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Something to Sneeze At


Posted on April 1, 2016

Sacramento is seasonal allergy central.


Whether you’re a sneezer or a wheezer, a fan of Flonase or a Claritin convert, if you suffer from seasonal allergies, you’re no stranger to the pollen pitfalls of Sacramento. You don’t need to consult a calendar to figure out when spring has sprung in the capital. Just look around at the number of people sneezing, coughing or rubbing their eyes and you’ll get a pretty good idea when the trees and grasses have started their seasonal bloom, sending thousands of regional residents into allergic fits and many of us scrambling for the antihistamine.

There are roughly 50 million seasonal allergy sufferers across the country. That’s one in five individuals—more than all other major diseases combined, according to the Asthma and Allergy Foundation of America. But many people love to say that Sacramento is the worst place for allergies in the country. (You may have heard this old saw: “I never had allergies until I moved to Sacramento.”) While suffering through a stuffy nose every April may make it feel like Sacramento is the worst, we actually rank 96 out of the top 100 spring allergy capitals of 2015 (down from number 88 the previous year), according to the AAFA. So what is it about Sacramento that makes our fair city feel like one big pollen ball every spring?

“In late winter and early spring, the various trees start to let go of their pollen and can overlap with the grasses, which tend to pollinate for a longer time in late spring to summer,” explains NaYoung Kim, M.D., of the Department of Allergy-Immunology at Kaiser Permanente North Valley. “You can imagine our ‘City of Trees,’ Sacramento, makes for a rough spring for many of our residents.”

Add to that our location in the middle of a valley and you’ve got the perfect recipe for trapped air pollution and allergens like pollen, grass and mold spores that can make even the strongest among us bury their noses in the tissue box. Global warming is making the whole mess even, well, messier. 

While Sacramento’s biggest allergy season typically runs from March through June, according to Sutter Medical Group Allergy and Immunology’s Ronald L. Brown, M.D., the unseasonably warm weather we experienced in February led to an early bloom for trees and grasses. Tree-pollen season usually peaks around April, but this year, due to the drought and a higher average daily temperature, trees released their pollen earlier, leading to a higher pollen count overall. From a global perspective, increasing carbon dioxide levels in Earth’s atmosphere have been shown in laboratory and field studies to increase plant biomass and to raise the pollen production of ragweed (a common allergen), according to an article published in the November 2009 edition of Environmental Health Perspectives.

So what does this mean for those of us who hear the word “spring” and are immediately brought to anticipatory tears of allergic agony? Read on to find out more about Sacramento’s worst allergic offenders, hear from some of your fellow comrades-in-coughing-fits and learn about remedies from local allergy experts.

The Culprits

Sacramento plays host to plants such as perennial ragweed, alfalfa and many species of grasses, as well as sycamore, oak, olive and mulberry trees, which are the biggest pollen polluters for seasonal allergy sufferers. (Thanks, City of Trees.) According to Sacramento ENT, the largest ear, nose and throat private practice in Northern California, most people who are allergic to airborne allergens from trees, grasses, weeds or mold experience seasonal allergic rhinitis (also known as hay fever), which causes coldlike symptoms including runny nose, itchy nose and roof of the mouth, nasal congestion, sneezing and sinus pressure. Watery or itchy eyes are also often associated with hay fever, as is swollen, blue-colored skin under the eyes (sometimes called “allergic shiners”) if you’re particularly lucky.

While “it can be difficult to differentiate between an allergy and a cold at first (both can have nose and eye symptoms and an associated feeling of malaise), fevers are not associated with allergy; they are associated with infections both viral and bacterial,” says Kim. To further differentiate an allergy attack from something more serious, according to Kim, “Colds generally do not last more than two weeks. Recurrent nasal and eye symptoms seasonally that respond well to antihistamines are more likely allergy.”

The Relief

So with all of the discomfort, disruption and often embarrassing effects, what can you do to treat seasonal allergies? The good news is that the over-the-counter medicine market is booming with options that promise to eradicate symptoms with the quick pop of a pill or the spritz of a nasal steroid spray. And doctors are getting better and better at identifying the common culprits and prescribing individualized treatment plans to help their patients manage symptoms and improve their lives.

