Cory wrote: : If someone is very allergic to inhaled allergens such as ragweed, tree pollen, and mold, I know you recommend that the patients get treated for these issues first. My question is: what constitutes effective treatment? Is it enough to treat the symptoms with drugs like Nasacort/Nasonex and OTC meds like Claritin? Or, is treatment to change the underlying immune system response to allergens required? Specifically, I’m referring to allergen immunotherapy (allergy shots).

A: Yes, it is important to treat allergic reactions because they require a lot of bodily energy — a commodity that runs short in PWCs.

We usually start treatment with non-sedating antihistamines such as loratidine/Claritin or fexofenadine/Allegra. The next step is to add a nasal steroid, as you suggested. If there is a poor response, or wheezing is also present we add a leukotriene antagonist such as Singulair. If severe runny nose or hives are present we will consider a more potent antihistamine, such as cetiritzine/Zyrtec or Zyrtec-D for better control, but this may cause some drowsiness.

Immunotherapy (or allergy shots) is a wonderful idea! These tend to help most in younger individuals, and may be associated with local reactions to the injection, so we encourage starting with very low doses and increasing the dose slowly.