Dr. Schemel's Blog
"I plan to use this space to comment on medical issues that are in the news, help answer questions that I encounter, and generally philosophize. I’ll add links to interesting sites and maybe even pictures. Check back occasionally for new updates."
- Lawrence Schemel, MD
Allergies or Infection?
Is it allergies or an infection, and when do I need to make an appointment to see the doctor? Since it is April and the flowers and trees are blooming, I get this question a lot. To start with, if you know you have spring allergies, then it’s allergies. There are quite a few over-the-counter allergy products that are safe for almost everyone to try. First line is the antihistamines. These have been the mainstay of allergy treatment for a long time. The older ones like Benadryl (diphenhydramine), Chlor-Trimeton (chlopheniramine), and Tavist (clemastine) work well but may cause drowsiness. That’s good if you’re trying to sleep but not so good during the day. You should avoid these if your job requires good concentration or if you operate heavy and/or dangerous equipment. The second-generation antihistamines are often a better choice. These drugs do not penetrate into the circulation around the brain and have much less drowsy side effects. They also last longer so you don’t have to re-dose as often. These include Claritin (Alavert, loratadine), Allegra (fexofenadine), and Zyrtec (cetirazine). One special note about Zyrtec – some people do have mild drowsiness with this and the FAA does not allow operation of an aircraft if you have used this within the previous 24 hrs.
Have you tried nose sprays? To begin with, saline nasal sprays are very good at removing pollen from your nasal passages and will help reduce the amount of allergic reaction that you develop. You need to use 2 sprays per nostril and repeat often – especially if you have been outside and have been exposed to a good dose of pollen. A medicated nasal spray you can get over-the-counter is NasalCrom. This works differently than antihistamines and works well in combination with them. However, unlike antihistamines, it will not block the effects of histamine that has already been released so will not stop allergic symptoms that you are currently experiencing. However, If you use it prior to exposure and then continue to use it routinely during your allergy season, it will decrease the sensitivity of the cells that make and release histamine so there will be less of the agent around to make your nose run.
If these strategies are not giving you the relief you need, then it’s time to schedule an appointment. I will discuss your symptoms and then recommend other prescription treatments that should help. Sometimes a steroid shot will help if your symptoms are particularly severe. I will also make sure that there is not secondary infection that needs to be treated. Some people with allergy symptoms that occur all year (perennial allergies) need desensitization treatment. This is performed by an allergy specialist, and if this is the case with you, I will help arrange a consultation.
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April 19, 2013