Allergies

Allergies

There's No Need to Suffer

You wake up one morning feeling a little sluggish and not quite with it. But you figure you're just a little tired--nothing a cup of coffee can't handle.

So you shower, dress and jet off to work, with the windows rolled down to let in some cool air. Upon arrival, you fill up that mug and settle down to write some memos.

About an hour later, it hits you.

It's that heavy feeling in your head. Not a headache, really--more like a huge piece of cotton has been stuffed through your nose and back into the deep recesses of your brain. It feels as if the cotton cloud is just sitting there, weighing down your thoughts, blocking your creativity, sapping your mental energy.

You take a brief break. You try switching to a different project. But no matter what, you just can't seem to shake that foggy, bogged-down feeling.

Then you realize it's that time of year again. Allergy season.

Allergies come in many varieties, affecting about 20 percent of women of childbearing age. Seasonal rhinitis, commonly known as hay fever, affects about 10 to 15 percent of the U.S. population, and women and men are believed to be equally affected. But in addition to seasonal allergies caused by pollen, women can be allergic to a host of other substances--dust, air pollution, molds, chemicals, animals, latex and even medicines. Some women (and men) develop allergic reactions when stung by insects such as bees, wasps and hornets. About 1 percent of the U.S. population has such reactions, and while some are mild, others are life-threatening.

With the exception of skin dermatitis and drug allergies, no one allergy appears to be more common in women than in men, allergists say. Women differ from men, however, in that their allergic symptoms and treatment are sometimes influenced by pregnancy. Hormonal changes during the menstrual cycle and menopause may also affect allergies, although how much is not well-understood.

Understanding Allergies

In their milder forms, allergies are uncomfortable, while the more severe types can be life-threatening. The irony is that an allergy is basically your body's way of trying to defend itself, says Daryl R. Altman, M.D., an allergist and immunologist and director of Allergy Information Services, an allergy consulting service in Lynbrook, New York. But in trying to protect you, it makes you feel miserable.

Here's how it works. A central component of your immune system is antibodies, special proteins that serve as lookout soldiers: Their job is to identify foreign invaders, capture them and transport them to cells in the body that can destroy them. In the case of allergies, your body mistakes certain foreign materials that are usually harmless--dust, pollen and mold, to name a few--as a threat. The antibodies, specifically IgE antibodies, carry the so-called intruder substances to special cells, which then release chemicals to destroy them.

One type of cell that often fights to protect the body is called a mast cell; these cells release histamine, the chemical responsible for runny noses, red, itchy eyes and several of the other symptoms familiar to those with allergies. Other cells are also called into action, and they release different chemicals that cause many of the other symptoms of allergy--congestion, skin rashes and hives. In severe allergies, some individuals experience anaphylaxis, a life-threatening condition in which the throat swells shut, blood pressure plummets and the body goes into shock.

Not everyone develops allergies. That's because it takes a special combination--one which researchers don't completely understand--of your genetic makeup and how much you are exposed to certain substances in the environment. Allergies can be inherited, so if your mother, father, grandparents or cousins have them, there's an increased possibility that you will, too. For some people with environmental allergies, one exposure is enough to trigger an allergy, while for others more repeated exposure is necessary.

Women and Allergies

By and large, women are susceptible to the same allergies as men. Two factors, however--the menstrual cycle and pregnancy--may create differences for women.

Some women notice either worsening or improvement of their allergy symptoms at different phases of the menstrual cycle, says Dr. Altman. Women who get hives, either from a food allergy or an allergy to medication, may find that the start of their menstrual cycle exacerbates the problem, adds Rebecca Gruchalla, M.D., assistant professor of internal medicine in the Division of Allergy at the University of Texas Southwestern Medical Center in Dallas. Physicians are unclear which hormones are responsible for the change in symptoms, but they suspect that progesterone may play a key role.

At menopause, some women who go on hormone replacement therapy--taking both estrogen and progesterone--experience an increase in nasal congestion. And if they have allergies, they may be even more stuffy.

Pregnancy can also affect allergy symptoms, doctors say. Approximately one-third of women find their allergies get worse, one-third experience no change, and one-third experience improvement in their symptoms, says Dr. Altman. In women who experience an improvement, the cause is not clear, says Dr. Gruchalla. Sometimes the improvement will continue even after the woman has had her baby, she says.

While it's difficult to predict how your allergies will respond to pregnancy, it is likely that how you respond the first time will be repeated in subsequent pregnancies, Dr. Gruchalla says.

Women may also have an increase in nasal symptoms during pregnancy, says Michael Schatz, M.D., clinical professor of medicine at the University of California, San Diego, School of Medicine and a staff allergist at Kaiser Permanente Medical Center in San Diego. About 35 percent of women complain of nasal congestion and sinus headaches at this time, he says. Hormonal changes that affect tissue elsewhere in the body also affect the tissues of the nasal passages: The blood vessels there tend to increase in diameter, causing more congestion. Pregnant women without allergies can experience this, but if a pregnant woman has allergies to boot, she can end up with a double whammy. These problems can make sleeping difficult for some women.