“Many over-the-counter options are available, including nasal steroids like Flonase and Nasacort (triamcinolone) in conjunction with OTC 24-hour antihistamines like cetirizine, loratadine and fexofenadine (brand names: Zyrtec, Claritin and Allegra),” Kim says. “Though they can be very effective, all of these medications are designed to treat symptoms.” By seeing an allergist, you can get skin testing or blood tests to see which allergens bother you. “Allergy shots, also known as ‘allergy immunotherapy,’ are immunomodulating, which means they change your immune system so that your body reacts less to these allergic triggers,” she says.

The Future

With global warming continuing to send temperatures climbing, pumping more and more pollen into the atmosphere each year, what’s a seasonal allergy sufferer to do? Woodland pharmacist Sara Shelley recommends reducing exposure to allergens. “Keeping windows closed, refraining from line drying clothes and regularly replacing air filters can all help, she says. “Those with severe allergies may refrain from outdoor activities when pollen counts are high. Consult your local pharmacist for help deciding which medication is right for you. If OTC medications do not help with symptoms, consider consulting your doctor.”

Kim concurs.

“There is a lot of hope for people with allergies, especially if they have never been seen an allergist,” she says. “Allergy shots, though they have been around for a long time, are still a very safe and effective treatment. If coming to the office is a problem, the FDA approved sublingual (under the tongue) immunotherapy in 2014. It is given under the tongue in our office for the first administration and can be done at home for subsequent doses. Of course, there are always new developments for safer and more effective medications for allergies, but you should discuss these options with your allergist.”

OTC RELIEF

Here’s a breakdown of some of the most common over-the-counter treatments and their potential side effects, provided by pharmacist Sara Shelley, Pharm.D., who works at family-owned Corner Drug in Woodland.

Steroid nasal sprays were available only by prescription until 2013. Now Nasacort, Flonase and Rhinocort are sold over the counter. These are best for moderate to severe allergies or mild but persistent allergies. They can help with sneezing, runny nose and congestion, and may help with itchy, watery eyes. They should start working the same day but may take up to two weeks of continuous use to reach maximum effect. Nasal irritation and bleeding are the most common side effects. 

Oral antihistamines are best for mild to moderate or intermittent allergies. They can reduce itching, sneezing, runny nose and ocular symptoms. The most common side effect of older antihistamines like Benadryl and Chlor-Trimeton is drowsiness. Newer products such as Claritin and Allegra are nondrowsy, while Zyrtec can cause drowsiness in some people. If this is a problem, take them at night.

Decongestants such as Sudafed (pseudoephedrine) can help relieve nasal and sinus congestion and can be taken in combination with antihistamines. Combination products include Claritin-D, Allegra-D and Zyrtec-D. Side effects include insomnia, decreased appetite and elevated blood pressure. They should be avoided by people with certain conditions or who take some other medications, so check with your pharmacist. Medications containing pseudoephedrine are available behind the pharmacy counter. Sudafed PE (phenylephrine) is available in the regular aisle but is less effective.

Nasal decongestant sprays (like Afrin) shouldn’t be used for more than three days or congestion may get worse when the medication is stopped. This is called rebound congestion. 

Decongestant/antihistamine combination eye drops such as Visine-A or Naphcon-A can help with red, itchy eyes but should also not be used for more than three days. Antihistamine eye drops such as Zaditor can help with itchy eyes and can be used for a longer period of time.

PSEUDOEPHEDRINE: Good, Bad or Ugly?

What is pseudoephedrine?

Pseudoephedrine is a decongestant that shrinks blood vessels in the nasal passages. It’s used to treat nasal and sinus congestion or congestion of the tubes that drain fluid from your inner ears. Decongestants such as Sudafed can be taken in combination with antihistamines, as in combination products Claritin-D, Allegra-D and Zyrtec-D. 

