transcript

Speaker 1:
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Speaker 2:
[00:17] You're listening to Life Kit from NPR. Hey, it's Marielle. I tend to be an optimistic, joyful person, but this is one of the things that makes me think we're in the bad place. As soon as the weather gets nice in the spring, many of us are besieged by seasonal allergies. The thing you want to do most is open your windows or step outside and enjoy the weather, and instead, you end up hiding inside, looking out the window longingly, while if you're me, nursing a sinus infection. The culprit here is of course tree pollen. When trees pollinate in the spring, that pollen floats around in the air, ending up in our noses, our eyes, sometimes in our lungs. It's very annoying.

Speaker 3:
[01:05] So the most common symptoms are going to be sneezing in an itchy nose, runny nose, nasal congestion or a stuffy sensation in the nose, itchy, watery eyes, redness of the eyes, puffy eyelids, post-nasal drainage, cough.

Speaker 2:
[01:22] Prathyusha Savjani is a board-certified allergist and immunologist with a clinic in central Houston. And she says when symptoms progress, folks can also have trouble sleeping or end up with a sinus infection or have their asthma flare up. On this episode of Life Kit, we're going to talk about what you can do to make this time of year more comfortable. I consider myself a seasoned sufferer of seasonal allergies and I learned some new things when we chatted, including that oral antihistamines are not the most helpful treatment for this problem, and that what really helps is calming down your nasal tissue using rinses and sprays. That's coming up after the break.

Speaker 1:
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Speaker 4:
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Speaker 2:
[02:58] I'd love to talk about some of the ways those of us with seasonal allergies can be a little bit more comfortable and less itchy this time of year. The thing that's top of mind, I think, for a lot of people is antihistamines, oral antihistamines. Let's start there. How often can we take these? Can you take multiple at once if it's not quite hitting?

Speaker 3:
[03:21] Oral antihistamines are the one medication that most people reach for when they start having allergy symptoms. However, they're actually not the most effective. It's not about the dose or the frequency or the type. It really is just that antihistamines are only treating one component of what occurs during an allergic response. So when people take an antihistamine, if it's a mild allergy, maybe it helps and it treats the itchy, runny, sneezy symptoms. But if it's an allergy or a situation where that allergen is still present for long periods of time or very high levels, inflammation builds up inside the nose, inside the sinuses and in other areas, that antihistamines can't really reduce. At that point, no amount of antihistamines really gives much relief. I have lots of patients that come in, they're trying to take antihistamines every day, they're rotating their antihistamines, they're even trying to take higher doses than what's recommended on the bottle and not getting any relief. The reason for that is that the symptoms are not just due to histamine.

Speaker 2:
[04:33] They're due to inflammation.

Speaker 3:
[04:36] Correct. And other mediators beyond histamine. I mean, we don't want to get too technical, but there are other things that are released, leukotrienes and additional mediators that cause allergy symptoms.

Speaker 2:
[04:49] All right, take away one. Oral antihistamines are not a catch-all treatment for seasonal allergies. Yes, they block the release of histamine, but histamine is not the only thing causing your allergy symptoms. When you encounter something you're allergic to, like pollen, for instance, your body will produce other substances that you've probably never heard of, like leukotrienes and prostaglandins, and these cause inflammation in places like your nose and your sinuses. And an antihistamine doesn't block these substances. So what do we do?

Speaker 3:
[05:21] I think of allergy treatment as a three-pronged approach. The first part has to do with doing what you can to reduce your exposure to the allergen. So the things that can be done there, when pollen counts are really high, keeping doors and windows closed, both at home as well as in your car, setting your air to recirculate the air inside the car rather than pulling in air from outside, having an air purifier running inside the house continuously to catch any pollen that flies in. Avoid being outdoors if it's possible. And if you do have to be outdoors for extended periods of time on high pollen days, then as soon as you come indoors, change your clothes, you want to shower and wash off all the pollen and leave your shoes and pollen-filled clothes kind of at the door. So one of the worst things that you can do is, oh, the weather's beautiful, let's open the windows, let's open the doors and go in and out frequently throughout the day. You're basically allowing that pollen to set in in indoor spaces and continuing that exposure beyond just when you go outside.

