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“НАШЕ ЖИТТЯ”, ЧЕРВЕНЬ 2018 WWW. UNWLA .ORG 33 THOSE DREADED ALLERGIES by Ihor Magun, M . D . , FACP The notorious old - fashioned expression for aller - gies was “hay fever . ” W e now know that most aller- gies ha ve nothing at all to do with hay and certainly nothing to do with fever. At the same time, aller- gies produce many symptoms that can be quite an- noying and bothersome. The basic definition of an allergy can be sum marized as an inflammatory condition of the nasal passages that is characterized by some form of obstruction of the nasal passages associated with nasal drainage, sneezing, itching, tearing and ocular irritation. Not all individuals will suffer from all of these manifestations but most allergy sufferers will experience one or more in varying degrees. Seasonal allergies are the most common al- lergies and are caused by exposure to pollens. In most parts of the country, blossoming trees are the main source of allergens in the spring. Oak and ma- ple are the most common allergens. Next are grass in the summer and ragweed in the fall; mold aller- gies, which can emerge at any time of the year; and perennial allergies (allergies that can provoke symptoms year round an d are mostly due to contact with house dust and animal dander). Allergies have a genetic predisposition; symp toms arise when this predisposition is coupled with airborne environmental exposure. It is possi- ble to “outgrow” this allergic state; children w ho ex- perience allergic reactions may not mani fest any al- lergies as adults. On the other hand, it is also possi- ble to develop allergy - related symptoms in adult- hood. The pathophysiology of how these symp - toms develop are as follows: pollen and other aller- g ens on the nasal mucosa of affected individuals trigger cells called mast cells that release mediators which produce swelling, redness and excessive mu- cus (fluid) in the nose and eyes. This inflammation allows allergens to penetrate deeper into tissue and prolongs annoying symptoms. When the allergen count decreases or is eliminated, the inflammation declines and the affected organs eventually return to a normal state. Avoiding exposure to the offend- ing agents is helpful but can be challenging for one obvi ous reason: allergy sufferers cannot literally walk around in a bubble. On the other hand, it is easy to keep windows closed, especially in the bed- room. Diagnosis of allergies is quite straight for- ward. An accurate history of symptoms correlates with the predominant type of plant (or other al- lergy - inducing agents) in a given locale, coupled with the classic symptoms listed above. Physical ex- amination usually reveals boggy and red nasal mu- cosa, associated with an itching nose or eyes or both. It is importan t to note the distinction between colds and allergies: allergy symptoms occur slowly over the course of several days whereas cold symptoms appear quickly, generally over the course of a single day. Allergies (for the most part) produce no fever or body aches. Some “aches” are possible, but these occur when symptoms are not medically controlled and often prevent good sleep at night. With allergies we become tired not from the condition itself but because of inadequate rest. There is no need for any specific im muno- logic testing for allergies, but such tests are availa- ble. An allergist can perform skin testing or blood tests. A Radioallergosorbnet test (RAST) can also be helpful, particularly in cases where a food allergy component is suspected. Most allergy test s can be done with a simple blood test, and most are covered by insurance plans. Getting relief from allergy symptoms has become easier because the number of medications and choices has greatly expanded in the past several years. Many allargy medicat ions are now available in prescription strength over the counter (OTC) brands. Allegra, Claritin and Zyrtec are very popular with allergy sufferers. The benefit is once a day dos- age, generic availability, relatively low cost, minimal side effects, and effe ctiveness. These brands are available in combination with a decongestant com- ponent, a drying agent that is useful for people ex- periencing significant nasal discharge. The combi- nation medication must be requested at the phar- macy counter but does not require a prescription. Topical nasal sprays are also an option. Topical vasoconstrictors, marketed as Afrin, should be used sparingly due to “rebound” congestion (simply translated, this means that after several days, inflammation is incr eased, not decreased.) This type of medication should only be used when your nose is literally “running.” Another option is topical steroids, which have now become available over the counter. They are quite effective, do not cause rebound, and are well to lerated. They are somewhat expensive but well worth the cost. Desen- sitization/hyposensitization therapy with an immu- nologist is also an option for certain individuals who do not respond to the suggested medicinal treat- ments.
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