If you suffer from allergies, here's how you can find relief without a prescription

The first question that you must answer is "do I have an environmental allergy?" The most common dilemma along this line is whether the nasal symptoms you're experiencing are due to allergy or due to a common cold.

Let's look at the differences:

Allergies typically begin in association with exposure to an identifiable environmental trigger. In the spring, that trigger is typically grass or tree pollen, and in the autumn the trigger is weed pollen or mold.

Colds, in contrast, are caught from someone else as an invisible virus is passed person-to-person and usually hand to mouth. Allergy symptoms continue for a longer period of time than cold symptoms. Allergies last months during which pollen rains down on us versus a week of cold symptoms while your body's immune system eradicates the cold virus. Environmental allergy symptoms, except those associated with a severe allergy to a food like peanuts or to medications such as penicillin or sulfa drugs, tend to be milder than those due to infection. Finally, allergies rarely have associated bodily symptoms such as fever and body ache, while those are hallmarks of colds.

Allergies are abnormal immune reactions by your body to agents in the air or in food. Allergies have triggers in your surroundings and targets in your body.

Allergic individuals frequently are susceptible to many triggers while most of us fail to react to any of these. Triggers include airborne pollens from grasses, plants, and trees, irritants such as dust particles, flakes of animal skin from cats and dogs, or tiny airborne organisms such as mites or mold. Many triggers are only in abundance during certain times of the year while others are present year round.

When an allergic reaction occurs it affects one or more targets in our bodies. The common targets for environmental allergies are the nose, the eyes, the throat, and the lungs.

Do-it-yourself allergy treatments are most available for nasal allergy, so called allergic rhinitis. Since allergies affecting the eyes and the airway can escalate with serious consequences, the FDA has wisely restricted access to those medications necessary for their definitive treatment. However, some oral allergy medicines and other general duty medicines can effectively control allergic reactions in all target zones.

Allergic reactions occur when a trigger enters the body and meets sensitized immune cells that release chemicals to produce reactions at the target regions. A common example is grass allergy. Grass pollen is inhaled and contacts the nasal linings. Previous exposures have already produced grass-specific antibodies of the IgE type that help the grass pollen bind to immune system cells. When that binding occurs, mast cells release histamine and typtases while other white cells release leukotrienes and cytokines. These effector substances lead to blood vessel relaxation, nasal congestion, an increase in respiratory secretions, sneezing, coughing, and most dangerous of all, the constriction of lower airways.

The key to eliminating environmental allergy misery is to identify the triggers and targets, to institute measures to prevent exposures to the triggers, and to employ effective aid to reduce the impact of the allergic reactions. As with most medical problems, it is far easier to prevent disease than to treat it once it occurs.

Trigger identification involves a bit of detective work, and the operative principle is guilt by association. Seasonal environmental allergies may be the easiest to find, since they tend to occur at the same time each year. Spring seasonal allergies to pollens from trees and grasses most often begin in mid-April and continue through June. Late summer and fall allergies to ragweed pollen and mold typically begin in mid-August and finish with the first frost of the season that frequently coincides with Halloween. The reactions occur when you are outside and exposed to the airborne agents.

So-called perennial environmental allergies, typically due to dust, mites, and animal skin flakes or dander, can occur at anytime during the year. The clue is that the symptoms occur when dusting has occurred or when playing with a pet cat or dog.

To decide which treatment to use, you need to observe which parts of your body are targets for the allergic reactions.

The most common target for environmental allergies is the nose with the onset of drippy congestion and a feeling of facial fullness due to poor sinus ventilation. Often the ears feel blocked due to poor airflow through the Eustachian tubes and the development of negative middle ear pressure and/or fluid. Nasal lining swelling can prevent air entry into the eustachian tubes. 

Your eyes may be affected as the pollens contact their sensitive conjunctival linings. The common eye allergy symptoms include itchiness, tearing, redness, and swelling of the eyelids.

When pollens are inhaled, airway reactions may begin. Coughing, wheezing, and shortness of breath with various levels of severity begin when allergic reactions occur in the throat, windpipe, and lungs. Isolated throat symptoms tend to be confined to itchiness, cough, and hoarseness.