Why does the pharmacist ask for my photo ID?

So officials can keep track of who’s buying the stuff per the Combat Methamphetamine Epidemic Act of 2005, which was incorporated into the Patriot Act signed by former President George W. Bush in 2006. The act bans over-the-counter sales of cold medicines that contain pseudoephedrine, which is commonly used to make methamphetamine. The sale of pseudoephedrine is limited to “behind the counter,” and the amount an individual can purchase each month is limited. Stores must keep personal information about purchasers for at least two years.

Any side effects?

They can include insomnia, decreased appetite and elevated blood pressure. Suzanne Teuber, M.D., warns that the drug can have adverse effects and is not recommended in children or older adults, and that consumers need to be aware of exactly what they’re buying. 

“Oral phenylephrine, an inferior product (available without an ID check), has been substituted by companies in many products and advertised as a decongestant,” she explains. “I doubt oral phenylephrine would be approved by the FDA today if it were up for review as a new medication.”

Woe Is Them

How do some local allergy-sufferers get through the season?

TINA MACUHA

“I don’t like to sound stuffed up on TV or radio,” says “Good Day Sacramento” anchor and KNCI 105.1 weekday radio host Tina Macuha. “I don’t like the itchy eyes when I’m on TV or sounding yucky on radio. If my allergies get really bad, I will get a horrible cough that lasts a month or so. It’s gotten so bad that I’ve tried inhalers. I’ve coughed so hard that I got X-rays because I hurt myself.”

Macuha is allergic to trees, grasses and weeds. “Taking my medication has become a daily ritual,” she says. “Just part of life living here in Sacramento.”

JERRY LEE

As you might imagine, going on air with a voice that sounds like gravel or stifling a sneeze every few minutes is hardly conducive to a great work environment, but sometimes it’s actually the environment itself that brings on the symptoms.

“Every time I’m doing a show and we move into the theater for technical rehearsals, I’m instantly affected by the dust,” professional musical theater performer and Sacramento native Jerry Lee says. “At my worst, I can get so stuffed up that it sometimes feels like I can’t hear certain pitches while singing. If I’m so stuffed up that I have to breathe through my mouth instead of my nose, I dry out very quickly, which strains my vocal chords.”

The Lee remedy? “I just suck it up and stay hydrated,” he says. “It’s amazing what that dose of adrenaline can get you through. I could be wheezing at five minutes to curtain, forge my way through a show, collapse in the dressing room, then have an audience member tell me they had no idea I was sick at all. Maybe they’re being kind. Or maybe I just always sound like that. . . .”

CARRIE HENNESSEY

Sacramento-based opera singer Carrie Hennessey knows the plight of the stuffy-nosed performer all too well.

“April and May—the busiest months of the year—tend to be the worst for me,” the hay fever-suffering soprano says. “I need to know how to sing through issues like constant sinus drainage, sinus pressure, itchy and swollen eyes and sneezing. My vocal technique is what keeps me going.”

Hennessey is no stranger to less-than-comfortable conditions.

“It’s always fun when singing an intimate love scene, right before the big kiss, and the nose begins running incessantly,” she says. “One time I was wearing only a slip and there was no way to try and wipe it away. The baritone was a very good sport, or maybe he didn’t notice.” 

Hennessey has discovered changing the ambient air has helped her stay sneeze-free. 

“It is too tricky to take medications that may cause small blood vessels in the vocal mechanism to burst,” she says. “I don’t take any OTC or prescription allergy medications. I mostly use aromatherapy: medical-grade essential oils in an ionizer that runs in our house every day. I am a fan of the neti pot if needed.”

RICHARD PORTER

Richard Porter, a principal dancer with the Sacramento Ballet, says his allergies are regional.

“I never suffered from allergies before I moved to Sacramento eight years ago,” says the Australian dancer. “At first they were terrible, almost like flu symptoms. My nose would not stop running and I couldn’t breathe. I had a ton of sinus pressure and felt super dizzy and spacey. This is not the best for my job, as it’s very cardiovascular, and I’m turning, jumping and throwing people over my head all day.”

