Dear NP

Dear NP,

I suffer from seasonal allergies that are not responsive to multiple antihistamines. I require frequent regimens of prescription steroids to help control my allergy symptoms of swollen eyes, sneezing and cough. How do I know when my allergies are severe enough to see a specialist for allergy testing?

Dear Reader,

Seasonal allergies are a problem for many people. About 24 million people in the United States suffer from seasonal allergies.

An allergic reaction to pollen from trees, grasses, and weeds causes most seasonal allergies. Symptoms occur more frequently in the spring and fall when the pollen is in the air. Common allergy symptoms include congestion, sneezing, itchy eyes, nose and throat, runny nose, watery eyes, postnasal drainage, fatigue, and cough. 

The first and best treatment for allergies is to ‌avoid contact with the things that trigger your symptoms. During high pollen seasons, keep your windows closed and use the air conditioner in your car and home.

Other tips include avoiding touching or rubbing your nose, washing your hands frequently, using a vacuum with a filter, washing bed linens and pillowcases often, using dust covers for pillows and mattresses and keeping pets out of your bedroom. 

When preventative measures aren’t enough, there are several over-the-counter and prescription medicines that you can try to treat allergy symptoms. 

Antihistamines come in pills or nasal sprays. They relieve nasal congestion, drainage, sneezing, and itching of the nose and eyes. 

Decongestants come in pills or nasal spray. These are for short-term use and help decrease nasal congestion by shrinking the linking of the nose. 

Nasal corticosteroids are nose sprays that decrease inflammation in the nose and help block allergic reactions. 

Leukotriene receptor antagonists are prescription medicines that block your body’s reaction to histamine, which triggers an allergic reaction. 

Cromolyn sodium is a prescription nasal spray that blocks the body’s response to histamine and leukotrienes.

If you have tried preventative measures and medications and are still suffering from allergies, it might be time to see an allergy specialist. An allergy specialist can perform allergy skin tests to help determine precisely what is causing your allergic reaction and then select a treatment plan to address those allergies.

Allergy testing involves exposing your skin to a small number of different substances that often cause allergies and then observing for signs of a reaction. 

Unfortunately, not everyone is a candidate for allergy skin tests. If you’ve ever had a severe allergic reaction, called anaphylaxis, you may be too sensitive to allergens.

Some medications can interfere with allergy testing, and your healthcare provider may want you to stop taking these before testing.

Skin conditions like eczema or psoriasis might interfere with testing if large areas on your arms and back are affected. Skin testing is usually performed on these areas. If you can’t have an allergy skin test, some blood tests can help determine allergies. 

After allergy skin testing, you’ll know which allergens are causing your reaction. A treatment called immunotherapy may be an option based on your allergies. Immunotherapy is usually given by “allergy shots.”

Tiny doses of allergens are given and gradually increased over time, making your body less sensitive to the allergen. Immunotherapy works well for allergies to pollen, pets, dust and bees or stinging insects.

Unfortunately, it doesn’t work well for allergies to food, medicines or feathers. Allergy shots are generally safe, but there is a chance you could have a significant allergic reaction, so they need to be given in a healthcare provider’s office under observation. 

Because allergy symptoms can impact your life and ability to be outdoors, you may want to talk about your symptoms and the medicines you’ve tried with your healthcare provider. They can determine if there are other treatments you can try before allergy testing or let you know it’s time to seek additional care. 

Dr. Wesley Davis is an Emergency Nurse Practitioner at Crook County Medical Services District and Coordinator of the Family and Emergency Nurse Practitioner program at the University of South Alabama. He encourages readers to send their questions to [email protected]