Allergic Rhinitis and Hay Fever Treatment

A hay fever episode is characterized by sudden sneezing, a wa¬tery nasal discharge, puffy eyes, and a sense of fatigue that can last for weeks. The most telling clue to allergy is a cause-and-effect relationship. Are your symptoms a result of exposure to a suspected allergen?

Eye allergies are especially common and deserve a word here. Eyes are particularly prone to allergic reactions because the conjunctiva, the mucous membrane covering the exposed portion of the eyeball and the inner eyelid, contains mast cells, which release histamine.

Preventive measures include wearing wraparound or goggle-type sunglasses to protect eyes from pollens. After exposure, wash your eyelids with soap and water, wash any facial hair, and wash your eyeglasses.

Cool compresses on the lids can be soothing. Both OTC and prescription drugs can provide relief. The former include Opcon-A, Naphcon-A, and OcuHist, which combine an antihis¬tamine with a decongestant. Pills such as Benadryl, Tylenol Se¬vere Allergy, Chlor-Trimeton, and Teldrin can help but may make you sleepy.
Ask your doctor about Crolom or Opticron (cromolyn sodium), which have to be taken before the season starts, and Patanol (olopatadine), a new prescription drug that acts both as antihistamine and mast cell stabilizer—that is, it prevents the mast cells from releasing histamine. To relieve itchy eyes, try Acular or Voltaren, nonsteroidal anti-inflammatories.

If your overall discomfort is severe, seek medical help, preferably from your primary-care doctor, who may or may not recommend an allergist. Symptoms of allergy often mimic symptoms of other diseases, including some serious ones. These diseases must be ruled out before allergy is ruled in.

The doctor should first review your complete history, asking how and when your symptoms occur, how long you've had them, home and work conditions, and so on. A thorough physi¬cal checkup should include a nasal smear (you blow your nose onto a plastic sheet and the specimen is transferred to a slide). A microscopic exam of secretions may show high numbers of eosinophils, special white blood cells present in allergy. The physician should also examine the mucous membranes of your nose. They usually appear swollen, pale, and bluish in allergic persons.

If your doctor sends you to an allergist for skin-testing, di¬luted extracts of allergens will be injected under the skin or ap¬plied to scratches on your back or upper arm. Positive results— raised welts surrounded by redness—show a high level of IgE antibodies, the standard indication of allergy.

Though you may sneeze, wheeze, or break out in a rash each time you wear perfume or sniff cigarette smoke, your skin test for that substance may be negative. This could imply a sensitivity or intolerance to the irritant rather than an allergy. Traditional doctors count only IgE-mediated reactions as "true" allergies.
Blood tests such as the RAST (radioallergosorbent test) are also used to determine IgE levels. But neither RAST nor skin testing is considered reliable for food or chemical reactions.