Having identified the triggers and targets, therapy begins by preventing exposure to those triggers. To keep the pollens and other triggers away from your nose, eyes and airways is in theory easy but in practice much more difficult. To keep your immediate environments clean, keep your windows closed at home and when you are riding in the car. Use air conditioners, and don't forget to change their filters.

While you or your children are out and about in pollen-infested zones, use saline mist nasal irrigation frequently to wash the pollens off the nasal linings before they can trigger the allergic reactions. Drink water or juice to clear the pollen triggers off the throat linings and wash them into the acid-filled stomach where they are destroyed.

When you return home, stop in the mud room and shed your clothes and shoes. Your pollen-coated clothing should go into the wash. Keep a robe handy to wear through the house on your way to the shower to wash pollens out of your hair and off your skin. This strategy prevents your and your childrens' bedrooms from becoming pollen-infested "meadows."

Remember too that airborne allergens of all sorts hang out in rugs and may be stored in mattresses. If possible, eliminate rugs in favor of hardwood floors and encase your mattresses in plastic. Use of HEPA air cleaners may also be useful for eliminating particulate matter in the home air.

If prevention alone fails and allergic reactions begin, you will need aid. Choice of treatment for multi-site environmental allergies is a blend of target coverage and simplicity.

The most readily available agents are non-sedating antihistamines including Claritin, Zyrtec, and Allegra and the sedating antihistamines such as Benadryl, ChlorTrimeton, or Tavist. These agents will block allergic reactions at all sites so that the use of additional nasal sprays, eye drops, and inhalers may not be necessary.

The non-sedating antihistamines are typically taken once daily or sometimes twice a day. The sedating antihistamines are usually designed for administration 3 to 4 times a day, but they may be taken only at night as a booster for the non-sedating agents.

Remember too other over-the-counter medications may enhance the response to the antihistamines, particularly when an isolated boost is necessary. The NSAIDs including the ibuprofen Advil or, for those 21 years and over, aspirin will be useful adjuncts. The antihistamines may also be taken with a decongestant Sudafed to open the nasal passages and for additional drying of secretions which will stop post nasal drainage and cough.

For the sake of simplicity, I use the brand names of the relevant medications. The original developers of these agents spent thousands of dollars creating names that will be easy for us as consumers to remember. Know, though, that most drug chains have their own generic equivalents available at slightly lower prices. These are usually found on the shelf nearby the brand-name drugs with similar packaging. My recommendation is to buy the brand-name drugs unless the no-name drugs have a significant price advantage. Remember to that Claritin, Zyrtec, Allegra, and many of the classic antihistamines are all available in liquid, chewable, and pill form for consumption by patients of any age.

Oral decongestants such as Sudafed may be a useful adjunct to anti-histamines in order to quickly open the nasal airway and dry up secretions. Antihistamines alone usually take longer to achieve these goals.  

I don't recommend buying the antihistamine-decongestant combos for three reasons:

1) You won't always want to use an oral decongestant with the antihistamine;

2) If you need a decongestant, topical decongestants such as mild Neo-Synephrine or Afrin work more effectively than oral products; and

3) Oral decongestants only work well for 9 days in a row as the supply of neurotransmitters that mediate their action becomes exhausted.

When recommending therapy, I usually begin with the simplest first. I suggest a daily dose of Claritin selecting that over the others as it has fewer side effects. If that is insufficient, I recommend switching to the Zyrtec or Allegra. Even if  the nose is the only target, a daily dose of oral liquid or a pill is still the easiest for most and particularly for children. 

For stronger oral therapy, your doctor or your child's pediatrician may prescribe Singulair or oral corticosteroids. Singulair is a specific leukotriene blocker that works in tandem with the antihistamines. Corticosteroids effectively block most mediators of the allergic reaction. I mention these and other prescription only medications so that you will see how they fit into the treatment plan and know to ask for them when necessary.

If only your nose is affected, you have your choice of using the non-sedating antihistamines or a medicated nasal spray. The most effective and safe medicated nasal spray is one of the Flonase sprays: either regular Flonase or Flonase Sensimist. The latter is a slightly stronger version of regular Flonase which lacks the rose scent of the original product. 

