North Texans know this time of year all too well. Just as the weather starts to get nice and we start spending more time outdoors, those pesky North Texas allergens seem to enjoy the warmer weather as well. That’s why we spoke with Samantha Cooper, D.O., a family medicine physician on the medical staff at Texas Health Dallas and at Texas Health Family Care in Dallas, a Texas Health Physicians Group Practice, to get her advice on how to prepare for allergy season before it strikes.
What are Seasonal Allergies?
First things first, it’s important to know what exactly seasonal allergies are, and how the symptoms differ from your basic cold, a sinus infection, the flu, or even COVID-19.
Seasonal allergies occur when the weather changes and different grasses/pollens/molds (allergens) become more prevalent in the air. If you are allergic to these allergens, then you can start to develop seasonal allergy symptoms such as runny nose, nasal congestion, sneezing, post-nasal drip (that pesky drip down the back of your throat that may also cause a sore throat or cough), itchy or watery eyes, and ear pressure or ear congestion. Your body recognizes these allergens as foreign invaders and creates a response against the perceived “threat.”
“Your body does this by sending white blood cells and fluid to the area of concern, which causes the nasal turbinates (nasal passageways) in the inside of your nose to swell and become enlarged and irritated,” says Cooper.
Those swollen passageways are what cause nasal congestion by making it difficult to blow your nose. So instead, the congestion runs down the back of your throat, or to your ears, and causes post-nasal drip and ear congestion.
“These are probably the most common seasonal allergy symptoms, and symptoms which are often confused for a sinus infection,” Cooper adds. “However, when this excess fluid hangs around in the sinuses for too long, it becomes the best environment for a viral or bacterial infection, which is most commonly a sinus infection.”
Understanding the Difference
Cooper says it’s important to know the difference, not only so you can get the appropriate treatment, but also so you can try to prevent illness in the future, especially in the case of allergies.
While colds often share the same symptoms as allergies (sneezing, watery eyes, cough, stuffy nose, runny nose, sore throat and post-nasal drip,) neither cause fever, as is common with COVID-19 or the flu. Sinus infection also typically comes with facial pain or pressure, a headache and bad breath. Nausea, vomiting, diarrhea, chills, fatigue and body aches are also common with the flu and COVID-19, but not a cold, allergies or a sinus infection.
Cooper says that while antibiotics are useful when treating bacterial infections, such as strep throat, they’re usually not necessary when treating allergies or a sinus infection. However, it’s common for people to think they may need them, especially when they don’t feel so great.
“Most sinus infections are actually caused by a virus and eventually resolve on their own,” she explains. “Taking an antibiotic for a viral sinus infection does not treat the infection and can actually increase your risk of developing antibiotic resistance.”
Antibiotic resistance occurs when you take antibiotics when you don’t need to, and subsequently, the bacteria that naturally occurs in your body starts to put up a defense so they can survive and keep going about their normal functions for your body. The risk is that one day when you need an antibiotic to work, it may not because of a developed antibiotic resistance.
This a growing concern for the medical community. In a November 2019 article published by the CDC, it is estimated that antibiotic-resistant bacteria and fungi cause about 2.8 million infections and contribute to 35,000 deaths in the US each year.
While it may seem frustrating, this may be why your health care provider recommends supportive care treatment initially.
“In general, if your symptoms worsen or do not improve within seven to 10 days, it is reasonable to be treated with an antibiotic but please remember to consult your personal health care provider about your individual treatment needs,” Cooper adds.
Treatment
That leads us into getting treatment. Cooper says it’s important to take notice of any patterns of illness throughout the year, especially if you tend to get the same symptoms or same illness multiple times.
If you get sick maybe once in a blue moon, and never typically around the same time each year, chances are you just have a bad case of luck and came down with the flu or a cold. But if you tend to get sick around the same time every year, Cooper explains there may be something behind it.
“When I hear, ‘Every year during this time I get a sinus infection requiring antibiotics,’ that actually tells me that you probably have environmental allergies during this specific time of year that are not being treated, thus possibly leading to a sinus infection,” she says.
Unfortunately, North Texas gets a bit of everything almost every single month out of the year. Spring brings us tree and grass pollen; which summer continues grassy allergen production. Fall ushers in high ragweed counts, and while other areas get a bit of relief in the winter, our usually warm winters allow cedar to explode. In fact, Dallas regularly lands within the top 20 most challenging places to live with allergens, according to the Asthma and Allergy Foundation of America.
No matter the time of year, Cooper says the first line of treatment is always an over-the-counter antihistamine, such as Claritin®, Allegra®, Xyzal®, Zyrtec®, or their generic counterparts. In addition to an antihistamine, she also suggests using a nasal steroid spray, such as Flonase®, Nasonex®, Rhinocort®, etc.
“I am a big fan of nasal steroid sprays and I’ll explain why,” she adds. “If the majority of your symptoms are nasal (runny or itchy nose, post-nasal drip, sneezing) then the nasal steroid spray helps treat the source of your symptoms. The nasal steroid spray works in your nose at the site of the swelling to help combat those symptoms.
“But I’ll add that I think most people do not know how to properly administer this spray, which is why most people hate them,” she continues. “I’ll vouch for you and say that I also did not know how to properly administer a nasal steroid spray until I worked with one of the best allergists in East Texas during my residency.”
Try these tips to get the most out of your nasal spray (and to clear up those pesky symptoms!):
- Use the spray during the time of day when your nose is most clear.
- Blow your nose and make sure it is good and clear.
- Stick the nozzle into your nostril and aim it straight back.
- Spray once in each nostril and let the medication sit.
“Do not take a big ol’ sniff with this — you know what I am talking about,” Cooper adds. “When you take a big ol’ sniff, you end up inhaling the medicine and swallowing it. All of the tubes in your face are connected. Your nose to your ears, and your nose to your throat. When you take a big ol’ sniff, you direct the medicine to the back of your throat, and it bypasses your nose. The medicine not only tastes bad if you swallow it, but it also won’t do its job if it gets swallowed.”
Cooper also recommends switching to a different brand if you notice that either your nasal spray or antihistamine doesn’t seem to work as well as it used to but steer clear of “D” formulations (Claritin-D®, Allegra-D®, etc.) if you have a history of high blood pressure, as these can increase your blood pressure.
In addition to seasonal allergies, if you also struggle with year-round allergies from things such as mold, pet dander and dust mites — typical indoor allergies — many times the same medications for seasonal allergies are effective for these year-round allergies as well.
The American College of Allergy, Asthma & Immunology recommends the following strategies to avoid seasonal allergy triggers:
- Check weather reports so you know when pollen counts are high.
- Keep windows and doors closed at home and in vehicles during allergy season.
- Know which time of day pollens are most “active.” In the warmer months, tree and grass pollen levels are highest in the evening, while ragweed pollen levels in the late summer/early fall are highest in the morning.
- Shower, wash hair and change clothes after playing, exercising or working outdoors.
- Wear a filter mask when mowing or doing other outdoor chores and take medication before you begin.
If your symptoms continue to occur despite combination treatment for longer than 1 month, you should consult your healthcare provider.
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