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Toolbox: Surviving Allergy Attacks
flowers650 Ahhhhh – it’s spring-time once again. Especially for those living in northern climates, the weather is warming up, the snow is off the roads and it’s time to enjoy riding outside. But it’s also time for local flora to come out of their winter hibernation and re-activate seasonal allergies – here’s some help.



Seasonal allergy, which is also commonly called “hayfever”, is mainly caused by pollen released from trees, grasses and weeds. Those who suffer year-round allergy symptoms probably also have allergies to insects, pets, and mold spores.

When pollen and other allergens contact the outer surface of the eye (conjunctiva) and the lining of the nose, there is a cellular release of inflammatory chemicals including histamines, which then causes the typical seasonal allergy symptoms of allergic conjunctivitis and rhinitis, including: itchy, tearful and red eyes, stuffy and running nose, sneezing, itchy/scratchy roof of the mouth and throat, post-nasal drip (mucous running down the back of throat) and coughing. These symptoms can often interrupt one’s sleep, which then causes day-time tiredness.

While allergy testing can be performed to identify specific allergenic types of flora, the treatment of seasonal allergy is generally the same, regardless of what one is found to be allergic to.

flowers
Spring can make for some beautiful pictures but can also cause many problems for certain cyclists


Prevention
Unfortunately, short of staying completely indoors with air conditioning, it is difficult to avoid being exposed to airborne allergens. However, one can try to minimize the exposure to allergens by: taking a shower to rinse off pollen from one’s hair and skin, wearing a mask to filter out pollens from the inspired air, and, when exercising outdoors, exercise at times of the day when air-borne pollen concentrations are the lowest.

Treatment
Treatment of allergic conjunctivitis and rhinitis symptoms consists of rinses, sprays, drops and oral medications.

Nasal rinsing/irrigation: Using salt water (saline) spray bottles can help to rinse off pollen from the nasal passages, sinuses, and upper throat

Nose sprays: Corticosteroid medications, in general, act to reduce inflammation. With respect to seasonal allergies, intra-nasal corticosteroid sprays (beclomethasone, flunisolide, budesonide, mometasone, fluticasone, and ciclesonide) reduce inflammation and mucous secretion of nasal passage lining. It can take days to weeks for the sprays to take full effect and should be use on a daily basis for maximal effectiveness. For those with more mild symptoms, intra-nasal antihistamine and decongestant sprays could be tried before using a corticosteroid nose spray.

Eye drops: Vasoconstrictor, antihistamine and mast-cell stabilizer eye drops (olopatadine, ketotifen, and cromolyn sodium, etc.) can be used to control eye symptoms. The frequency of using the eye drops each day varies and some eye-drops can be purchased without a prescription.

While using sprays and drops are preferred since they are usually faster acting and less likely to cause systemic effects, if ones symptoms are not well controlled with topical medications, then oral medications can be used.

Anti-histamines: Non-sedating long acting oral antihistamine medications (desloratadine, loratidine, fexofenadine, and cetirizine) are the mainstay of seasonal allergy treatment. Theses medications have minimal side effects and are taken once or twice daily.

Decongestant medications: Decongestant medications (pseudoephedrine and phenylephrine) reduce mucous secretion of the nasal passages. These medications are taken every 4 to 6 hours.

If one’s symptoms are difficult to control despite the combination of topical and oral medications, then immunotherapy in the form of subcutaneous injections or sublingual/oral medications could be considered. The use of these treatments usually requires allergy testing and is usually overseen by allergy/immunology specialist physicians.

Year-Round Allergies
If the symptoms of those who have year-round allergies become worse during seasonal allergy season, then the dosage and/or frequency of ones medication(s) may need to be increased (if possible) or adding a new type of medication may need to be considered.

Asthma
Up to 50% of asthma suffers will also have seasonal allergies. The medical treatment of one’s asthma should be reviewed if one’s asthma symptoms worsen at the same time as when seasonal allergies become aggravated. Adding or increasing the use of inhaled corticosteroids may need to be considered.

Anti-doping
The medications discussed in this article are generally not on the 2014 World Anti-Doping Agency’s (WADA) Prohibited List. The main exceptions are decongestant medications, which are forms of oral stimulants: pseudoephedrine is prohibited in-competition when its urine concentration is greater than 150 micrograms/mL and ephedrine and methylephedrine are prohibited in-competition when their urine concentration is greater than 10 micrograms/mL. Phenylephrine is in WADA’s Monitoring Program and is not considered prohibited. Corticosteroids are only prohibited when administered in oral, intravenous, intramuscular or rectal forms. If you are competing at level requiring anti-doping testing, have all your medications (prescribed and over-the-counter) reviewed by a sport medicine physician or your national and/or international sport federation.

Medications can also be reviewed on-line: http://www.globaldro.com.




Dr. Victor Lun, MSc., MD, CCFP, Dip. Sport Med (CASEM) is a Sport Medicine doctor who practices at the University of Calgary Sport Medicine Centre and is the team physician for a number of Canadian national sport teams.

Medical Advice Disclaimer
The information included in this article is for educational purposes only. It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult their healthcare provider to determine the appropriateness of the information for their own situation or if they have any questions regarding a medical condition or treatment plan. Reading the information in this article does not create a physician-patient relationship.

 

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