My tree pollen allergy questions answered. (And, okay, I seriously feel better since.)
Key points from a conversation with an allergist that improved my life almost immediately.
This is an installment of Inside Inside Medicine, available to premium subscribers only.
Last week, I hosted allergy specialist Dr. Lacey Robinson on the Inside Medicine premium subscribers–only Facebook group platform for a Live Q&A to discuss my fairly awful tree pollen allergies.
Dr. Robinson taught me things I simply had not known—but wish I had years ago. Because I am a seasonal allergy sufferer, her advice made an immediate impact for me. She also shared some other advice that I think will help me in the future as well.
For those of you who haven’t seen the interview (which you can stream at any time once you’re a premium subscriber to Inside Medicine), or if you just prefer to have the key points distilled in written form, here you go!
Which antihistamines should I use?
Use 2nd generation antihistamines like Allegra (fexofenadine), Zyrtec (cetirizine), or Claritin (loratadine). These are now available without prescription. The generic forms are just fine. There’s no need to use 1st generation antihistamines, such as Benadryl (diphenhydramine), because they probably do not work as well, and they certainly have more side effects like drowsiness.
Currently, I am using loratadine, but I chose that at random. Dr. Robinson says it’s possible that the other options would be more effective. So I may switch at some point. I’ve used Allegra in the past and found it helpful. Bottom line: Use 2nd generation antihistamines like Allegra (fexofenadine), Zyrtec (cetirizine), or Claritin (loratadine).
Can I take a 2nd generation antihistamine more than once per day?
Yes. Even though the bottles often say “24-hour relief,” they tend to wear off after 12 hours, and it is totally safe to take a 2nd dose of most of these products. In fact, for severe allergic reactions, we often put patients on 4 doses per day for a few days—albeit those are more acute cases. I’d been taking loratadine (10 mg) twice per day because I read that it might help a bit. That said, I’d been feeling guilty that I was maybe doing something wrong. But it turns out that twice per day (and even three times per day) is completely fine. So, I’ve been doing twice daily without any guilt, and I am finding that helpful. Bottom line: 2nd generation antihistamines can be taken twice or even three times per day routinely. In some cases, four times per day is fine, too, temporarily.
When should I take nasal sprays?
Flonase (fluticasone) is a steroid that works well. But I’m always concerned that by the time I am spraying it up my nose, my runny nose (“allergic rhinitis” being the official term) is basically negating the effect. I spray it up there, and 2 minutes later I have to blow my nose. Did the spray even have time to work? Probably not, says Dr. Robinson. So it might be best to take a hot shower and clear your nose out (and maybe take your antihistamine first) and then spray once you’re cleared up a bit. But the really important insight that I had not realized is that I should start doing my daily fluticasone spray weeks before allergy season. That way, my body is actually ready to fend off the allergens. So rather than waiting until the tree pollen explodes next year (usually April and May), I’ll be following Dr. Robinson’s advice and starting in the middle of March. Saline rinses are also great. I don’t use them, but many people swear by them. Bottom line: Take steroid nasal sprays like fluticasone before allergy season starts. Once your symptoms do begin, take it after you’ve cleared things out up there so that it actually works.
How often can I take my eye drops?
I use Patanol (olopatadine) eye drops. One formulation says once per day. Another says twice per day. Can I take them more often? No, probably not, according to Dr. Robinson. But using rewetting drops (I use Systane) can help in between doses. (Don’t use Visine; allergists and eye doctors hate Visine, but I’ll leave that aside.) Also keep your rewetting drops/artificial tears in the fridge. It feels so good when they’re cold. (No need to keep olopatadine cold, though.) Bottom line: Don’t take olopatadine eye drops more than the bottle says. But you can get some relief from cold rewetting eye drops.
After I spend time outside, does it matter if I shower?
Yes. Yes. Yes. I really had not thought of this, but when you’re outside for a while, the pollen gets all over your body. Then, even after you’re inside, your eyes, mouth, and nose are continually getting reexposed to that pollen. So, just like you’d remove clothes and shower after being exposed to poison oak or poison ivy, do the same after being outside when there’s tons of pollen. I started doing this after talking to Dr. Robinson and—oh my goodness—the difference has been massive. I also do this before I lie on the couch or bed. I don’t want to turn my house into a pollen convention! No need to rinse your contact lenses, though. They actually do a nice job of creating a barrier for your eyes.
Should I bathe my outdoor pets more during my tree pollen allergy season?
Yep! They also harbor allergens. So, the more you can remove pollen from your indoor life, the better.
Do allergy shots work?
Yes, and many people are literally cured of their allergies after they’ve had allergy shots. That said, it’s a time commitment because it is not a one-and-done type of thing. I keep putting this off. But it’s an option for the future that I may consider.
Thanks again, Dr. Robinson!
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