Being Nosey about Allergies & Non-allergies
Spring is in full swing and with it comes the flowers, trees, and the nose problems. I'm guessing most of us have had the runny nose, sneezing and nasal congestion that we assume comes from allergies, but why does it happen and how can we best avoid it?Your body has taken a very long time to try to figure out what's OK to come in and what should be kept out and a lot of things have factored into that - where you grew up, how much time you spent outside, who or what lived in your house, what your home was made of, what the air was like, what you eat and the list goes on. Your body generally has an inclination towards keeping pollens out as well as other irritants like smoke and strong scents.
Your body does this in 2 ways generally. First, it swells up, like after a bee sting or the sensation of nasal congestion or eye swelling, in order to make it harder for the offending agent to move any further into your system. The second way is usually by secreting liquid, which can help trap any particulates in the air like flies in a spider web. When this happens in the nose, it's called rhinitis (rhin for nose, itis for inflammation) and technically is rhinosinusitis because the lining of your nose is continuous with the lining of the sinuses, like the curb following a road into a bunch of cul-de-sacs. When it happens in the eyes, it's called conjunctivitis. Unfortunately, these defense mechanisms aren't great at turning off quickly once the desired effect has been reached, which is why some people will get an over-reaction and excessive swelling and drainage causing congestion and lots of mucus everywhere.
Rhinitis can be caused by basically any respiratory virus as well as basically any allergen. Allergic Rhinitis is also called Hay Fever. But there's also a type of rhinitis called "non-allergic rhinitis". The main difference is that the non-allergic type does not have sneezing or nasal itching. Non-allergic rhinitis is usually more related to irritants like smoke, fragrances/odors, temperature/pressure changes, and hot/spicy foods.
Many people will be confused when they develop allergies after never having them before but this can and does happen often. Anybody will have a reaction if the concentration of something is high enough in the air but over time your body becomes more sensitized to make stronger reactions the more you are exposed to something it sees as an allergen. In recent years, we had a marked shift in pollen counts as we swung between drought and flooding. Too dry and there's a lot of dust in the air, too much water and there's too many flowers blooming. This can also happen when you move and are exposed to new allergens.
While the best way to treat allergic/non-allergic rhinitis is avoiding whatever the trigger is, that's usually not possible for most people. For many years, oral antihistamines like Claritin (loratadine), Zyrtec (cetirizine), and Allegra (fexofenadine), have been the mainstay. But the more we learn about medications, the more we realize that if the problem is just in one spot, there's no reason to send medication everywhere in your body with a pill.
Thus, the most recent recommendations from the allergists is that intranasal steroid sprays like Flonase (fluticasone) and Nasacort OTC (triamcinolone nasal spray) are the best options for treating and preventing rhinitis (though not from viruses). After that, a topical antihistamine is usually a good next step (Azelastine) but it is a prescription so most people go with one of the oral antihistamines I mentioned earlier. Benadryl (diphenhydramine) is a good option at night as it is an older and stronger antihistamine, but also makes most people too drowsy for work or operating heavy machinery.
Sudafed (pseudoephedrine) can usually be used safely along with those as an adjunct decongestant. The only caveats are that you need the real stuff that the pharmacists keep behind the counter (to prevent people from buying lots of it to make methamphetamine) and the over-the-counter alternative (phenylephrine) is basically worthless. There are a bunch of other less commonly used treatments that we can talk about if needed. Afrin is an alternative nasal spray version of sudafed but can only be used for about 3 days at a time or it risks making the nasal congestion worse.
People often ask about seeing an allergist. In general, there is little they can do or recommend for allergies that I can't except for immunotherapy, a.k.a. Allergy shots. These are a big step to take and require a lot of visits for usually at least a year and work well for the worst cases but generally most people can get them under control without needing an allergist.
I definitely recommend checking out www.pollen.com if you know you have allergies to get the reports coming up in the near future and start using the treatments I mentioned above a few days beforehand. Don't let your nose keep you from stopping to smell the flowers.