Springtime is just starting to warm up in Beijing, and it feels great to be putting away those thick down coats and dusting off those pastel shirts and Easter finery. It also heralds an annual spring tradition in my clinic– patients feeling miserable with sneezing, itchy and watery eyes. It’s allergy season! I also get allergies every year, so I know firsthand how miserable this can feel. The medical term for spring allergies is allergic rhinitis, which literally means ‘inflammation of the nose’. Most people more commonly call it hay fever, which still confuses me to this day as allergies don’t cause a fever. But certainly the hay part makes sense, as grasses are a major cause of these symptoms.
The chief culprit every spring is pollen, found first from the flowering trees and then from flowering plants. These tiny particles get breathed into the nose, and 5-10% of people develop an abnormally strong reaction to these particles, releasing too much of the chemical histamine and thus causing the typical allergic symptoms of sneezing, itchy and watery eyes, clear runny nose, and headache. Many also have other allergy-type illnesses such as asthma and eczema.
One of the healthiest treatments is very simple, and it’s almost free! It’s called nasal saline rinsing, where you literally squeeze salty water through each nostril and have the water flush out the other nostril or your mouth. While this may sound a bit gross, it actually does wonders to flush out those pollen spores and dust before they trigger an allergic attack. It’s also very useful for anyone with congestion, chronic sinusitis, colds and flu, and maybe even asthma. You can buy these pre-made kits in local pharmacies, but you can also make the solution yourself. All you need is a small squeeze bottle or what is called a Neti pot. It’s important to use purified, distilled water to ensure no fungus or bacteria get inside your nose and sinuses. Click here for more information on nasal rinsing.
The main spring allergy treatments are the over the counter (OTC) antihistamines. There are two generations, the first one including diphenhydramine and chlorpheniramine. These are quite effective but only last for a few hours, and they also cause drowsiness. Diphendydramine (AKA Benadryl) in particular is so sleep-inducing that it’s the active ingredient in most OTC sleeping pills such as Tylenol PM.
The second generation pills last almost 24 hours and cause much less drowsiness, but perhaps may not be as effective for some. Common pills include loratadine (Clarityn) and cetirizine (Zyrtec). If you have a lot of runny nose and congestion, sometimes adding the decongestant pill pseudoephedrine (Sudafed) can really help. This medicine is the “D” ingredient in the allergy combination pills such as Claritin-D. But pseudoephedrine also has common side effects, especially insomnia and loss of appetite. And it’s also notorious for being the base drug for methamphetamine, which is why in many countries this is no longer sold over the counter. Unfortunately, the new substitute decongestant phenylephrine (called PE on most packages) isn’t nearly as effective. Fortunately for us in China, we still use the more effective pseudoephedrine in our OTC medicines.
If you have bad eye symptoms of tearing and itchiness, an OTC eyedrop medicine can help, such as naphazoline (Naphcon-A). If you need stronger medicines, the doctor can prescribe longer-lasting eye drops such as olopatadine (Patanol).
If you or your child are still having bad hay fever symptoms even after using a combination of these treatments, it’s time to see your family doctor. They may decide you need prescription medicines such as the popular steroid nasal sprays. These are the medicines of last resort and are extremely effective, but they don’t work immediately. You need to take it regularly, once or twice a day, and after a couple of days you should have a dramatic improvement in your symptoms. Side effects are usually minor, including dry nose and nose bleeds.
Some people with severe hay fever need to take a combination of prescription nasal sprays plus OTC pills and eye drops — and the nasal rinsing! I think that’s perfectly fine for a few weeks and can really help their quality of life. Usually by May as summer approaches, most of us have survived our annual spring misery.
Follow me on: