Do I need to see an allergist?

03/11/19
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Greg Nieckula, D.O., internal medicine physician with CHI Memorial Internal Medicine Associates – Signal Mountain

 

It’s a question I get asked frequently in my practice – and there’s a good reason for it! If you’re suffering from sniffling and sneezing that’s interfering with your daily activities or your ability to sleep soundly, allergies can be a real problem. Unfortunately, where you live has an impact on the problem of seasonal allergies. Chattanooga routinely appears on the list of top 25 cities where seasonal allergies are the worst, based on the pollen count and the use of allergy medication.

The first step in treating allergies is over-the-counter medication. This can be really confusing because there are hundreds of options and brand combinations of drugs to treat these problems. Pills, liquids, nose sprays, and eye drops abound. Instead of recommending specific products, I look to the categories of medications to help people identify what medication may address their specific problem.

Category 1 – Anti-histamines. These medications block histamine in your body and stop your immune system from releasing the chemical that causes symptoms. Benadryl is the first generation of this medication. The second generation includes Claritin, Zyrtec, Allegra, Clarinex and more, and they all have the same basic formulation. The difference between the first and second generation is that Benadryl causes drowsiness. The second generation almost always doesn’t lead to drowsiness, making it the better choice for daytime relief. Another tip I give my patients: I don’t recommend anti-histamine nasal sprays or eye drops because they are not as effective as taking a pill.

Category 2 – Decongestants. When you experience a quick and immediate nasal and sinus congestion, it’s usually a temporary situation. In these instances, I recommend a decongestant like Sudafed that will help ease those intense symptoms. These medications don’t treat allergies, but they do provide quick relief. Certain medications that combine second generation anti-histamines and pseudoephedrine are good options. Examples include Allegra-D or Claritin-D (D for decongestant).

Category 3 – Steroid nasal sprays. For allergy sufferers, steroid nasal sprays like Rhinocort and Nasacort are your best choices. Not only do they do a good job of relieving symptoms like congestion, sneezing and runny nose, they also prevent it from happening. One drawback to steroid nasal sprays is that they can sometimes cause dry nasal passages or nose bleeds. These are not serious complications, but they can be alarming.  If they occur, I tell patients to back off and use the spray every other day. 

Prescription Option

Leukotriene inhibitors (brand name Singulair) are another class of allergy medication that’s only available as a prescription. This medication blocks histamine in a similar way to over-the-counter medications and works very well for some patients. We try this option after over-the-counter options fail.

The Bottom Line

If the over-the-counter or basic prescription medications aren’t working or you continue to have uncontrolled symptoms year-round (not just in spring or fall allergy season), it’s a good time to seek treatment from an allergist.

To find a primary care physician in your area, visit CHIMemorialMedicalGroup.org. To schedule an appointment with Dr. Nieckula, call (423) 886-2004.

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Karen Long
Media Communications Specialist 
p:423-495-7884
e: karen_long@memorial.org



Doctor Talk, CHI Memorial's blog, focuses on health and welness.