As the icy gray of winter gives way to the pale warm yellow of springtime, many Americans prepare to deal with the onslaught of pollen released by flowering trees and blossoming shrubs. For many allergy sufferers, springtime means not only looking forward to welcoming the warmer season, but also coping with the allergies that accompany it.
While hay fever is not considered a serious illness, and often can be controlled with medication, many people know how difficult it can be to go about your day-to-day life when your allergies are uncontrolled or require some extra effort. My experiences dealing with hay fever every spring, particularly while going through my medical training, has taught me a lot about how to cope with allergies in day-to-day life. In particular, the worsening of allergy season each year has taught me new ways and steps that I need to take to make sure I’m staying on top of my health.
Rates of allergies and asthma are increasing, and many theories exist as to why. The hygiene hypothesis argues that lack of exposure to common pathogens and allergens prevents the immune system from learning the difference between harmful and harmless irritants. Another hypothesis is that lack of Vitamin D due to the modern indoor lifestyle can increase rates of allergies and asthma.
The lifestyle hypothesis, in particular increasing obesity, has also been linked to increasing rates of asthma. Finally, worsening air pollution and climate change have also been cited as factors in worsening allergies and asthma. With warmer temperatures in colder areas and with increased CO2 from air pollution in the atmosphere, plants are now able to thrive in these areas and produce pollen. In fact, the pollen count is expected to increase 200% by the end of the century.
For many working professionals, particularly in jobs where you are interacting with others, dealing with bad allergies can be difficult. According to the CDC, 1 in 3 adults have seasonal allergies. Taking medications early, before the start of allergy season, and regularly every 24 hours or as directed, even when allergies seem controlled, is imperative to keeping allergies under control. Antihistamines are the most commonly used allergy medications (i.e., loratadine, cetirizine, fexofenadine, diphenhydramine). If one type of antihistamine is not working, it can be beneficial to try different medications to see which one works best.
Some patients may require allergy medication that has a different mechanism of action, such as montelukast, to supplement antihistamine. Supplemental nasal sprays such as nasal steroids to calm down runny nose and congestive symptoms and nasal saline to maintain moisture in the nose can be helpful.
Finally, anti-allergy eye drops such as azelastine and olapatadine can help fight ocular irritation and itch. Olapatadine also comes in an extra strength formulation for particularly stubborn ocular allergies.
Many patients with allergies have asthma, which can be exacerbated by springtime allergies. For these patients, controlling allergies is especially important and may require inhaler use, even if patients do not regularly need to use medication to control asthma. For long-term control, many patients opt for allergic immunotherapy (“allergy shots”), which can decrease allergy symptoms over time.
As allergies and asthma increase around the world, and as allergic symptoms become more severe with climate change, it is important to be proactive in maintaining allergic symptoms. As physicians, we need to be familiar with all of the options available to treat allergies, especially symptoms specific to our fields. As working professionals, we need to stay on top of our allergies so that we can stay in good health to take care of our patients.
What helps you stay in control of allergies? Share in the comments.
Dr. Rabia Karani is a vitreoretinal surgery fellow at the Johns Hopkins Wilmer Eye Institute. She finished her ophthalmology residency at Columbia University in NYC and is a native of Houston. Her interests include public health ophthalmology, prevention of chronic diseases such as diabetes, and using imaging and technology to further develop treatments for retinal disease. Outside of work, she enjoys exploring museums and cities, learning about nature and animals, and traveling. Dr. Karani is a 2022–2023 Doximity Op-Med Fellow.
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