When using any medicated nasal spray, always cleanse the nasal linings first with an aerosol nasal saline spray such as Simply Saline. Then instill the Flonase or Flonase Sensimist by directing the nozzle inside the nose upward and outward so that the mist covers the side walls of your nose. I typically recommend the Flonase for all but children under 4 years or for those who object to the rose scent. Children under 4 may use the Flonase Sensimist. The standard dose is one spray a day for the youngest children. For older children, adolescents, or adults the dose would be two sprays a day either together or one in the morning and one later in the day.

I recommend the Flonase products in preference to the other over-the-counter nasal steroids Nasacort (triamcinolone) or Rhinocort (budesonide) as Flonase is the safest. Only 0.5-1% of any absorbed Flonase steroid every circulates around in the body, and 99% is eliminated quickly in the liver. The other over-the-counter nasal sprays leak from 34-46% of their corticosteroid into the body.

By the way, there is no true infant or child version of either saline or of the Flonase products. You can use any version as the product labeled for children contains the same concentration of medication as that labeled for adults. However, Flonase Sensimist is safer for children than the original Flonase. 

Another nasal spray option for those who dislike the idea of using any steroid is Nasalcrom. This spray contains cromolyn, an agent that prevents mast cells from releasing their histamine in response to the allergen. The downside is that the Nasalcrom must be administered at least three times a day.

Also useful for improving penetration of the nasal sprays are topical nasal decongestants like NeoSynephrine for younger children and Afrin for all those 6 years and over. These sprays shrink swollen nasal linings permitting the topical nasal steroids to reach tissues further back in the nose. The decongestant should be sprayed in after the saline mist irrigation.  You should then wait at least 5 minutes between spraying the decongestant and spraying in the Flonase or Nasalcrom.

There are several prescription nasal sprays that you may request from your doctor if the topical nasal steroids alone are ineffective.  These contain  prescription only topical antihistamines either alone as Astelin or Patanase or compounded with the steroid in Flonase as Dymista.

If environmental allergies are making your eyes itchy, the oral antihistamines and topical saline eye drops are your best bets. Don't forget that oral NSAIDS will also help. Then, if your symptoms are poorly controlled, ask your doctor for prescription eye drops. Both cromolyn and antihistamine eye drops are available as Crolom and Patanol.

Again, due to the potential danger of airway allergies, the only over-the-counter agent that is available to you is the oral antihistamine. Another non-prescription medication that could be useful is the Asthmanephrin inhaler. This racemic epinephrine spray can temporarily open a constricted, "tight" airway.

I cannot emphasize strongly enough that, if you have airway allergies often synonymous with asthma, your doctor or allergist should frame a program for you to follow. Use of over-the-counter medications for these disorders is ill-advised and dangerous.

Don't irritate you linings by nose blowing, eye rubbing, throat clearing, or coughing. Use supportive care including NSAIDS, topical saline, nasal decongestants such as NeoSynephrine or Afrin, oral decongestants such as Sudafed, and expectorant cough suppressants such as Delsym and MucinexDM to keep these surfaces clean and clear.

Remember that effective prevention before the symptoms begin is far better than therapeutic aid after the fact. Begin with avoidance strategies and oral antihistamines early. Start at least 2 weeks before you expect pollen counts to rise. That would be early April for spring allergies and early August for fall allergies. Be sure to follow pollen counts online at weather.com and similar sites to know when you will likely need more preventive and therapeutic horsepower.

Be prepared by stocking your medications before the season begins. Don't forget to bring them when you travel.

Do it yourself allergy management is effective if you follow the IPA Gameplan. Aggressively identify allergens and their whereabouts, prevent confrontations with the allergens, and be prepared to aid yourself and your children with over-the-counter medications that can manage the symptoms should allergies occur.

If you have serious airway and eye allergies or allergies that never seem to take an intermission, see an allergist. In this situation, you must pinpoint with allergy testing those triggers that bring on your reactions. You will need this information for the doctors to formulate a comprehensive treatment plan using both over-the-counter and prescription medications.