Dear Dr. Roach: I am 62 years old and have no health problems except seasonal allergies during spring and fall. I exercise regularly and eat only healthy vegetarian food.
My symptoms are watery eyes and nose, itching, chest congestion, sneezing, coughing and difficulty sleeping at night due to pollen in the air during early spring/fall seasons. I have had this issue for the past 30 years, since moving from India. The allergies last for 10 to 15 days each season, and then I am normal. During allergy season, I can do only mild exercise since my chest is congested and breathing becomes tough.
During this time, I try not to go outdoors, use HEPA-filter fans and air conditioning to filter out indoor pollen and dust. This gives me a lot of relief most of the time. I take antihistamine drugs (Claritin) and cough medication for chest congestion if the problem is acute, but don’t like their side effects of raising blood pressure, uneasiness and sleepiness.
I was told by doctors that this is an immune overreaction issue and will never go away in my lifetime. Do you think I can train my immune system to gradually accept pollen? I hate to take medications due to their side effects. Is there any natural therapy, traditional or natural medication or homeopathy?
M.K.
In the spring, tree pollens are an abundant source of allergens, while in fall, weed pollens cause misery to those afflicted. Those may be your triggers, but it’s only a guess. Finding your specific allergy trigger can help in making a plan for avoiding allergens, although what you have done already is a very good start for most outdoor allergens.
Allergies are indeed an effect of a robust immune system that’s been activated against what it perceives as an invader. Tamping down the immune system is one effective strategy. Antihistamine drugs work against one part of the cascade. They are helpful for many, but don’t seem to be working perfectly well for you. Loratadine (Claritin) has the advantage of not getting into the brain, so it does not cause uneasiness or sleepiness any more than a placebo. It also does not raise blood pressure. It’s much more likely that it’s the decongestants causing that side effect. If one antihistamine doesn’t work, it is reasonable to try another, such as cetirizine (Zyrtec) or fexofenadine (Allegra). Nasal steroids are more effective than antihistamines for most, and the combination of the two is highly effective. Unfortunately, since nasal steroids take at least a week to reach full effectiveness, you would have to start them before symptoms develop in spring and again in fall. There are alternative medications, such as leukotriene inhibitors (another part of the inflammatory cascade) and mast cell inhibitors (which block a key cell in the pathway).
Some plant-based substances used in traditional medicines have similar effects as Western prescription or over-the-counter medication. For example, butterbur inhibits leukotrienes, similar to the prescription medication montelukast (Singulair). Quercetin stabilizes mast cells like cromolyn (Nasalcrom). Homeopathic medicines are expensive water, which do not contain enough active medication to have any pharmacologic effect.
Training the immune system to tolerate allergens is the theory behind immunotherapy, where minuscule amounts of what you are allergic to are injected, gradually increasing over time, until the immune system learns to tolerate it. Immunotherapy is an effective but slow treatment method. This must be done under trained supervision, since severe allergic reactions can occur.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu
