Environmental Allergies: Symptoms, Causes and Treatments

Pollen Count in My Area

What Causes Environmental Allergies?

Mowing and Stirring Up the Pollen

These allergens include things like pollens, ragweed, pigweed, cock weed, birch, oak, molds, weeds, leaves, plants, dust mites, roaches, pets, smoke, chemicals in the air (room fresheners, candles, bug spray, etc.) and air pollution to name just a few. According to the American College of Allergy, Asthma,  and Immunology, allergies affect up to 30 % of adults and 40% of children in the United States. Once you have an allergy, you may be stuck with it. Most allergies do not go away once they have developed. Here are, however, several approaches that can improve symptoms

(see links below). 

Worst Cities for Allergies

One allergen that often goes undiagnosed is mold, a type of fungus. While it tends to grow in humid areas like the states along the coastlines, the Northeast, Ohio, and even Kansas (which is very humid). Mold growth also depends on temperature fluctuations, structural problems, building materials, basements and bathrooms, refrigerator door surfaces, and drip trays because of the moisture. It can grow in other places, like couches, pillows, and mattresses, depending on the environment's moisture. It is not unusual to discover mold in your workplace! It tends to like shady and dark places, and although it can grow year-round, molds thrive during the most common growing seasons -  mid-spring to mid-fall (depending on where you live and the weather). 

Mold is typically black, green, or gray but can also appear in many other colors like orange, pink, brown and yellow.  Among the most common molds that cause allergies are alternaria, which appears grayish-green and is often found in fruits and vegetables. Another culprit is Aspergillus, also known as black mold. Cladosporium has a brown, dark brown, or grayish-green appearance; Penicillium, the green, blue-green, or grayish-green bread mold, can also known to trigger allergies. These molds are not a welcome sight when found in your home, as they can lead to various health issues (sometimes serious!).

Some people are allergic to mold spores, which can occur both indoors and outdoors. When these spores are inhaled, typical allergy and sometimes asthma symptoms can arise. This is why it's important to be aware of mold allergies and their potential health effects.

Symptoms of Environmental Allergies

While some histamine helps create mucous to clear foreign particles from your airways, too much histamine can cause the following symptoms:

• Itchy watery eyes

• An irritated throat

• A runny nose, sneezing, and congestion

• Occasional sinus pressure

• Ear pressure

• A hacky cough

• Occasional headaches

• Bluish circles below the eyes ("allergic  shiners")

• Achy joints (rare)

• A change in taste and smell

• Puffy eyes

• Occasionally, skin problems like hives or dry, scaly skin

• Sometimes asthma-like symptoms (wheezing, shortness of breath)

If these allergies affect your lungs and you develop asthma-like symptoms, wheezing, shortness of breath, or a cough (reactive airway), you may be running into trouble - if you have an albuterol inhaler, use it. If not, and symptoms are progressing rapidly, you will want to seek medical attention ASAP.

Allergies can range from mild to severe life-threatening (anaphylaxis).

Instilling Soothing Eye Drops

Do I Have Allergies or Is This Just a Cold?

Ask Yourself:

​ 1. Do you have a fever? (Allergy typically does NOT come with a fever)

2. Do you get this at about the same time every year? (especially spring and fall, or when the Christmas tree goes up?)

3. Do you have a family history of allergies? Do your parents and children have allergies and asthma? These tend to run in families, so you may have them, too.

4. Do you find that you are clearing your throat a lot, chronically or seasonally? This may also be a sign of allergies (some people sit in front of me continually clearing their throats and do not realize they do it!)

5. How long has it lasted? If it is a cold, the watery, sneezy, itchy symptoms usually last about seven days (although a cough can linger for sometimes three weeks after a cold). If it is ongoing, you need to suspect one of two things: Your allergies have laid the groundwork for a sinus infection, or you have an ongoing exposure to an allergen.

6. DO YOU HAVE A NEW PET? Have you moved into a new home?

7. Do you have other autoimmune problems like hypothyroidism (sometimes hypothyroid people have symptoms that mimic allergies, but are NOT allergies)?

What You Can Do to Avoid Environmental Allergies

1. Test your home for allergens and molds

      You can order do-it-yourself tests to check for allergens and mold in your home, or hire a local air quality inspector to do the testing.

• Of course, try to remove yourself from exposure. ​

• Consider a dehumidifier.

• Use exhaust fans (especially in bathrooms).

• Clean the mold away (diluted bleach, dilute vinegar (some of the best reviews), hydrogen peroxide, various chemical products sold in the store like Lysol [type for mold and mildew], Moldex, and others). 

• If all this fails, you can spend some money on do-it-yourself mold removal chemicals or hire a mold removal company to come clean the mold out of the area ($$$).

• Try a squeeze bottle or Neti-Pot to flush pollen or other offending agents from your nose. (Be sure to follow directions carefully).

• Remove and wash any clothing worn outside (if an allergy is from outdoor pollen).

• Dry clothing in a dryer rather than outside.

• Invest in a portable high-efficiency particulate air filter or dehumidifier (if mold).

• Vacuum regularly with a vacuum that has a HEPA filter.

• Drink plenty of fluids.

• Try to stay indoors as much as possible during your allergy season.

• Don’t open windows—use a fan or an air conditioner (unless you suspect more mold outside than inside).

• Use exhaust or ceiling fans to create airflow.

• Get rid of carpets. 

• Use an air purifier.

• Keep humidity in your house between 35 - 50% (this also often helps eczema, a skin          condition related to allergies.

• Keep an eye on pollen levels so that you can act accordingly with preventive measures.

• Use UV light to help get rid of mold.

• Wear a mask when mowing if necessary​ (I see sinus infections that originate from mowing!)

TREATMENTS AND REMEDIES FOR ENVIRONMENTAL ALLERGIES

Conventional Over-the-Counter Medicines for Environmental Allergies

Oral​ Antihistamines

​What are Histamines?

Histamines are chemicals our immune system produces in response to foreign bodies. When the immune system overreacts, a person often develops allergy symptoms like watery, runny eyes, sneezing, runny nose, congestion, itchy eyes, and nose, as well as itchy rashes. (Histamines also have other functions outside our scope here.)

What Are Antihistamines?   

Antihistamines fight against the effects of histamine. In this way, they arrest inflammatory reactions, including inflammation caused by allergies.

They tend to dry a person out a bit, so it is important to stay well-hydrated when you use these. “But I don’t like water,” you say? Drink it anyway, keep a glass next to you, and sip it when you happen to look at it - you don't need to chug it. And it's good cold! Many people acquire a taste for it and then find it difficult to give up.​

If you feel you have allergies or get localized swelling from bites or stings, you can try one of these antihistamines:

Diphenhydramine (common: Benadryl) - This is one of the first antihistamines developed. It is very effective for environmental allergies and itchy skin rashes, but often makes people so drowsy that it is sometimes used for insomnia (Generic diphenhydramine is usually the least expensive). Diphenhydramine also comes in other forms (IM, IV).

Loratadine(common: Claritin) - This is an oral antihistamine. You can start treating with this (it seems to be the mildest, but this is often what people start with). It is one of the least expensive, especially the generic one.       

Allegra (fexofenadine) - This is also an oral antihistamine. This is a suitable, non-drowsy medication, but a bit costly.

Cetirizine (common: Zyrtec) is also a very good antihistamine. It is a bit costly and can make you tired. However, it is reputed to be more effective than Claritin and Allegra for allergies and itchy skin rashes.     

Levocetirizine (common: Xyzal) This is an oral antihistamine. You can get it over the counter or as a prescription.

Something to be aware of - If you have frequent allergies and use the same antihistamine medication over the long term, it may stop working as well as it did when you first started taking it. If this happens, consider changing to one of the other antihistamine medications (above).     

​Most oral antihistamines are not covered by insurance, but will be covered by your health savings account (if you have one). Nearly all over-the-counter antihistamines have much less expensive generics that contain the same active ingredient as the brand name. The active ingredients should be pretty uniform as the manufacturers are required to comply with FDA standards.       

Oral Decongestants 

Pseudoephedrine (common: Sudafed and "D" Products) - If you have terribly "watery" eyes,

nose) and congestion - even when taking the antihistamine, you can take the “D” products like Claritin D, Allegra D, and Zyrtec D. The "D" stands for decongestant and is actually pseudoephedrine  (Sudafed) and is sold behind the counter in pharmacies because of its occasional use in making meth. Some patients feel that this works very well.

The "D" products can have all kinds of potential side effects like insomnia, rapid heartbeat (tachycardia), and a significant elevation in blood pressure in some people (I see this in my practice too frequently). Sometimes, these also dry out mucus so much that it thickens and festers, leading to a sinus infection.

