Health & Fitness

AaaaaaaAAAACHEW!!!

Don’t stifle it. Rear back; aim, deflect and/or cover it to minimize the fallout; and let it curl your toes. Your nose simply sensed some passing detritus it wanted to expel at 200 mph, and diverting that into your sinuses can harm them. An occasional sneeze means nothing, is far more socially acceptable than some of its competition, and feels great. Enjoy, and pretend you couldn’t stifle it!

But frequent sneezes usually mean something. If you have allergic rhinitis (AR, AKA hay fever), they often mean, “DANG! Spring is here!” And it doesn’t even have to be spring; hay fever strikes whenever whatever you’re allergic to is spewing whatever you’re allergic to.

Let me rephrase that. We’re not really allergic to whole trees, bushes, or animals. The irritant is actually microscopic bits – allergens – those sources produce. Allergens include plant pollens (the worst offenders are trees, weeds, and grasses), animal dander (microscopic bits of crud your cat or wookie sheds 24/7), the mold spores and dust mites that surround us, and other substances such as foods. Any given pollen has a favored season; your other allergens may bother you all year. Visible flowers are seldom allergy threats.

Allergens often cause nasal obstruction in children, and the obstruction can grow with the children to produce sleep problems including mouth-breathing, snoring, frequent colds and ear infections, and apnea (ultimately a serious heart health threat). Lost sleep, in turn, can lead to bed-wetting, sleepwalking, and such behavioral problems as short attention span, irritability, poor school performance, and excessive daytime sleepiness. Could early AR intervention prevent many cases of “ADD”? Could correcting your child’s breathing improve his personality, school performance, athletic ability, and/or cardiovascular health? If your kid’s breathing hassles last more than a couple of weeks, get him to a pediatric ENT specialist; children are totally dependent on us for their medical care, and allergy treatments beat Ritalin by a wide margin. A very common infancy milk allergy, untreated, could lead to decades of life-threatening asthma.

The allergies you’re allergic to irritate the mucous membranes lining your nose, sinuses, eyes, and/or throat, triggering several symptoms as our bodies try to neutralize and expel the invaders. Our eyes itch and burn, sandy granules form in the inner corners of our eyes, our nose and/or eyes may run or even gush, our throat or sinuses may hurt, our sinus and/or nasal output may run down our throats and make us cough, and we may be drowsy. Severity ranges from a PITA to disabling, and 60 million people in the U.S. alone suffer from it.

Imagine a cold (i.e., infectious rhinitis) that lasts for weeks, months, or year-round (a real cold lasts only for days). Now crank up its severity tenfold, to the point the victim can’t see, breathe well, sleep, drive safely, perform desk jobs, take final exams, taste anything, or carry enough boxes of Kleenex to last more than a couple of hours. That’s allergy season for many of us, including yours truly before medical science cured me, and some people have this all year long! We may be predisposed to AR by genes, eczema, asthma, growing up overprotected from germs, or overexposure to common allergens. In turn, AR can make us more susceptible to colds and asthma. Most victims grow into their allergies between the ages of one and 30 (it takes exposure to establish an allergy), and some outgrow their allergies by middle age. Untreated, AR can lead to a variety of chronic, maybe permanent, ear and nose problems.

Theoretically, we should usually breathe freely, with ease, through our noses, all day and night. Fighting for air is miserable and harmful; if you must open your mouth to breathe when not exercising hard for more than a couple of weeks a couple of times a year, find out why and fix the problem before it harms your health. Toughing AR out is for uninformed masochists; no one should have to live that way. If your doctor suspects AR, have her refer you to an allergist for specific, simple tests to determine exactly what you’re allergic to. Then avoid it.

Hallelujah! You’re cured. End of article, end of problem, end of clawing at your eyes with your fingernails.

Alas, now back to the real world. We can’t all move away from juniper trees, avoid cats, eliminate all molds from our house and yard, or make people on the street stop bathing in perfume. Ragweed pollen can drift across several states, we ain’t going to fire Rover, and those electronic breeze air cleaners do nothing for AR and actually exacerbate your asthma. They’re TEEVEE, folks, not science.

