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Do you really have an allergy?

Even at this time of year, congestion and runny eyes don’t always mean allergies. But knowing the real cause is key to treatment.

Published: April 2013

April showers bring May flowers—and for many people, congestion, sneezing, and itchy, runny eyes. But sometimes those symptoms, even in the spring, don’t stem from plant and tree pollen but from dust mites and pet dander. And at least a third of people who think they have allergies actually have a condition known as nonallergic rhinitis, a reaction that can be triggered by an infection, a sensitivity to chemicals or drugs, or changes in weather patterns.

Effective treatment starts with identifying the cause. But that doesn’t always mean allergy tests, especially the ones now offered by some pharmacies or those you can buy to test yourself. In fact, the American Academy of Allergy, Asthma, and Immunology is so concerned about the potential overuse of those tests that it recently included them in a campaign called Choosing Wisely, which highlights unnecessary and sometimes harmful medical care.

Read below to see how you should test for allergies, what symptoms to watch out for, what simple steps you cant take to bring relief, and when to see a doctor.

Identify the cause

If you suspect that your symptoms are caused by an allergy, you can often get confirmation—and relief—by taking the simple steps described below. But if you’re uncertain or the measures don’t help, talk with a doctor.

A physical exam and a few questions about your symptoms, environmental and occupational exposure, hobbies, overall health, and other factors should help narrow it down. If necessary, an allergy skin test, which involves pricking the skin with a tiny amount of the suspected allergens, can confirm a diagnosis. A little redness shows that you have an allergy; no reaction suggests nonallergic rhinitis.

Be wary of any allergy test that’s not prompted by worrisome symptoms, a doctor’s exam, and your medical history. The free tests offered in pharmacies or home tests that you can buy often check for common allergens, including cat dander, cedar, dust mites, egg, and grass. But such tests are often misleading and can cause you to make unnecessary lifestyle changes.

Coping with allergies

If you do have an allergy, the following recommendations often help.

Avoid allergens. For outdoor allergies, check pollen and mold spore levels with the National Allergy Bureau. When counts are high, stay indoors with the windows shut and air conditioner on. For indoor allergies, use an air conditioner or dehumidifier, remove carpeting from bedrooms, wash rugs, curtains and bedding often, and vacuum regularly. To control dust mites, encase your mattress, box spring, and pillows in allergen-proof covers. Keep pets out of your bedroom. Fix leaks and ventilate rooms, and clean up mold promptly.

Use the right drug. The best first choice is often a generic version of the over-the-counter antihistamines cetirizine, fexofenadine, or loratadine. All cost less then their brand-name counterparts (Zyrtec, Allegra, and Claritin, respectively). Prescription steroid nasal sprays, such as fluticasone (Flonase and generic), are effective. Stop using them if they cause irritation or nosebleeds.

For nonallergic rhinitis

Start by trying to avoid known triggers. If a drug is the culprit, ask your doctor about trying an alternative. If you can’t avoid the trigger, consider using prescription steroid nasal sprays for treating serious allergies beforehand, or with the prescription nasal antihistamine azelastine (Astelin, Astepro, and generic). Steroid sprays also work well for persistent symptoms.

Symptom checker

To see whether you have an allergy or something else, start by keeping track of your symptoms, when you experience, and what triggers them. Then see below to determine whether you likely have an allergy or nonallergic rhinitis.


Allergies


Symptoms: Congestion, itchy and watery eyes, clear nasal discharge, sneezing, and scratchy or ticklish throat.


When: Outdoor allergies usually start in February or March and end in October. Indoor ones often last yearround, though they can come and go.


Triggers: Pollen from trees, grass,and weeds; indoor and outdoor mold; pet dander; dust mites; flakes of dried skin; and cockroach feces, saliva, or body parts.


Nonallergic rhinitis


Symptoms: Congestion, runny nose, and sneezing, but without the itchy eyes or sore throat.


When: Often lasts year-round, though periodically.


Triggers: Respiratory infections,changes in weather and temperature, cold or dry air, food (especially spicy items), alcohol, strong odors or fumes, cigarette smoke, perfume, air pollution, and certain medications, notably aspirin, ibuprofen (Advil and generic), naproxen (Aleve and generic), certain blood pressure drugs, and erectile dysfunction drugs, such as sildenafil (Viagra), tadalafil (Cialis), and tamsulosin (Flomax)


Editor's Note: A version of this article first appeared in the monthly newsletter Consumer Reports on Health. 
   

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