Spring has finally arrived and with it, all of the allergy symptoms we know so well: itchy watery eyes, sneezing, nasal congestion, runny nose and cough. You're not alone if you suffer from allergies. As many as 15-25% or 40 million Americans have allergies to indoor and outdoor allergens. Springtime means tree allergies. The yellow dust that will cover our cars later this month is due to oak trees, besides other important trees such as maple and elm. Spring is followed by the summer grasses and fall weeds. Remember that allergies are genetic in origin (i.e., runs in family) and environmental as well. Therefore, whether a child or adult, if allergies run in your family and you happen to live in the Mid-Atlantic region where allergies can be severe, you may over time develop allergy symptoms.

So much for the bad news. The good news is that our understanding of the mechanisms of allergies in addition to treatment options have increased considerably over the past 5-10 years. We now know that inflammation is primarily responsible for the symptoms of allergies. Inflammation occurs when cells in the tissues, and cells in the blood which migrate into tissues, react to allergens and release potent chemical mediators such as histamine. Histamine in turn causes itching, swelling, mucus production and drainage. Furthermore, inflammation from allergies, if left untreated, is now known to cause sinusitis (infection of the sinuses) and even asthma, which can be life threatening. Sinusitis in turn can also cause asthma. It is therefore very important to control and if possible, eliminate inflammation.

Steroids are the best medication available to control and eliminate inflammation (shown below). Not all steroids are the same. Indeed, steroids differ in their ability to penetrate tissue, remain active in the tissue (i.e., half life) and reduce inflammation. Studies indicate that Rhinocort, Flonase and Nasonex are the most potent nasal steroids, and in all cases, steroids control nasal symptoms better than oral antihistamines. The newest nasal steroid, Rhinocort Aqua, has the additional advantage of being fragrance free, which may be helpful for those patients having nasal irritation from fragrance. Most important, recent studies now show that inhaled steroids do not cause any significant growth reduction in children, and are therefore very safe to use.

NASAL STEROID SPRAYS

 

Name	Steroid	Available As	Dosing
Rhinocort	Budesonide	Aerosol, Aqueous (Aqua)	1-2 sprays once or twice daily
Flonase	Fluticasone	Aqueous	1-2 sprays once or twice daily
Nasonex	Mometasone	Aqueous	1-2 sprays once or twice daily
Nasacort	Triamcinolone	Aerosol, Aqueous(Aq)	1-2 sprays once or twice daily
Nasalide	Flunisolide	Aqueous	1-2 sprays twice daily

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