Q: Last year I struggled with hay fever for the first time since childhood. Is that unusual? Can I prevent it from recurring again?
A: Hay fever, also known as seasonal allergies, can affect people at any time in life. Although most people begin to experience allergies in childhood or early adulthood, sometimes the symptoms become more problematic later on.
If you moved to a new location, you may be exposed to a new set of pollens. But even if you are still in the same home, it's not uncommon to become more sensitive to the same pollens that come out every spring in your surroundings. Why this happens to people in middle age or older is not clear.
The biggest culprits for spring and summer allergies are tree, grass, and ragweed pollen. When you inhale pollen, your immune system generates antibodies called immunoglobulin E (IgE) that trigger mast cells to release chemicals called mediators, such as histamine. These eventually spread to different tissues like the nose, throat, and eyes.
With high pollen exposure, the immune system can go haywire and flood the body with mediators. The result is often hallmark symptoms of allergic rhinitis, such as runny and itchy nose and throat, nasal congestion, sneezing and coughing. Many people also experience red, watery, itchy eyes.
This doesn't mean you automatically are doomed to weeks or months of piling up empty tissue boxes. Rather than waiting for the first symptoms, it's better to start treatment before the pollen onslaught.
The reaction to even small amounts of pollen can have a snowball effect. Once the reaction starts, it's hard to stop as more mast cells are recruited to the nose, throat and eyes. Symptoms become more severe and harder to treat. It's better to block the reaction before it begins.
Nasal corticosteroid sprays, such as mometasone (Nasonex) and fluticasone (Flonase), are very effective both as a preventive and to treat ongoing symptoms. Many of these nasal sprays are available over the counter. To get the most benefit, start the spray a couple weeks before you expect the spring bloom.
Antihistamines are another option, and you don't need to begin them so far in advance. Also, you can combine an antihistamine with a nasal corticosteroid spray to get maximal protection against symptoms. Many over-the-counter antihistamines are available. The newer ones, such as loratadine (Claritin), fexofenadine (Allegra) and cetirizine (Zyrtec), are less sedating. Generic versions can save you money.
(Howard LeWine, M.D., is an internist at Brigham and Women's Hospital in Boston and assistant professor at Harvard Medical School. For additional consumer health information, please visit www.health.harvard.edu.)
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