Porter admits that “I have definitely flung a booger or two across the studio.” He copes by using pseudoephedrine and nasal spray. “If it’s bad, none of it really is effective,” he says.

LISA THEW

“The most difficult adventure with allergies is going to see live theater,” says Lisa Thew, who produces, directs and performs in plays as a co-founder of KOLT Run Creations and is also a staff member at UC Davis. “I’m always petrified that an attack will happen during the show and that it will disturb the audience and/or actors. I try to sit on the aisle as often as is possible. But there have been times that I’m pretty sure audience members around me missed lines of dialogue because I was sneezing up a storm trying to get out of the theater.” 

Thew has noticed that her symptoms have lessened since she began eating local honey. Adding a teaspoon of honey to a daily cup of warm turmeric milk, which aids in decreasing inflammation in the body, has helped immensely, she says.

PETER TATEISHI

‚ÄčPeter Tateishi, president and CEO of Sacramento Metro Chamber, keeps eye drops and tissues in his car at all times. He is moderately affected by grasses, weeds and trees, but he can sometimes have severe symptoms.

“I take over-the-counter allergy pills to control most symptoms,” he says. “But in windy situations, my eyes will water and itch uncontrollably and turn bright red.”

What’s the bottom line, budgetwise? “It probably costs me about $100 in medication a year,” he says, “so nothing terrible. But if I forget the medication, it can quickly turn into a sinus infection, and then I’m out for a few days.”

That’s why he takes his capsules and tablets a week before the seasons are projected to change. “I don’t know if that works or not, but in my head it seems to help,” he says.

KELLY CULLITY

Kelly Cullity, a vocal teacher at Natomas Charter School’s Performing and Fine Arts Academy, doesn’t know what she’s allergic to. “My assumption is some sort of tree, but I don’t know for sure,” she says. I’ve always wanted to get tested to find out exactly what I am allergic to.” The problem ramps up at the end of March and lasts until early June. 

“My symptoms include itchiness all over my face and inside my head!” she says. “It’s shifted as I’ve gotten older. It used to be that my eyes would itch really badly. Now my soft palate itches the worst. As I’ve gotten older, I’ve also developed seasonal asthma.”

Being a teacher with allergies has its challenges. “Talking and singing all day already taxes my voice,” she says. “But then add swollen vocal chords on top of that and I almost always end the allergy season with no voice.”

So what does Cullity do?

“When I lived in Las Vegas, I took a pill and I used a nasal spray,” she says. “Now I’ll take a pill if it’s really bad, but I don’t find that it really helps that much, so I’m hesitant to actually take anything.”

BETH RUYAK

How badly do allergies to molds, dust, grasses and pine pollen affect Beth Ruyak, host of “Insight” on Capital Public Radio?

“‘Badly’ was an understatement until about six years ago,” says Ruyak. “Years ago, I battled headaches, sinus problems, bronchitis, asthma and worse. Every late winter and early spring left me sick with a scratchy voice, an ugly cough, a plugged nose. Geez, I sound like a cough syrup commercial.”

Ruyak has found that having regular allergy shots works wonders.

“In the bad allergy years, I took far too much Advil Cold & Sinus and other OTC allergy meds and let too many symptoms develop into secondary infections,” Ruyak says. “There were doctor appointments, heavy-duty antibiotics and many, many sleepless nights. Then, six or seven years ago, I was hiking with a group of people that included a family friend, Dr. Rich Harvey. Hearing my bad breathing and coughing, Doc Harvey made me promise to get aggressive about treatment. Keeping that promise actually changed my life. I finally had a skin test for allergies, started a protocol of shots, cut back on OTC medicines and tried saline nasal rinsing. I started watching pollen counts more closely and taking more responsibility for stopping symptoms before they turned into a secondary problem. Now, by comparison, I hardly take any medicine, haven’t had problems with asthma and bronchitis and am certainly happier. Treating the allergies has been priceless.”

 

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