We’ve all seen the advertisements on television for allergy medications where the husband laments that he has indoor allergies and his wife has outdoor allergies. The implication is that their symptoms are different and so is their treatment. Except, the drug advertised is different from the others because it is approved to treat both.

The difference between outdoor and indoor allergy is minimal. When a person with allergies encounters either type of allergen, there is an initial period of watery eyes, runny nose, sneezing and itching. This lasts a few minutes to a few hours until continued exposure starts to cause swelling and congestion. With continued exposure, the sneezing and itching will almost disappear, and congestion and post-nasal drip become the major symptoms.

If your nose is irritated and congested from allergy exposure, other things start to cause more congestion and irritation. Smoke, perfume, scented candles, and cleaning agents are more likely to bother you when you have a cold or are congested from allergy exposure.

When someone is allergic to an outdoor pollen or mold and spends several hours outdoors or continues to be exposed intermittently for a few days, they develop the same congestion and post-nasal drip that a person suffers when they live with a pet to which they are allergic.
They are unable to clear their symptoms between exposures and merely develop a spiral of increasing congestion, blockage, sinus headache, increased risk of infection and even snoring. A person can identify an allergy to an animal only when they visit someone else’s pet and have the acute reaction of sneezing, watery nose and eyes, and itching. Living with the pet to which you are allergic changes from the acute reaction to a chronic one complicated by reactions to smoke, perfume, and cleaning agents. These people often begin mouth-breathing, snoring, and have recurrent infections.

Seasonal allergy refers to pollens and molds that have a season of growth and release of their pollen or spores. In the springtime the trees produce the majority of seasonal allergens. They reproduce by pollinating other trees as the wind blows their pollen into the air.
Most tree pollen is released in the late morning hours. Because the season for each tree species is so short, there is a great amount of pollen released. Tree pollen counts have risen from an average of 1,000 10 years ago, to recent counts as high as 12,000.

The spring allergy season has been getting much more intense perhaps related to the changing climate. Grasses pollinate in the early summer and weeds generally pollinate in the fall. Molds are generally worse in the fall and early winter as the leaves and grasses die and begin to hibernate for the winter. Their counts have not changed much in the recent past.

Most people buy their medications “over the counter” when they start to have allergy symptoms. Antihistamines are effective at treating sneezing and itching, the early symptoms that people experience. As the season progresses most people will start to grab “allergy sinus” or antihistamines with “D” content (both are oral decongestants). Only Loratidine products are not sedating when bought over the counter.

All other antihistamine and “allergy” products carry a warning that they should be used with caution when driving. Unfortunately it also should say that you will not pay as much attention at school or be able to learn as well while taking them. The decongestants have the opposite effect … stimulation and nervousness. The combination is hoped to counteract each other, but usually merely causes you to fall asleep at work and stay awake at night. Decongestants also affect blood pressure and the male prostate.

The best treatment for either seasonal or perennial (year-round) allergy is prescription nasal sprays. Because they are applied topically into the nasal cavity, they avoid side effects to the body. It is important to note they are not the same as over-the-counter decongestant sprays that work well, but are addictive and actually make the congestion worse with continued use. Prescription nasal sprays often need to be used daily to prevent symptoms. They can take several days for maximal benefit because they are such a low dose and extremely safe way to take the medication.

Untreated allergy symptoms lead to infections of the ears, sinuses and even the lungs. It is important to consider allergy testing if you need to take medications for more than a few months of the year. Testing helps identify what you are reacting to and helps guide the use of your medication. Allergy shots can also be used to reduce your life-long allergy problem. These shots are used for three to four years and can provide life-long benefit.

Please consider a visit to a board-certified allergist, especially if you have complications of respiratory infections or chronic congestion interfering with sleep. Studies show that patients that are poorly treated will have impairment of learning and performance at work.

Greg Lux, M.D., is a board-certified allergist and practices at St. John’s Clinic-Allergy & Immunology. Please call 417-885-0823 for an appointment.