generation antihistamines such as diphenhydramine (Benadryl®)and chlorpheniramine (ChlorTrimeton®). They can cause drowsiness and symptoms like dry mouth, dry eyes, and constipation and are considered driving under the influence in a majority of United States. Look for non-sedating treatments such as cetirizine, levocetirizine, fexofenadine, loratadine or desloratadine instead. Dry eyes are especially an issue if you use a computer for several hours a day.
  2. Intranasal Lavage and Intranasal corticosteroids are an effective treatment – Intranasal lavage with nonsteroidal agents that may include nasal saline or the use of intranasal solutions containing essential oils such menthol and eucalyptus (e.g. Sinusol® Breathe Easy  www.drbrx.com). Intranasal corticosteroids (fluticasone, mometasone, budesonide, triamcinolone) are the most effective treatment if you suffer from persistent allergy symptoms, especially if they are interfering with your quality of life. Treatment of the intranasal allergic inflammation may even help control the symptoms that accompany eye allergies. 
  3. Pseudoephedrine is effective but has side effects – Many people use the oral decongestant pseudoephedrine to clear up a stuffy nose. Unfortunately, pseudoephedrine is the main ingredient in methamphetamine – commonly called “meth.” It is only available by prescription or by specially requesting it from a pharmacist, depending on what state you are in. Pseudoephedrine has many side effects including insomnia, loss of appetite, irritability, and heart palpitations. It should also not be taken if you are pregnant. The chronic use of intranasal decongestants may cause a chronic rhinitis syndrome known as “rhinitis medicamentosa”. This is not see with the use of essential oil based intranasal treatments such as Sinusol® Breathe Easy (noted above).
  4. No verdict on alternative treatments like acupuncture – In developing the guideline, the allergists did an extensive review of medical studies that examined the effectiveness and safety of alternative treatments such as acupuncture and herbal medications. Because there is a lack of adequate studies on acupuncture, they concluded that they could not currently recommend for or against the use of these treatments for hay fever, but the use of various herbal formulations and intranasal essential oil solutions have been suggested to provide relief for various allergy symptoms . 
  5. Food allergy testing should not be a part of testing nasal allergies – When patients get tested for allergic rhinitis (nasal allergies,) they often also get tested for food allergies. The guideline strongly emphasizes that food allergy testing should not be performed in the routine evaluation of allergic rhinitis because food allergies do not cause nasal symptoms. Occasionally patients have food-pollen cross reactivity.  Testing for hay fever should include sensitivity to pets, dust mites, trees, grasses, weeds, and mold as they are the most likely triggers for nasal allergies.