Hay fever and other nasal allergies (medically called allergic rhinitis) affect about 20 percent of American adults, who spend months every year with runny noses, watery eyes, scratchy throats and a handy box of tissues. The disease is reportedly the fifth most common ailment. Between the doctor visits to seek help, allergy medications sufferers regularly take, missed time at school or work, and other expenditures, allergic rhinitis costs anywhere from $2 to $5 billion a year.
What causes the stuffy nose and other symptoms? “When you inhale something you’re allergic to, the inside lining of your nose becomes inflamed,” according to Sandra Y. Lin, M.D., an associate professor at Johns Hopkins University School of Medicine. The result is congestion, runny nose, sneezing or itching.
Many over-the-counter remedies as well as in-office treatments are on the market. But, millions, particularly in a bad allergy season, seek professional medical help from a wide variety of practitioners. Led by Lin, a leading expert on allergic rhinitis, an expert panel that included ear, nose and throat specialists; pediatricians; allergy specialists; family practitioners and even acupuncturists was convened by the American Academy of Otolaryngology-Head and Neck Surgery Foundation. The group gathered to establish guidelines for all physicians trying to help hay fever sufferers minimize or alleviate their allergy symptoms.
A key topic was the latest type of recommended treatments, sublingual immunotherapy, which was approved by the U.S. Food and Drug Administration in April 2014. Immunotherapy slowly desensitizes patients to the particular allergens that trigger their symptoms. Commonly known as allergy shots, immunotherapy treatment for allergies used to require regular visits to a doctor’s office for injections. Now, however, the new sublingual (under the tongue) version allows patients can take tablets or drops at home.
Lin pointed out the group was establishing the first guidelines for the “since the FDA approved sublingual immunotherapy tablets.” However, the immunotherapy is only recommended for patients who test positive for specific allergens and do not respond well to other methods of treating the allergic rhinitis. It is not a first option, because the treatment can take up to five years.
Other guidelines recommend that:
- Allergic rhinitis should be diagnosed by clinicians and treated when patients have histories pointing to it, based on symptoms like a stuffy, runny or itchy nose; sneezing; and watery eyes.
- Allergy testing is useful to determine the specific allergens if the patient’s symptoms do not respond to standard treatments. The experts did not recommend routine sinonasal imaging.
- Medical practitioners should look for and document related conditions, such as conjunctivitis, asthma, sleep difficulties that are breathing related and skin conditions.
- Topically applied steroids are suggested when symptoms impair the patient’s quality of life.
- For patients with relatively minor hay fever symptoms, primarily sneezing or itching, the panel recommended less-sedating antihistamines.
- Acupuncture was supported as a treatment for patients who want to avoid pharmacological options, but herbal therapies were not endorsed.
The experts do say that hay fever sufferers seeking help need to be cognizant of the right drug for their allergy specific symptoms of take with their doctor. For example, antihistamines help with sneezing and itch but do not address stuffiness. Decongestants do alleviate stuffiness and drippy noses. Steroid nasal sprays are good for treating stuffiness and mucus, but only triamcinolone (Nasacort), is available over the counter. Lin recommends visiting the doctor to see if the condition really is allergies or something else.
By Dyanne Weiss
American Association for the Advancement of Science
Health News Direct