Local doctors say 2013 will be bad year for allergies

By Scott Welton

scottw@standard-democrat.com

SIKESTON -- A scratchy throat, sinus problems; it's going around. But is "it" a spring cold? A sinus infection? Allergies?

It could be any of the above -- maybe with one leading to another, according to local physicians.

"It's a bad year for sinuses," said Dr. George Livermore, a physician with the Ferguson Medical Group who specializes in otolaryngology. Otolaryngologists are often called 'ENT doctors' as much of what they do involves the ears, nose and throat. "People are miserable this year."

The first wave of pollens, which is from trees, usually hits earlier in the year -- around late February, according to Dr. Michael Critchlow, who specializes in allergy and immunology at FMG.

"This year we didn't see many at that time," Critchlow, said. "It was delayed a bit because of the cold weather."

We are getting that now, instead -- and other allergens won't be far behind.

"Tree pollen season merges with the grass pollen season," Critchlow said.

And that pollen can remain a problem until "it gets really hot -- usually in June," he said.

Brown grass doesn't look good but it is an indication there will be little new grass pollen in the air.

But there is "some carryover," Critchlow, said, from pollen that fell to the ground and is later stirred up before it decomposes.

Added to this delayed but annual pollen assault is a longterm effect from the flooding in spring 2011.

"Mold spore counts in the area are the highest in the nation," Livermore said. "I've had people come in with allergy problems this year they have never had before."

And a good number of those people live in places that were hit with flooding such as East Prairie and Morehouse.

One clue to help figure out whether it is allergies or something else is to see if you are running a temperature.

"'Hayfever' is a misnomer," Critchlow said.

With allergic rhinitis, which is the inflammation of nasal airways due to an allergen, there isn't a fever, he explained.

But a fever is a good indication it could be a cold, Critchlow said, and high percent of colds do include a sore throat in the symptoms.

And colds can lead to sinus infections -- and sinus infections may also cause you to have a fever.

But, Critchlow, added, the symptoms of hayfever do make someone "more prone to have a sinus infection."

Livermore said an obstruction in the sinuses can lead to sinusitis: the inflammation of the sinus. That inflammation in the sinonasal tract interferes with the body's normal, natural drainage, he explained.

And when mucus that should be draining builds up in the sinuses it can make them vulnerable to a bacterial infection, he said.

Livermore recommends that if sinuses have drainage problems for two weeks, they should be checked for an infection -- especially if mucus is discolored: "green or bloody."

What people describe as a "scratchy throat" could be the result of post-nasal drainage or a part of an allergic reaction, Critchlow said.

He said doesn't ask patients if they have a scratchy throat but rather asks if their throat is seriously sore as that can indicate something other than allergies.

"If it hurts to swallow, that is not found in hayfever," Critchlow said. A high percent of colds do have a sore throat, he said.

Symptoms such as itchy eyes are not found with colds but are an allergy symptom.

"The eyes may swell, get puffy, even swell shut," Critchlow said.

Eyes irritated by allergens can be treated with antihistamine drops kept cool in the refrigerator, he said.

"It's soothing, typically, and doesn't injure your eye at all," Critchlow said.

For physicians, the easiest diagnosis tool is to look at the inside of the nose.

If someone is experiencing only allergy symptoms, the inside of the nose will be pale or lavender.

"With an infection it will be red and often 'beefy,'" Critchlow said.

Livermore said he likes to use a CAT scan to get a detailed picture of what is happening with a patient experiencing chronic sinus allergies.

Dealing with allergies used to come down to deciding between choosing between two of the Seven Dwarfs: take over-the-counter antihistamines and be Sleepy or remain alert and become Sneezy.

"We don't have to put up with that now," Critchlow said. "I encourage people to take either Zyrtec, Allegra or Claritin because of their low potential for sedation."

Critchlow explained these are preventative medications, however.

"Take it in the morning before you leave the house rather than waiting until you have symptoms," he advised.

Another way to reduce allergy symptoms is to cut down exposure to allergens by keeping windows up in the car and closed at home.

Driving with the windows down in spring is nice, but it is also "a great way to sample a lot of pollen," Critchlow said.

Livermore recommended a saline irrigation to flush allergens and other irritants from the nose after spending time outside.

He explained the nose is pretty much just a "wet filter" for the body's respiratory system and rinsing out the mucus blanket can speed a process that takes the body about eight hours to complete on its own.

For parents trying to determine whether to take a child to the doctor or not, Dr. Joseph Blanton, a pediatrician at FMG, advised that "with the first sniffle, sneeze or snort they don't have to run to the doctor."

Blanton said he doesn't refer nearly as many children to an allergist as he did 20 years ago.

"We have fairly effective therapies for allergies," he said. "Things are different now."

Unlike some of the older steroids used to treat allergies, "the inhaled steroids are much, much safer," Blanton said.

But an over-the-counter antihistamine may be the first thing to try, he said.

As parents are much more knowledgeable now, Blanton said, they understand that "antibiotics really don't help a routine cold."

Decongestants are now not given to children under the age of 2, he said, "and some people say not under the age of 6."

Sometimes the best response is to just "let these colds run their course," Blanton said.

One thing to remember, Critchlow said, is that colds are contagious -- but allergy symptoms are not.