Hay Fever: Should You Move to Escape the Misery?
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Hay Fever: Should You Move to Escape the Misery?

Twenty-seven sneezes. That's what forced Ann to stop her car alongside the road on a windy spring day in Nebraska. Ann's prescription medication was no match for Nebraska's airborne pollens. She's thought about moving back to Colorado where, with the exception of one bad spring, she lived free of hay fever for six years.

Allergy and immunology specialist Betty Wray, MD, of Atlanta, Georgia, says that if Ann were her patient, she'd recommend allergy testing to learn exactly what Ann is allergic to. "It's not painful or dangerous, and it gives you so much information," she says. Wray believes that avoiding allergens and getting treatment are reasonable options for Ann—and far less unsettling than moving.

Testing, for example, could reveal that Ann's allergies are caused by indoor irritants, such as molds or dust mites. If so, moving would probably not be the answer. Ann could avoid these allergens by dust-proofing her house, using electronic air cleaners to filter the air, and washing her bedding frequently.

The Myth of Hay Fever Havens

Following medical school, Murray Grossan, MD, a board-certified otolaryngologist (an ear, nose, and throat doctor) in Los Angeles, was stationed in Washington, DC, assigned to run an allergy clinic. "I didn't have hay fever in Georgia where I went to school, but when I moved to Washington, the hay fever hit me full blast," he says. He moved to Los Angeles, fully expecting to be allergic to local pollens, but it never happened. "I'm one of the lucky ones," he says.

People who move and leave their allergies behind for good are the exception. For most people, there's a two- to three-year "honeymoon phase" before they react to pollens and molds in the new environment. And even in environments once viewed as havens for allergy sufferers, things have changed. Wray points to the addition of flora and fauna to Phoenix, Arizona, and Grossan notes the planting of cedar trees in Japan.

Another theory to explain why former havens are no longer hay fever-free is that yesterday's hay fever refugees passed on the genetic predisposition for allergies to their descendants.

"There are so many factors involved in allergies—including stress, predisposition, and psychological issues—that I would be very hesitant to recommend a move," says Grossan. Both Grossan and Wray say that taking a vacation, especially an ocean voyage, at the height of allergy season is a good idea. "Or go to the seashore where the wind blows from the ocean," Grossan suggests.

Treatment Options

If you get tested and find out that you're allergic to allergens such as tree, grass, or weed pollens, Wray says that beginning medication before the season starts is often the answer.

"We have wonderful medications available that are relatively nonsedating and have fewer side effects than medications in the past." Wray speaks from experience. Her own allergies are under control today, but they weren't always. "My nose dripped all the way through medical school. I couldn't tolerate any of the medications available at that time."

Allergy Medications

She'd recommend that Ann first try cromolyn (Nasalcrom), an over-the-counter nasal spray. "It's a preventive type spray that will work better if she knows what she's sensitive to, knows when the season begins, and gets started on it before the fact," Wray says.

If that doesn't help, Ann's next step might be a prescription antihistamine or cortisone nasal spray and possibly an anti-inflammatory medication. These, too, work best if started before allergy season is in full swing. Wray says the objective of any treatment is to prevent the first attack, because of what she calls a "priming effect." Cortisone nasal sprays (available only by prescription) are among the most effective of allergy medications. These generally are well-tolerated and have been shown in some studies to be even more effective than prescription nonsedating antihistamines.

"Once you've had a reaction, the next reaction is a little worse, and it takes a little less pollen to trigger a reaction," she says. "It's like priming a pump. Get it started, and it doesn't take much to keep it going."

Another mistake people make is taking medications only when symptoms appear, according to Wray. "If people have very mild allergies, taking medications symptomatically may give them relief. But most people need to take them every day during the season."

Allergy Shots

If medications don't provide Ann with adequate relief, Wray says she should consider a course of allergy shots . "We call it allergy vaccine now because 'immunotherapy' was a confusing term," she says. Shots are typically given once or twice a week during the build-up phase, then once every two, three or four weeks during the maintenance phase.

