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Alana Nicol of Cumberland, Maryland, used to take long hot showers in the middle of the night, hoping that the steam would ease the pain of her throbbing sinuses. Her back-to-back sinus infections had been making her sick and miserable all winter long. Despite popping loads of over-the-counter pain meds, she'd missed several days at work. Antibiotics didn't help, either. After trying stronger and stronger drugs, she actually started having heart palpitations, a reaction to the medications, and wound up in the hospital. At that point her physician suggested that she see an allergist.
An allergist? "It never occurred to me that I had allergies, because I had them when I was a child and the symptoms weren't the same," she says. "I used to have the sneezing, the runny nose, the itchy eyes, but as an adult I just had sinus infections." Still, her tests came back positive. She was seriously allergic to tree pollen, grass, and cats. Nicol immediately started taking allergy shots to build up her resistance and has had only one mild sinus infection since then.
As Nicol discovered, allergy symptoms can be more subtle, and serious, than most people realize. And they are often the culprits behind respiratory ailments like sinusitis and asthma. Researchers are finding that they also contribute to seemingly unrelated conditions like sleep apnea, migraines, and acid reflux -- even depression. On a more basic level, allergies can make you feel crabby, tired, and not in the mood for sex. Yet many allergy sufferers are never diagnosed, and most aren't getting treated.
Why the neglect? While the symptoms of allergies are aggravating and can even be dangerous, they're not the kind of life-threatening problems that often push people to see a doctor, says UCLA allergy expert Gary Rachelefsky, MD, a member of the LHJ Medical Advisory Board. Many people put up with postnasal drip or stuffiness, self-treat with over-the-counter decongestants, or mistake allergy symptoms for a spring cold or infection.
When people do go to the doctor about their symptoms, they often leave with a prescription for an antibiotic, antihistamine, or inhaler but without a diagnosis. "Doctors aren't being medical detectives," says allergist Dean Mitchell, MD, author of Allergy and Asthma Solution. Or they're just not well educated about allergies, adds Dr. Rachelefsky. Chasing your symptoms with antihistamines and decongestants may not be enough to make you feel better -- in fact, they can make you worse. If you have any of the following conditions, the message is simple: Consider the possibility of allergies.
Are you constantly stuffed-up and congested or sniffling with a runny nose? So are about 60 million other Americans. It's called chronic rhinitis, and allergies are at least partly to blame in as many as two-thirds of these snifflers, experts say. Most people who have allergic rhinitis don't have it under control, says Linda Cox, MD, past chair of the American Academy of Allergy, Asthma & Immunology diagnostics committee.
Congestion can lead to other issues like sinusitis, sleep problems, and facial pain. So ask your doctor to check you for allergies -- to outdoor allergens and indoor ones like mold, dust mites, and pet dander. It's important that he know whether your congestion is due to allergies before he prescribes medication. For example, oral antihistamines are helpful for allergic rhinitis, but nasal antihistamines may be better for non-allergic rhinitis.
Sinus Inflammation and Migraines
About 55 percent of people who have chronic sinusitis -- inflammation of the sinuses that causes throbbing pain in the face or head -- also have a history of allergic rhinitis, says one study. Yet doctors often recommend that patients with recurring sinus infections get CT scans to look for sinus malformations and even recommend sinus surgery without testing for allergies. The CDC estimates that Americans undergo more than 200,000 sinus surgeries every year. Sinuses, the air pockets around the bones of the face and forehead, are lined with mucous membranes, which can become inflamed when the nose is exposed to allergens. The swelling can prevent sinuses from draining, making them a breeding ground for infections, says Mark S. Dykewicz, MD, director of allergy and immunology at the Wake Forest University School of Medicine. Before you go under the knife (or get a CT scan), ask your doctor to screen you for allergies.
One study also found that people with allergies were 14 times more likely to have migraines. "When the lining of the nose becomes inflamed from allergies, it may activate the trigeminal nerve, which provides sensation to the face and can trigger migraines," says Brian Grosberg, MD, director of the Inpatient Headache Program at Montefiore Medical Center in New York City.
Many patients don't have asthma under control even if they're taking medications for it. One reason? You guessed it: untreated allergies. More than half of adults with asthma have allergies and many don't know it. "If you don't control the allergy symptoms, it makes it a lot harder to control your asthma," says Dr. Rachelefsky. Allergies can cause chronic inflammation of the airways and make them hyperreactive, setting up asthma attacks. The National Institutes of Health recommends allergy testing if you have persistent asthma. Lessening exposure to allergens can dramatically improve asthma symptoms and lower the amount of meds you need. If you're allergic to dust, even simple steps like protecting mattresses with an allergen-proof encasing (the airtight type also used to prevent bedbugs) can help.
Fran Howard couldn't stop coughing. Her doctor tried antibiotics and then an asthma inhaler. "It was a dry, hacking cough that wouldn't go away no matter what I did," says Howard, of Chicago. Her doctor finally sent her to an allergist, where she learned she was allergic to grass, trees, pollen, and bee stings. It's a common scenario for coughers; they're given antibiotics or just told to wait it out, says Dr. Rachelefsky. Coughs, along with hoarseness and sore throats, can be caused by postnasal drip or from the allergens that irritate the lungs and throat. Treating allergies often calms coughing.
