By John Todd, APRN, FNP

It’s a beautiful time of year here in Vermont, yet some of us just can’t appreciate it because of our sneezing, stuffy noses, watery eyes, and our unending battle with mucous. Some of us have these same symptoms through the winter as well due to dust, dust mites or mold in our apartments or houses. The body’s response to allergens and irritants is a part of our immune system called the histamine response. It is supposed to protect us, but some of us with heavier allergy symptoms don’t experience this as protection; it can be a nuisance, make us feel unwell and impair our ability to work or enjoy the company of family and friends. People around us might feel like we could make them sick from our sneezing or coughing (we won’t, allergies are not infectious). Some of us with asthma and other chronic respiratory conditions find that allergies can worsen our asthma or Chronic Obstructive Pulmonary Disease. Mild seasonal and environmental allergy symptoms can be controlled with some commonly available over-the-counter medicine, but more intense and prolonged symptoms require further evaluation, and may include allergy testing through a specialist.

John Todd, APRN, FNP
John Todd, APRN, FNP

While this article is about seasonal and environmental allergies, it is important to note there is one set of allergies, such bee sting or severe food allergies, which can be life threatening. These can cause anaphylaxis; a condition that includes sudden airway tightening and severe shortness of breath. This reaction requires an immediate 911 call and prompt emergency room treatment. Anyone who has had a sudden anaphylaxis reaction in their past should see their primary care provider to discuss if they need an emergency-use prescription, such as an Epi-Pen; a quick way for a person to give themselves life-saving medication.

Seasonal allergy symptoms that affect your eyes, ears , nose, throat, and lungs are not life-threatening, but can interfere with your daily life Over-the-counter medications have come a long way since the 1970s when Benadryl was THE thing for allergies. Benadryl (Dipenhydramine) is an anti-histamine that, when swallowed, can settle down allergy symptoms for 4 to 6 hours. It can relieve the congestion and sneezing caused by allergies, but it often makes people feel sleepy. Look closely at any over-the-counter sleep medicine, and you will find it contains Dipenhydramine (Benadryl) because of its sleepiness effect. The first safe, non-sedating antihistamine, Claritin (loratadine), was approved by the FDA for prescription use as a once-a-day medication in 1993 and became available for over-the-counter purchase in 2003. The two other non-sedating antihistamines, Zyrtec and Allegra, became available over-the-counter in 2008. All three of these medications can be found in an over-the-counter generic form, and have the same essential properties, but some people find that one works for them better than either of the others. They are all designed to be taken once daily.

For allergy symptoms that are not controlled with a once-a-day day medication like this, I’d suggest a discussion with your nurse practitioner, physician, or physician assistant. They might recommend that you try a more direct-acting medication such as the nasal sprays that are newly available over-the-counter, Nasacort or Flonase. For best effect, use nasal sprays like Flonase and Nasacort in this specific manner:

  • Hold the spray bottle vertically.
  • Lean over the bottle, aiming deep into the nose (not up the nose), toward the back of your head as you spray.
  • Then sniff the medicine back into your nasal cavity.

When used twice daily you should get better allergy control after 2 to 3 days. The sinus/nasal passages are histamine triggering centers, so just a nasal spray can help ease allergy symptoms, even without a non-sedating antihistamine.

If you are having allergy symptoms that are not controlled with these two types of over-the counter medications, I suggest you contact your Primary Care Nurse Practitioner, Physician, or Physician Assistant to discuss treatment options. Several options for further evaluation exist, and I have had patients tell me that a Naturopathic Practitioner has been able to help them get ahead of stubborn allergy symptoms through use of naturopathic treatments. An evaluation by an otolaryngologist (ear, nose, and throat specialist), or an allergy specialist, might also be a next step. Both types of specialists can do further testing for specific allergies, either through blood work or pin-prick skin testing. My core message is: “Don’t feel like you have to suffer through allergy symptoms. Call us to find out how we can help you enjoy this time of year — it might be easier than you think.”

John Todd, APRN, FNP is a family nurse practitioner at Putney Family Healthcare, a department of Brattleboro Memorial Hospital. He can be reached at 802-387-5581.