Spring forward - into seasonal allergies
by David Dunaief
Apr 07, 2021 | 4334 views | 0 0 comments | 521 521 recommendations | email to a friend | print
Dr. David Dunaief is located in Downtown Brooklyn and focuses on the integration of medicine, nutrition, fitness and stress management.
Dr. David Dunaief is located in Downtown Brooklyn and focuses on the integration of medicine, nutrition, fitness and stress management.
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Now that spring has sprung, we look forward to flowering gardens and “greening” trees and parks. However, for people who suffer from seasonal allergies, life is getting miserable.

Just over 19 million U.S. adults were diagnosed with seasonal allergies in 2018, and an additional 5.2 million children were diagnosed, according to the Centers for Disease Control and Prevention.

What sparks allergic reactions?

A chain reaction occurs in seasonal allergy sufferers. When foreign substances such as allergens interact with immunoglobulin E (IgE), antibodies that are part of our immune system, they cause mast cells in the body’s tissues to degrade and release inflammatory mediators. In other words, it is an allergic inflammatory response.

The revved up immune system then responds with sneezing; red, itchy and watery eyes; scratchy throat; congestion; sinus headaches; postnasal drip; runny nose; diminished taste and smell; and even coughing. Basically, it emulates a cold, but without the virus. If symptoms last more than 10 days and recur, then it’s likely you have allergies.

Medical treatment options

The best way to treat allergy attacks is to prevent them, but this is can mean closing yourself out from the enjoyment of spring by closing the windows and using the air-conditioning.

On the medication side, we have intranasal glucocorticoids (steroids), oral antihistamines, allergy shots, decongestants, antihistamine and decongestant eye drops, and leukotriene modifiers (second-line only).

The guidelines for treating seasonal allergic rhinitis with medications suggest that intranasal corticosteroids should be used when quality of life is affected. If you have itchiness and sneezing, then second-generation oral antihistamines may help.

Two well-known inhaled steroids that do not require a prescription are Nasacort (triamcinolone) and Flonase (fluticasone propionate). While inhaled steroids may be most effective in treating and preventing symptoms, they need to be used every day and do have side effects.

Oral antihistamines, on the other hand, can be taken on an as-needed basis. Second-generation antihistamines, such as loratadine (Claritin), cetirizine (Zyrtec) and fexofenadine (Allegra), have less sleepiness as a side effect than first-generation antihistamines.

Alternative treatments

Butterbur (Petasites hybridus), an herb, has several small studies that indicate its efficacy in treating hay fever. In one randomized controlled trial (RCT) involving 131 patients, results showed that butterbur was as effective as cetirizine (Zyrtec) in treating this disorder.

In another RCT, results showed that high doses of butterbur — 1 tablet given three times a day for two weeks — was significantly more effective than placebo. Researchers used butterbur Ze339 (carbon dioxide extract from the leaves of Petasites hybridus L., 8 mg petasines per tablet) in the trial.

A follow-up study of 580 patients showed that, with butterbur Ze339, symptoms improved in 90 percent of allergic rhinitis patients over a two-week period. Gastrointestinal upset was the most common side effect in 3.8 percent of the population.

The caveats to butterbur use are several. First, the studies were short in duration. Second, the leaf extract used in these studies was free of pyrrolizidine alkaloids (PAs).

This is very important, since PAs may not be safe. Third, the dose was well-measured, which may not be the case with over-the-counter extracts. Fourth, you need to ask about interactions with prescription medications.

Dietary interventions

While there are no significant studies on diet, there is one review of literature that suggests that a plant-based diet may reduce symptoms of allergies, specifically rhinoconjunctivitis affecting the nose and eyes, eczema and asthma.

In my clinical practice, I have seen patients improve the course of seasonal allergies over time with a vegetable-rich, plant-based diet, possibly due to its anti-inflammatory effect.

While allergies can be miserable, there are many of over-the-counter and prescription options to help. Diet may play a role in the disease process by reducing inflammation. There does seem to be promise with some herbs, especially butterbur.

Always consult your physician before starting any supplements, herbs or over-the-counter medications.
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