Allergy and Asthma - Part I

Now is the time when skaters with allergies begin their annual “suffering” season along with the skating season. And although the allergy season often peaks in early spring to early summer and late summer to the first frost, some suffers have nearly year-round symptoms, depending on their specific allergens. This first article of two will cover allergy in general and upper respiratory problems of the eyes, ears, nose, and throat. The second article will cover asthma and EIB (exercise induced bronchospasm). I won’t cover skin and intestinal allergy.

Allergy refers to a genetically-determined condition in which your immune system reacts to allergens (substances encountered in the environment – dust, mold, animal dander, pollens, smoke, pollutants, and strong odors) with an inflammatory reaction instead of “ignoring” them as do the immune systems of non-allergic people. A specific portion of the immune system involving the IgE antibodies reacts with the allergens and produces an inflammation in the respiratory tract, skin, or intestinal tract. This inflammation causes the release of chemicals such as histamine, leukotrienes, and others. These chemicals produce swelling of tissues, increased mucus production, and spasm in smooth muscles lining the respiratory tract – leading to the physical symptoms.
The all-too-familiar symptoms are: itchy red watery eyes, itchy runny stuffy nose, ear pain or block, sneezing, coughing, hoarseness, sinus headache, and wheezing. Compounding these symptoms are irritability, sleep problems, fatigue, and decreased appetite. This constellation of symptoms can lead to decreased performance as well as an increased tendency to injury due to decreased attention and alertness.

Although allergy is not in the strictest sense curable, many effective treatments to control the allergies are available. In general, the best control is achieved by treatment before the symptoms begin because once the inflammation starts, it is difficult to shut off. Diagnosing your specific allergens is done by skin and blood tests from your doctor. Some idea of the allergens also can be gotten by your experience: problems in the fall (ragweed and mold season) or problems every time you are around a cat might suggest a likely culprit. The management of allergy can be specific (directed at your specific allergens) or general (directed at the inflammatory response regardless of the allergen).

Specific management involves avoidance of allergens and immunotherapy (allergy shots). Avoidance, if possible, is the best treatment and uses reduction of allergen exposure by such things as filtered air, mattress covers, masks, staying away from allergens (avoiding cats, e. g.), and dust reduction. While not strictly avoidance, saline nasal washes or Neti pots, done multiple times a day, wash out the allergens out of your nose. You must use sterile or boiled saline for the washes to avoid infection. Allergy shots, done by an allergist after specific allergen testing, are repeated injections of very tiny doses of allergen to interfere with the response of the IgE system. Immunotherapy is usually advised for someone who is severely allergic and does not tolerate or respond well to other means of control.

General management uses treatments that interfere with the inflammation response or its chemical mediators. A short article such as this allows for a brief overview of these medications. But hopefully, you will be better prepared to discuss them with your doctor. We will discuss the treatments for asthma in the next part of the article.

Antihistamines, with which most people are familiar, are now available in long-acting and less sedating forms and are quite effective for many people. They work best if started before symptoms begin. There are oral, nasal spray, and eye drop forms. NSAIDs (non-steroidal anti-inflammatory drugs), are similar to ibuprofen and naproxyn and come in nasal spray and eye drop forms. Orally, NSAIDs are not effective for allergy management but are useful for treating the pain of sinus headaches or ear pain. Corticosteroids or cortisones (unrelated to muscle-building steroids) are one of the most effective treatments we have. They are very effective at treating inflammation. Most commonly, cortisone is used in a nasal spray form. Although oral and eye drop forms of cortisones are available, they are used less often and only in short courses due to the side-effects. An older, fairly effective medication, cromolyn sodium is available in nasal spray and eye drop forms. But cromolyn must be used 4 - 5 times a day which makes it more difficult to use. Leukotriene blockers (Singulair® and others) are used more as adjuncts to the other medications. Various combinations of the above noted medications may be used for some allergy sufferers. In allergy, it is always best to begin control before symptoms start and to continue control through the season.

Summing up: know your allergies, use avoidance when possible, use control medications early and consistently. Then allergy won’t trip you up on the track.