U.S. Food and Drug Administration
FDA Consumer magazine
May-June 2002
http://www.fda.gov/fdac/features/2002/302_itch.html

Itching for Some Allergy Relief?

by Michelle Meadows

Pollen grains from trees, grasses and weeds can float through the air in spring, summer or fall. But along with staying on mission to fertilize plants and tree flowers, pollen particles often end up in our noses, eyes, ears and mouths. The result can be sneezing spells, watery eyes, congestion and an itchy throat.

Pollen allergy, commonly known as hay fever, affects about 1 out of 10 Americans, according to the National Institute of Allergy and Infectious Diseases (NIAID). For some, symptoms can be controlled with occasional over-the-counter (OTC) medicine. Others have reactions that may more seriously disrupt the quality of their lives. Allergies can trigger or worsen asthma and lead to other health problems such as sinusitis and ear infections in children.

"You can distinguish allergy symptoms from a cold because a cold tends to be short-lived, results in thicker nasal secretions, and is usually associated with sore throat, hoarseness, malaise, and fever," says Badrul Chowdhury, M.D., Ph.D., an allergist and immunologist in the FDA's Division of Pulmonary and Allergy Drug Products. Many people with seasonal allergic rhinitis notice a seasonal pattern with their symptoms, but others may need a doctor's help to find out for sure that pollen is the source of their misery. If these symptoms crop up year-round, dust mites, pet dander or another indoor allergen could be the culprit. This is known as perennial allergic rhinitis.

Chowdhury suggests you see a doctor if you're experiencing allergies for the first time, if your symptoms interfere with your ability to function, if you don't find relief in over-the-counter (OTC) drugs, or if you experience allergy symptoms on a chronic basis. You may need an allergy test, the most common of which is a skin test that shows how you react to different allergens, including specific pollen allergens like ragweed or grass pollen.

Once you know you have seasonal allergies, probably the most important step you can take is to avoid pollen as much as possible. Try to stay indoors when pollen levels are highest. In the fall ragweed pollen season, pollen levels are highest in the morning. During the grass pollen season in the spring and summer, pollen levels are highest in the evening. Pollen counts measure how much pollen is in the air and are expressed in grains of pollen per square meter of air collected during a 24-hour period.

It may also help to keep windows closed in your house and car and to run the air conditioner. If possible, avoid mowing grass and other yard work.

Of course there will be times when pollen is inescapable. Here's a rundown of drug options that can help you survive the sneezing season:

Nasal corticosteroids: These are typically sprayed or inhaled into the nose once or twice a day. The newer drugs in this category are Nasonex (mometasone furoate) and Flonase (fluticasone propionate). Side effects may include stinging in the nose.
Oral antihistamines: These drugs, which are available in both OTC and prescription forms, counteract the action of histamine, a substance released in the body during an allergic reaction. Benadryl (diphenhydramine) and Chlor-Trimeton (chlorpheniramine) are examples of OTC antihistamines. Drowsiness is a common side effect, so don't take the drug when you have to drive, operate machinery, or engage in other activities that require you to be alert. You could try newer and relatively non-sedating antihistamines that are available by prescription such as Clarinex (desloratadine), Claritin (loratadine), or Allegra (fexofenadine). Zyrtec (cetirizine), also available by prescription, has sedation frequency slightly higher than the relatively non-sedating antihistamines mentioned above. Last May, the FDA held a public hearing that discussed whether Claritin, Allegra and Zyrtec should be moved from prescription to OTC status. The FDA has not made a final decision yet.
Decongestants: Decongestants are available both by prescription and over-the-counter. These drugs come in oral and nasal spray forms, and are sometimes recommended in combination with antihistamines. Antihistamines alone do not have an effect on nasal congestion. Allegra D (fexofenadine and pseudoephedrine) is an example of a prescription drug that contains both an antihistamine (fexofenadine) and a decongestant (pseudoephedrine). Note that prolonged use of nose sprays and drops can result in even worse nasal congestion.
Non-steroidal nasal sprays: NasalCrom (cromolyn sodium) nasal spray which is available without a prescription, can help prevent symptoms of allergic rhinitis if used before symptoms start. It's a non-steroidal anti-inflammatory drug and needs to be used more often than the nasal steroids, three to four times a day.

If you have any other health conditions, check with your doctor first to determine which OTC medicine to take. For example, people with uncontrolled high blood pressure or serious heart disease shouldn't take decongestants unless directed by a doctor.

Immunotherapy, commonly known as allergy shots, is also an option for treating allergic rhinitis. Candidates for immunotherapy might include those who don't respond to either OTC or prescription medications, or who suffer from frequent complications of allergic rhinitis.

According to NIAID, about 80 percent of people with hay fever will experience a significant reduction in their symptoms and their need for medication within a year of starting allergy shots.

"Discuss the option of immunotherapy with your doctor thoroughly because immunotherapy is not for everybody, and there is a significant time commitment involved," Chowdhury says.

The process involves receiving injections of small amounts of allergens that are considered to be responsible for your symptoms. The injections are given over at least three to five years. The doses are gradually increased so that the body builds up immunity to the allergen, with discontinuation being based on minimal symptoms over two consecutive seasons of exposure.

Chowdhury points out that because allergy shots have been around since the early 1900s, they have been grandfathered in. "They have not been tested rigorously in accordance with current FDA standards."

To check on pollen counts in your area, tune in to your local weather reports or contact the National Allergy Bureau, which monitors pollen counts throughout the United States. The Bureau is run by the American Academy of Allergy, Asthma, and Immunology. Contact 1-800-9-POLLEN (1-800-976-5536) or visit http://www.aaaai.org/.

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