Healthy Living

Allergy season is here: Learn more about seasonal and perennial triggers, treatments

Immunotherapy can provide relief, but can take three to five years

(Adobe stock photo)
(Adobe stock photo)

For those with seasonal environmental allergies like hay fever, over-the-counter remedies may be sufficient to alleviate the symptoms of allergies. According to Dr. Ryan Dempewolf, an ear, nose and throat specialist with Physicians’ Clinic of Iowa in Cedar Rapids, the most common medications fall under the categories of antihistamines (Allegra, Claritin and Zyrtec), nasal steroid sprays (Flonase, Nasacort and Rhinocort) and decongestants (Afrin, Dristan, Vicks Sinex and Sudafed).

Decongestants also are combined with antihistamines for medications like Allegra-D, Claritin-D and Zyrtec-D. Those are typically stored behind the counter and require the purchaser to be at least 18, have a valid ID and sign for the medication.

After determining the cause or “trigger” for an allergy, Dempewolf said avoidance may be a potential solution.

“Unfortunately, the most common grasses and trees that cause allergies are all around us,” he said. “That’s particularly true for people allergic to corn pollen who are driving anywhere around Iowa.”

If you are fortunate to be allergic to one particular thing, by all means avoid it, if at all possible.

“The majority of people we see have lots of allergies.”

Dempewolf said perennial allergies, affecting people throughout the year, have become more common than seasonal allergies.

“We see allergens from dust mites, cats, dogs and various livestock,” he said. “Unfortunately, people are around them all the time.

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“If you are indoors in the winter months, dust mites can be a real problem. You can buy special furnace filters to deal with them because the indoor ventilation system is circulating them throughout the house.

“You can purchase covers and bags for mattresses and pillows. There’s also chemicals that can be used to kill dust mites in rugs.

“Unfortunately, studies have shown that while environmental controls reduce dust mites, people who are sensitive to them really don’t notice much of a change in their symptoms.”

Dempewolf said recent studies have prompted the testing of all patients for cat allergies.

“Cats are one of the most potent allergens that exists,” he said. “A small exposure can cause a big response.

“Cat dander is everywhere as their skin flakes, but it’s also their saliva. Cat dander and saliva have been found in doctor’s offices, homes, schools and stores where a cat has never been present.

“It’s from people bringing in dander or saliva on their clothing, backpacks or shoes. You can find it just about anywhere.”

Dempewolf said testing of young children for allergies often is overlooked.

”You will hear the old wives’ tale that ‘All children have runny noses’ or ‘Kids get sick a lot,’” he said. “While that may be true in some cases, a lot of children have underlying allergies — especially those with a family history of allergies.

“The chances of any individual person having an allergy goes up quite a bit if they have a first-degree relative with allergies — their parents, brother or sister. If a child has a perpetual runny nose or is coughing in their sleep at night, those are sometimes symptoms of an underlying allergy.”

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While it might appear that more people have respiratory allergies today than in years past, Dempewolf said it is more a matter of awareness.

“I think we are more conscious of it today, for sure,” he said. “The actual things leading to allergies have not changed. We have seasonal profiles of allergens specific to regions of the country that have been prepared over the decades.

“I think we are more aware because there are apps for cellphones that provide the daily pollen count and the source, like ragweed. Allergies also come up in conversations with our family, friends and co-workers.”

When allergies affect daily life, help is available

Chris Soltwedel, of Muscatine, was taking over-the-counter respiratory allergy remedies every day, but nothing was working.

“Each morning, I would take a Claritin, a couple of Sudafed and use eye drops,” Soltwedel said. “By the afternoon, I would need Flonase. By the evening, I would need more Sudafed, additional allergy eye drops and take a Zyrtec because of the drowsiness factor.

“I would break out with hives and sneeze as many as 100 times a day. I wasn’t sleeping, and I had a constant headache.

“I was way overmedicating myself, and my son urged me to go to a doctor and get some help.”

Soltwedel made an appointment with Dempewolf, the PCI specialist.

“When you get to the point where your symptoms are affecting your life, you can’t sleep or go outdoors and over-the-counter medications are not working, it’s time to go see somebody about what else can be done,” Dempewolf said.

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Soltwedel knew her son, who also had suffered with serious allergies, had tried immunotherapy with great success.

Immunotherapy is a type of preventive treatment for allergens like pollen, dust mites, mold and animal dander. It involves receiving gradually increasing doses of the allergens, either through shots or drops placed under the tongue.

The gradual introduction of the allergens helps a patient’s immune system build up a natural immunity or tolerance, making them less allergic. The treatment typically requires from three to five years to develop a lasting immunity.

“My son had done the allergy shot therapy when he was a teenager, and I had always kicked myself for not doing it when he did it.” Soltwedel said. “It worked amazingly for him — like night and day. You would never know that he had such trigger allergies.”

Trying to schedule regular shots for immunotherapy three times weekly was not an option for Soltwedel, who travels 70 percent of the time as part of her job.

“I heard about the allergy drops and made an appointment to see Dr. Dempewolf,” she said. “It’s been roughly two-and-a-half years since I started the drops and within six months there was a huge, noticeable difference.

“I’m still taking the drops, and it’s getting better and better, but I recently had a sneezing attack where I quickly sneezed three times in a row. My husband noticed and commented that hadn’t happened in a long time.”

While many insurance plans will cover the cost of allergy shots, the cost of the “sublingual” immunotherapy drops is not covered. Some insurers contend the safety and efficacy of the drops has yet to be established by the U.S. Food and Drug Administration.

For Soltwedel, paying for the allergy drops is a financial trade-off she is willing to accept.

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“I was spending at least as much for over-the-counter medication, and it wasn’t helping me,” she said. “I was missing work, always having to carry facial tissue with me, and it was embarrassing. It is amazing how much this has changed my life.”

The sublingual drops are prepared by an allergist after a patient has been tested to determine their sensitivities. Soltwedel takes drops from two different vials to build up an immunity to different allergens.

“I put four drops from one vial under my tongue each morning and wait 10 minutes,” she said. “Then I put the drops from the other vial under my tongue and wait 10 minutes before I eat or drink anything.

“I work it into my morning routine, and it’s no big deal.”

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