I am writing this article on the first day of spring. The snow is melting, the sun is shining and the longer hours of daylight encourage us to look forward to the new season. Unfortunately, COVID-19 has affected the world and the lives of many people for which I am sad . Please follow all the precautions and guidelines that health care and governments have offered to keep us safe.
As much as we look forward to the change of seasons, 1 in 5 Canadians will dread this time of year due to seasonal allergies. Our bodies have what we call an immune system, a system that tries to defend us against germs. An allergic reaction occurs when this immune system becomes sensitive and reacts to substances in the environment called allergens. These allergens come in contact with "mast cells" which are found in the lining of the nose, lungs, skin and other areas of the body. The immune system produces antibodies which are attached to the mast cell. It is this interaction that causes the mast cell to release chemicals including histamine into the bloodstream. This histamine acts on the eyes, nose, throat, lungs or skin and causes inflammation and the symptoms of an allergic reaction. The histamine release is what causes the sneezing, itching, hives and watery eyes.(1)
Seasonal allergies are sometimes called hay fever or allergic rhinitis. The symptoms are often similar to a cold. However there are some symptoms (Table 1) that are usually indicative of an allergy.
Table 1
Itchy, red and watery eyes
Dark circles under the eyes
Sneezing, runny nose, post nasal drip
Stuffy nose with congestion that might lead to a headache
Sore throat
Fatigue (maybe some irritability)
Ear fullness and popping
Overall you may just feel unwell and this could have an affect on your ability to concentrate and affect your daily performance as well as interfere with your diabetes management.
One of the most common environmental allergens is pollen. Pollen comes from trees, grass and weeds. Spring allergies are probably due to the tree pollen; summer allergies due to grass and weed pollen and fall allergies are likely due to weed pollen. Mold, animal dander and dust can be considered allergens for some people, and I wouldn't be a pharmacist if I didn't mention allergies to drugs, however this is beyond the scope of today's discussion. Having diabetes may alter the body's immune system and reaction to both allergy symptoms and allergy medications.
Treating allergies
I think the best way to treat your allergy is to know what triggers the onset of symptoms. In some cases you might want to consider an allergy skin test. This test is the most effective method to confirm if you have underlying allergies. Ask your health care provider if he/she thinks this would be beneficial.
There are both pharmacological and non-pharmacological steps to help manage your symptoms, so let's start with the non-pharmacological ideas. (Table II)
Table II: Steps to take to reduce your exposure to seasonal pollen
Shower or bathe daily before bedtime to wash off any pollen that has collected in your hair or on your skin. Wash hands frequently especially if you have been outside and avoid touching your face.
Avoid the outdoors, especially on dry and windy days.
Check the pollen/allergen report on the weather channel. Pollen amounts are usually higher in the morning and on warm, dry, breezy days and lowest when it's chilly and wet.
Keep windows and doors closed to reduce the amount of pollen that can get in the home.
Stay indoors during peak seasons.
Avoid drying clothes outside, especially during high pollen times.
Vacuum and dust often. Clean rugs and curtains regularly or consider replacing rugs and curtains.
Consider using a Neti-pot to flush out the mucous and inhaled allergen. Always use distilled or boiled cooled water to make the solution. Be sure to clean the neti-pot after use. I like to sterilize the device with boiled water.
Use a furnace filter and consider purchasing a HEPA filter. These HEPA filters work by forcing air through a fine mesh that traps harmful particles. Many stores have this type of product so check and do comparisons once you know what you want it to do for you (perhaps the whole house or just the room you most commonly use).
Many patients who suffer from allergies also have asthma. Managing symptoms becomes a bit more difficult and the choice of treatment option will vary and depend on how severe your symptoms are and how they are affecting your quality of life. Always discuss treatment options with your pharmacist, nurse or physician.
Pharmacological Options
Antihistamines have been discussed in Blog #2. These agents can reduce sneezing, runny noses, watery eyes and itchy throats. They work best if you take the medicine before your exposure to the allergen(s) and usually last in the system for up to 24 hours. Antihistamines can be sedating or non-sedating. Be aware of this such that you are not sleepy all day and performing hazardous tasks. Antihistamines, in general, are safe to use in diabetes.
Decongestants can help relieve a stuffy nose and should only be used for a few days at a time. Decongestants were also discussed in Blog #2 and these guidelines still exist whether they are used for colds or allergies. Be wise and ask for guidance. These are the agents to be cautious about in diabetes.
Nasal sprays/drops are available over-the-counter and by prescription. A prescription spray usually includes a steroid ingredient. The steroid decreases the damage done by the inflammatory cells brought to the nasal lining by the allergic reaction or the infection. For seasonal allergies, you may need to start these steroid sprays a few weeks ahead of time and use them daily to prevent symptoms. Be careful when using a nasal spray containing a steroid. Steroids when taken by mouth or injection (needle) can cause a rise in blood sugar (glucose) values. Therefore, when getting your prescription filled the pharmacist may advise you to monitor your sugars more frequently until you have established how, if any, your blood glucose is being affected. An article published in 2001 in Clinical Pharmacology 51:(103-105) authored by Peter T Daley-Yates did a study to measure and compare how much of the steroid nasal spray/drops did get absorbed into the bloodstream since these agents are applied topically. The outcome/conclusion of this study was that the availability of the product in the circulation was low even when 12 times the dose was administered. Therefore, they seem to be safe products to use, but I still advise caution and take steps to monitor your blood glucose. Again, if you are not feeling well your blood glucose could be already elevated and it is important to distinguish, if possible, the actual cause.
Eye drops may be considered for eye symptoms not controlled by oral medication. Eye preparations are available as either a prescription or non-prescription. The prescription products start to work fast and provide fast relief and last for about 12 hours. The non-prescription products take a while to work and you should probably start their use ahead of time based on your past experiences of allergies and eye symptoms.
Managing symptoms of allergies takes time and knowledge. Know your triggers, make an action plan to reach your goal and monitor your blood glucose Choose medications carefully and ask for advice from trained professionals.
The above information is not a comprehensive discussion on Seasonal Allergies but I do hope it helps and invites you to make informed decisions.
#diabetes&allergies
References:
1)https://asthma.ca/allergies/about-allergies/ accessed on March 20th, 2020
2)https://www.diabetesselfmanagement.com/blog/sneezes-wheezes-seasonal-allergies-diabe accessed March 20th, 2020
3)https://www.adwdiabetes.com/articles/allergies-and-diabetes accessed March 20th,2020
4)Daley-Yates PT,Baker RC. Systemic bioavailability of fluticasone proprionate administered as nasal drops and aqueous nasal spray formulations. Br J Clin Pharmacol, 51,103-105
Feel free to share your experiences with treating allergies.
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