Allergies are a little like sinus disease in that they’re
probably not as prevalent as people think. Having said that, a lot of
people do have allergies. Allergic symptoms are well known to most of
us, and include runny nose, stuffy nose, and itchy, watery eyes. Depending
on what one is allergic too, symptoms can be either seasonal or year-round.
In general, the way I diagnose allergies is by the patient’s history
and whether their symptoms respond to allergy medications (see below).
However, the scientific diagnosis of allergies is by allergy testing.
This can be done either by certain blood tests (RAST testing) or by skin
testing. I consider RAST testing to be a bit too sensitive for routine
use, and only use it to confirm a suspected food allergy or in children
too young for skin testing. Skin testing is fine, but it’s expensive,
and I generally only order it if the patient and I agree that allergy
shots might be an appropriate treatment (since one has to get tested to
mix the shots) or if some question exists as to whether the problem is
truly allergic or not.
Treatment of Allergies
There are a number of treatments for allergies. If one knows what one
is allergic too and can avoid it (like cats), obviously this is the simplest
solution. Since this is often not possible, huge fortunes have been made
on drugs to treat allergies. The most basic of these are the various antihistamines
available over-the-counter (OTC). If your symptoms are truly allergic,
any of these should work quite well, as by definition allergic symptoms
involve the release of histamine. For some people, however, OTC antihistamines
may make them drowsy or give them a dry mouth. If you are one of these
people, the drug companies will be more than happy to supply you with
a non-sedating antihistamine that costs about ten times more than an OTC
antihistamine. Examples include Claritin, Zyrtec, and Allegra. What the
drug companies don’t tell you, however, is that a significant minority
of allergic patients don’t respond to these drugs. Thus, if you
have tried one for a week and haven’t noticed any effect, you are
probably in this group and need to try something else.
Other medications for allergies generally come as nasal sprays. These
include a large number of steroid sprays, an antihistamine spray (Astelin)
and a cromolyn spray (Nasalcrom). All of them have their advantages and
Finally, if your allergies bother you more than 4-6 months of the year,
you may want to consider allergy shots. Since shots can’t be started
and stopped like medications, I generally consider them only for people
who need to be on something almost year-round. They also have their advantages
and disadvantages, and do not work for everyone.