Nasal Sprays 

Nasal Antihistamines                         

• Azelastine (common: Astepro) - This is a nasal antihistamine spray. If the nasal steroid does not work, you might try this spray. Patients respond well to this when nasal steroids are not working. Also, unlike nasal steroids, these sprays start to work immediately. They are a little bit pricey. It may be cheaper if you have a prescriber order them and put them through insurance.     

Nasal Steroids 

• ​Flonase (fluticasone propionate) - Flonase, a steroid nasal spray, decreases inflammation in the nasal and sinus cavities.​ Flonase also claims to work for watery, allergic eyes, likely because the sinus is "connected" to the eyes.

​ Notes: Some patients tell me this smells too "flowery."

• Nasonex - (mometasone furoate) - Nasonex nasal spray is also a steroid nasal spray, very similar to Flonase. Please see the notes (above) for Flonase use and effects - they are very similar. 

• Nasacort (triamcinolone nasal)

Important Notes about nasal steroids:

Nasal steroids typically take one to three days to start working. So, if you do not see any "magic" in one day, it is important to use it for a few days longer for full effect. Please don't give up on it right away. If you skip days of treatment, it likely will not work as well.

                                                     -also-

How to use this nasal spray: When you spray this, lean over and look at the floor as you spray - this will help penetrate the sinus and will not all run down your throat.

Unlike nasal decongestants like oxymetazoline (Afrin, Dristan, Zicam nasal sprays), which can be used for two to three days ONLY, Flonase and Nasonex can be used on an ongoing basis.

Sometimes, insurance will cover nasal steroids if the healthcare provider writes a prescription.  

Nasal Decongestant Sprays

Afrin, Dristan, and Zicam nasal sprays - are oxymetazoline sprays. This is a great decongestant spray that works immediately for the congestion caused by allergies and colds. But it comes with a BIG caution: You cannot use it for more than three days at a time.

If you continue more than three days in a row, you will likely get a "rebound congestion: You won't be able to breathe through your nose without it! (How many times do I hear patients say, "My grandfather used it every day for years!"). Some patients insist, "I can't use that; I will become addicted!" It is a physically driven "addiction". If you follow instructions and use it for ONLY two to three days, this should not happen. You don't want to use it long-term. Doing so can lead to damage to the nasal mucosa. You can, however, come off it for several days and go back on again for three days.​     

Alternative/Herbal Approaches to Environmental Allergies 

• Bromelain - This is a derivative of pineapple with decent antihistaminic and anti-inflammatory properties, which help treat allergies and inflammatory processes within the respiratory tract, including nasal passages.

• Butterbur -This herb has antihistaminic effects and helps decrease leukotrienes (chemicals produced when exposed to allergens that cause inflammation and increased drainage).

• Spirulina - This is a blue-green algae that can help with immune function. It has been cited as a significant treatment of allergic rhinitis as it inhibits histamine.

• Quercetin -  An antioxidant found in apples, red onions, grapes,  citrus fruits, red wine, capers, parsley, and tea, acts as an antihistamine and can help reduce inflammation caused by allergies. This gets pretty high reviews from many allergy sufferers (especially in combination with bromelain)

• Stinging Nettle - This herbal remedy has been used for centuries for its antihistamine and anti-inflammatory properties.

• Curcumin/Turmeric - This is known for its anti-inflammatory and antihistamine properties. It may act to decrease inflammation and allergic rhinitis caused by allergies.

• Vitamin D - Low vitamin D has been shown to increase the incidence and severity of allergies.

• Probiotics—According to the NIH, some probiotics have been cited to help reduce the severity of allergies and allergic rhinitis (hay fever). These include (but are not limited to) Lactobacillus acidophilus, L. rhamnosus, L. plantarum, and L. paracasei.   

IMPORTANT NOTE: If you have plant allergies, be sure to check if you have any cross-allergies with the herbs mentioned above.            

Prescriptive Treatment of Environmental Allergies

If your allergy symptoms become severe or cannot be controlled with over-the-counter medications or supplements, consider seeing your healthcare provider or an allergist for prescriptions. Your healthcare provider can prescribe allergy medications, and an allergist can investigate further and possibly perform some testing. 

• Flonase (fluticasone) (also over-the-counter)

• Patanase (olopatadine) - Nasal antihistamine

• Singulair - Leukotriene inhibitor (leukotrienes are responsible for many allergic/ inflammatory diseases

Note: Singulair is pretty effective for many people, BUT it is getting a bad rap these days because some users are reporting depression as a side effect. A recent study reported that 32 per 1000 people taking Singulair reported depression.

• Prednisone - Short-term, low-dose oral​​