Ep. 34: 8 Reasons Why Your Allergy Treatment is Not Working
I cannot count the number of people who have told me that their allergy treatment is not working for them. I am not just talking about patients who are seen in my office for this problem. But I am talking people who share this information during casual conversations, even when we had been sitting together watching our kids at sporting events. Ineffective allergy treatment is a common problem.
First of all, what are allergies? A while ago, I wrote a scientific (aka geeky) post sharing what happens in our bodies when an allergic reaction occurs. This is important because it also helps people understand how allergy treatment can be used to block those reactions.
When I am not your physician, I can only answer by rambling on about different ways other people manage their allergies. I do not know their (or your) medical history; therefore it is important to know that each person may have a different reason why they are unsatisfied with their allergy treatment results.
When I began blogging, I shared posts to help people understand the differences between allergy treatments. But there still seems to be confusion about how to get the most out of a specific treatment.
Medicine is not an exact science because everyone does not respond the same way to the same medications; therefore, I want to share some ideas you may consider to better understand how you can improve your symptoms.
8 common reasons allergy treatment is not effective
1. You may not actually have allergies.
Many people assume that if over the counter allergy medications control symptoms, it must mean allergies were treated. This is not true. Many allergy medications are also helpful to improve symptoms caused by viruses.
For the most part, if minor symptoms are easily controlled, a formal diagnosis of allergies may not be needed. However, if symptoms are not controlled, or if complications like ear infections and sinus infections are occurring, a true diagnosis of allergies is needed!
To determine if allergies are present, an allergy test is needed. Now, this is where the tricky part comes in. All allergy tests are not created equal AND they may be used differently based on age and symptoms.
2. You did not have adequate allergy testing
There are several types of allergy tests that can be done and it is important to understand why your physician has chosen a specific one for you. No matter what test is done, it must be interpreted by a physician well trained in allergy. The test alone is not enough to make a diagnosis because it must be combined with clinical symptoms and physical exam.
Allergy blood tests usually measure IgE, the protein our body makes as part of an allergic reaction. Some blood tests, usually ordered by non-physicians, measure IgG, which is a protein that marks other types of immune system reactions. Because this protein is not part of the allergic reaction, IgG testing is more commonly associated with intolerance or may simply represent a past exposure.
Classic testing is with skin prick. But for older kids and adults with more chronic allergies, a needle may need to be placed under the skin to show the true reactions.
Many patients tell me which test they want; however, they do not understand that different information is obtained by different tests. This is not an ideal situation.
Discuss with your physician the allergy symptoms you are concerned about and let them determine if testing is needed, and which test should be done.
3. Medications were started after severe symptoms were present
Once the allergic reaction begins, the lining of the nose and other parts of the respiratory tract swell and mucus production begins. If you start your allergy medications at this point, it will take much longer to feel better. The current symptoms need to be improved as well as preventing new symptoms.
It is best to work with your physician to diagnose your allergies and determine when allergy medication should be started. Many people say they have “seasonal” allergies; however, it is important for me to remind you that there are FOUR seasons! Therefore, you must ask your physician which season you need to start your treatments.
Although many seasons overlap, a rough guideline that I share with my patient is:
- Spring: Trees
- Summer: Grass
- Fall: Weeds
- Winter: Mold (also, year-round….)
Clearly, this is oversimplified, but it is a good starting point. In the south, we see blooming trees and green grass most to the year; however, the main blooming season is what I outlined above. And this does not include the year-round dust and animal allergic reactions.
I highly recommend you speak with your physician to better understand your personal reactions and set up a treatment plan to prevent symptoms instead of reacting after they occur.
4. The medication you chose is not for your specific symptoms
All allergy medication is not effective for the same symptoms. I have had patients who have been on a medication for a year but the symptoms are not controlled. That is way too long to use a medication that does not work! If a medication is not working, please discuss with your physician which symptom you are trying to treat.
In my post about 9 surprising allergy symptoms, I share how important it is to determine what your personal symptoms of allergy actually are. Many people have nasal congestion as their primary symptom, and this leads to glue ear, sinus infection complications, and headaches.