Insomnia and Sleep Apnea
About 80 percent of people with allergies say that feeling congested makes it difficult to fall asleep or causes them to wake up in the middle of the night. Being stuffed up can lead to microarousals: You don't realize you're awake but you can't get into that restorative deep sleep, explains Dr. Cox. The more congested you are, the worse your sleep will be and the more tired you'll feel the next day. Allergies also contribute to snoring and increase your risk of sleep apnea, when you literally stop breathing for seconds at a time throughout the night. Sleep apnea can cause fatigue, memory problems, high blood pressure, weight gain, and other serious health issues.
People with allergies have a higher rate of depression than the general population. One recent study even found an increase in suicide during allergy season. The connection is not well understood, and any health condition can put stress on people and lead to depression. Allergies can wreak havoc with your quality of life. They make you tired, irritable, and physically uncomfortable and can put a damper on your social life. All of that can contribute to the blues, says Scott Patten, MD, professor in the department of community health sciences at the University of Calgary. But some experts think allergies might play a more direct role in depression. The inflammatory chemicals released during an allergic reaction may affect the nervous system and mood, but more research is needed. Meanwhile, try treating the allergies and see if that lifts your spirits, too.
High Blood Pressure
Allergic rhinitis may lead to hypertension, according to research. Those with year-round allergies seem to have the greatest risk. While findings aren't conclusive, some experts theorize that the allergy-sleep apnea connection could play a role, since apnea has been linked to high blood pressure, explains Tania Aung, MD, an internist at the University of Rochester Medical Center and author of A Review of the Research. Another theory says the cascade of chemical activity from allergies may cause patients to retain sodium, which raises the risk of hypertension.
Heartburn and Stomach Trouble
Caroline Hill of New York City started having stomach issues a few years ago. "I had diarrhea and bloating and I'd feel like my throat was closing when I ate certain things," she says. She thought she had lactose intolerance and saw a gastroenterologist, who also tested her for celiac disease, but both tests were negative. After she had a particularly frightening reaction one day, she decided to see an allergist. He tested her for 250 allergens and found that she was allergic to barley, corn, shrimp, and mustard seeds. "It made sense because I was eating multigrain sandwiches with mustard," says Hill. She was also diagnosed with eosinophilic esophagitis, an emerging allergic condition that doctors are seeing more and more. People with the illness complain of heartburn-like symptoms and feeling as if they have a lump in the throat, but not the classic symptoms of food allergies like hives, itching or wheezing, explains Dr. Mitchell, who diagnosed Hill. Patients often think they have gastroesophageal reflux disease, but the drugs for GERD don't help. Doctors usually diagnose the condition by doing an endoscopy of the esophagus, but you may want to get tested for food allergies before undergoing this invasive procedure.
Rather than just treating your symptoms with a medicine cabinet full of drugs, your best strategy is to try to prevent symptoms in the first place.
Avoid Your Triggers
If you're allergic to indoor allergens, like dust mites or pet dander, try encasing pillows and mattresses and keeping pets out of bedrooms. And if you reduce the number of hours your dog stays inside, allergen levels will drop considerably. To avoid outdoor triggers, use HEPA air purifiers to remove allergens from your home.
Consider Getting Shots
Allergy shots, also called immunotherapy, are not that popular because, well, who wants to go have frequent needle jabs? But compare that to months of suffering from symptoms year after year. "Immunotherapy can give you symptom control for years without needing any medications," says Dr. Cox. Here's how it works: Once or twice a week you get a shot that contains tiny amounts of the substance you're allergic to. Your doctor will increase the amount over time, as you slowly build up resistance to it. After several months, you cut back to three times a month, then twice a month, then once a month. After three to five years, most people can stop the shots altogether. Allergy shots have been very successful in treating allergies to pollens and dust mites, but a bit less effective against mold, cats, and dogs, says Dr. Dykewicz.
Try the New Drops
Called sublingual immunotherapy, this new preventive treatment could have mass appeal once it gets FDA approval (it's off-label now). SLIT involves putting drops under your tongue once a day -- no needles! Plus, you take the drops at home, so it's more convenient than going to your doctor for shots. About 6 percent of allergy doctors now offer it. The drops aren't covered by insurance and can cost about $300 for a three-month supply, but you'll save money on office co-pays. The FDA is reviewing sublingual tablets, says Dr. Cox, which would work like the drops but probably be covered by insurance once approved.
The message is clear. Don't assume you don't have allergies. And even if you know you have hay fever, you may want to be tested for indoor allergens. Underlying allergies can make your seasonal symptoms worse. Start with your primary care physician. Some general practitioners are educated in allergies and can diagnose you by taking a thorough symptom history without any need for tests. Once you've been diagnosed, your doctor should refer you to an allergy specialist, who might order a blood test to check for allergens that are common in your region, or a skin-prick test to get more-detailed information.
Originally published in Ladies' Home Journal , May 2011.