MUST-READ EDITION FOR SPRING ALLERGY AND CHRONIC SINUSITIS SUFFERERS
Does this year’s allergy season already have you suffering with nasal congestion, headaches, watery eyes, and/or sinus pressure? With of the tens of millions of Americans who suffer from seasonal allergies, and who routinely take medications for those allergies, this subject is clearly worth discussing.
Of the arsenal of medical products available for allergies, a vast majority of them are available “Over the Counter” (OTC). Antihistamines, decongestants, and nasal steroids, all previously prescription-only, can be purchased at any grocery or drug store. While availability creates independence, it also leads to self-medicating, because we anticipate that the physician would prescribe the same or similar remedies.
For the most part, doctors continue to rely on prescription solutions for symptoms, in addition to OTC products. (In reality, statistics show that patients feel unsatisfied leaving the doctor’s office without a prescription in hand.) Fortunately, there are several things patients can do to enhance their resilience to allergens and the efficacy of available allergy treatments and medications during allergy seasons.
Allergy Medication Compliance/Adherence
An undisputed fact regarding patients with Allergic Rhinitis is that medicine adherence is poor and is often overstated by physicians. Non-adherence can
be not purchasing, stopping therapy before instructed, or taking only when symptomatic. Health implications include increased hospitalization and symptom escalation to chronic respiratory illness.
I reviewed several publications on this topic regarding antihistamines and Intranasal steroids. What is notable is that approximately 40% of non-compliant patients took their medications irregularly and only as reactive symptom treatment. Patients report forgetfulness, symptom resolution, and testing of disease activity as reasons for not taking medications. Of patients dissatisfied with therapy, only one third request new medication.
Roughly 80% of patients taking allergy medications have moderate to severe symptoms of seasonal allergies. Most patients attempt to control allergies with OTC medications prior to seeing a doctor. Surprisingly, roughly one third are satisfied with the results. This number improves marginally with prescription medication; however, these medications require a prescription and may be significantly more expensive. In many cases, they are in the same class of medications as the OTC products.
Understanding ALLERGY MEDICATIONS
Antihistamines (Benadryl, Tavist-D, Zyrtec, Allegra, Xyzal, Claritin)
Antihistamines work by reducing the amount of histamine released into the body by the immune system when our bodies are invaded by foreign allergens. Histamine makes capillaries permeable to white blood cells and fluid, so that cells can move out of your blood and into surrounding tissues to fight infection. With seasonal allergies, pollen, which is not a true threat, activates the leaky capillaries, which causes inflammation or swelling. Antihistamines can block your immune system from over-reacting and causing inflammation.
First-generation antihistamines have been available since the mid 20th century. These products still work. The issue with these medications is that they penetrate the blood-brain barrier and can cause drowsiness or sleepiness to the degree that people cannot function normally. Second-generation antihistamines (Zyrtec, Allegra, Claritin, Xyzal, etc.) no longer penetrate the blood-brain barrier and do not cause drowsiness. All of these medications have been so widely used, with such a wide body of safety data available, that they can be sold directly to the consumer.
Nasal Steroids (Flonase, Nasacort, etc.)
Nasal steroids have been available OTC since 2013. Two of the most widely used nasal steroids, Flonase and Nasacort are also available in less expensive generics. These corticosteroids mimic the effects of hormones produced naturally in the body by your adrenal glands. Intranasal Sprays and inhalers deliver corticosteroids directly to the sinus or lung tissues that become inflamed, therefore reducing swelling and inflammation, so that you can breathe. These products are effective in providing allergic rhinitis relief, although perception of “steroids” and intranasal delivery limits the patient acceptability of the medication. Further, nasal inhalation techniques can limit efficacy. In other words, the full or correct dose of the medication is not always getting into the body.
Nasal and Oral Decongestants (Afrin, Neo-Synephrine, Pseudoephedrine, etc)
These products are available at the drug store and provide a more immediate relief to certain allergy symptoms. While these medications provide relief, they are only recommended for short periods of time and become problematic if taken for longer. Use of nasal delivered decongestants for long periods of time (as an example, Afrin Nasal Spray) will cause rebound congestion which may be worse that the allergic congestion and take longer to get better (weeks). The oral decongestant, pseudoephedrine, is often coupled with other medications and represented with a capital D (Example: Tavist D). Special attention to the manufacturer’s package insert or a physician’s directions should be heeded as there are a variety of health conditions, drug interactions, and age/pregnancy considerations. In addition, these medications are not recommended for use for more than 7 days.
Bigger Guns (Prednisone, Singulair, Nasalcrom)
Oral steroids and other leukotriene medications are sometimes prescribed. Oral steroids, like Rx Prednisone, are much more efficacious but have significant long-term side effects that can compromise your health in other ways including immunosuppression. Nasal delivery of the steroid limits the absorption, therefore limiting long-term side effects caused by oral steroids.
Singulair is another prescription medication approved for allergic rhinitis. It works by inhibiting the actions of leukotrienes which cause nasal passages to swell and mucous production. It is often used by physicians only after nasal steroids are not effective. Given that it is a pill that is digested and metabolized, it carries significantly more risk of side effects. Neuropsychiatric events have been reported.
Nasalcrom is a prescription mast cell inhibitor that has antihistamine effects. It is used less frequently as it must be started 1-2 weeks prior to pollen season and frequent dosing is necessary (three times per day, every 8 hours).
