Your Ultimate Allergy Survival Guide
Ericka McConnellMost springtime sneezers—some one in five Americans—are aware they've got allergies. But knowing how best to treat them is another story. Drugstore aisles are stacked high with an array of pills, capsules, sprays, mists, and drops, and that's before you even get to the prescription options. The upside of all those choices, though, is "there is no need to suffer with seasonal allergies—good treatment is available," says Gainesville, Georgia, allergist Andy Nish, MD. The key to finding the products that will do the most for you, he says, is to first determine the severity, frequency, and duration of your symptoms, which may include sneezing, runny nose, nasal congestion, itchy throat, and itchy, watery eyes.
• Your allergies are mild if you get a twitchy, itchy nose and watery eyes while hanging around outside during pollen season (from early spring to early summer, depending on where you live). It's a nuisance, but not really life-altering.
• Your allergies are moderate if you have sneezing fits or need tissues even when you're inside, and if you're congested enough that you have trouble sleeping or wake up with a sore throat, affecting how you feel over the course of your day.
• Your allergies are severe if you're just plain miserable all the time: Your nose is constantly congested or running, you carry tissues 24/7, you go into frequent sneezing fits, and your eyes are incredibly red, puffy, and itchy. Your throat may even get so sore and itchy that you wonder if you're sick. (You're not.) Suffice it to say, your symptoms consume your life.
Now that you know where you fall on the allergy scale, here's how to find the right remedies for your symptoms.
If your allergies are mild
It sounds like a no-brainer, but every allergy doc worth his degree will urge you to avoid exposure to pollen—produced by trees, grass, weeds, and flowers—as much as possible during peak allergy hours (generally noon through late afternoon). Of course, you can't stay inside all the time, so pop an over-the-counter antihistamine such as Zyrtec, Allegra, or Claritin every day before you head into the great outdoors. These drugs work by blocking the effects of histamine, a chemical your body produces to attack invaders like pollen—launching such immune reactions as watery eyes and sneezes. Which antihistamine should you pick? In the end, all antihistamines on the market work the same way, but different people respond differently (both positively and negatively) to each one; trial and error is the only way to find the product that's best for you, says Paul M. Ehrlich, MD, president-elect of the New York Allergy & Asthma Society.
• Got a stuffy nose? Consider using an antihistamine with an added decongestant—look for a "D" or the word "sinus" in the name (think Claritin-D or Benadryl Allergy and Sinus). Decongestants relieve clogging by shrinking swollen tissues and blood vessels, which also shuts down the feedback loop that keeps mucus flowing. (Don't take decongestants if you're pregnant or have hypertension.)
• Itchy eyes? Use over-the-counter eyedrops such as Zaditor or Alaway.
• Still reaching for the tissues? Try using NasalCrom, a mild OTC nasal spray, especially a few hours before you know you're going to be out in nature, says Tim Mainardi, MD, senior fellow in allergy and immunology at Columbia University Medical School. It prevents mast cells—which are like "little land mines full of histamine," says Dr. Mainardi—from blowing up and releasing their symptom-causing goods.
Next Page: If your allergies are moderate [ pagebreak ]If your allergies are moderate
Ericka McConnellAre you still a mess after trying the advice for mild cases? Talk to an allergist or your primary care doctor about prescription-strength options. She'll likely start you on a nasal corticosteroid spray, to be used every day. Believe it or not, when it comes to Rx solutions, nasal steroids—not oral antihistamines—are the best first line of defense against allergic rhinitis (also known as hay fever or seasonal allergies), according to the AAAAI. Several studies have shown them to be more effective, and with fewer side effects (so you won't feel the urge to nap on your desk all day). Nasal steroid sprays work by lowering inflammation, which, in turn, reduces nasal stuffiness, sneezing, and an itchy, runny nose—even itchy, watery eyes. "Think of inflammation as a forest fire where lots of different things are burning at once," Dr. Mainardi explains. "Nasal steroids act like a helicopter dropping water on the fireóit doesn't care exactly what's burning; it just puts the fire out." Dr. Mainardi says the newest nasal steroid, Veramyst, may be the most effective because it sprays a finer mist that's able to reach the clogged upper passages of the nose.
• Add these on: Allergists often double up, prescribing oral antihistamines or combined oral antihistamine/decongestants in addition to nasal sprays, because they work in different ways. Xyzal, a prescription antihistamine from the makers of Zyrtec, is the new darling of many allergy doctors. "It works faster and it's stronger" than other drugs, Dr. Mainardi says. Its snooze factor is lower, too. Whichever your doc prescribes, start popping one antihistamine pill a day before allergy season begins so you can build the drug in your system and prevent flare-ups in the first place.
• Still sneezing? If the sneeze-fest continues, add Singulair, a prescription pill that's similar to an antihistamine. It relieves congestion by blocking chemicals called leukotrienes, which are released along with histamines as part of an immune reaction.
• Itchy eyes? Combat 'em with prescription eyedrops such as Pataday or Bepreve, antihistamines combined with mast-cell stabilizers for added symptom control.
If your allergies are severe
If you're still feeling the pollen in a big way after trying Rx treatments for moderate symptoms, talk to your MD about immunotherapy (allergy shots). Traditional immunotherapy means weekly (or more frequent) shots for some six to eight months to build up tolerance to specific allergens, then a maintenance period of getting shots every month for a few more years. But newer techniques can fast-track the relief. Rush immunotherapy, which involves getting multiple shots two or three days in a row, can ease symptoms in just weeks. New studies show that even very short-term immunotherapy—seven shots total before tree-pollen allergy season, for example—can really help lower the sneeze factor. (Needle phobes can get their immunotherapy from allergy drops placed under the tongue, but they don't work quite as well.) "Immunotherapy is the ultimate allergy treatment," says Jeffrey G. Demain, MD, director of the Allergy, Asthma, and Immunology Center of Alaska. "Drugs lessen symptoms temporarily, but immunotherapy can treat them permanently."