Harnessing Hay Fever

The itchy eyes, sneezing, nasal drip and tickle in the back of the throat are all well known to sufferers of hay fever or "Allergic Rhinitis."  What is not commonly understood is how fatiguing this condition can be as well.  People suffer from allergies because their immune system recognizes a foreign substance (antigen) that usually enters the body through the nose and mouth.  A primed immune system will bind that antigen by a histamine receptor to what is called a Mast Cell.  The interaction causes the Mast Cell to release histamine into the blood stream, resulting in an immediate release of inflammatory products which trigger swelling of the lining of the nose, throat and eyes.  This is what causes that runny nose and watery eyes.  The work required to create this inflammation is very fatiguing.  In fact, any medical condition that causes inflammation will cause fatigue.  Sufferers of Multiple Sclerosis, Rheumatoid Arthritis or Chron's Disease know this well. In fact, it is very common for a patient with pneumonia to still feel fatigued weeks after the cough has gotten better.

Most sufferers of allergies do just that; they suffer through it.  I'll admit that I am usually one of them.  Keeping them under control, though, can help you feel more energetic and less miserable.  Let me explain the different treatment options and the rationale for each so you can decide what is best for you.  The most commonly used medicines are the antihistamines.  This includes Claritin (loratadine), Allegra (fexofenadine), Zyrtec (cetirizine), and Benadryl (diphenhydramine) to name the most common ones.  They block that initial triggering event discussed above.  Logically, the sooner they are used, the better they will work.  If you wait till you are full of fluid, they will keep your allergies from getting worse but they will not help for what you have already been exposed to.  The horse is out of the barn in this case and it is too late to close the door.  During a bad season it may be best to take the medicine on a daily basis.  They can work quite well intermittently if given prior to an exposure.  I have used them effectively prior to wood working, mowing the lawn or going to a friend's house who has a cat.  The medicines are all available over the counter now and most have a generic form which makes them less expensive.  The main draw back is that they themselves can be fatiguing.  The least sedating is Claritin and Allegra, followed by Zyrtec.  Benadryl is the most sedating.  There are also antihistamine nasal sprays and eye drops.  Those are not sedating at all but have to be used more frequently.

Nasal steroids reduce the inflammatory response from the histamine release.  They can be used with or without the antihistamine.  Since they are absorbed right in the nasal passage, almost none of the medicine enters the bloodstream, making them quite safe.  The draw back to these medications is that many people do not like squirting medication in their nose and they are quite expensive.  Thankfully, one of the best ones, Flonase (fluticasone) is now available in generic form.  They do all require a prescription.  If used daily over many weeks or months, the lining in the nose can become too thin and result in nose bleeds.  Stopping the medication for 1-2 weeks will solve that problem.  They do not work quite as well as antihistamine medications on an as needed basis.  Many use them for a few weeks out of the year during a bad season.

Allergy shots are the most effective way of reducing long term symptoms.  They induce tolerance in the immune system by introducing a small dose of antigen on a regular basis.  Over time, the immune system becomes desensitized, similar to what happens with teenage boys when their mother speaks to them.  The trigger is still there but nothing registers.  There are some obvious drawbacks to injection immunotherapy (allergy shots).  First, they are given by injection.  Second, if the dose of antigen is too high, it can induce a more serious reaction in the whole body so they must be given at the doctor's office.  Third, they have to be administered weekly for the first few months and then monthly for many years.  The hassle factor can be a big impediment.  Lastly, if you move to a new area, you have to start all over.  The injections only work for the antigens in your current environment.

There are other possible ways to help your allergies as well.  The simplest, of course, is avoidance.  That may not always be the best course of action, however. There is some evidence that children born and raised in the city have more allergies than children born in the country.  There is likely a critical age in the developing immune system where exposure induces tolerance rather than activation.  The science behind this has not been completely worked out yet.  Some have suggested that ingesting unfiltered bee honey can help.  When bees return to the hive, they not only bring the nectar to form honey but also lots of pollen.  The rationale is similar to that of injections but instead of sensitizing to very specific antigens, this would in theory sensitize to a more broad range of them.  For this to work, it should be unfiltered honey from local bee keepers to make sure that the antigens are ones that exist in your own environment.  There are likely many antigens that would not be covered by the honey, such as animal dander or dust.

I hope you find this informative.  Thanks to Debbie for the requested topic.  If you have specific questions that I did not touch, on please let me know.