Medications and Pregnancy

Allergy treatment is a special concern for women who are pregnant as well as for those who are thinking about starting a family. Certain allergy medications are not recommended during pregnancy because they can have an adverse effect on the fetus. Since pregnancy is not always that easy to plan, women who are contemplating becoming pregnant should discuss allergy medications with their doctors ahead of time, says Dr. Altman.

"The good news is that there are a number of allergy drugs that are well-known and have been used for a very long time during pregnancy and have not been shown to increase the risk to the mother or the fetus," says Dr. Altman. "Although you should have a healthy respect for medications used during pregnancy, there's no reason for a woman to suffer and be miserable with allergies during pregnancy," she says.

If you're looking for an over-the-counter antihistamine, those containing diphenhydramine (Benadryl) carry no increased risk for pregnant women and their fetuses, says Dr. Altman. Women do need to keep an eye out for--and avoid--a medication called brompheniramine, says Ellen Garibaldi, M.D., assistant professor of internal medicine in the allergy and immunology division at St. Louis University Health Sciences Center. "It's known to be harmful to the fetus," she says . "And these things are available over the counter, so it's really buyer beware."

The prescription anti-inflammatory nasal spray cromolyn (Nasalcrom) is very poorly absorbed and therefore safe for the fetus as well, says Dr. Altman. But probably the antihistamine of choice for doctors and patients is a prescription medication called tripelennamine (PBZ tablets), says Dr. Garibaldi. It's effective and doesn't pose a risk to the mother or her baby.

Pregnant women or those planning a pregnancy need to pay particularly close attention to the over-the-counter decongestants they choose. "There are certain decongestants that can cause limb or organ malformations in the fetus," says Dr. Garibaldi. "They can be very common products. They can be over-the-counter products," she says.

In particular, pregnant women should avoid phenylpropanolamine (which is in Triaminic Expectorant and some other cold medications), says Dr. Garibaldi. A safe option is pseudoephedrine, found in brands like Guaifed, Bromfed and Tussar. "Pseudoephedrine can be given throughout pregnancy with no ill effects," she says.

While over-the-counter nasal sprays are safe in pregnancy when used as recommended, women often stay on them longer than they should--sometimes months at a time instead of the recommended three days. They also often use them more frequently than they should--sometimes every two hours rather than four times a day, says Dr. Garibaldi. This can cause a dependence on the spray to the point where the woman cannot decongest without it. If women use a lot more than recommended, the drug may endanger the fetus by leading to constriction of the umbilical arteries and veins, she says.

Go for Control

The first step in preventing allergies is to take whatever steps you can to change or control your environment so your exposure to whatever offends you is kept to a minimum. There are a number of lifestyle modifications you can make, both at home and away from home, that can help decrease your allergic reactions.

First, find out what bothers you. The only way to effectively avoid or reduce your exposure to an allergen is to find out what it is. If you think you've got allergies, go to an allergist or immunologist and get tested, says Dr. Altman.

There are several tests doctors can do to determine what you are allergic to. One is a skin-prick test, where the doctor pricks your skin, introduces possible offending agents and waits to see if your arm gets puffy and red in the area where you were pricked. Another test, the RAST test, is a blood test that looks for the IgE antibodies in your system. For referral to an allergist, call the American Academy of Allergy and Immunology's Physician Referral and Information Line at 1-800-822-2762.

When the Problem Is Mites

If you are allergic to dust mites, a very common problem, try the following strategies.

Get down to the basics. Eliminate the clutter in your home, says Dr. Altman. This means anything that can collect dust--stacks of newspapers, piles of books, knick-knacks and fuzzy stuffed animals. Clothes can harbor dust mites, which feed off human skin flakes. So if you're in the habit of letting your laundry build up into a huge pile, move the laundry basket into a room other than the one you sleep in, says Dr. Altman.

Go minimalist. Carpets and drapes are major dust-mite strongholds, so get rid of the wall-to-wall carpet, says Dr. Altman. "A bare floor is better than carpeting," she says. No amount of vacuuming takes care of dust mites, she says. Shades or mini-blinds may be harder to clean than drapes, but they'll collect less dust.

Scald those sheets. Your sheets and pillowcases can also harbor dust mites. Be sure to wash them in scalding water at least every one or two weeks, says Dr. Garibaldi.

Double case it. Dust mites can also live in your mattress, box spring and pillows. Since you can't wash your mattress and box spring, and it's not convenient to wash pillows that often, cover all of them before you put sheets and pillowcases on, says Dr. Altman. Some bedding encasings are vinyl, while others have vinyl on one side and cotton on the other.

Clean your office. Keep your work space clear of clutter, says Dr. Altman. Clean your desk once a week with a damp sponge, and don't let paper accumulate in dust-collecting piles.

