What To Tell Your Patients

I'm afraid Fluffy will just have to go

It's revenge of the allergens season. Allergist Dr Keith offers a few tips for helping your patients dodge the pollen

By Julia Cyboran

Arnold Johnson is tired. Sure, spring has sprung, the birds are singing and the flowers are blooming � and that's exactly where his troubles started. Since that first bloom mocked him from the hedgerow, he's been living full-time with public enemy number one: allergies. He's spent a small fortune on over the counter drugs (OTCs) and nasal sprays, but nothing seems to stop the runny nose or the constant itch in his eyes. He's at his wit's end and turns to his FP for help.

Mr Johnson's predicament is by no means uncommon in Canada. No official stats are available on the exact number of allergy suffers, but to say that there are millions wouldn't bean underestimation. To get an idea, across the US there are close to 35 million people who suffer from hay fever and another 11.8 million with pet, food, and drug allergies.

FPs deal with the bulk of allergy sufferers. But when it comes to treating allergies, things aren't as cut and dried as prescribing some meds and sending the patient home. Recommendations to make simple lifestyle changes are often impractical and many patients are often unwilling to make them. For instance, many doctors tell patients to get rid of pets, which many consider essential members of their families, or to remove all carpeting. These changes can make a world of difference when it comes to a runny nose, but may be unreasonable (or inconceivable) for the patient.

McMaster University professor and allergist Dr Paul Keith offers up some practical tips on how to help your patients navigate the meds maze and give them some simple pointers to live with allergies. Gesundheit!

WHAT TO TELL YOUR PATIENTS ABOUT ALLERGIES Shut that window: Dr Keith recommends that people who suffer from seasonal allergies should keep the windows shut. "Having the windows open on a dry, sunny day exposes patients to millions of allergens." He also recommends investing in an air conditioner as they help clean the air. Living with pets: Many patients who have pet allergies don't want to give up their furry friends. Dr Keith advises these patients to at least keep pets out of the bedroom. "People spend eight hours in their bedroom," he says, "so keeping the pets out makes a big difference." He also says that hepa-filters (air purifiers) may help reduce pet dander, the main cause of pet allergies. OTCs: During allergy season many patients turn to OTCs for relief. There are two kinds of OTCs on the market, both antihistamines. The older types are sedating and not recommended. "Many people may not be even be aware that the older products are sedating, so they should talk to their GP," says Dr Keith. The newer antihistamines are non-sedating and the ones that patients should ideally be taking. Those who don't like antihistamines' side effects, could also consider decongestants � but should note they can keep you up at night. Decongestant nasal sprays should not be used for more than three consecutive days. Scripts: In Dr Keith's books, intranasal steroids (INSs) are the most effective allergy meds around. "These drugs are great for nasal congestion. Patients with chest congestion also experience some benefits, especially if they take the steroids before the allergy season hits," he says. Dr Keith adds that the INSs are more effective if taken twice daily. Immunotherapy: Allergy shots do have a long-term benefit but should only be used if antihistamines and INSs aren't working. "They do work," says Dr Keith. "Generally we see 75% improvement in 75% of patients. The response is best in people who have seasonal allergies and single allergies." When to see a specialist: GPs should send patients to the allergist when they're at a loss to explain the cause of the symptoms. "If patients and GPs don't know what they patient is allergic to, they should be sending them to a specialist," explains Dr Keith. They should also consider a referral when the patient's symptoms are out of control.