Speaker 2:
[06:33] What if you have a pet who you're taking for walks outside?

Speaker 3:
[06:38] That does make it even more challenging because, yes, of course the pollen will get on their fur and then if they bring it in, then they're all over the house, they are spreading it. We'll sometimes talk about washing your pet more regularly during those seasons, maybe even finding some way to kind of wipe them down to try to remove any pollen particles that are floating around.

Speaker 2:
[07:02] So what about if you're outside and you do have to go out, especially in a high pollen moment, could wearing a mask help? Could wearing sunglasses help?

Speaker 3:
[07:11] Absolutely. Those are helpful. And I do recall during early 2020, when a lot of people were wearing masks, I had a lot of patients notice and tell me that they have found that their usual spring pollen allergies weren't as bad as previous years when they were not wearing a mask.

Speaker 2:
[07:30] Should we be washing our sheets and our blankets more often or vacuuming more often?

Speaker 3:
[07:34] Definitely. Washing blankets and sheets helps to remove the pollen, wiping down surfaces, vacuuming regularly with a good HEPA filter. All of those things can also help to reduce the exposure.

Speaker 2:
[07:48] Take away two. Whenever possible, avoid the pollen. Lots of ways to do that. Keep the doors and windows closed at home. Set your air to re-circulate in your car. Use an air purifier with a HEPA filter. If you have a pet, wash them or wipe them down more often than usual. Wash your sheets and blankets and vacuum more often. Consider wearing a mask and or sunglasses when you're outside on a high pollen day. Avoid exercising outside when pollen counts are high. You can look up pollen counts in your area online. Pollen levels tend to be higher on dry windy days and lower right after it rains. We'll have more Life Kit after the break.

Speaker 4:
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Speaker 2:
[09:37] What's the next prong? We've talked about avoidance. What comes after that?

Speaker 3:
[09:41] The next prong we talk about is medications. Antihistamines, like I mentioned, they may work a little bit, but they're not as effective as we'd like. There are other medications that are actually now available over the counter. They used to be prescription only. One is nasal steroid sprays such as Flonase is the most recognizable one, but the generic name for that is Fluticasone. There's also Triamcinolone. There are other nasal sprays. So nasal steroid sprays work by reducing inflammation inside the nose. They get rid of those little allergy cells that are building up inside the nose and that are ready to react when they see the allergen. So by getting rid of them, you're actually preventing that initial allergic response from even starting, potentially preventing the inflammation from building. Now, if you don't start it before the pollen actually hits the air, it's a little bit harder for those to work. A lot of people will give up on them. They'll try it once or twice and say, well, this is not doing anything, so they'll put it aside. In actuality, it can take hours, days, possibly even a week or two for sprays like nasal steroid sprays to fully kick in and do their job. How well they work depends on how bad the allergies are at that point. That also determines how long it takes for things to start feeling better.

Speaker 2:
[11:10] What I'm hearing is, one, it helps to start using a steroid nasal spray at the very beginning of spring allergy season before things have gotten too bad in your nose, before things have gotten too inflamed.

Speaker 3:
[11:25] Correct. I often tell my patients to start around Valentine's Day because here in Houston, by March 1st, the pollen levels are already up. If you can get ahead of it, you're getting your nose ready for that exposure, so it's less likely to react.

Speaker 2:
[11:41] If it is now, like whoever is listening to this episode now, it's past Valentine's Day, is it worth trying a steroid nasal spray?

Speaker 3:
[11:51] Absolutely. It will still work, but depending on how swollen and how congested and how much mucus is in there, it may take a week or two before you really start noticing improvement. Now, if you combine it with some form of nasal saline, either a saline nose spray like Simply Saline Mist or Nettie Pot, something of that sort that helps to wash out the inside of the nose and the sinuses, that A, by itself, helps significantly to help reduce congestion and wash out pollen, wash out mucus, but then will also allow the medicated nasal spray, like the Fluticasone, to get into the tissues and properly reduce inflammation.

Speaker 2:
[12:33] Yeah. Let's talk about the saline nasal sprays. These are game-changing, I think, especially once you actually know how to use them.

Speaker 3:
[12:43] I agree, definitely. Most patients, if they figure out how to use it right and learn how to tolerate it well, find that this makes a huge difference, regardless of whether it's allergies or other sinus problems. Now, there are a lot of different devices out there, but which one is used doesn't make a huge difference. It is important that distilled water be used in these devices. You never want to put tap water up your noses or in your sinuses, but you're right. This can make a big difference and definitely be a game changer.

Speaker 2:
[13:18] I finally learned the right head tilt to go actually through my sinuses, because I felt like it was for a long time just going in one nostril and then coming out the same nostril. I just find I feel so much better when I do that when I get home after a day of being out in the world and having pollen in my face.

Speaker 3:
[13:40] You're definitely right and this is actually a very similar experience that I hear from a lot of my patients where initially they don't feel like they're quite getting it, but eventually they find that right angle of tilting the head where it works properly. When you do a nasal rinse, you're not only washing away the pollen, but you're also washing away mucus. The saline solution helps to decongest and shrink the tissues a little bit. In places like here in Houston, oftentimes we're also breathing in high levels of pollution that acts as an irritant and further leads to worsening of inflammation and swelling. That also can help to be washed out.

Speaker 2:
[14:22] In terms of timing, would you do these every night?

Speaker 3:
[14:26] What I tell patients is as often as you're able to, that helps with your symptoms. For some people, that's twice a day. For some people, that's once a day. For some people, they're only able to do it a few times a week, but that works for them.

Speaker 2:
[14:41] Then does it matter how you time that if you're also using a steroid nasal spray? Should you use the saline nasal rinse first and then do the steroid spray?

Speaker 3:
[14:50] Yes. We do recommend doing the saline nasal rinse first, and then maybe even giving it a few minutes to make sure that the saline is all fully out, then following it up with the medicated nasal spray. Because if you do it the other way, you will most likely wash out the medicine before it has a chance to actually take effect.

Speaker 2:
[15:10] What about antihistamine nasal sprays?

Speaker 3:
[15:13] These are my number two most recommended allergy medications. Once you're already using a nasal steroid spray, if you're still having symptoms, adding on a nasal antihistamine such as azelistine, astapro, other prescription options that we have, that actually can further reduce any leftover symptoms and inflammation. This can be used in conjunction, so they can be used together at the same time. There are some formulations where there are both a nasal steroid and a nasal antihistamine mixed together in one bottle to make it more simple, so you're not having to reach for multiple bottles.

Speaker 2:
[15:55] What about eye drops? What kinds are there?

Speaker 3:
[15:58] Antihistamine and eye drops are usually the ones that we recommend first. Steroid eye drops are reserved for more severe cases where all the other things that we've recommended are not working. Now, we also recommend lubricating eye drops, so just as we talked about rinsing out the nose and hydrating the inside of the nose with saline, the same thing can be done with the eyes using lubricating eye drops.

Speaker 2:
[16:25] Take away three, look beyond the antihistamines. You could try an over-the-counter steroid nasal spray. Just keep in mind if you have a lot of inflammation and congestion right now, it might take longer to see results. A secondary option is an over-the-counter antihistamine spray, and sometimes you can find both in the same product. Also, get a saline nasal rinse or a neti pot. These can make a huge difference and you can use them just before the medicated sprays. With a neti pot, just remember, don't fill it straight from the tap. Distilled water is a good option. If you have itchy eyes, try antihistamine eye drops or even simple lubricating eye drops. And if you absolutely cannot stand your pollen allergies anymore and you don't want to have to treat them with medications forever, you have another option. This is the third prong.

