Do you drive with your eyes closed? You do while sneezing. Driving with a bad cold or with allergies can be hazardous. Treating allergies is good for your safety, not just your sniffles.

Allergies are often worse certain times of the year. Spring is bad, since plants bloom, releasing pollens. If you're allergic, your body reacts to these pollens and to other allergens (things you're allergic to) as if they're invading organisms: it tries to kill them. Mold releases spores when humidity rises, triggering allergies in people with mold allergies when it rains or gets damp.

Allergies can be confused with an upper respiratory infection, like a cold. Though symptoms may be similar at first, colds eventually involve more systems than just your nose. They'll usually cause fever, muscle aches, and sometimes nausea, vomiting, and/or diarrhea. Allergies won't.

Colds may resemble allergies since the body's defense mechanisms against cold viruses and allergens are similar. Your nose gets stuffy and runny, you sneeze, and sometimes you cough. This is how your body tries to trap and eliminate invaders, which may be bacteria, virus or allergens.

Treatments for allergies vary. Most work by convincing your body not to fight so hard, or by blocking some of your bodys defense mechanisms.

Histamine is a substance that's central in your body's response to a perceived threat. It's released by mast cells after your body "recognizes" enemies. It makes blood vessels leak a little, in order to get some of your body's defense mechanisms out into the tissue where the "problem" is. When this happens in your nose after you breath in an allergen, it causes the nasal tissue to swell and get more moist. The resulting stuffy, runny nose is part of the histamine response.

Antihistamines block this response, more or less, and may help stop the runny nose and itchy eyes typical of many allergies. The problem is that most of the antihistamines available without prescription can impair your functioning. Here's an interesting fact: the most common class of drug found in the autopsies of pilots who've crashed is antihistamines. They can impair your brain function, even if you don't feel sleepy. What's more, you're more likely to fall asleep with antihistamines on board. Case in point: Benadryl (diphenhydramine), a strong over-the-counter (OTC) antihistamine, is also sold as Sominex, a sleeping pill. Most of the cold and cough remedies, like Actifed, Dimetapp, Theraflu, and Nyquil, also have sedating antihistamines. Don't take them and ride or drive.

There is a newer class of antihistamines that are called "non-sedating." Claritin (loratidine) was the first in this class, and tends not to sedate much at the standard 10mg dose. Unfortunately, it's not as powerful as some of the OTC (but sedating) ones. Other newer "non-sedating" antihistamines include Allegra (fexofenadine) and Zyrtec (cetirizine). Zyrtec is the strongest antihistamine, but does cause some drowsiness in some people.

If you get allergies that mostly affect your nose, the steroid nasal sprays are a very good choice. They work by stabilizing the cells that cause the release of histamine. In other words, they convince your nose not to worry about the allergens floating by. Flonase (fluticasone), Beconase (beclomethasone), and Nasonex (mometasone) are examples of this class of meds. They typically only need to be used once a day, and have essentially no systemic effects. After using this kind of medication for a few days, most folks feel like their nose moved to the New Mexico desert - their allergies disappear.

Decongestants, like Sudafed (pseudoephedrine), are also popular for allergies, but they should be used with caution. They constrict blood vessels inside your nose, drying it out. When your nose is running, "drying it out" sounds good, but since a dry nose can't moisturize the air going to your lungs, your lungs get dried out, too. Then, the mucus lining the lungs' airways gets hard and sticky, and stays there inside your bronchial tubes. Not only does this cause irritation that can trigger asthma, but it can cause some people who've never known they had asthma to start wheezing. If you take decongestants, be sure to drink a lot of liquids.

There's another class of medications called "mast cell stabilizers" that is very useful for some kinds of allergies. If used before you're exposed, it can prevent you from reacting - for example, you might use a mast cell stabilizer beofer visiting a friend with a cat, or riding through an area you know will have a lot of pollen. Nasalcrom (cromolyn) is available for use in the nose, and similar medications can be used in the eyes and lungs. They have very few side effects and are worth a try.

Not all allergies affect the nose and/or lungs. Many people get red, itchy, watery eyes from allergies. There are antihistamine eye drops available without prescription that can be helpful, but they shouldn't be used for more than a few days. If used too long, you may get a "rebound effect" with worsening of your symptoms. Prescription antihistamine eye drops are useful, too, but like the OTC drops, many need to be used often - sometimes 4 times a day. There are "mast cell stabilizer" eye drops available, too.

Acular and Patanol are other very useful eye medications - they often work like magic. If your eyes bother you a lot during allergy season, and an antihistamine or mast cell stabilizer doesn't do the trick, ask about one of these type drugs.

The take home message is that allergies are more serious than just a little stuffy nose. They can affect your lungs; your sinuses; they can even trigger an asthma attack. Remember: allergies are nothing to sneeze at.

(c)flash gordon md 2003


for more articles like this, see my book "Blood, Sweat, and Gears." Available from Whitehorse Press (800-531-1133) or by clicking here from amazon.

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