What are some of the Health complications from repeated hay fever attacks? Chronic sinusitis — inflammation of the sinus cavities — is one of these problems. Another is nasal polyps, or growths. In addition, a significant percentage of people with hay fever have or develop asthma.

How is it treated? As we mentioned above, the culprits for symptoms of allergic rhinitis are pollens and the body’s reaction to them. So the treatment of allergic rhinitis focuses on avoidance of pollens and lessoning of the body’s reactions to the pollens, i.e, decreasing the amount of histamine, leukotrienes, interleukins, and other cytokines.

The pollen count information you can get from the local weather broadcast or from the web can serve as a guide about what days should avoid outdoor activities and vice versa. Also, The pollen count is usually highest in the late morning and early afternoon and relatively low in the evening. So late afternoon may be the best time to exercise outdoor. The time of the year that one should be particularly vigilant depends on the types of the pollens he/she is sensitive to. In the Northeastern region, the tree pollens are usually highest from April to June, the grass pollens from mid-May to beginning of August, the weed pollens from mid-August to mid-October.

If that alone is not effective, then the first line drug treatment is steroid nasal spray. Topical intranasal steroid therapy is presently the most effective single therapy for allergic rhinitis and causes few side effects at the recommended doses. Topical nasal steroids are more effective than second generation antihistamines in treating allergic rhinitis. Corticosteroids are also more effective than antihistamines in reducing nasal blockage because of their anti-inflammatory effects.

How does it work? Glucocorticosteroids, by blocking the interaction between pollens and nasal mucosa after it is sprayed into the nostrils, inhibit allergic inflammation in the nose at many levels. In experimental nasal allergen challenge, they decrease the amount of histamine release by 75 percent and decrease the effects of a number of proinflammatory cytokines, such as leukotrienes and interleukins. In multiple clinical trials, nasal steroid performs consistently better than anti-histamine such as Claritin and anti-leukotriene such as Singular.

Some people may ask: steroid? Isn’t that medicine associated with a lot of side effects? The fact is the current second generation intranasal steroid is quite lipophilic (thus tend to stay unabsorbed) and quickly inactivated by the liver once it is being absorbed by the body. The frequently prescribed Flonase and Nasonex are being absorbed into the blood stream only 2% and < 0.1 percent of the amount being sprayed into the nose. This contrasts sharply with the first generation agents like Rhinocort (10 to 34 percent), and Nasolide(40 to 50 percent). Clinical trials showed that even with long-term use, second generation nasal steroid has no inhibitory effect on growth of children, on the adrenal glands, and nasal biopsies after five years of use have shown no evidence of mucosal atrophy.

Especially for people with very bad allergy, I recommend them to start nasal steroid about 2-4 weeks prior their usual onset of allergy. This will decrease the sensitivity of nasal mucosa to pollens and the amount of mast cells inside the mucosa. With persistent pretreatment prior to the onset of symptoms, allergic symptoms decrease year by year. This is clearly working for one of my patients. He had worsening symptoms every years to the extend of complete blockage of nasal passage despite the use of three different types of anti-histamine. Once he adopted the method of pretreatment, his symptoms improved dramatically. Last year, he proclaimed to me proudly: “Dr. Liu, this year I had no symptoms at all while my son is sneezing up a storm.”

Other Therapy

Any of the present antihistamines are clearly less effective than topical nasal steroids, partially because histamines are only one of the many inflammatory mediators that this class of medicine works on. Antihistamines typically reduce itching, sneezing, and rhinorrhea, but may not completely eliminate the symptoms of nasal congestion. They are most effective when used prophylactically before allergen exposure. The addition of a decongestant frequently provides additional symptom control.

Overall, second generation (non-sedating) antihistamines (such as Allegra or Claritin) for acute symptoms and combination second generation antihistamine-decongestants (such as Claritin D or Allegra D) for chronic symptoms may be preferable in patients with mild symptoms, or those preferring pills over nose sprays, especially if allergic conjunctivitis is also present. I usually reserve the use of Zyrtecfor those who fail Claritin or Allegra, as Zyrtec has some sedative properties.

Immunotherapy: Immunotherapy is usually considered in patients in whom pharmacotherapy and avoidance of allergens have failed to resolve symptoms. Increasing dose of allergens to which an individual is sensitive are injected into skin to make the body less and less sensitive to the pollens. They are effective in about 70% of the time. But it involves repeated needle injections and risks of anaphylaxis, it is usually used as treatment of last resort.

In summary, for those with allergic rhinitis alone, I consider nasal corticosteroids to be the first-line treatment and antihistamine to be alternative strategy. For those with both rhinitis and allergic conjunctivitis, I prefer initial pharmacologic therapy with an oral second generation antihistamine/decongestant combination agent (Allegra-D or Claritin-D); this is because intranasal corticosteroids are not effective in reducing the symptoms of allergic conjunctivitis. If symptoms persist, addition of intranasal steroid provides additional relief. I reserve immunotherapy for those who failed the above measures.

Isn’t that nice that you can smell the spring again?