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Allergy Symptoms and Signs to Look Out For

Allergy Symptoms and Signs to Look Out For

Written By:
Dr. Robert Bocian, MD, PhD, FAAAAI
Dr. Robert Bocian, MD, PhD, FAAAAI
Dr. Bocian earned his MD and PhD at University of Illinois, Chicago, then moved to the Bay Area to complete his residency and allergy-immunology fellowship at Stanford. Robert has remained at Stanford for 30 years, serving as an adjunct clinical associate professor of allergy-immunology. Robert also leads multiple allergy departments throughout Northern California at a large multi-specialty health system, including his own large Palo Alto-based practice. Robert splits his time between Palo Alto and Los Angeles with his wife and 4 children.

What are some signs of allergies? (some obvious and less well-known symptoms would be good to include, so not just itchy eyes for example).

Symptoms of allergies typically include nasal congestion, runny nose, post-nasal drip, sneezing, itchy nose, itchy throat, itchy palate, persistent throat clearing, cough, itchy ears, ear plugging, itchy eyes, red eyes, and watery eyes. 

What should someone do when they first notice these signs or suspect they have allergies?

The safest and most effective approach to treating allergy symptoms of the nose is a nasal spray. This is safer than oral medications, such as oral antihistamines or oral decongestants, since spray medication is applied directly to the inflamed nasal lining and is not significantly absorbed systemically - unlike the systemic absorption and body-wide distribution of oral medications.

Usually, a combination of multiple nasal sprays is needed — first and foremost, a decongestant nasal spray to open the nasal passages, making them breathable, and greatly improving the access for additional sprays, including an antihistamine nasal spray (such as azelastine or olopatadine) to treat sneeze, itch and runny nose, and an anti-inflammatory corticosteroid nasal spray (such as mometasone, triamcinolone, or budesonide) to broadly address nasal inflammation, on which all nasal symptoms are based. 

(Despite its sales volume, we do not recommend fluticasone propionate, since it contains an alcohol that is drying and irritating to the nasal passages and can cause nasal bleeding, not to mention that the alcohol imparts a bitter taste and irritative fragrance.)

Marketed nasal decongestant sprays are intended to be used for a very short period of time (not more than 3 days). Such products might be useful during a cold, sinus infection or acute allergic reaction, but are not recommended in the treatment of the chronic congestion of allergy. The reason for this is that at the high concentration sold over-the-counter, there is a risk of side effects such as rebound congestion.

Prescription dual-ingredient nasal sprays such as fluticasone propionate-azelastine contain the above-mentioned irritative, alcohol. Mometasone-olopatadine was recently introduced and is quite costly. 

Allermi is a unique telehealth company that provides allergy sufferers with individually customized prescription nasal spray that contains up to four active ingredients in adjustable concentrations, all in a single pump-spray bottle. Unlike all other nasal sprays, Allermi treats congestion directly while also being safe to use long-term, due to micro-dosage decongestant combined with antihistamine and anti-inflammatory. This customization minimizes the risk of side effects such as rebound congestion, and maximizes effectiveness and convenience. 


What can happen if you ignore allergy symptoms?

(For example, my experience of needing steroids, or can allergies get worse over time? Lead to an anaphylactic reaction?)

Ignoring nasal allergy symptoms can lead to secondary symptoms such as fatigue, brain fog, sleeplessness, mouth-breathing, gingivitis, and headache. Prolonged ignoring of nasal allergy can lead to sinus infection, middle-ear disease, intensification and prolongation of viral-respiratory symptoms, and worsening of asthma or other lower-airway conditions. 

What are the scariest/worst things that can happen if you ignore allergy symptoms, even if they are unusual?

Sleep quality can be compromised by allergic inflammation and congestion of the nasal passages to such an extent that operating a motor vehicle or other machinery can become dangerous to others and to oneself. People, especially children, whose chronic allergic nasal inflammation has long precluded normal sleep, can manifest substantial daytime dysfunction, including cognitive impairment and mood changes, in work or school. 

When should someone try an OTC antihistamine? When should someone see an allergist?

An OTC antihistamine is recommended for acute allergic symptoms such as sneeze and itch of the nose/eyes/throat. 

An OTC antihistamine will leave nasal inflammation unaddressed, and so symptoms of the nose will be only temporarily reduced. It is important to note that congestion is not addressed by OTC antihistamines. 

One should try a comprehensive nasal spray treatment first, such as via Allermi.

Anything else you think people should know about the importance of not ignoring allergy symptoms or that you would like to add?

Good nasal health is imperative to one's total health, and to normal mental and physical functioning. Normal nasal function is indispensable to normal sleep, which in turn is indispensable to normal daytime wellbeing and productivity..

I would like to hear from anyone who personally ignored signs of a non-food allergy and what happened.

We have seen children and adolescents whose nasal allergies were chronically under-recognized and undertreated and, as a consequence, they displayed growth delay, dental malocclusion, abnormal development of the facial bones, and reduced speech articulation.