Really, though, avoiding your specific allergens is your first line of defense. Once your allergist has identified them, choose from this menu to avoid the ones that set you off:

  • Stay in your closed home or office more during pollen season and especially on windy days in high pollen count periods (watch the TV weather and/or look for pollen in the air or on your car). Pollen production depends more on the calendar than on the weather, but in its season, it tends to peak early on warm, dry, breezy mornings.
  • Get rid of the cat, replace your carpeting with washable rugs, and/o replace your mattress. Cats are major 24/7 dander producers, there are no allergen-free cats or cat treatments, and their dander hangs around for many years in a mattress.
  • Run HEPA air filters in the closed bedroom 24/7. AC filters, duct cleaning, hypoallergenic bedding with pore size > 6 microns (the majority), and high-end vacuum cleaners don’t stop dust mites.
  • Keep Chewbacca outside during pollen season (he’s a walking pollen magnet even if you’re not allergic to his dander).
  • Choose between your hay fever and your smoking spouse (any smoke cranks your AR way up).
  • Shower and launder more often.
  • Reduce household molds by dehumidifying the house, fixing leaks, and sealing a damp basement.
  • Wash your bedding in hot water, and don’t even think about drying your laundry outdoors during your allergy season.

To help remove allergens you’ve already inhaled, flush your nasal passages with saline solution, AKA salt water. Buy Salinex or Ocean, or add half a teaspoon salt and a pinch of baking soda to a cup of water, and snort a handful. The homemade version stays safely sterile for only a day; mix a fresh batch each day.

Your next line of defense is drugs to block the culprit that causes your symptoms. Symptoms are caused not by the allergens themselves, but by the histamines your body produces to fight the allergens you’re allergic to. Big chain stores offer half-price, house brand, true equivalents for many of the drugs discussed here.

One group of hay fever drugs – the antihistamine -- tries to “neuter” histamines before we react to them, and should be taken before and during your allergy season. Older OTC antihistamines such as Benadryl and Chlor-Trimeton make us really groggy (Benadryl’s active ingredient is diphenhydramine, the main ingredient of many OTC sleeping pills), but newer ones such as OTC Claritin and the more effective prescription Allegra let us think more clearly and drive more safely. In general, antihistamines help most of the symptoms except nasal congestion, a shortcoming often overcome by combining oral and nasal antihistamines.

The most effective AR meds are nasal spray prescription corticosteroids such as Beconase, Rhinocort, Nasarel, Flonase, Nasonex, and Nasacort. Their primary side effect is nasal membrane irritation. Safer, but less effective, are mast cell stabilizers such as Nasalcrom, Alimide, and Alocril. There’s also a new nonsteroidal prescription oral drug, Singulair, which fights asthma and seasonal AR in yet another way, by blocking leukotrienes our bodies produce to oppose allergens. Systemic (oral or injected) steroids for AR are unadvised due to side effects.

Those meds take weeks to become effective, so are ineffective as an overnight cure for an AR attack. They should be used throughout your allergy season, beginning weeks before it begins. For occasional, instant, overnight, relief from a nose too stuffed for sleep, there’s the brute force, last ditch, short-term-safe, nonsteroidal OTC nasal decongestant. A simple snort of Afrin, for example, can shrink your swollen nasal passages in seconds to clear your head for an entire night of pleasant sleep. Similar choices include Actifed, Dristan, Sudafed, Allerest, and Neo-Synephrine; ask your drugstore pharmacist which one s/he recommends. But remember: if used more than three or four successive nights they are likely to cause much worse congestion. Save them for the occasional real sleep emergency when you feel like you have footballs up your nostrils.

The right mix of OTC eye and nose drops and pills (again, ask the drugstore pharmacist) can safely mitigate symptoms enough to let many sufferers get on with their lives, maybe even in relative comfort. If not, ask your doctor about prescription drugs. At the very least, they don’t knock us out like older OTC antihistamines do. Whether it takes OTC or prescription drugs to control your AR, allergen avoidance is still important, as allergen exposure challenges even the best meds.

For those whose immune systems really go berserk and drive their symptoms off the charts, there’s immunology -- allergy shots, hundreds of them, spread over years. If your insurance covers the cost, there’s no downside. The needle is too small to feel, and if they work for you, you’re cured. Mine were worth every shot, including the need to carry my vial of “formula” with me on prolonged trips so I could drop into any clinic and get my weekly or monthly shot.

Hay fever need not be endured. It’s usually preventable or curable, or at least reducible to a minor nuisance, with an informed mix of effort, OTC meds, and/or the assistance of physicians. Don’t let it ruin what should be a good night’s sleep, a great time of the year, or your child’s health. For much more information, ask Google about “allergic rhinitis” “hay fever”, including the quotes to narrow your results.

Bless you.

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