Changing seasons can cause allergens to spike in the environment. Catherine Rich, MD, discusses how you can tell the difference between an allergy and a cold, how to identify seasonal allergy triggers and the best ways to manage them.
Catherine Rich, MD
Catherine Rich, MD, is a primary care provider in the general internal medicine department at BMC. As a clinician educator and program director, she focuses on training future primary care and internal medicine doctors while maintaining her primary care practice.
Melanie Cole (Host): As we head into the Spring, seasonal allergies can become much more common. My guest is Dr. Catherine Rich. She’s a Primary Care Provider in the General Internal Medicine Department at Boston Medical Center. Dr. Rich, what causes an allergic reaction, especially when we’re talking about season allergies, things outside, things around?
Dr. Catherine Rich (Guest): Hi Melanie. So, a lot of my patients are having allergic reactions to things like the pollen – the trees, the grasses, the weeds, the things that we see coming up in the Springtime. That’s what causes most of the Springtime seasonal allergies.
Melanie: How do you know if it’s an allergy or if it’s cold because in the Springtime and in the Fall, people get colds as well. They start getting sniffly, and their throat gets tight – how do you know that’s what it is?
Dr. Rich: Sure, it can sometimes be hard to tell the difference between a cold, which is usually caused by a virus versus an allergic reaction, which is your body’s immune system overreacting to the pollens that are in the air. The most common symptoms of allergies are things like runny or stuffy nose, sneezing, itchy eyes. People can have itchy throats or itchy ears. One of the things that I look for is – certainly, a person with allergies is not going to have a fever, so if you have a fever or body aches, that tends to be much more of a viral illness like a cold.
And also, people with allergies, if they do have a runny nose, it should be a clear runny nose. A person with a cold or a sinus infection might get discolored runny nose – sort of like greenish or yellowish. Those are the main things that I would say that can sort of distinguish.
Melanie: Who is at risk for allergies? Are people that have allergies at an increased risk for asthma or vise-versa? Is there a genetic component to these types of allergies?
Dr. Rich: Yeah, that’s a really good question. Most people with allergies do have allergies in childhood – the allergies start in childhood, and it does run in families. They think that there is some sort of genetic component to it. If your mom had allergies or our mom had allergies, there’s probably a higher chance that you’ll have them too – that you’ll react to the same kinds of pollens, and grasses, and trees. And then, there is an association for some people with asthma. Some people have asthma allergies and tend to get skin rashes like eczema, but there are people who just have the seasonal allergies that don’t have asthma as well.
Melanie: If someone exhibits these symptoms every season -- and as you’ve said, they have kind of told the difference whether it’s cold or allergies – what are some treatment options, and how is it diagnosed that this is – you know, people think of allergy shots – is that how they still diagnose it?
Dr. Rich: Yeah. I do have people come into my office and want to get tested for allergies, and what I would say is that most of the time, you can diagnose seasonal allergies just by talking to your primary care doctor and being examined in the office. It doesn’t usually require a visit to the specialist, but there – and we can treat pretty easily. We have quite a few both over the counter and prescription medicines that can really bring a lot of relief to people with seasonal allergies
Let me just mention about testing because you asked about that. There are Allergists – specialists who will see exactly what you’re allergic to. That’s usually a skin test where they put a little skin prick with some of the substance in, and they see if you develop a rash. I would say those tests are really only necessary after you’ve worked with your primary care doctor to try to get relief from allergies. There are a few occasions when we want to know exactly what you’re allergic to, and maybe we can in that case target therapy. The allergy shots that you mentioned? Not everybody with seasonal allergies needs allergy shots. We still do use allergy shots, and they now have a new kind of treatment, which is under the tongue substance – like a little pill that dissolves that’s similar to the allergy shot. Those are for people with really severe allergies that don’t get better with medications. In that case, you do need allergy testing to know what you’re allergic to. The allergy shots or the allergy pills are to help your immune system not overreact to those substances.
Melanie: How are the medications today working for seasonal allergies? Are they working well? Are you hoping that some of them are changing? Some of them are over the counter, and some of them are prescription – speak about treatments.
