Allergies are a little like sinus disease in that they’re probably not as prevalent as people think. Having said that, a lot of people do have allergies. Allergic symptoms are well known to most of us, and include runny nose, stuffy nose, and itchy, watery eyes. Depending on what one is allergic too, symptoms can be either seasonal or year-round.


Diagnosis of Allergies

In general, the way I diagnose allergies is by the patient’s history and whether their symptoms respond to allergy medications (see below). However, the scientific diagnosis of allergies is by allergy testing. This can be done either by certain blood tests (RAST testing) or by skin testing. I consider RAST testing to be a bit too sensitive for routine use, and only use it to confirm a suspected food allergy or in children too young for skin testing. Skin testing is fine, but it’s expensive, and I generally only order it if the patient and I agree that allergy shots might be an appropriate treatment (since one has to get tested to mix the shots) or if some question exists as to whether the problem is truly allergic or not.


Treatment of Allergies

There are a number of treatments for allergies. If one knows what one is allergic too and can avoid it (like cats), obviously this is the simplest solution. Since this is often not possible, huge fortunes have been made on drugs to treat allergies. The most basic of these are the various antihistamines available over-the-counter (OTC). If your symptoms are truly allergic, any of these should work quite well, as by definition allergic symptoms involve the release of histamine. For some people, however, OTC antihistamines may make them drowsy or give them a dry mouth. If you are one of these people, the drug companies will be more than happy to supply you with a non-sedating antihistamine that costs about ten times more than an OTC antihistamine. Examples include Claritin, Zyrtec, and Allegra. What the drug companies don’t tell you, however, is that a significant minority of allergic patients don’t respond to these drugs. Thus, if you have tried one for a week and haven’t noticed any effect, you are probably in this group and need to try something else.

Other medications for allergies generally come as nasal sprays. These include a large number of steroid sprays, an antihistamine spray (Astelin) and a cromolyn spray (Nasalcrom). All of them have their advantages and disadvantages.

Finally, if your allergies bother you more than 4-6 months of the year, you may want to consider allergy shots. Since shots can’t be started and stopped like medications, I generally consider them only for people who need to be on something almost year-round. They also have their advantages and disadvantages, and do not work for everyone.