Seasonal allergies.(Women's Health Adviser)

Seasonal allergies affect up to 40 million people in the United States and cost an estimated $4.5 billion in medical care annually. In addition to causing almost 4 million missed school and workdays every year, these allergies can be associated with the development of asthma, rhinosinusitis, and otitis media.

Diagnosis. Symptoms are most common during times of high pollination: early spring to early summer and again in late summer and into the fall until the first killing frost. However, in temperate climates allergy symptoms can occur year round.

In allergy-prone individuals, the pollen of trees, grasses, and flowering plants can create an inflammatory cascade that results in a number of unpleasant symptoms: wheezing, sneezing, coughing, headache, nasal congestion, impaired sense of smell, itching of the nose or oropharynx, and allergic conjunctivitis.

Although seasonal allergies may exhibit similar symptoms to a cold or upper respiratory infection, they are not accompanied by fever and they tend to persist, rather than resolving in 7-10 days.

Opinions vary about specialist referral. Some studies show that primary care physicians diagnose allergies correctly less than 50% of the time. This suggests that early referral to an allergist results in earlier appropriate treatment and a decrease in the development of allergy-related illnesses such as asthma.

Serologic testing is a good way to ascertain that symptoms are caused by a histamine-mediated reaction. Consider referral to an allergist for testing and immunotherapy if the patient has severe symptoms, including ocular symptoms, or if symptoms continue despite Pharmacotherapy.

Treatment. During times of high pollen count, advise patients to keep windows and doors dosed at home and work and to use air conditioning, which filters out most of the pollen. Patients should refrain from outdoor activities when pollen counts are high, especially before noon, when pollination peaks. After outdoor activities, they should shower and change clothes. Since clothing picks up lots of pollen, tell patients to dry their laundry in a vented dryer, not by hanging it on an outside line.