Allergy Season!
Posted on April 1, 2015 by bob in In Every Life
After a cold and windy winter, spring seems a welcome relief — until the onset of seasonal allergies. Although many people experience reactions to food, medications, or other substances throughout the year, sensitivity to airborne pollens or molds can cause a seasonal allergic rhinitis (inflammation of the nasal mucosa), increased watering of the eyes, sneezing and possibly coughing. Seasonal pollens vary: early spring brings tree pollen, such as oak, elm, poplar; early summer brings flower and grass pollen; and early fall brings weed pollen (ragweed, goldenrod). Additionally, airborne mold spores require a damp and warm environment, and can persist throughout the year in areas that do not experience freezing temperatures. 
Allergic rhinitis is among the top 10 reasons for visits to healthcare providers. The proportion of those who experience allergic rhinitis actually increases with age, due to increased exposure and changes in the immune system. Inhaling a substance such as mold or pollen begins to sensitize a person. Then, on subsequent exposure, slowed action of cilia (that sweep out particles in nasal mucosa) causes swelling (edema), dilation of blood vessels, and increased capillary permeability, resulting in clear, watery nasal discharge and itching of the nose. Nasal drainage results in itching of the soft palate and throat leading to coughing and attempts to clear the throat. Further symptoms can include headache, pain over the sinuses, bleeding of the nose (epistaxis), fatigue, loss of sleep, and difficulty concentrating. In other words, misery!
Accurate diagnosis includes a history of the onset and progression of symptoms, examination, and diagnostic tests such as nasal smears, blood counts, allergy testing, and/or elimination of causative triggers. Avoidance measures can help decrease symptoms. For example, high-efficiency particulate air purifiers [HEPA] in air or vacuum filters reduce allergens. Furthermore, air conditioners, removal of dust-catching furniture, rugs, or drapes, pillow and mattress covers, removal of pets, and smoke-free environments can reduce substances that cause allergic sensitivity. Other methods to reduce pollen or mold spores include changing clothing when coming in from outside, bathing to wash allergens from hair and skin, and/or using an over-the-counter nasal irrigation device to remove allergens lodged in the nasal passages.
If taken when symptoms begin, over-the-counter antihistamines can help manage mild allergies by preventing development of additional symptoms. However, antihistamines have a side effect of sedation that can increase fall risk, and possibly contribute to cognitive decline. Benadryl and Chlorpheniramine are included in the Beers List of potentially inappropriate medications for older adults due to physical changes of aging that may not allow the body to effectively clear the medication. Over-the-counter medications such as Sudafed or Afrin actually constrict the blood vessels in the nasal mucosa, but after a few days can cause rebound congestion.
Nasal decongestants can reduce nasal blood flow, watery discharge, and nasal edema, but can interact with other medications. NasalCrom is a spray that reduces the release of histamine and the immune response, but may take a week or more to achieve benefits. Discuss with your health care provider if over-the-counter medications are safe and appropriate for you, and specifically which one is least likely to interact with your physical changes or other medications. Ask specifically about anticipated side effects, and suggestions to maintain safety if you determine the potential benefits outweigh the risks. See also http://www.guideline.gov/content.aspx?id=37706 and http://www.americangeriatrics.org/files/documents/beers/2012BeersCriteria_JAGS.pdf
Arlene Morris
Arlene H. Morris, EdD, RN, CNE, is Professor of Nursing, Auburn Montgomery School of Nursing, and Immediate Past President of the AL State Nurses Association. Reach her at amorris@aum.edu.
