Learning

May 11, 2011

Keep control of your allergy, asthma symptoms

My 19-year-old patient was bothered by allergies for years. Her eyes were usually red, swollen and puffy. Her throat was itchy. Because she was unable to breathe through her nose, she seemed to have a constant cold. As a child, her allergies kept her from rolling down grass hills with her friends. For a couple of weeks at a time, she would try a new medication without success.

At our first visit, I emphasized the need for a consistent regimen. She began using an oral antihistamine, a nasal spray and eye drops on a regular basis. One month later, she reported much less itching and good overall control of symptoms.

Allergies represent an unwarranted response by our immune system to generally harmless foreign substances called allergens. When people have allergies, their immune system releases chemicals such as histamines to fight off the allergens. Interestingly, it is the presence of these histamines rather than the allergens that produces most allergy symptoms.

In the Pacific Northwest, seasonal allergies peak in February-April for trees, May-September for grass, and May-October for weeds. Dust mites, mold and animal dander usually bother people throughout the year. If you are not sure what is causing your symptoms, allergy testing can be helpful. Testing is not needed if you know that you itch every time you are around cats or lie in the grass.

Allergy relief begins with reducing exposure to personal triggers. Make sure your house is clear of molds. Buy a bed cover and wash sheets regularly to protect against dust mites. Dont let pets sleep in your bed. Wash stuffed animals and keep them out of your childs bed.

The next step is to control symptoms with appropriate medicines.

• Oral antihistamines provide relief from itchy eyes, sneezing and a runny nose. I recommend that my patients start with Zyrtec, which is stronger than Claritin. For very severe symptoms, Benadryl can be taken at bedtime, but it causes too much drowsiness for regular use. All of these products are available over-the-counter.

• Prescription nasal steroid sprays (Flonase) provide relief from nasal congestion by preventing and decreasing inflammation in the nose. A trial of two weeks may be needed for symptom relief.

• Zaditor, an antihistamine eyedrop, is used to relieve itchy eyes. It is available over-the- counter.

In recent years, Neti pots have gained popularity as a drug-free alternative for relieving nasal congestion. They look like small teapots and are used to flush allergens by pouring water through each nostril. If you try them, use 16 oz. of lukewarm water mixed with 1 tsp. of salt and dont be surprised if it feels uncomfortable initially to have water in your nose.

Allergy shots target the immune system response. They are used to desensitize the body to a specific allergen by injecting it in small but increasing doses. For bee stings and other severe allergies, this type of immunotherapy can help prevent anaphylaxis, a whole-body response that can lead rapidly to difficulty breathing, shock and death.

Asthma and allergies are closely related. During an asthma attack, the muscles surrounding the airways become tight and the lining of the air passages swells. Shortness of breath, wheezing and coughs are primary symptoms. If you are exposed to an allergen that causes nasal congestion and itchy eyes, it can also trigger an asthma attack. Other common asthma triggers are respiratory infections and cold air. Tobacco smoking and second-hand smoke are major triggers that should be avoided to prevent attacks and further damage to the lungs.

Most patients take long-term prescription medicines to reduce the inflammation that leads to asthma attacks. In addition, all asthma patients should have a quick-relief bronchodilator such as albuterol. When taken at the start of an asthma attack, this medicine keeps symptoms from worsening by relaxing the tightened muscles around the airways.

Asthma control is measured by daytime and nighttime symptoms. If you need your rescue inhaler more than twice a week, wake up at night with trouble breathing, or are not able to pursue normal activities, it is time to visit your healthcare professional for additional guidance.

Kelsey Platt, A.R.N.P., is an advanced registered nurse practitioner at the UW Medicine Neighborhood Clinic in Factoria. To find a UW  Neighborhood Clinic near you,  call 800.852.8546 or visit www.uwmedicine.org/uwpn.