Seasonal allergic rhinitis is commonly called hay fever. Pollen is the problem… mostly from trees, grasses and weeds. It‘s all around us. You can’t get away from it. For example, samples of ragweed pollens have been collected 400 miles out to sea and two miles up in the air.

Dr. Clark Kaufman of Allergy & Asthma Center is an allergist and avid reader and traveller, as well as one who favors plant based foods such as soy products and whole grain rice as part of his daily diet.

Here he offers some suggestions for treating the widespread problem known as hay fever.

Q: Dr. Kaufman, why is it called hay fever when it is rarely caused by hay and there isn’t any fever?

Dr. Kaufman: When people are suffering, they generally attribute it to what they see happening around them.  Hay fever originally defined the late summer allergic rhinitis, which occurred when haying was taking place. Another term, rose fever, was used to describe the springtime problems people had with allergic rhinitis. We now know that’s due to grass pollen which peaks at the same time as the roses.

Q: Who are the people most apt to get it?

Dr. Kaufman: Allergies run in families. If one parent has it, you have maybe a 30% chance of getting it; two parents; about a 70% chance. 

Q: How do you know you have it?

Dr. Kaufman: The symptoms most obvious are sneezing, nasal itching, runny nose, and itchy eyes.  Some people only have nasal congestion and sinus problems during these seasons.

Q: Sounds a lot like a cold.  How can you tell the difference?

Dr. Kaufman: Well, this is one of the more difficult distinctions to make especially when there is congestion without sneezing or runny nose.  Generally when the symptoms last for more then ten days without sign of improvement it is likely that allergy is the cause. Also, during a cold a child would not feel well, maybe not eat well and maybe not act quite as normal as usual.

Q: Tell me about two particularly descriptive symptoms known as the allergic salute and the allergic shiner.       

Dr. Kaufman: Well, the allergic salute describes an upward motion of the hand against the nose, which is used to relieve the nasal itch, rather than rubbing side to side. Allergic shiners are the dark, bluish circles under the eyes which seem to be related to congestion deep in the nose. The color comes from the blood vessels which are close to the surface and can either be dark or bluish depending probably upon how fair your skin is.

Q: In order treat allergic rhinitis or hay fever how do you begin to find out the specific cause?

Dr. Kaufman: The first thing we do is ask what season of the year seems to be the biggest problem for you. And then we take a full history to determine what happens during different seasons of the year. We want to find out whether things change when you are away from the area and then increase when you are back in your home area. In other words, do you do better at the beach or at the mountains or perhaps when you are on a cruise?  Those things may change if the problems you are having are here in central Pennsylvania and not when you are away.

Q: In addition to asking questions, do you also do some kind of physical exam?

Dr. Kaufman: Part of our physical examination includes looking for signs which may indicate allergy such as a crease on the nose in someone who has been doing a lot of the allergic salute. Some pale swelling in the lining of the nose or some redness in the lining of the eyes or even some wheezing on occasion may indicate that asthma may be part of the allergy reaction as well. In order to be very specific about what the allergens are, we do allergen skin tests where we try to identify exactly what in the air is causing those symptoms.

Q: What are the approaches in reducing the discomfort? 

Dr. Kaufman: The best treatment in allergy is always avoidance. This means staying in the house during times of high pollen exposure and keeping the windows closed. When the windows are opened in the home 90% of the pollen outside will come inside. It can also be helpful to know the pollen count for the day.

Q: If that’s not enough, is that when you turn to medications?
           
Dr. Kaufman: Medications can be helpful in two ways; they can either relieve
symptoms when you’re having them, or, when used appropriately they
can prevent symptoms if used before the exposure to the pollen which
causes the problem.

Q: For example?

Dr. Kaufman: We would have you take an antihistamine, a drug that blocks the
histamine released in an allergic reaction, as an immediate reliever if you are having some sneezing or a runny nose.  We may also ask you to take an antihistamine in the morning before you go outside for the day. That way it can block any symptoms you have from being exposed to pollen.

Q: What are some of the most common medications you prescribe?

Dr. Kaufman: The antihistamines can be divided into two types.  One is sedating, the other, non-sedating.  The sedating antihistamines are available over-the-counter.  The non-sedating antihistamines are available by prescription and they include Claritin, Allegra and Zyrtec. Zyrtec only has a small chance for drowsiness. It is not truly non-sedating.

Q: Do these really work pretty well?

Dr. Kaufman: Yes, they do but there is a lot of individual variation as far as which antihistamine will work best in each patient.  So, if one is not working optimally then we try another one to see if that might give a better effect.

Q: Do they all just have to be taken just once a day?

Dr. Kaufman: These non-sedating antihistamines are all once per day.  We like to give this medication first thing in the morning so it is at its peak effect through the day and evening when you are exposed to pollen. Another treatment for allergy beyond antihistamines, especially if there is a lot of nasal congestion or sinus pressure or if you are predisposed to sinus infections, is to use a medicated nasal spray. There are several of these sprays available and all of them work to keep the allergy swelling in the nose to a minimum. That makes it easier to breathe through the nose and there is less chance of having sinus problems.

Q: Are these usually taken before you go to bed?