Dr. Rich: Yeah, so actually, when you come to the primary care office if you have a mild symptom, we can usually treat you with some relatively well-known and straight-forward over the counter medicine. The mainstay – we have two things that we use. One is the nasal spray that’s a steroid nasal spray. Fluticasone is the one that’s available over the counter. This helps enormously for people who have a runny nose, the sneezing; even the itchy eyes actually can be treated with a nasal spray.
The other one that we typically use either added on to the nasal spray or by itself is the antihistamine. We tend to use the second generations -- things like brand names Claritin, Zyrtec, and Allegra people know them by, and they have generic names – because those are the second generation and they’re not as sedating as the first-generation antihistamines. We usually start with those or with the nasal spray, or we can do a combination. If people have – and that actually works for the majority of people. Even people with moderate symptoms that tend to work really well.
You can add in other things. You can add in a decongestant – pseudoephedrine, which is known as Sudafed – to the antihistamine. That helps for people who have the congestion or who weren’t helped by just the antihistamine alone. We also have eye drops that we can add – antihistamine eye drops. If the pill or the nasal spray is not also helping and the eye symptoms are really bad – those itchy eyes, we can add a specific eye drop. There are even more than those, but I would say that those are sort of – starting with the nasal spray, the antihistamine, adding a decongestant, and an eye drop, we can usually treat most peoples’ symptoms.
Melanie: What a great explanation. What about home and lifestyle? Do you want people to do things like Neti Pots or nasal lavage? How do they steer clear of some of those triggers if they have to be out and about?
Dr. Rich: Absolutely, yes. There is a big component of prevention when it comes to allergy. There is a big component of prevention when it comes to allergy. Things that people can do to stop themselves from getting into a really bad allergy attack – number one don’t go outside on high pollen days. It sounds a little bit crazy, but it actually is really effective when you just avoid those days when the pollen is really high when you see that powder covering the cars.
And then, particularly when you’re indoors, you should be sleeping with the windows closed. If you have air conditioning, that will be really helpful because you will filter the air that comes into your house. I think that those things can go a long way towards preventing allergy attacks. Even things like when you come home at the end of the day, before you get into bed, rinse off in the shower just to get the pollen off of your body and out of your hair. That can help to sort of reduce the allergic triggers. And what was the other question you asked me?
Melanie: About Neti Pots, nasal-
Dr. Rich: Reducing triggers-
Melanie: Yeah, nasal lavage.
Dr. Rich: Oh, right. Yeah, so I really do recommend that. I think the simplest thing – and I should have mentioned this even before we start the nasal steroid spray that I mentioned – is that people can use saline spray and do that four or five times just to rinse the nose and it gets the pollen out of the nose, and it can be very helpful. It can be a little bit tricky if people are really stuffy, and then you might want to try a decongestant and then continue with the nasal rinse.
For people who need the nasal steroid, we also recommend doing just the saline – the salt water rinse – before you put the steroid in. And then, I always find that the Neti Pot is a little bit more of a commitment for people, but it’s definitely effective. If people are willing, the Neti Pot alone could be all that a person needs to control their allergy symptoms, or it can be used, like we said, in conjunction with the nasal spray or the antihistamine. As long as they start with sterile water -- distilled water or they boil the water just to make sure there aren’t any bacteria, then they can rinse the sinuses with it, and it’s a great way to control allergy symptoms. I’m definitely an advocate of that.
Melanie: And as you said, if they’re willing, because it may not be the most comfortable thing, but it certainly gives your nose that shower that we’re not always able to give. Wrap it up for us, Dr. Rich, with your best advice about allergies, and maybe preventing them in the first place.
Dr. Rich: Absolutely. One of the mainstays of treating allergies is to start early. If you know that you have allergies and you know that Springtime has sprung, start your antihistamine, or start your nasal steroid, or even your saline nasal spray before the symptoms get back because you can control them better. You can visit your primary care doctor if you have tried the over the counter and it’s not working for you, or you want to discuss how to treat yourself best. And that coupled with trying to keep the windows closed and stay inside on the high pollen days should hopefully help people get through the allergy season.
Melanie: Thank you so much, for being with us today. It’s really important information for listeners to hear. This is Boston Med Talks with Boston Medical Center. For more information, you can go to BMC.org, that’s BMC.org. This is Melanie Cole. Thanks so much, for listening.