Send Pollen Packing

If you're allergic to pollen and have a problem with hay fever, here are some suggestions.

Use the dryer. Try not to hang your sheets, or any laundry for that matter, out on a line to dry. They'll pick up pollen. Zapping them in the dryer may not be as energy-efficient, but it can help cut down on your hay fever symptoms.

Turn on the AC. Keep the windows closed and turn on the air conditioner, says Dr. Altman. Do this in your car as well as at home, she says.

Call for the count. Find out what the pollen count in your area will be by calling the Pollen Forecast Hotline (1-800-POLLENS). When you call, you'll be asked to key in your ZIP code or the abbreviation for your state. The hotline then tells you whether the pollen level is low, medium or high, and what plants are pollinating.

Change your exercise routine. Outdoor activity increases your exposure to offending pollens. In general, pollen counts are highest in the early morning and decline throughout the day, says Dr. Gruchalla. So consider planning your outdoor walk, run or bike ride for late afternoon or early evening, she says. You might also consider moving your exercise routine indoors when pollen counts are really high, says Dr. Altman.

Wear sunglasses. If you have to be outdoors when pollen counts are high, wear wrap-around sunglasses, says Dr. Garibaldi. They'll act as a barrier to prevent pollen from getting into your eyes. Or wear regular glasses for your walk or run.

Fighting Other Reactions

If you have allergies, what's routine for most people can be a nuisance for you. Here are a few things that could be making your allergies worse.

Reconsider getting a pet. If you have allergies and don't own a pet, think twice before you buy one. If you already have one and you can't bear to part with it, try to keep your symptoms to a minimum. "Don't sleep with it," says Dr. Altman. And if you have a cat, bathing it once a week in warm water, while not always an easy thing to do, can be effective in cutting down on dander, she says. The same goes for dogs, which are generally easier to bathe.

Watch out for wicker. Wicker baskets used for houseplants can be a prime breeding ground for mold. Move the plant into a nonwicker container. Or place it in a plastic or ceramic pot before putting it in the basket. The pot will keep water from soaking into the wicker basket, preventing mold growth.

Steer clear of smoke. "Try to avoid smoke-filled areas," says Dr. Altman. And if you're a smoker, do your best to give it up. "Smoking makes allergy symptoms worse," she says, because it irritates your eyes, nose and lungs.

Go for a filter. An air filter will help if you've got dust, pollen or animal dander allergies or are exposed to smoke. A HEPA air filter is very effective, says Dr. Altman. It costs between $100 and $200, but in some cases, insurance may cover it, she says. You can buy a freestanding filtering machine at a hardware or variety store. Or you can have a filter installed in a central heating and air-conditioning system that circulates air.

Get a filter to go. If you work in an office where you are exposed to things that trigger your allergies--smoke or dust, for example--consider buying a freestanding, self-operating air filter for work.

Wear your bracelet. If you are allergic to a medication--penicillin, aspirin, morphine or sulfa--wear a bracelet that identifies your allergy. MedicAlert is one company to call (1-800-423-6333).

When Change Is Not Enough

While changing things in the environment may be enough to control allergies for some women, others with allergies require medication. Here are some tips to help you make your choices.

Start with OTCs. If you've got hay fever, you can start with antihistamines or decongestants. Just be sure to read the packaging carefully. Many of the stronger over-the-counter antihistamines induce drowsiness and should be taken only at night, says Dr. Gruchalla. And while some packaging may warn you not to take the medication if you are pregnant or think you may be, not all labels carry such warnings. If there's nothing on the label about pregnancy, talk to the pharmacist and ask if it's safe, says Dr. Gruchalla.

Finally, if you've got high blood pressure, see your doctor before taking any allergy medications, says Dr. Gruchalla. Some contain decongestants that may cause elevated blood pressure, she says.

Take it ahead of time. If you're going to exercise or walk outdoors, take your antihistamine at least an hour before you go out, says Dr. Garibaldi. This gives the medication time to go to work before you're exposed to pollen.

Stay lubricated. Antihistamines reduce watery eyes and runny noses by causing the tissues in those areas to dry up. But just as your nasal passages dry up, so can your vaginal tissues. If you're taking an antihistamine, you may find you don't lubricate as easily when you're sexually excited. Try a water-based lubricant, says Jo Kessler, a licensed nurse-practitioner and certified sex therapist in San Diego.

Consider prescriptions. If over-the-counter medications don't relieve your symptoms, see an allergist about possible prescription medications.

Arm yourself. If over-the-counter and prescription medications don't control your allergies, allergy shots are a possibility. Your doctor may start you off on a low-dose shot that contains the allergen you react to. Your body will build up an immunity, and the shots will eventually prevent your allergy symptoms from kicking in. Doctors won't start allergy shots if you're pregnant, but if you're already taking the shots when you get pregnant, you can stay on a maintenance dose. Doctors don't like to increase the dose of shots during pregnancy because there is a chance they can cause anaphylaxis.