Dr. Kaufman: These nasal sprays can be used either once or several times a day depending upon which nasal spray it is. One effective one, Nasalcrom, is available over-the-counter.  There are two or three other types of nasal sprays that can be helpful for allergies that are available by prescription.

Q: What about shots?

Dr. Kaufman: Shots or immunotherapy use a mixture of the allergens that you are allergic to. By giving those injections in small doses in a controlled way on a regular basis, the body can build up an immunity to the things you’re allergic to and, in the long run, your immune system will no longer be allergic to those allergens.

Q: Let’s talk about how treatment may differ depending on where you spend most of your time; for example…home, school, work or play.

Dr. Kaufman: The key factor at home is to keep the windows closed. Usually in early and mid-spring and even in late summer we may not have those very hot temperatures so it may be a little easier to keep the windows closed. That keeps the majority of pollen from coming into the house. In midsummer there is little outdoor pollen but mold spores predominate.

Q: What can you do if you’re allergic to grass and you’re the one who needs to cut it?

Dr. Kaufman: If have to cut your own grass what many people do and find very effective is to wear a mask. You may also need to take some allergy medication about an hour before you go out to do that.  And then taking a shower and changing clothes afterwards should make you feel better and keep your allergies at bay for a while.

Q: What about school where you have less control than you do at home?

Dr. Kaufman: Unfortunately in the few schools where the windows can be opened they are generally not air-conditioned.  However, until the weather does get warmer, at least on comfortable days temperature- wise, I think it would be helpful to speak with the teacher about keeping the classroom windows closed during the allergen pollen season.

Q: Any other school tips? 

Dr. Kaufman: The major thing for schools to do is to make sure children are not given medication that will make them sleepy and interfere with their learning. Any of the over-the-counter medications can cause a reduction in a child’s ability to do schoolwork. So using a non-sedating antihistamine is really critical to allow the child to perform at his or her best during an allergy season.

Q: How important is communication with the school nurse about your child’s problem?

Dr. Kaufman: That’s especially important if your child has asthma during a particular season because going outside and running through the fields in the spring or late summer can cause an asthma attack. If the grass outside the school has just been cut it may be a good idea for your child not to be going out to play at recess. The nurse should always be informed as to your child’s allergies or asthma.

Q: And at work? 

Dr. Kaufman: The work place more and more these days is primarily enclosed and that’s especially good during the pollen season. For those people who work outside, certainly use of non-sedating allergy medications would be helpful and important in allowing them to feel their best. Avoiding sedating medications is particularly important for anyone who works with heavy machinery or for any who have to drive to work. That makes it even more important for people at work to use non-sedating antihistamines.  Unfortunately, Benadryl may be even more sedating than alcohol in terms of affecting driving, as well as performance in the work place. And, if you have a car equipped with air conditioning and  the ability to recycle the inside air… use it, instead of pulling in more allergens from outside.

Q: And at play?      

Dr. Kaufman: First of all, we want to encourage people to be outside playing during any time of the year. It may be helpful to be outside during times of the day when the pollen counts may be somewhat lower and that may be early in the afternoon or early evening, especially if it is not too windy a day.  Using medication before that outside activity is also very important.  If there is a choice between a couple of different activities where one is on a ball field and the other a tennis court or swimming pool, it may be best to pick the latter.

Q: What is your opinion of herbal remedies?
           
Dr. Kaufman: Well, we are frequently exposed, in the media, to the possibilities of what herbs can do to help our general health but more study is needed. There are some alternative treatments that may be dangerous in someone with allergies. One is the use of bee pollen, which may contain the pollen that some people are allergic to. This has been shown to cause serious reactions, which have resulted in emergency room visits.  So that should be totally avoided.

Q: What’s another that can present problems?

Dr. Kaufman: Use of ephedra can also be a problem because it can be a very strong stimulant to the heart and unless there is medical clearance that drug should not be used.  As far as other herbs beyond these, I know of no negative influences. Unfortunately, there have not been enough studies in this country to really understand the benefits of those treatments. I would think, for the most part, they are safe. I generally would recommend them if people would be interested in trying them but as an adjunct at least to conservative medicine, and with the knowledge of their allergist.

Q: What is coming in the future for all the sneezing, sniffles, stuffiness, sore throats, itchy eyes and more that plague many of us?

Dr. Kaufman: Well the future looks very good.  There are a lot of studies being done to look for a means of shutting off the allergy response, teaching the immune system not to respond to harmless pollens with an allergic reaction. This may involve several injections a year rather than the more intensive kind of allergy injection treatments as required at this time.

Q: Will we ever get rid of these symptoms entirely?

Dr.Kaufman: Unfortunately it looks like allergic disease is becoming more of a problem rather than less in the developed world. Until we understand why we are seeing more allergy it is not likely we will be able to naturally prevent allergies. I think the first thing that will happen is there will be some medications or some treatments to turn off the immune system from allergies. The main impetus of research hopefully would be to find out what stimulates someone to become allergic in the first place. Then we can interfere with that situation rather than treat the allergy problem once it has occurred.

Q: So, until then you keep on seeing challenges and you keep on meeting them.

Dr. Kaufman: Yes…that’s what we see and that’s what we do. That’s why we’re here.

Back to Allergy Contents

Back to Home Page