Allergy Management

For sensitive individuals, your body may mistake harmless allergens as harmful releasing histamine into the bloodstream. Histamine is the cause of symptoms associated with allergies such as

• Sneezing
• Itchy, watery eyes
• Runny nose
• Itchy throat
• Stuffy nose
• Fatigue
• Recurrent ear infections
• Recurrent sinus infections
• Throat clearing
• Post nasal drip
• Hives
• Nasal Polyps
• Asthma

These symptoms are often called hay fever (although hay fever is neither caused by hay or results in fever).

There are several ways to test for allergies. Most physicians have demonstrated that certain kinds of skin testing gives superior results than others. The Pasha Snoring & Sinus Center utilizes 2 techniques to accurately diagnose your allergies in the office:

1. Prick Testing: This test is typically used as a screening to determine only if you are allergic and takes only a few minutes. A series of allergens are placed on the forearm by gently scratching the surface of the skin. If you are allergic to a certain allergen, redness appears within a short period of time.
2. Intradermal Testing or Skin End-Point Titration (SET): SET testing takes more time but is much more sensitive than prick testing. A series of small injections using only small needles are placed just under the skin causing only mild discomfort. The test substance is placed on the arm (or back) in rows. If the small bumps enlarge in short period of time then it indicates that one is allergic.

Dr. Pasha does not believe that blood testing for allergies (RAST testing) is accurate or appropriate for proper allergy management.

Pasha Snoring & Sinus Center focuses on the allergens most common to Texas. Many allergy sufferers react to the pollen of weeds, trees, and grasses.

• Pollen is carried in the air (may be as far as hundreds of miles away!) and may be inhaled by allergy sufferers.
• Early springtime allergens are often from pollens or trees (e.g. Live Oak, Maple, Elm, Mountain Cedar, and Birch).
• Late spring allergies often come from grasses (e.g. Bermuda, Johnson, and Timothy).
• Ragweed is the most common culprit in weed allergies and occurs primarily in late August until the first frost or late October.
• Flowery plants tend to have heavy pollens and do not stay airborne, thus are not a common cause of allergies.
• Molds are fungi that exist on spoiled food, mildew, damp places, and household and outdoor plants. Molds may take the form of spores, which may drift into the air. Molds do not go away during the frost and may last most of the year (especially for indoor molds).
• Dust and Dust Mites is the most common allergen. Dust is a combination of several different antigens including cockroach and dust mites, which may live in mattresses, pillows, and carpets.
• Other common antigens: include cats, dogs, insects, and foods.

1. Avoidance: The first line of therapy for allergies is avoidance. Knowing what activates your allergies through allergy testing allows you to avoid being exposed to harmful triggers. For instance, knowing you are allergic to dust mites directs you to obtain dust mite resistant bed sheets and pillows. Reducing your exposure may dramatically improve your nasal complaints. Many allergens, however, such as dust, pollens, and mold are difficult if not impossible to avoid, especially at work.
2. Medications: Medication is the most common way to deal with allergies. Although medications may give you temporary relief, they offer little to no long-term benefit. Nonetheless, understanding how to use your medication is critical in your overall management of allergies.
3. Immunotherapy (allergy shots): Immunotherapy is the mainstay option in treating the underlying cause of your allergic response rather than treating only your symptoms. Immunotherapy is especially ideal for those who cannot avoid their allergens, who have severe allergies, or who wish to be off of medication.
4. Treat Secondary Effects: the last step in allergy management is to manage any consequences of long-term untreated allergies. These effects include recurrent sinusitis, turbinate enlargement, ear infections, and formation of nasal polyps.

Medication is the most common way to deal with allergies. It is important to understand how the different types of medications work and when to use them. There are six basic types of medications to control your allergies.

1. Antihistamines: There are many types of prescription and over-the counter antihistamines (eg., Clarinex™, Allegra™, Benadryl™, Xyzal™, and Zyrtec™). Antihistamines should be used as needed to control allergy symptoms such as itchiness, drainage, sneezing, and congestion. Antihistamines have no long-term benefit so do not need to be taken when you do not suffer from allergy symptoms. Aside from medications that you take by mouth, some antihistamines may be applied directly to the eyes (eg., Pataday™, Optivar™) control itchy, watery eyes or to sprayed into the nose (eg., Astelin™, Astepro™) to address nasal itchiness and congestion. Antihistamines may also be used preventively when you are at risk of allergen exposure.
2. Corticosteroid Nasal Sprays: Nasal corticosteroid sprays (Nasonex™, Veramyst™, Nasocort AQ™) are very common. They only work if used daily. Single use or “”as needed”” use will not be effective since the benefit from nasal corticosteroids take 1-2 weeks. Nasal sprays reduce nasal swelling, inflammation, and drainage. The side effects of nasal steroid sprays are minimal since the steroid has little penetration into the bloodstream. They are not addicting.
3. Nasal Salt Water (Saline) Sprays: Salt water or saline solutions that may be acquired as an over-the counter nasal spray (Nedipot™, Ayr spray™, Ocean Spray™) or made yourself is very safe and may be used as many times as you wish. The benefit of salt-water solutions is that it physically cleanse the nose of allergens. It also “”washes out”” the mucous that may be trapped in your nose and sinuses.
4. Antileukotrienes: Antileukotrienes (Singulair™) address allergies in a different pathway than antihistamines by blocking the late phase allergy response. This phase occurs several hours later and causes congestion and runny nose. Asthmatics also use these medications to control their attacks. Antileukotrienes must be used on a daily basis during your season to be effective.
5. Nasal and Oral Decongestants: Nasal decongestants such as Afrin™ or Neo-Synephrine are over the counter medications that reduce swollen nasal membranes. They clear nasal passages almost immediately and are useful in treating temporary severe nasal congestion. Nasal decongestant sprays are safe to use for only 3-5 days. Prolonged use leads to rebound congestion or “”nasal spray addiction””. Oral decongestants are primarily over-the counter such as pseudoephedrine (Sudafed™) and phenylpropanolamine. They may also be considered for temporary relief of nasal congestion. Oral decongestants may cause anxiety, urination difficulty (enlarged prostate), worsened high blood pressure, and an increased heart rate. Patients with high blood pressure, enlarged prostate, or heart problems should consult with Dr. Pasha before using decongestants. Please note that some decongestants are combined to reduce the number of pills and are often given the suffix “”-D”” such as Claritin-D™, Allegra-D™.
6. Corticosteroids: For those of you who have severe allergies, nasal polyps, or severe sinus infections, Dr. Pasha may recommend corticosteroids such as Prednisone or a Medrol Dose Pack™. Corticosteroids have many potential side effects especially when used for the long term. Prescribed steroids must be used exactly as prescribed for its entire course. Do not stop the use of the drug without consulting Dr. Pasha as conditions may become worse if suddenly stopped. Review the side effects profile in detail with your prescription package and report any side effects to Dr. Pasha.

Steroid or corticosteroid injections have the benefit of requiring one injection that may last several weeks. Dr. Pasha does not like to use steroid shots for several reasons.

First, steroid shots do not have any long term benefit. Therefore, steroid shots require repeat injections.

Steroids also have a considerable side effect profile. The immediate risk of steroid injections is that they can cause dimpling in the skin from destruction of fat under the skin at the injection site. This can be unsightly. Secondary long-term effects can occur if steroid are given repeatedly. These side effects include weight gain, hair growth, acne, and risks of high-blood pressure and worsening of diabetes.