Your Allergy Questions Answered

If "gesundheit" is becoming the byword of the day, you may have entered hay fever season. That's the time of year when your immune system may go a little haywire, overreacting to all the pollen in the air.

There's a lot you can do about seasonal allergy symptoms – especially if you work closely with your doctor. To get the most from your doctor appointments, first know the right questions to ask. With the help of allergy experts, WebMD has given you a few to get you started. Also, be prepared to answer your doctor's questions – about your allergy triggers, symptoms, and responses to any medication you've taken. Then, you can discuss a treatment plan for seasonal allergies that may work best for you.

1. How can I be sure this is hay fever and not a cold or something else?

With hay fever, the typical symptoms are sneezing and a runny nose. But there's also more itching and watering than is typical with colds, says Kelly Stone, MD, PhD, staff clinician with the National Institute of Allergy and Infectious Diseases at the National Institutes of Health in Bethesda, Md.  Eyes can be itchy and watery, too.

Colds or flu may share some of these symptoms. But other symptoms, such as fever, sore throat, and body aches, also tend to be present. "With colds, the symptoms typically last for seven days or so, then go away," says Stone. But with allergies, symptoms last longer. It's a predictable pattern: "The symptoms of allergies tend to be present when pollen counts are high, and go away when the allergen is no longer present," says Stone.

2. What are the possible triggers for my hay fever? Can I take steps to avoid them?

If you have hay fever, it may not take long for your nose to "sniff out" the general source of the problem – whether it's trees blooming in spring, grass being mown in summer, or ragweed and mold flying in the fall.

Although it's easier said than done, avoid these triggers as much as possible, says Richard F. Lavi, MD, allergist with the Allergy Asthma & Sinus Relief Center Inc. in Twinsburg, Ohio. For instance, try to stay inside when pollen counts are highest. That's typically between 10 a.m. and 4 p.m. "After being outside for long periods, remove your clothing and shower, so you're not continuously exposed to the pollen," Lavi says.

If your symptoms are really severe, stay inside with windows closed and use air conditioning, if needed. Also:

• Keep your car windows closed.
• Don't hang clothing out to dry.
• Track pollen counts by checking local newspapers or web sites such as that of the American Academy of Allergy Asthma & Immunology. You can also call the National Allergy Bureau at 800-9-POLLEN or download WebMD’s Pollen Widget.

3. Will I always have hay fever? Will it get better or worse over time?

A seasonal allergy waxes and wanes, and can come on at any time of life, says Lavi. However, it typically starts in childhood and may get better during the teen years. "For a lot of people, it then comes roaring back in the mid-20s,” he says. For some, it may even get worse in mid-life.

The severity can vary from year to year, depending on pollen counts and other factors, says Stone. "But, in general, once you develop the allergic sensitization, it is present throughout your lifetime."

4. What treatment do you recommend for my hay fever?

Sometimes avoiding allergic triggers isn’t enough – you need allergy medicine. There are a variety of over-the-counter and prescription medications to treat allergies and their symptoms. This includes antihistamines, decongestants, nasal corticosteroids, and leukotriene blockers.

Antihistamines can help with symptoms of a runny nose, sneezing, and itching of the nose and throat, as well as eye symptoms. "Antihistamine sprays are good for congestion and are fast acting," says Lavi. Over-the-counter oral antihistamines are often the first choice of treatment for seasonal allergies. Antihistamines available over the counter include brompheniramine (Dimetapp Allergy), certirizine (Zyrtec), chlorpheniramine (Chlor-Trimeton Allergy), diphenhydramine (Benadryl Allergy), fexofenadine (Allegra), and loratadine (Alavert, Claritin).

Some are also available with a prescription.

Decongestants relieve nasal congestion. People often use them in combination with another medication, such as an antihistamine. They are available over the counter and come in both oral and nasal spray forms. Oral decongestants include phenylephrine (Dimetapp Cold Drops, Neo-Synephrine, Sudafed PE) and pseudoephedrine hydrochloride (Sudafed). Don’t use oral decongestants for more than seven days without checking with your doctor. Nasal spray decongestants, such as naphazoline (Privine), oxymetazoline hydrochloride (Afrin), and phenylephrine hydrochloride (Neo-Synephrine), should be limited to no more than three days. Longer use can lead to rebound effects where your symptoms come back, and usually worse than at the beginning, says Stone.

Nasal corticosteroids reduce inflammation from allergies and can help with a stuffy, runny, or itchy nose and sneezing. You spray these prescription medications into your nose once or twice a day, and can use them on a regular basis for symptom control during hay fever season. "But they need to be used consistently," said Lavi. "They're not designed for fast relief." Nasal steroids include Beconase, Flonase, Nasocort, Nasonex, Rhinocort, Veramyst, and generic fluticasone.

Leukotriene modifiers are available only by prescription. They are used to treat asthma and to control the symptoms of nasal allergies, and work by blocking inflammatory chemicals called leukotrienes. Singulair (montelukast) is the only leukotriene modifier approved to treat allergies.

5. What kind of side effects can I expect from hay fever treatment?

"Antihistamines may make your mouth dry and sedate you," says Lavi, "so they can make you feel goofy or groggy." But newer antihistamines, such as Alavert, Allegra, and Claritin, tend to cause less drowsiness. Clarinex is another antihistamine that causes less drowsiness that is available by prescription.

Decongestants can raise blood pressure, so be sure to discuss this risk with your doctor. Other side effects of decongestants, says Stone, include:

• nervousness
• dizziness
• sleeplessness

Stone says that nasal steroid sprays may cause:

• local irritation
• dryness
• nosebleeds

Leukotriene blockers cause few side effects, although headache and stomach upset can rarely occur, says Lavi.

Always read and follow the label carefully when taking any over-the-counter medication. Ask your doctor about prescription allergy medicines.

6. Should I see an allergist? Am I a candidate for allergy shots?

Have your symptoms bothered you for more than two months out of the year and you're simply not getting relief? Then you should consider seeing an allergist, a doctor who specializes in treating allergies.

The allergist will take a history and do a physical exam. He or she may also do allergy testing, which typically involves blood or skin testing to confirm what you are allergic to. You may have lung function tests to check for asthma.

If other treatments haven’t worked or caused too many side effects, you might be a candidate for allergy shots, says Lavi. Allergy shots help your body build up a tolerance to what you're allergic to, he says. 

If you improve after a one-year trial, then you may get periodic shots over a three- to five-year period, says Stone. "The hope is that, at the end of this period, you'll continue to be protected for years."