Recently, the American College of Allergy, Asthma, and Immunology (ACAAI) took part in publishing a practice guideline for allergists and other healthcare workers about the latest developments in understanding allergic rhinitis.
“The guideline highlights the fact that cough is a common symptom of hay fever,” said allergist Dr Luz Fonacier, ACAAI president. “Many people aren’t aware of that, and especially as we face another spring with Covid-19, people should be aware that a cough isn’t necessarily a Covid-19 symptom, it can just be part of allergies.”
Five additional recommendations highlighted in the guidelines included:
1. Avoid first-generation antihistamines: Advise patients taking an oral medication to treat their hay fever to think twice before using first-generation antihistamines such as diphenhydramine and chlorpheniramine. They can cause drowsiness and symptoms like dry mouth, dry eyes, and constipation. Instead, they should opt for non-sedating treatments such as cetirizine, levocetirizine, fexofenadine, loratadine, or desloratadine.
2. Intranasal corticosteroids are an effective treatment: Intranasal corticosteroids (fluticasone, mometasone, budesonide, triamcinolone) are the most effective treatment for patients who suffer from persistent allergy symptoms, especially if they are interfering with their quality of life. They may even help control the symptoms that accompany eye allergies.
3. Pseudoephedrine is effective but has side effects: Many people use the oral decongestant pseudoephedrine to clear up a stuffy nose. Unfortunately, pseudoephedrine is the main ingredient in methamphetamine – commonly called “meth.” Pseudoephedrine has many side effects including insomnia, loss of appetite, irritability, and heart palpitations. It should also not be taken by pregnant patients.
4. No verdict on alternative treatments like acupuncture: In developing the guideline, the allergists did an extensive review of medical studies that examined the effectiveness and safety of alternative treatments such as acupuncture and herbal medications. Because there is a lack of adequate studies, they concluded that they could not currently recommend for or against the use of these treatments for hay fever.
5. Food allergy testing should not be a part of testing nasal allergies: When patients get tested for allergic rhinitis, they are often tested for food allergies at the same time. The guideline strongly emphasises that food allergy testing should not be performed in the routine evaluation of allergic rhinitis because food allergies do not cause nasal symptoms. Occasionally patients have food-pollen cross reactivity. Testing for hay fever should include sensitivity to pets, dust mites, trees, grasses, weeds, and mould as they are the most likely triggers for nasal allergies.
Patients suffering from nasal allergy symptoms that don’t respond to regular treatments should be encouraged to make an appointment to see an allergist.
SOURCE: Ohio State University Wexner Medical Centre
Link to https://wexnermedical.osu.edu