Speaker 3:
[17:10] The third prong is immunotherapy. So that is desensitization, teaching your immune system how to learn to tolerate these allergens is the most effective treatment that we have. And allergy is a situation where you're overreacting to something that you don't need to react to. And it's a learned response. So nobody is born with allergies. You're born with the genetics that lead to these allergies. And it often takes high level exposure at some time in your life to become allergic to that substance. And we can reteach your immune system through allergy shots or sublingual immunotherapy how to stop being allergic to those substances.

Speaker 2:
[17:48] So I have actually been thinking about allergy drops myself, the sublingual kind. They are slightly less effective than allergy shots, right?

Speaker 3:
[17:57] Yeah, so the allergy drops are not only less effective, but also for most patients, they're more expensive. They're not FDA approved. They're not as likely to induce as long term tolerance as the allergy shots do.

Speaker 2:
[18:12] But much more convenient.

Speaker 3:
[18:14] Right, of course. They can be done daily at home versus having to come in to an allergy office for injections.

Speaker 2:
[18:23] The one thing I've been turning over in my head, and I just have to ask my allergist about this, but maybe other people are considering this too, it's allergy season, and so I don't know if it's a good time to start allergy shots right now. Would that be overwhelming for my system?

Speaker 3:
[18:42] So when we first start allergy shots, we start with very low doses. It's just a teeny tiny amount of the allergen that's in those injections. So for most people, it's no big deal to start during their allergy season.

Speaker 2:
[18:58] And how long does it take before you might start to see your allergies get better?

Speaker 3:
[19:03] Allergy shots are done differently depending on where you go, who's giving you the shots. Each allergy doctor gets to decide how much allergen they're going to put in your shots. And they also get to decide how quickly they build up and move up in the dosing. The improvement usually comes when you get close to your final dose or after you've been on that final dose for a while. So patients who only come in very infrequently for their allergy shots, they may not start feeling better for quite a while, say, 6 to 12 months. But I have patients who come in very regularly. They're determined to get their allergies better. They come in twice a week. They start feeling better within a few months.

Speaker 2:
[19:51] Takeaway four, consider immunotherapy in the form of allergy shots or allergy drops. With immunotherapy, you'll be exposed to a small amount of the allergen little by little to teach your immune system to stop reacting to it. How quickly you see results depends on how often you go and what doses you're getting. Thank you so much, Dr. Savjani.

Speaker 3:
[20:12] Thank you.

Speaker 2:
[20:16] Takeaway one, oral antihistamines are not the most helpful treatment for seasonal allergies because histamine is not the only thing causing your allergy symptoms. Takeaway two, some tips to avoid pollen. Keep your doors and windows closed. Set your air to recirculate in the car. Run an air purifier with a HEPA filter at home. If you have a pet, wash them or wipe them down more often. Also, wash your sheets and blankets and vacuum a lot. Consider wearing a mask and sunglasses when you're outside on a high pollen day. And avoid exercising outside when pollen counts are high. Takeaway three, when it comes to treatment, you could try an over-the-counter steroid nasal spray or an over-the-counter antihistamine spray, and sometimes you can find both in the same product. Also, get a saline nasal rinse or a neti pot. Those can make a huge difference, and you can use them just before the medicated sprays. For itchy eyes, try antihistamine eye drops or even simple lubricating eye drops. And takeaway four, consider immunotherapy in the form of allergy shots or allergy drops. You'll be exposed to a small amount of the allergen, little by little, to teach your immune system to stop reacting to it. For more Life Kit, check out our other episodes. We have one on spring cleaning and another on protecting migrating birds. Also, we love to hear from you. So if you have episode ideas or feedback you want to share, email us at lifekit at npr.org. This episode of Life Kit was produced by Sylvie Douglas. Our digital editor is Malika Garib and our visuals editor is CJ Rekulon. Meghan Kane is our senior supervising editor and Beth Donovan is our executive producer. Our production team also includes Andy Tagel, Claire Marie Schneider, Margaret Serino and Mika Ellison. Engineering support comes from Damien Herring. Fact-checking by Tyler Jones. I'm Marielle Segarra. Thanks for listening.

Speaker 4:
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Speaker 1:
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