"Our rule of thumb is that if the shots have worked well, we continue them [for] at least three years," she says. "If they don't work, that suggests we don't have the right mixture, or we're giving too large a dosage—and maybe that's triggering the symptoms."

Sublingual Immunotherapy

Another way of administering immunotherapy that does not involve shots is sublingual immunotherapy (SLIT). This treatment has been used in Europe for many years, with a growing numbers of allergy specialists in the US that are using this method.

SLIT involves daily administration of liquid substance under the tongue, eliminating the need for shots. The treatment can also be administered at home, which eliminates the frequent and time-consuming doctor’s visits that are a part of traditional immunotherapy. Based on available research, mostly done in Europe, SLIT has been found to be efficacious and safe. Many specialists, however, still do not use it routinely. Talk you doctor to see if this method could be a good option for you.

Sinus Irrigation

Grossan recommends daily irrigation of the sinus passages with a saline solution to wash out the antibodies to which allergens cling. Although many doctors recommend saline nasal sprays, Grossan further advises against sprays containing a preservative called benzalkonium, which he feels can aggravate allergies. You should consult your otolaryngologist for detailed instructions on how to perform sinus irrigation, as well as for directions on making a home nasal rinse, if recommended.

Know Your Season

Besides knowing your allergens, it's important to know in advance when they'll attack, so you can start your medication or plan your escape. You can figure on tree pollen in early spring, grass pollen in late spring through summer, and weed pollen from spring through fall. Ragweed begins in late summer and lasts until the first frost.

The closer you are to the equator, the earlier the season begins, so if you live in Florida, you'll start having symptoms long before your cousins in Minnesota. Molds typically appear in the fall when leaves decay. Damp or humid conditions produce molds at other times of the year, and there are even molds that thrive in dry climates.

Say No to Suffering

"People need to be encouraged to get help [for their allergies] for the sake of [their] quality of life," says Wray. "People with significant hay fever may not be sleeping well, may have headaches, may not be able to focus at work, and may miss work or school. They put up with symptoms not realizing that relief is available and that life could be so much better."

RESOURCES:

American Academy of Allergy, Asthma and Immunology
http://www.aaaai.org/

Patient Health Info Index
American Academy of Otolaryngology—Head and Neck Surgery
http://www.entnet.org/healthinfo/

References:

Alvarez-Cuesta E, Berges-Gimeno P, Mancebo EG, Fernandez-Caldas E, Cuesta-Herranz J, Casanovas M. Sublingual immunotherapy with a standardized cat dander extract: evaluation of efficacy in a double blind placebo controlled study. Allergy. 2007;62:810-817.

American Academy of Allergy, Asthma, and Immunology website. Available at: http://www.aaaai.org

Facts about hay fever. American Lung Association website. Available at: http://www.lungusa.org/air/envhayfever.html .

Fiocchi A, Pajno G, La Grutta S, et al. Safety of sublingual-swallow immunotherapy in children aged 3 to 7 years. Ann Allergy Asthma Immunol. 2005;95:254-258.

Hay J. Allergies: Questions You Have...Answers You Need. People's Medical Society; 1997.

Marcucci F, Sensi L, Allocca G, et al. Sublingual immunotherapy: from safety to mechanism of action [review]. Allerg Immunol (Paris). 2007;39:101-103.

Omnes LF, Bousquet J, Scheinmann P, et al. Pharmacoeconomic assessment of specific immunotherapy versus current symptomatic treatment for allergic rhinitis and asthma in France. Allerg Immunol (Paris). 2007;39:148-156.

Tahamiler R, Saritzali G, Canakcioglu S. Long-term efficacy of sublingual immunotherapy in patients with perennial rhinitis. Laryngoscope. 2007;117:965-969.

Young SH. Allergies: The Complete Guide to Diagnosis, Treatment and Daily Management. Consumer Reports Books; 1992.



Last reviewed July 2007 by Marcin Chwistek, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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