Your Wellness with NorthBay Health Experts

Your Wellness is a blog focused on general health topics and information from NorthBay's excellent cadre of health care professionals.

Battling the Blossoms

May 31, 2018

The beautiful blossoms of spring may be nice to look at but for allergy sufferers, the desire to be rid of them is certainly understandable.

Since the bloom is unavoidable, however, managing the symptoms of seasonal allergies needs to be the focus, said NorthBay pediatrician Michael Ginsberg, M.D. And there are plenty of options. "Today, the vast majority of your allergies can be treated with over-the-counter products," said Dr. Ginsberg.

Using an over-the-counter nasal steroid spray as directed is the first step in managing allergy symptoms, said Dr. Ginsberg. The three brands available over-the-counter are: Flonase (fluticasone proprionate), Nasacort and Rhinocort. "Flonase stings and burns, while Nasacort works just as well without the stinging and burning," Dr. Ginsberg said. "I've never had a compelling reason to use Rhinocort over the less expensive generics. All of these can be had for as little as $10/month and are probably available at your local big box store. I usually use Nasacort."

Dr. Ginsberg adds that when taking a nasal steroid, it's really important to take it every single day until the end of allergy season. "These medications take 48-72 hours to reach peak effect, so although they are a daily-use treatment, they are not for immediate symptomatic relief," he noted.

If you have itchy eyes, Dr. Ginsberg recommends ketotifen drops (Alaway or Zaditor). "They burn a bit, but will stop the itching in seconds for the vast majority of people," he said.

If over-the-counter nasal steroid spray and eye drops fail to manage your symptoms, Dr. Ginsberg suggests adding a non-sedating antihistamine such as Cetirizine (Zyrtec), which he said works well in the majority of patients, but may cause mild sedation in a small minority of patients. Fexofenadine (Allegra) is quite effective and non-sedating, he added, but can cause insomnia, so he doesn't recommend taking it at night.

As for loratadine (Claritin), he said to skip it, as he has found "it only works well in a minority of patients."

If, after trying all of this, your allergy symptoms are still not under control, Dr. Ginsberg says it is time to see a doctor for prescription allergy medication.

"If the complaint is itchy eyes, I switch from ketotifen to either olopatadine (Patanol, Pataday) or azelastine (Alastin and others)," he said. "If the complaint is continued nasal congestion, then I add montelukast (Singulair)."

If even this doesn't help, Dr. Ginsberg said he would send you to an allergist to find a long-term treatment option such as immunotherapy (aka allergy shots), given every week.

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