Dear Dr. Sangani,

What would you advise for someone like me who has frequent and severe allergies? I’m sick and tired of having itchy eyes and sneezing so much! – Still Sneezing and Counting

Dear Sneezing,

Allergies have been a common nuisance for people who live on the Coast, even in the winter. Although allergies generally do not kill people, they sure make life miserable. We have invited Dr. Gregory Meekin, who is a board-certified ear, nose, and throat physician, to further enlighten us about allergies.

Q: The Coast is well known for its allergies. Tell me how they affect the ear, nose and throat system?
A: The Coast is a really big place for allergies mainly because of the climate. The pollen counts tend to be high almost year-round, so patients who have allergies do have problems. In the northern climates, we do not have as many pollens in winter so patients get some relief. We see allergic presentation with sneezing, itchy eyes, running, and drainage down the back of their throat, sometimes nasal congestion, and pressure. When the pine pollen starts around February, that is when you see the allergy season really begin.

Q: What are some primary symptoms of sinusitis or allergic reactions?
A: Sneezing, itchy eyes, and runny nose. Sometimes patients can develop an infection on top of it that tends to turn the drainage to a yellowish-greenish color. Generally, it is a clear type of drainage and sometimes a little bit of cough associated with it.

Q: What is the usual treatment for this kind of condition? 
A: When the patient comes in and is having a seasonal type of an attack, we tend to try to treat them first with nasal sprays – especially for the nose symptoms. If they do not respond well to the nasal sprays, we tend to add a non-sedating antihistaminic. Some patients will have what they call perennial allergens, which are the allergens that affect them year-round. Common ones would be dust mites and some of the molds that can grow in homes. These tend to be things that do not go away with the seasons, and then we have to treat those year-round. With the seasonal allergens, patients know that they are going to have problems, and I start them on anti-histamines and nasal sprays prior to the breakout to prevent the attacks from occurring.

Q: What are the complications of these allergy attacks?
A: If the patient develops recurrent bouts of allergy attacks, they can develop sinusitis, which is very common. They start out with the itchy nose/running nose that becomes more congested. If they do not get treatment, or the treatment does not seem to work, if they continue with the nasal congestion they will end up with an infection in their sinuses. Then they complain of facial pressure, headaches, loss of smell, and at that point we generally have to add an antibiotic to the therapy. If the patient continues with these kind of symptoms, and really long-standing problems, we would go on to allergy testing. Eventually treating them with immunotherapy (the shots that everyone hears about to try and reverse their immune system’s response to the allergens). If they continue to have problems with their sinuses, we will get a CAT scan of their sinuses and look at potential surgery for any mechanical obstructions.

Q: The surgery for this usually does not leave any scars, am I correct?
A: That’s right, nasal surgery is generally endoscopic. The patients are brought in as outpatients and we use a computer guidance system, similar to a GPS. This takes us to the spots in the sinuses that are blocked.

Q: So, the common myth that you should take antibiotic anytime you have the allergic reaction is really not correct? 
A: Right. If the patient only has an allergic reaction such as sneezing, itching, and clear drainage. An antibiotic is not needed.

Q: Let’s talk of the antihistamines. What are the usual medicines used?
A: People are familiar with many. Claritin, Zyrtec, Allegra, Clarinex are newer ones. I believe in December, Claritin plans to go over-the-counter. That would be the first over-the-counter, non-sedating antihistamines. Benadryl and chlorphenaramine are also available but they tend to make the patient sleepy.