Unlike some of my classmates in medical school, diseases themselves are not something I often feel a passion to study.  I find philosophy, theology, politics, literature, history, psychology, and so many other subjects much more interesting.  But when I see a person suffering and looking for answers and relief, I am motivated to learn all that I can to help.

So while the topic of allergies is not something that really revs my jets, I think it’s worth writing about since it’s affecting so many in the city of Austin, where I practice.  Indeed, I don’t recall ever seeing so many congested, itchy-eyed, hoarse, coughing, rhinorrheic people all at once.

So what exactly is occurring when people suffer from allergies?  In response to airborne particles such as cedar, inflammation occurs, causing sneezing, itching, and fluid buildup.  There are 4 major categories of allergens, or substances that causes allergies: pollens, insects, animal allergens, and molds.

The ideal response to allergies is identifying the offending allergen and avoiding it. So in the cedar fever season, affected individuals should close the windows of their car and home, stay indoors when possible, and shower every night before bed to removes cedar from their skin and hair.  But, of course, remaining inside all day is pretty impractical and lame.

The next step, then, is to take steps to reduce the inflammation that the allergens cause.  Here are some steps for doing so.

Rinse your nose

This is particularly useful for treating drainage down the back of your throat, sneezing, nasal dryness, and congestion.  It helps by rinsing out allergens and irritants from the nose.  Do it once or twice daily.  Saline nasal sprays and irrigation kits can be purchased over-the-counter.

Steroid nasal sprays

These are the first-line treatment for allergies.  I most commonly prescribe Flonase (fluticasone) since it’s generic and cheap.  These drugs have few side effects and significantly relieve symptoms in most people.  You may need to use a nasal decongestant like Sudafed for a few days before starting the nasal spray to reduce nasal swelling.  Be patient as it can take days to weeks for these sprays to have their full effect.

Antihistamines

Think Allegra, Zyrtec, Claritin.  These relieve itching, sneezing, and runny nose, but doesn’t help with nasal congestion.  Antihistamine nasal sprays such as Astelin, Astepro, and Patanase are also available and work quickly.

Singulair

I add this medication when people are not receiving sufficient relief from the other treatments. Some people find it to be quite effective.

Steroid pills or shots

If you’re really struggling, a short course of prednisone or a corticosteroid shot can provide quick, dramatic relief.  However, your symptoms are likely to quickly return unless you get on a maintenance treatment.  Because of their side effects, steroid pills are not a viable long-term strategy for managing allergies.

Allergy shots or drops

If all else fails, I send people to an allergist for allergy shots or drops. They contain solutions of the allergens to which a person is allergic.  By receiving them, your immune response to the allergen lessens over time.  The downside of this approach is that it can be time-consuming and somewhat expensive.

James Marroquin is an internal medicine physician who blogs at his self-titled site, James Marroquin.