Sneezing, congestion, runny noses and itchy eyes. For people with seasonal nasal allergies — commonly known as hay fever — these symptoms are nothing new. They are as predictable as the explosion of tree pollen happening now in many parts of the country and the bursts of grass and ragweed pollens still to come.
But when it comes to treating those symptoms, there is some news this year.
First, consumers can now buy one kind of allergy medicine, a steroid nasal spray, without a prescription. Nasacort is the first drug in that class to make it to drugstore shelves.
Second, the Food and Drug Administration has just approved the first two of several dissolvable pills that may replace allergy shots for some patients. The pills contain grass pollen extracts and, taken over time, will help some patients build up tolerance – without having to return to a doctor's office for months or years of injections.
But those medications are not the first things to try, doctors say. In fact, some tried and true strategies don't involve medication at all. Among them:
• Pay attention to pollen counts. "In many parts of the country, pollen counts are highest between 5 a.m. and 10 a.m. and start to rise again after dusk," says Michael Foggs, an allergy specialist in Chicago and president of the American College of Allergy, Asthma and Immunology. Fit in your jog or gardening between those peaks or right after a cleansing rain, he suggests.
• Close your windows. "What I tell people with significant pollen allergies is that if they open the windows to get the breeze and fresh air, they also are inviting a cloud of pollen into their houses," says James Li, an allergy specialist at the Mayo Clinic in Rochester, Minn., and president of the American Academy of Allergy, Asthma & Immunology.
• Turn on the air conditioner. Or at least run the fan on your heating and cooling system. Good ventilation, combined with a high-efficiency filter, will help clean indoor air.
• Keep yourself clean. After some time outside, leave your shoes at the door, rinse off in the shower and put on fresh clothes.
• Try nasal rinses or sprays. Saline rinses and sprays can help wash pollen away and soothe tissues. "We tell patients who live near the ocean to go jump in" for the saltwater effect, Foggs says.
• Don't forget your eyes. Strategies that help your nose often help eyes too. But some people need more. That might include prescription eye drops but also can include rinsing the eyes with cold water, using cold compresses or chilling artificial tear drops before use, says Mark Blecher, an ophthalmologist at Wills Eye Hospital in Philadelphia. "People tend to forget that things that are so simple and safe can be very helpful," he says.
Many people will find they do need medications to get through their worst weeks or months. The first to try, because they have the fewest potential side effects, are the non-sedating antihistamines on drugstore shelves, Foggs and Li say. If those don't work, steroid nasal sprays — the one available over the counter and prescription versions — are good options, they say. Guidelines from several physicians' groups say the steroid sprays are the most effective medications for nasal allergies. Additional prescription medications, including antihistamine nose sprays, are available.
"There's individual variability in response to medication," Li says. "You can try several until you find the best fit."
When those fail, or side effects are a problem, there's immunotherapy — treatments designed to lower sensitivity by exposing patients to tiny but increasing doses of allergens (the offending pollens or other substances). Traditionally, that has meant going to an allergist's office to get shots.
The new immunotherapy tablets can, after a first dose in a doctor's office, be taken at home. But there's a catch: the first few in the pipeline work against just one allergen type at a time. For example, the first two tablets approved by the FDA work against grass pollens; others will work against rag weed or dust mites.
Allergy shots, by contrast, can combine extracts from several allergens. That comes in handy, since most people are allergic to more than one thing, Li and Foggs say.
Allergy specialists can test patients to find out exactly what those things are and whether any other conditions are causing their symptoms.