The onset of spring & allergic rhinitis go hand in hand

May 5, 2020

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

Coronials, covidials, quaranteens. Home schooling, videoconferencing, four legged classmates with tails who bark. To say my kids are in uncharted waters during the COVID-19 pandemic is an understatement. Eric's biggest distractions, video games and Netflix, share the same screen as his schoolwork. Both of Eric's parents work during the day. Guess how that's going? Emily is much better at staying on task with schoolwork. But Emily needs hours in the DRCSS welding shop to get her welding credentials. But, she isn't allowed into the DRCSS welding shop. Now she is trying to decide if she wants to delay her post-secondary schooling and go back to the DRCSS in September for a couple months to finish her welding credentials. And then there is Grad. June 20 was supposed to be the day Emily and the Class of 2020 crossed the stage, received a diploma and had a party in the evening. That isn't going to happen and the alternate plans are interesting.

Spring might really be here now. Getting outside, as long as you keep your social distance from others, is great for your physical and mental health. But with Spring comes runny noses and watery eyes. Most people call this allergies. The medical term for this is allergic rhinitis. What is allergic rhinitis? When a person with allergic rhinitis breathes in an allergen such as pollen, mold, animal dander, or dust the body overreacts as if these benign substances were attacking the body. The body releases chemicals like histamine that cause inflammation and allergy symptoms. Symptoms may include: itchy, watery eyes, stuffy nose, cough, sore throat, and fatigue.

What can you do about allergic rhinitis? If this is the first time you've ever had any of these symptoms before, get assessed by your doctor. Doctors are doing many assessments over the phone now, so call your doctor's office first before just showing up at their office. They will want to rule out other illnesses, and possibly have you sent to a specialist to find out exactly what substances are your triggers. If you and your doctor are sure your problems are just allergies and the symptoms aren't too severe, you can start with trigger avoidance.

To avoid your allergy triggers, you have to know what they are. Allergy testing can determine your triggers, and you can help yourself by keeping an allergy diary. In an allergy diary you list what you did and what you were exposed to and how your symptoms were in a given day. If it turns out you are allergic to pollen or outdoor molds try to remain inside during pollen season. Watch the pollen counts on the Weather Station and avoid outdoor activities on high pollen count days. Shower or bathe after outdoor activity to remove pollen from hair and skin and to prevent contamination of bedding. If you have indoor allergies like dust mites, then try to avoid carpeting. The less carpeting in the house, the better, especially the bedroom. A central vacuum system that exhausts outside is best, and the allergic person shouldn't even be in the home when the vacuuming is done, if possible. Encase all mattresses, box springs and pillows in zippered, allergen-proof casings. Keep indoor humidity under 50%.

Allergen avoidance isn't always possible or sometimes even desirable. While getting people to not smoke in the house is probably attainable, getting rid of the family cat is probably not. How we treat allergic rhinitis without a prescription has changed over the last couple years. Nasal steroid sprays like fluticasone are available without seeing your doctor. This is great news because nasal steroid sprays are much more effective at treating allergic rhinitis symptoms than antihistamines. Nasal steroid sprays are very good, but they aren't Dristan. They don't work quickly. It may take 2-4 weeks for them to be fully effective and they are designed to be used everyday during allergy season. One trick to get less nose bleeds and irritation from nasal steroids is to spray them away from the septum in the middle of your nose. Think about spraying towards the "outside" of your nose. It sometimes helps if you spray into your right nostril with your right hand and your left nostril with your left hand. If you find you need your over-the-counter nasal steroid for more than 2-3 months, it is time to talk to your doctor to see if a prescription might be a good idea.

Another recent change in treating allergies is the recommendation not to use the prescription medication montelukast or singulair for just allergies. Montelukast is a once a day pill that is usually used for asthma. It had become popular to use montelukast to treat allergic rhinitis. The jury is still out, but there are concerns that more cases of depression and suicide than expected are happening in people taking montelukast for allergic rhinitis. So due to an abundance of caution, using montelukast for allergies is now a treatment of last resort.

Over the counter antihistamines can also be effective for allergies. We used to stay take an oral antihistamines from before the snow melts until after the first month or two of spring when the pollen count drops. And that still works. But because the nasal steroids work so well, they are probably a better choice for the moderate to severe allergy sufferers. Now we'll probably just use loratadine or Claritin and cetirizine or Reactine for mild allergy symptoms that come and go. Antihistamines start working in about an hour. They are good for itchy eyes and running nose, but they don't do as well for nasal congestion. I often point people towards loratadine than cetirizine for allergic rhinitis. I think cetirizine actually works better than loratadine for all types of allergies, but cetirizine seems to cause drowsiness in about 10% of people. Cetirizine and loratadine are called second generation antihistamines. We don't recommend first generation ones like chlorpheniramine (Chlor-Tripilon), and diphenhydramine (Benadryl) for allergic rhinitis anymore because they can cause dry mouth, trouble passing urine, and drowsiness.

Convocation for Emily and the Class of 2020 is the walk across the stage and get the diploma ceremony. Convocation is controlled by the DRCSS. Safe Grad, the party for the Class of 2020, is controlled by the parents. In a normal year, these are coordinated on the same day. This is not a normal year. As of this writing, Convocation will be September 4th. Many students have commented they will already be at post-secondary studies outside of Dauphin by September 4th. The Safe Grad party will probably be split into two parts. A socially distanced parade of students in the backs of trucks on June 20th and a much smaller party in late August or possibly the fall, whenever the ban on gatherings is lifted. But as a completely biased parent, I'd still like to see some coordination. I wonder why the DRCSS Principle couldn't hand out diplomas with a 6 foot reaching stick on June 20th to Grads in the backs of a trucks while an outdoor PA system announced each student. It would make the DRCSS Coronial Class of 2020 extra memorable. Just saying...

The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.


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