Allergies And Upper Respiratory Symptoms

Allergies are one of the most common complaints that is treated by primary care physicians. Often patients will come to the office thinking that they have bronchitis, pneumonia, influenza, or even a very serious common cold, but upon examining these patients typically one finds that they are not suffering from an infectious process but more likely are experiencing allergies.  Sometimes there will also be a component of asthma that is observed in these scenarios.  It’s often hard for patients to wrap their head around the idea that what they are experiencing is a form of asthma and/or allergies as opposed to a pneumonia or bronchitis or influenza.  While giving people antibiotics in this scenario is not the worst thing that one can do, and it certainly is possible to misdiagnose these things, and the vast majority of people with these types of symptoms giving them antibiotics will do nothing but potential to cause adverse effects and they will not address the pathology that is the root cause of the patient’s symptoms.

We have seen a dramatically increased number of patients coming into the office complaining of symptoms like this after hurricane Sandy. This is something that other physicians have observed as well, and the medical literature is starting to reflect this experience and offer some hypotheses about why this is occurring. While the potential causes for this are academic; regardless of the origin of allergies the treatment is the same. However there are two theories that seem most likely. The first is that the hurricane caused flooding which increased the growth of molds that we know to be allergenic.  The other is that changing weather patterns have caused allergens from south of New York to be more prevalent, and these are allergens that people who have lived in New York for many years have not been exposed to and are potentially more likely to mount an allergic response to.

Treating allergies is a fairly formulaic process.  There is little controversy about the best way to treat allergic symptoms initially.  Treatment for allergic symptoms typically encompasses three components:

  1. Antihistamines.  Allegra and Zyrtec are typically regarded as the most potent antihistamines. Antihistamines work by blocking the immune response that causes people to have runny noses, itchy eyes , itchy skin,  etc.  Antihistamines work best when taken as a preventive measure, and since Zyrtec and Allegra have extensive safety data that show that they are relatively innocuous drugs in terms of long-term side effects,  taking an antihistamine prophylactically during the period of the year one notes here she has allergies is not an unreasonable thing to do.
  2. Nasal steroids. These drugs block the immune response to allergens in the nasal mucosa. Steroids are very potent blockers of the immune response, and that is why giving people systemic steroids like prednisone can be dangerous. Drugs like prednisone are very effective, but given the fact they are absorbed systemically and have such potent effects on the immune response they can also have very significant side effects. When treating allergies, since the majority of the immune response that is concerning and troublesome is often localized in the nose giving people a steroid that predominantly remains in the nasal mucosa is a very good strategy. Since steroids are a more potent inhibitor of the immune response when one  is in the midst of a significant flareup of allergies, a nasal steroid is often needed in addition to antihistamine to provide significant relief.
  3. Decongestants. Sudafed is the drug that is most commonly used as a decongestant. Decongestants work differently than the other two types of drugs because they don’t specifically inhibit the immune system; decongestants work by constricting the blood vessels so that immune cells have a harder time reaching out into the tissues to cause their ill effects. They also have more side effects than other drugs, because in addition to constricting blood vessels they can increase blood pressure and heart rate.  Sometimes in a severe flareup of allergies giving somebody Sudafed in addition to an antihistamine and nasal steroid is necessary, but the use of decongestants like Sudafed should be restricted to no more than 5 to 7 days.  For some patients with high blood pressure or other cardiovascular conditions, the risks of Sudafed outweigh its potential benefits.

There are also non-pharmacologic approaches to treating allergies. While most are intuitive, like removing carpeting, reducing or eliminating one’s exposure to pet animals, and ensuring that one’s living space is as dust free as possible, having a humidifier in one’s living space can also improve one’s allergy symptoms.  Encasing pillows and mattresses in special covers that prevent dust mites and other allergens  that congregate in these areas from being liberated into the air can be helpful also.  Vacuuming one’s mattress and opting for non-feather/down filled pillows (choosing synthetic fibers instead) is another, potentially less uncomfortable strategy.

We often are asked if we can be allergy testing in the office. We do not do allergy testing here, because to do allergy testing effectively requires equipment that it is just not feasible for us to have given the low volume of testing we would do. There are some patients for whom allergy testing is appropriate. These patients are people in whom one suspects they have a discrete allergy to one or two avoidable allergens. The vast majority of people are allergic to ubiquitous things like dust and pollen which are difficult to eliminate from one’s life. So unless one suspects that the patient’s  allergies are due to a discrete and avoidable substance or you plan to have the patient undergo allergy desensitization, “allergy shots,” there is really little use for allergy testing, because the treatment is going to be the same as delineated above.