Better Understanding, Better Outcomes
As with most medications, some work better than others. This is because no two people are exactly alike. It is also important to note that these products are approved based on their results versus a placebo. In the case of antihistamines, a given medication may be efficacious on 50-70 % of patients versus 20%+ with placebo, as an example. This means that 3-5 out of 10 patients may not gain notable relief. Most patients do not maintain a continuous dialog with their physician to sufficiently make medicine adjustments or changes. It is also important to note that most physicians prescribe whichever brand that they are the most familiar or have the most experience with. In today’s OTC world, most allergy sufferers self-medicate with what their doctor prescribed previously and seldom make changes.
Antihistamines and nasal steroids do not always provide immediate relief. Taking the product as directed improves efficacy. Starting the medications ahead of peak allergy season, and adhering to daily usage is critical for the product to work. In many cases, it can take up to a couple of weeks before results are noticeable. Patience is required. This systematic approach is sometimes the only way to truly determine efficacy or whether you should you potentially change medications. Changing medications can have a significant impact on overall efficacy if you allow the proper evaluation period before making changes. Otherwise, you will not see results.
You can ask your physician to order an immunoglobulin test (IgG and IgE) to determine what allergens, molds, and foods that you react to. The food allergy component is essential, since digestion of allergic foods regularly can cause many types of inflammation and lead to more significant health risks. This testing will also identify foods that you may be intolerant of, such as gluten or dairy. In these cases, a diet change can significantly improve health and wellness. My case is one example. My allergic rhinitis symptoms were due to food allergies.
MOLD, THE UNTREATED ALLERGEN
In the event you are immunocompromised for whatever reason, mold allergies can significantly impact your wellness and possibly make you more severely sick. Mold is ubiquitous and is a year-round antigen. Autoimmune disease, children without fully developed immune systems, the elderly, or anyone sick with any number of illnesses are at risk to be made very sick by mold.
The immune system reacts somewhat differently to mold allergies. This is because mold spores are living organisms. The production of mucous caused by the inflammatory response becomes “food” for mold within the dark, moist environment of the sinuses; and there is risk of fungal infection or overgrowth. Antihistamines and steroids have no impact on fungi. When this happens, fungal sinusitis can occur and eventually lead to the need for surgery to remove a “fungal ball” from the sinuses.
If, in fact, you are allergic to mold, several symptoms may eclipse others over time. Early indicators, like coughing and sneezing, scratchy throat, irritated eyes, and skin irritation or rash may require a physician’s attention.
- Finally, several mold species found predominantly in water-damaged homes and buildings produce mycotoxins that can cause severe, hard-to-diagnose chronic illnesses. Water damage from leaks or flooding are particularly guilty of mycotoxin producing molds. The combination of gypsum drywall absorption and retention of water, moisture, and cellulose and paper components provide fertile breeding grounds for aspergillus, penicillium, and stachybotrys (Black Mold). These molds can reproduce in large quantities and produce harmful mycotoxins. These toxins can have significant impact on respiratory, organ, cognitive, and motor function. If you believe you have a mold allergy or sickness, you can take a free online Sinusitis and Mold Sensitivity Evaluation. Also, read Mold Sick and Feeling Hopeless? 3 Actions to Take Right NOW to Gain Control of the Situation!
Rule of thumb, if you can see mold or smell it, it is a problem that needs to be remediated. You can fit 250,000 mold spores on the tip of a pin. If you are not an experienced DIY’er, professional remediation may be required.
Daily rinsing of your sinuses is probably the most impactful action you can do to stay well. Removing pollen, mucous, and mold from the sinuses allows your body and immune system to operate in a “healing” mode while resting. Micro Balance Health Products developed supplements and treatments to be used and taken in addition to other allergy medications to address the mold component of your allergies. I strongly recommend the Nasopure Nasal Rinse system with Citridrops to comfortably rinse your sinuses without the worry of contamination or inner-ear issues common with the older neti-pots.
Other Non-Medication Best Practices for Allergies
There are several “Best Practices” that can have significant impact on your allergy symptoms. Most important is the air you regularly breathe:
- Be aware of the pollen count outdoors. Numerous websites will alert you to troublesome days. Limit your time outdoors on these days. Keep windows and doors closed in your home and car.
- Remove pollen or mold-exposed clothing and shoes prior to entering your home to avoid tracking allergens inside. Recognize that pets can bring allergens inside too. Wipe their paws and spray their coats with EC3 Mold Spray before they come inside.
- Use EC3 Laundry Additive in every wash to rid your clothing of mold hitchhikers and bacteria.
- Test your home for mold. An inexpensive mold test plate kit with directions will tell you if you have a mold problem in your home. (EC3 Mold Screening Test Kit- 6 pack)
- A healthy diet and regular exercise will always contribute to overall wellness. If you are experiencing the digestive impact of an overabundance of yeast in your gut, a Candida diet to starve the fungi will have a dramatic impact on your health and energy levels.
- Using a high-quality HEPA air purifier will remove allergens and pollutants from your immediate air.
- Vacuuming with a HEPA canister vacuum will remove pollen, dust, and mold that regular vacuums will not remove. Regular HEPA vacuuming alone can reduce mold counts by over 80%. (Non HEPA vacuums simply recirculate settled pollutants and redistribute into the air.)
- Monthly or frequent fogging with EC3 Mold Solution Concentrate will temporarily reduce fungal air counts to almost zero in indoor environments.
By Cesar Collado