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April 20, 2019
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It is that time of the year again! Your eyes are watery and you have this itch in the back of your throat! You are sneezing constantly and your nose is running like a faucet! You went through a box of tissues in a morning and your eyes are heavy and swollen. It is Hay Fever season again! We are excited to run outside and smell the flowers but there are a lot more than just love in the air! There is also mold and spores that seem to turn your body into a water fountain. If you get seasonal allergies every spring it is good to be aware of what you can do to help you get through the season without suffering from the symptoms of Hay Fever. We will look at various things you can do to manage your Hay Fever including non-pharmacological therapies as well as medications and which best suits your needs.

What is Hay Fever or Seasonal Allergies?

This is an allergic response our own body has to do with mold, spores, trees, grasses and weeds that release pollen particles into the air as they attempt to fertilize other plants. Some of the symptoms of Hay Fever include:

Runny Nose

Congestion

Sneezing

Cough

Itchy nose or Throat

It should be noted that sometimes symptoms of Hay Fever and cold symptoms are very similar. The one symptom that be used in most cases to differentiate between Hay Fever and the Common Cold is itchiness. Hay Fever is often associated with itchiness such as in your eyes, ears, mouth and throat. You can sometimes get an itchy throat with the common cold but this symptom of itchiness is much more prevalent with Hay Fever.

Medications

Antihistamines

Antihistamines are the most commonly used medications for the management of Hay fever. Histamine is a chemical made by your immune system that helps to signal to the body to start inflammatory responses and helps to medicate the reaction of itchiness. These types of responses are triggered by our bodies immune system to help fight off what it perceives as foreign invaders. A side effect of this though is that we do experience the many symptoms of Hay Fever as your body tries to fight off the foreign invaders.

First Generation Antihistamines

First generation antihistamines are antihistamines that are used generally for more serious allergic reactions such as skin eruptions. The benefit to using a first generation antihistamine is that they work fairly effectively and quickly but it does cause sedation. Benadryl is the most commonly used first generation antihistamine for allergic reactions.

Benadryl (Diphenhydramine)

Benadryl can help in the management of Symptoms of Hay Fever in that it works very quickly. However the downside of using Benadryl as we discussed above it is that it can make you quite drowsy and you may not be able to function during the day. If anything it will make you feel like having a nap. Benadryl is helpful for allergies in general but maybe reserved for more serious allergic responses then Hay Fever. An example would be is if you were getting a rash that is spreading or getting raised skin your physician may recommend that you do take Benadryl. Sometimes it is taken just at night to take advantage of its sedative side effects so patients can get some decent sleep. In kids however it can cause what is called the Paradoxical effect. In kids instead of getting sleepy they can instead become stimulated and hyperactive and end up bouncing off the walls instead of going to sleep. Overall because of its sedative side effects generally Benadryl and other first generation antihistamines are not used to help in the management Hay Fever.

Second Generation Antihistamines

Second generation Antihistamines are used commonly for signs and symptoms of Hay Fever as they can help to alleviate the symptoms but are not associated with excessive sedation the way first generation antihistamines are. Although they can help with most symptoms of Hay Fever they generally do need to be combined with decongestants to help with symptoms of congestion. Sometimes patients will take a particular second generation antihistamine for a while and then they will notice that it is not working as well. This is known as the phenomenon of Tachyphylaxis. So in this case it will be helpful for you to switch to another second generation antihistamine so you can continue to get relief from your Hay Fever.

Aerus (Desloratadine)

Aerius is a medication that is over the counter that can be used in the management of Hay Fever. It can help with all the typical symptoms of Hay Fever. If you are experiencing congestions as well then you may need to get the combination version that also includes a decongestant.

Reactine (Cetirizine)

Reactine is an over the counter medication that also is used for the management of Hay Fever symptoms. The over counter strength comes as strong as 10mg. However as a prescription product it comes as 20mg and sometimes is a benefit for patients on their insurance plans. Reactine is also available in combination with a decongestant for patients who are suffering more with congestion.

Claritin (Loratadine)

Claritin in another over the counter medication that helps with the symptoms of Hay Fever and is also available in combination with a decongestant for patients who are suffering from congestion.

Allegra (Fexofenadine)

Allegra also help with the management of the symptoms of Hay Fever. It is an over the counter medication that is also available in combination of a decongestant that can help with the management of congestion.

Blexten

Blexten is a newer medication that is an antihistamine but is only available by prescription. It can help with Hay Fever symptoms but it also helps with congestion without the use of an oral decongestant. Oral decongestants for some patients can increase blood pressure so it is not recommended for all patients. Blexten therefore may be great for patients who are also suffering from congestion but cannot take an oral decongestant.

Decongestants

Decongestants help with the management of congestion and are often used in combination with antihistamines as they alone cannot help with the symptoms of congestion. However there are some downsides to using decongestants in that they can cause stress on your cardiovascular system by increasing blood pressure as well as your heart rate. If you are not on blood pressure medication and you heart rate and blood pressure are well controlled it should be safe for you to take a decongestant but it is always a good idea to ask your pharmacist or your physician for consult.

Pseudoephedrine

Pseudoephedrine is often used to manage congestion that accompanies Hay fever as most of the anti-histamines do not manage Hay Fever on their own. You should definitely speak to a health professional before using any type of decongestant as they can increase blood pressure and put an increased strain on your heart. For that reason it is not recommended for everyone. Some of the side effects associated with decongestants include rapid heart rate, increased blood pressure and insomnia. Generally the earlier in the day you can take a decongestant the less likely it will be to interrupt your sleep. Avoid taking this class of medication in the evening as it may make it difficult for you to fall asleep.

Phenylephrine

Phenylephrine is also a decongestant that helps in regards to management of your nasal congestion that may appear with Hay Fever. Phenylephrine is less potent than pseudoephedrine generally as such it may be better tolerated.

Nasal Corticosteroids

Nasal Steroids can help with congestion and are preferred sometimes over oral decongestants in that they can help with the congestions that can accompany Hay Fever but they do not increase blood pressure or put extra strain on a patient's cardiovascular system. They are available over the counter as well as by prescription. It can be advantageous to get one by prescription as it may be covered through your insurance. In terms of side effects of using nasal steroids is it can cause nasal dryness and make your more prone to nosebleeds.

Eye Drops

It is also handy to use eye drops for itchy watery eyes as a result of seasonal allergies. Eye drops are also available over the counter as well as by prescription. Eye drops are well tolerated and are able to help you with your symptoms. When comparing over the counter to prescription there are distinct differences though. Prescription eye drops are generally used once daily or at most twice daily. For over the counter eye drops you have to use them up to four times a day for them to be effective and it can take up to four weeks to see their full effects. Due to convenience and increased compliance I recommend that you get a prescription for eye drops for hay fever symptoms through your pharmacist or family doctor.

Non-Pharmacological Measures

Here are some things you can do around the house to minimize your exposure to seasonal irritants:

Close doors and windows during pollen season.

Don't hang laundry outside — pollen can stick to sheets and towels.

Use air conditioning in your house and car.

Use an allergy-grade filter in your home ventilation system and change it regularly.

Avoid outdoor activity in the early morning, when pollen counts are highest.

Stay indoors on dry, windy days.

Use a dehumidifier to reduce indoor humidity.

Use a high-efficiency particulate air (HEPA) filter in your bedroom and other rooms where you spend a lot of time.

Avoid mowing the lawn or raking leaves.

Wear a dust mask when cleaning house or gardening.

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