DOCTOR IS IN: Surviving allergy season

By Alpen Patel, MD

Spring is here and with its beauty comes budding trees, greening grass, blooming flowers — and allergies. While many of us long for warmer weather and getting outdoors more, most of us do not look forward to the pollen that it brings. Unfortunately, for the next few weeks as pollen counts increase, allergy sufferers can expect a surge in sniffling and clogged nose, sneezing, watery eyes, and coughing and scratchy throat.

Of course Atlantans are not the only ones suffering the pollen onslaught. As many as 40-50 million people in the United States suffer from allergies, according to the American Academy of Allergy, Asthma and Immunology.

So, what causes allergies? Essentially, an allergy is an increased hypersensitivity to a specific substance that causes a reaction. An allergy comes about when the immune system, which is there to protect us from microbial invaders like viruses and bacteria, reacts to a normally harmless substance.

Environmental allergens, or allergens found in your everyday environment, include pollen, mold, dust and dander from animals or other elements. Some foods, harmless to non-allergic people, can be very harmful to those who are allergic to them. Foods known to cause the most common allergies are dairy, eggs, wheat, soy, peanuts, tree nuts, fish and shellfish.

Nasal congestion can be one of the key symptoms of an allergy. It is a natural part of the body’s inflammatory response to histamine (a compound released by cells of the body’s immune system during an allergic reaction). If you experience nasal congestion or some of the other symptoms I described above, you probably are having an allergy attack.

Beginning in March and early April, we see a variety of allergens in the air. Tree pollens are the worst springtime offenders. In early summer comes grass pollens, and in late summer and fall come weed pollens such as ragweed.

Allergists can offer skin and blood testing to identify substances or allergens that cause sensitivities. Once I determine the type of an allergy a patient has, I can work with him or her to develop a personalized treatment plan. This may include allergy shots, medications, antihistamines, decongestants and corticosteroids. In addition, I may suggest saline washes and nighttime showers for removing pollen collected in the nose and on the body during the day. Sunny, dry, windy days can be tough on people with pollen allergies, so try to stay indoors on those days with the windows closed and the air conditioner on.

One of the newest treatments for environmental allergens that we use at Emory is allergy drops — self-administered daily allergy drops given under the tongue. Called sublingual immunotherapy, this new form of treatment is much more convenient for patients, equally effective and safer than receiving allergy injections. As with traditional allergy shots, allergy drops are not quick fixes. It still takes several months to build up immunity to the most common allergens before reaching a maintenance level. Once there, patients will take the drops for three to five years, as they would with allergy shots.

Your doctor can help you sort out whether you have allergies, but you can help with information he or she needs for the diagnosis. You can keep track of when and where you get symptoms, for one. Check your local pollen and mold counts and see if high numbers match up with when you get your symptoms. Controlling allergies requires planning, skill and patience. An allergist has specialized training and can develop a treatment plan for your individual condition. In the end, we want to enable you to lead a life that is as normal and symptom-free as possible.

Atlanta, what has been your experience? Share your stories, share your ideas. Post.

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7 comments Add your comment

Mike Edwards

April 2nd, 2009
10:24 am

Alpen, you doubtless keep up to date with allergy medication and air purification; have you seen a new development called a liquid Ioniser? It clears the air, even in remote corners of the room by spraying partially charged liquidions. It doesn’t need to move the air with a noisey fan and is as effective as many fan based air purifiers. One real benefit from the technology is that once it has knocked the allergen from the air it locks it out for good so it doesn’t re-enter the airspace even if you disturb the furnishings in your room. This also means that there is no need to carry our a major refit of your home to rid it of carpets and curtains.

April 2nd, 2009
12:07 pm


Interesting article! You might try a shower at night if your allergies get bad!



April 2nd, 2009
2:13 pm

I have terrible seasonal allergies, but this year I beat them. I started taking Zyrtek and Flonaise (spray) all through the winter. I also tried allergy shots for over three years and I believe that this helped me tremendously.


April 2nd, 2009
10:57 pm

Leave it to the ENTs to claim that sublingual immunotherapy is as effective as traditional injection immunotherapy. If it were indeed equally good, safer, and more convenient, wouldn’t the FDA have approved a sublingual product for use in the US? Wouldn’t every allergist offer it in his/her office? The fact is, most sublingual studies have been conducted in Europe, where there are different populations with different genes exposed to different pollens, and study designs have used widely varying doses and in some cases no or poorly chosen controls. Not surprisingly there have been mixed and irreproducible results. There is a lack of data from rigorously designed clinical trials in US populations and until then it is irresponsible to claim that this therapy is equally efficacious.

But this is what you get when you see a surgeon for a medical problem. Dr. Patel’s profile on includes on his list of clinical interests epilepsy, facial paralysis, neck pain, parathyroid surgery, tongue malignancies, and trauma among many others. Consulting a physician like this for allergies is like taking your broken lawnmower to an auto mechanic.

Bottom line – if you are one of the many millions who suffer from allergic disease, you are far better off seeing a board certified allergist who spent 3 years in subspecialty training to actually understand how the immune system works.

Princess Runny

April 10th, 2009
8:50 pm

The literature supporting allergy drops is very impressive. There are more than 400 citations in Pub Med including 100 double blind studies and four meta-analysis. That sublingual immunotherapy works and is safe and cost effective is undeniable. There are important benefits such as a four-fold decrease in asthma as reported by Novembre et al. There is no medication that can do this. Sublingual immunotherapy has equivalent efficacy to injection therapy yet is safer, has better compliance and costs less.

The limitation on the use of sublingual immunotherapy is a lack of expertise. Tucker et al reported that less than 6% of Allergists have any experience with this form of immunotherapy. There are more ENTs prescribing allergy drops than Allergists and this gap in expertise will continue to grow. The Allergist’s approach of prescribing medications as first line treatment rather than prescribing a safe form of immunotherapy means that patients will go where they can get help.

Ray From Connecticut

April 19th, 2009
8:27 am

I was a SLIT patient in Conn. for about a year, and it did help me. However, the cost $1200/year was too damn expensive. I know it can work because I was better able to cope with the symptoms.
I think the big hurdle to it in the USA is the FDA. Had it been approved by the FDA, my insurance would have picked it up, but why should the FDA approve it especially when they are controlled by the pharmaceutical companies who make tremendous profits from their pills. To me, that is corruption!
If anyone knows of a reasonable cost supplier of SLIT (for Tree Pollen), please let me know!


July 13th, 2009
1:08 pm

Damn, that sound’s so easy if you think about it.