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The Second Opinion

Q: What causes my allergies to flare up in the spring?

Dr. Jim Mumper:  Pollen is the most likely cause. Your immune system has mistakenly learned to remember the pollen released by various plants as potentially harmful, and responds with the familiar allergic symptoms. Each species of plant releases pollen at about the same time every year. Trees are usually the first plants to release pollen, usually in the early spring. Grasses come next in the spring and early summer. Weeds generally release their pollen in late summer and fall. The specific types of pollen and the time of their release depend upon the local climate and vary around the country.

In Virginia, during the spring, pollinating trees are responsible for causing hay fever. Over the summer, grasses and weeds are the main producers of pollen. In the fall in Virginia, weeds are mostly to blame, with ragweed being the main culprit. Hay fever can also be caused by mold releasing its spores, from approximately late March until November, usually peaking in late summer and early fall.

Q: How do I know it's allergies versus a cold?

Dr. Virginia Kladder:  It is sometimes difficult for people to know whether they have a cold or if they are suffering from allergies because allergies and colds share some of the same symptoms. They are, however, very different diseases.

Seasonal allergies are an immune system response triggered by exposure to an allergen. This response can induce symptoms that are similar, but not identical, to the common cold. The most common signs and symptoms of seasonal allergies are itchy eyes and a runny or stuffy nose. Signs and symptoms may sometimes include fatigue, cough and sore throat, but never fever or general body aches and pains. Seasonal allergies cannot be passed from person to person and usually last for several weeks. The only way to truly know if you have allergies is to be tested for them in your doctor's office.

Signs and symptoms of a "common cold" — which is caused by a virus — usually include cough, sore throat, runny or stuffy nose, and sneezing. You may also feel tired and, occasionally, experience body aches and pains. Rarely, you may have a mild fever. One typically does not experience itchy eyes with a cold. A common cold is easily spread from person to person and usually lasts from three to 14 days.

Q: What are some over-the-counter medicines that are able to provide me some relief? Are there any side-effects with these?  

Dr. Stuart Solan:  There are a number of over-the-counter medications available to help relieve symptoms of allergy. One such category of drugs is known as antihistamines. The allergic reaction triggers the release of a substance called histamine contained in cells in the body known as mast cells. Histamine causes nasal congestion, increased mucus production and can cause itching of the nose, throat and eyes. Antihistamines help block the ability of allergens to trigger the release of histamine.  Examples of over-the-counter antihistamines include Chlor-Trimeton, Benadryl, Dimetane and Tavist which all share drowsiness as a potential side effect. Also these older antihistamines can block the ability of the urinary bladder muscle to squeeze to some extent which can result in difficulty voiding in men with enlarged prostates.  Claritin is largely free of those two side effects just mentioned. The antihistamine brand names mentioned above are available as less expensive generics.

Decongestants are classes of medications that work by making the muscle that surrounds blood vessels constrict thereby occupying less space in the mucous membranes in the nose. This results in a temporary shrinkage of the thickness of the nasal mucous membranes resolving in greater ease of breathing through the nose.  Sudafed is a brand name decongestant which generically is known as pseudoephedrine. There are a variety of antihistamines available that are combined with a decongestant.  Some of these products will indicate they contain a decongestant by adding the letter D after the product such as Claritin-D. Dimetane contains just an antihistamine while Dimetapp contains the antihistamine plus a decongestant.  Over-the-counter nasal spray decongestants such as Afrin and Neo-Synephrine are available but use for 3 days or more can cause rebound congestion of the nasal mucous membranes.  Most otolaryngology's (ear, nose and throat specialists) recommend avoidance of nasal decongestant sprays for allergic rhinitis. Decongestants cause insomnia in some patients and have the potential for elevating blood pressure. Also decongestants can cause constriction of one the muscles at the base of the bladder making voiding difficult for men with enlarged prostates.

Those patients who have itching of their eyes from allergy have what is called allergic conjunctivitis. One product available over-the-counter for allergic conjunctivitis is an antihistamine eye drop called Ocu-Hist.

Another medication available over-the-counter for nasal allergies is Nasalcrom which belongs to a class of medications known as mast cell stabilizers which have a very low side effect potential. Nasalcrom is a nasal spray that does not cause rebound nasal congestion and is gentle on the mucous membrane of the nose. 

Q: What is a skin test? How does it work?

Dr. Leon Spiers:   Skin testing is one of the main ways an allergist evaluates a patient for possible allergies.  A mixture of protein (or other material) from the suspected triggering agent (the "allergen") is gently scratched or poked into the patient's skin.  If the patient has significant antibodies to the allergen in his or her system, then a whelp will develop at the site in fairly short order. The allergist then measures the size of the whelp, if any, and grades the reaction from zero to 3+, which correlates with how allergic the patient is to that particular allergen. The whelps usually resolve in a few days.

Q: What can influence the severity of the allergy season?

Dr. Wu-Pong:  Hay fever, or seasonal allergic rhinitis, affects an estimated 40 million Americans and causes symptoms of sneezing, itchy and watery eyes, runny nose and a burning or itchy sensation in the throat or palate. Spring allergies are most commonly caused by tree and grass pollens, and depend on where an allergic individual lives and the time of year that pollination occurs.

While there is no way to accurately predict pollen counts or how bad this spring allergy season will be, according to the American College of Allergy, Asthma and Immunology (ACAAI), there are several factors that can influence how much allergy sufferers will sneeze, wheeze and itch their eyes.

Weather can influence the timing and severity of the season. A mild winter often leads to a more severe pollen season. The grass season varies the most. If the spring is warmer and wetter than usual, that can provoke more grass to grow earlier, leading to a more severe season during the late spring and summer. Rain does have benefits, as well. It washes pollen that has already been released out of the air. 

Q: I know some people get allergy shots. Who should get these and will they keep my allergies from coming back?

Dr. Patricia Burkwall:  Allergy shots (immunotherapy) are a treatment that is aimed at decreasing your sensitivity to substances (allergens) that trigger your symptoms. Your specific allergens can be determined by skin testing. Immunotherapy is then created specifically for those allergens. This form of treatment is recommended for patients who have severe allergic asthma, rhinitis, conjunctivitis or stinging insect allergies. Typically these patients have not improved with environmental control or medications. Other patients decide they would prefer immunotherapy instead of long-term medication use, especially if there are unwanted side effects from the medication. Other factors to consider are the time commitment required and cost of immunotherapy.

Once the allergens are determined, a patient then begins a process of injections under physician supervision with increasing amounts of allergen over 3-6 months (typically once or twice weekly). Once an effective therapeutic dose is achieved, immunotherapy is continued with the maintenance dose once every 2-4 weeks for a few years. Immunotherapy is most effective against grass, weed and tree pollens, dust mites, cat and dog dander and insect stings. It is not useful for food allergies. Patients must be at least 5 years old to begin immunotherapy. Immunotherapy is not recommended for patients with severe asthma, heart disease requiring beta blockers or those who are pregnant. 

PartnerMD is Richmond's leading preventive-based primary care practice. By limiting their six physicians to a patient enrollment of 85 percent less than traditional practices, PartnerMD is able to offer a level of care that otherwise would not be possible. Benefits include 24/7 doctor access, doctor's cell phone number and a "waitless" waiting room to name a few. Since opening in 2003, the practice has expanded its patient base to more than 2,500 members and works with many top Richmond companies to provide Richmond's Premier Executive Physical program. Please call 804-237-8282 for more information.

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