Duke Raleigh Hospital

Winter Can be Allergy Season for Some

Perennial allergy sufferers rarely get a break. Here’s help.

By Matthew Ellison, MD

Allergy triggers, such as pollens, show up seasonally. Trees generally cause springtime allergies; weeds generally cause them in the fall. And grasses can do a number on people for three full seasons.

But allergy triggers can be present year-round, including in the dead of winter. Dust mites, molds and mildews and animal dander can make people cough, sneeze and wheeze. We call these perennial allergens. Some of these are easy to eliminate, so their symptoms are easy to control. Others can be difficult to even recognize, and thus nearly impossible to eliminate.

Perennial allergy symptoms are similar to seasonal allergy symptoms. They include:

• Congestion (Difficulty breathing through the nose comfortably)
• Frequent runny nose
• Sneezing attacks
• Post-nasal drip or drainage
• Pressure, pain or headaches in the face and sinus areas
• Frequent infections of the nose (with fever, unusual or discolored drainage, pain   and obstructed breathing)
• Itchy, red, watery eyes
• Dark circles around the eyelids
• Fatigue or cloudy/hazy thinking
• Vertigo attacks or dizziness
• Hoarse or raspy voice
• Chronic cough
• Difficulty breathing (wheezing, chest tightness, asthma)

The First Step

An accurate diagnosis is the first step. To get to the diagnosis, we’ll ask you a lot of questions and thoroughly examine your nose, ears, throat and lungs. We may even take pictures or videos of the nasal passages and throat.

The biggest clues to a perennial allergy problem include symptoms that are worse in the morning, symptoms being much worse after close exposure to the allergen and symptoms showing up after grooming your pets, cleaning out the basement, dusting the house and the like.

We may recommend skin testing, which involves a series of small pricks in the skin. Each prick will have a different allergen extract on it. Sometimes a small injection into the skin is used to verify or refine the results of the skin prick testing. The skin test will provide objective evidence that allergies are involved. Skin testing very accurately identifies what is triggering your allergy symptoms. At the Duke Otolaryngology Sinus and Allergy Program, we use Modified Quantitative, or MQT, allergy testing, which is blood work-based testing.

Controlling Your Symptoms

The Duke Raleigh program offers all the medically approved approaches to treating allergies:

• Counseling about how to avoid your trigger
• Medication to control symptoms
• Immunotherapy to change the way your body reacts to your allergens.

If you can completely avoid your allergen triggers, you will be completely symptom-free. That isn’t always so easy. Pet owners are often reluctant to give up a beloved cat or dog. The cost of drying out a mildewed house may be prohibitive. Dust mites are found everywhere humans are, and many scientific studies have confirmed that it is impossible to completely eliminate dust mites.

So, we can help arm you with a few reasonable strategies:

• Wash bed sheets every week in very hot water
• Keep pets outdoors or at least out of the bedrooms
• Bathe pets every month or more (if OK with your veterinarian)
• Check the furnace room and damp areas of the house for obvious mold
• Keep bedrooms simple – minimize clutter, stuffed animals and carpets
• Let family, friends and co-workers know you have allergies; maybe they’ll exercise caution when inviting you over and avoid pet hair on their clothes when they come to work.
• Let someone else do the preliminary cleaning of particularly dusty or damp areas and get out seldom used items from the attic.

Medicating

There are many very good medications to control perennial allergy symptoms. Some are over-the-counter. Look for cetirizine, fexofenadine and loratadine. Others require prescription, like montelukast, fluticasone, mometasone and triamcinalone.

Some work right away after taking, while others take a few days to achieve significant benefit.  In general, you should take fast-acting medications, such as antihistamines, about an hour before expected exposure. Read the package insert, and be aware of potential side effects.

Immunotherapy

Immunotherapy is more commonly known as allergy shots. By exposing your body – in a controlled way – to the things you are allergic to, we alter the reaction your nose and other body parts have to your allergens. The process takes several years, but you’ll start to see results in about three months. The shots not only reduce the severity of symptoms, but they also reduce the need for medications. The benefit will last even after the immunotherapy is stopped – and potentially for a lifetime.

At Duke Raleigh, we offer an approach called subcutaneous immunotherapy, or SCIT. With SCIT, you come in to our clinic (or sometimes your primary care physician’s office) on a regular schedule to get your allergy shot – a customized mix of allergens, based on your skin testing. The visits are about 20 minutes, and we try to make them as comfortable as possible. You’ll come in every week during the initial period of three to six months and then just once a month thereafter.

For those who don’t want shots, we offer allergy drops. The sublingual immunotherapy, or SLIT, approach has been approved by the World Health Organization (WHO). It has been used in other parts of the world for decades, though it still awaits FDA approval.  With SLIT, you place five drops of your customized mix of allergens under your tongue each day, at your own home.

Don’t let allergies bring you down this winter. There are commonsense strategies to reduce your risk and a variety of effective treatments at our clinic.

Dr. Matthew Ellison is director of the new Sinus and Allergy Program at Duke Otolaryngology of Raleigh. To learn more about the clinic and the services Dr. Ellison and team offer, call 919-862-5730.