• Allergy season can trigger more than sneezes and sniffles

    January 2008

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    About 40 million Americans suffer seasonal allergies, with the accompanying runny noses, sneezing, itchy and tearing eyes, and occasional sinusitis or ear infections. Springtime, when trees are pollinating, can be especially problematic.

    2011 was even worse than usual, according to many news reports of record high pollen levels in most areas throughout the country.

    Extremes of weather and an increase in the amount of carbon dioxide in the atmosphere have been blamed for these rising levels.

    Lexington has often made the list of worst cities for allergies, according to the Asthma and Allergy Foundation of America.


    Extremes of weather and an increase in the amount of carbon dioxide in the atmosphere have been blamed for rising levels of allergies.


    Allergies linked to depression?

    Several studies in recent years have suggested allergies may also lead to a greater risk of depression and suicide. At the University of Maryland, a 2008 epidemiological study found the rates of depression, anxiety an sleep disturbance to be greater in patients with allergic rhinitis than in the general population. Researchers also reported that preliminary data suggests patients with a history of allergies may have a higher risk of suicide. As a result, they recommended that doctors treating patients for allergies ask about depression and those treating patients for depression inquire about allergies.

    After analyzing patient data, researchers reported that the spring allergy season, from April to June, coincides with the peak season for suicides. Tree pollen, which occurs in the spring, accounts for 75 percent of the yearly total of pollen. Finnish population studies in 2000 and 2003 also established a link between allergies and depression

    "One possible explanation for this phenomenon is that one or more of the known suicide risk factors – depression, anxiety, aggression or sleep impairment – may be affected by exposure to allergens in vulnerable individuals," the Maryland researchers stated.

    In studies using rats and mice, the researchers established that exposure to allergens caused an elevated expression of the gene cytokine to the orbito-frontal cortex. An increase of cytokine has been found to exist in suicide victims. More animal studies are needed, the researchers state, to examine suicide risk factors and exposure to allergens. The article appeared in the September 2008 Current Treatment Options in Neurology. 

    Treatment of allergies

    Mild, seasonal allergies can be treated by:

    • Avoiding allergens.
    • Taking an oral antihistamine.
    • Using an intranasal or oral decongestant.

    For moderate to severe or persistent allergies:

    • Use intranasal corticosteroids as a first-line treatment.
    • Add a short course of decongestant if necessary.
    • If symptoms persist, add an oral antihistamine and ipratropium.

    In cases where seasonal allergies persist, allergy injections should be considered.

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Page last updated: 5/22/2014 3:20:32 PM
  • What the news means for you

    Getting treatment for seasonal allergies

    Beth Miller, MD
    Allergist

    Wright, Heather, MDThe primary culprits for allergies are tree pollen in the spring, grass in summer and ragweed in fall. Mold can be present year round, especially if the winter is mild.

    If the weather patterns are typical in Central Kentucky, we can expect to have a bad allergy season.


    “I see a lot of patients who have lived with allergies all their lives.” 


    Many people don't realize they have allergies or else they just put up with them. Some people don't complain often about their allergies; others downplay the problem. It's usually only when people experience a dramatic change in their quality of life that they seek help. In my practice, I see a lot of patients who have lived with allergies all their lives. And often after they undergo treatment, they realize how miserable they have been from their allergy symptoms.

    Allergies impact quality of life

    Conditions that may drive patients to see an allergist include severe sinusitis, asthma and snoring. The person may have gotten to the point where he or she doesn't want to go outside because of allergies or depression.

    The recent University of Maryland study suggests a link between allergy and suicide. Other studies have shown that people with allergies report a diminished quality of life.


    “I've seen striking cases of people who are very fatigued becoming much more energetic once they begin treatment with allergy injections.” 


    However, it's very hard to establish the link between allergies and depression. Allergic patients are often depressed because they feel bad, and there also seems to be an increase in allergies in people with depression. So the question is which came first – the allergy or the depression?

    One issue I haven't seen much publicity about is allergic fatigue. I've seen striking cases of people who are very fatigued becoming much more energetic once they begin treatment with allergy injections. Fatigue, irritability, anxiety, depression and insomnia are all common symptoms among people who have allergies.

    Young children often cannot verbalize these symptoms. It's up to the parents to observe them. Look for the inability to sleep or concentrate, increased irritability and falling asleep in class. The child may also have "allergic shiners" – dark circles under the eyes. Constant rubbing of the eyes or nose are other signs of allergies.

    What to expect at the allergist's

    Primary care physicians see so many different kinds of illnesses that they may not approach rhinitis as an allergy. It's not an immediate life-or-death issue. On the other hand, a physician who specializes in allergies will take the patient's history along with a physical exam to help pinpoint the cause of the rhinitis. If there's no family history of allergies, it could be vasomotor rhinitis rather than an allergy. If the patient has a strong family history of allergies, plus allergy symptoms, and other conditions are ruled out, a skin test will identify what he or she is allergic to and help the physician choose medication that will work. The skin test is a very useful tool. You wouldn't guess at your blood pressure or cholesterol—why guess at what is causing your allergies?

    If medication doesn't work, then the next step is injections. However, most people who get skin tests do not end up having to get injections. These injections are very time-consuming during the build-up phase. They are given at first twice a week, then weekly, then once a month. Injections are the only cure for allergies to date.


    “You wouldn't guess at your blood pressure or cholesterol – why guess at what is causing your allergies?” 


    Medications
    Allergy medications can get very complicated. The No. 1 treatment I recommend is a nasal corticosteroid such as Flonase or Nasonex, which work very well for allergies as well as for vasomotor rhinitis. They help with all allergy symptoms – itchiness, sneezing, tearing, runny nose and postnasal drip. They're also very safe and do not affect final adult height when taken by children.

    I am very meticulous in choosing medication according to allergy symptoms and the time of year when these symptoms appear. For example, oral antihistamines don't help alleviate stuffiness, one of the major symptoms of mold allergies. But the nasal sprays can.

    Research directions

    More research is needed to prove that allergies can increase risk for suicide and depression among humans. So far there have been no studies showing the biochemical changes in the human body are triggered by allergens.

    The University of Maryland study is important, however, because it raises awareness of the link and the need to consider treating a person for allergies if he or she is depressed.

    Dr. Miller is chief of allergy and immunology and medical director of the UK Asthma, Allergy & Sinus Clinic, as well as associate professor of medicine in the UK College of Medicine.

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