A nasal steroid spray is an excellent allergy medication to address a wide range of symptoms, especially nasal congestion. Antihistamines are not effective to improve swelling which is why many people begin to use products such as Zyrtec D. The “D” in this medication is a decongestant, which is not meant for long term use.
When nasal congestion becomes more severe, people may turn to Afrin nose spray for immediate relief; however, this action leads to worsening symptoms due to Afrin addiction.
5. The wrong medication dose is being used
Adult medications are often much easier to dose correctly. Medications in children are typically based on weight; therefore the dose you used last season may not be the correct dose this season.
It is important to read the labels on medications purchased over the counter because you may be buying a different product than you bought the last time. An example of this is when patients buy Allegra, which is an antihistamine that has two different adult strength products. One formulation is the 60mg tablet that is used twice each day while the other is a 180mg slow release tablet that is taken once each day.
You guessed it. I have seen people taking the short-acting tablet once per day and overdosing by taking the slow release tablet twice a day. This is a reminder that you must always be sure you are dosing your medications correctly.
If you have recurrent allergy symptoms and are self-treating, please consider discussing your treatment regimen with your physician so you can get input on medications that you might be mixing and matching. It is also a good way to double check that you are using the correct dosing. This, of course, means that you remember exactly what medication dose you are taking! To help, use my tip to always know your medications when you go to see a physician.
6. Medication is being taken at the wrong frequency
I have already touched on this but it is good to repeat it here.
Zyrtec and Claritin are used once a day. Allegra is also an antihistamine so many people use it the same way. Once per day. Well, if you have the slow release tablet, Allegra can be used once per day.
However, many people buy the standard bottle of 30mg or 60mg; these formulations are dosed twice per day. Always double check the medications you buy and read the label. It may look similar to what you last purchased, but it might be different.
7. No preventative treatments have been used
The best allergy treatment is avoidance. Often it is not possible to avoid all exposures to allergens but reducing exposure as much as possible is the goal.
Some of the recommendations I routinely make to my patients include:
- Avoid food allergies which cause anaphylaxis. (and carry an epipen everywhere)
- Stop sleeping with pets (sometimes even avoid letting pets into bedrooms)
- Use pillow and mattress covers to reduce dust exposure
- Wash stuffed animals and blankets regularly
- Take a bath before bed to remove outdoor allergens
- Wash hair to remove excess pollen
- Use saline nose washes before bed
- Consider saline eye drops for eye allergy symptoms
((for podcast: My favorite saline washes…a salt bath for your nose. Check out previous posts and out some salty secrets about saline washes! More commonly now I am seeing eye symptoms. Do you know how pollen makes your glasses dirty? Well if you don’t have in glasses, that pollen hits you directly in the eyeball. Kids wake up with gunk in eyes and rub them till red and guess what they are diagnosed with? Yup pink eye. If a child is rubbing eyes, doing hard blinks consider using some of the otc drops that many of us use to lubricator dry eyes. Many times can avoid medicated drops by using a few drops at night. Give your eyes a bath.))
8. Your severe allergies need immunotherapy
If you have severe allergies, they may not ever be adequately controlled even with the most perfect combination of medications and preventative practices. You need allergy shots to create your own defense that will block allergens from reaching their target.
I get it. No one wants shots especially when you hear it could take 3-5 years. But no one wants to take a boatload of medications forever either.
If you are recommended for allergy shots, it means your allergies are in the small percentage of people that we do not think will be successful at control due to the amount and severity of your reactions. Addressing this problem early may save you many complications such as chronic mouthbreathing, nosebleeds, and sinus infections.
Although many people decline the recommended allergy shots, it is never too late to begin treatment. However, the sooner you start, the sooner you finish. How profound!
But seriously. I have really sick 10-year-olds who have had a variety of ENT surgeries because they do not want to take their medications or use salt water rinses. When these kids enter high school and become star athletes, I often see them on an urgent basis because the allergies are impacting their performance. Allergy shots are then started but are still a 3-5 year treatment. If it had started before, the kids would be completed in high school. Just food for thought: pay me now or pay me later.
Allergies can lead to a significant impact on your school, work and personal life. Find a way to control yours.
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