Many people obtain adequate relief from seasonal allergies by limiting their exposure to pollen and using over-the-counter medications.
If the return of warmer weather also means a return to the nasal congestion, watery eyes and nagging cough of seasonal allergies, Scott Kay, MD, has a three-step plan for breathing easy and seeing clearly this spring.
Scott Kay, MD, Princeton Otolaryngology Associates
1) Minimize exposure. “Tree pollen is the predominant allergen from March until the end of June,” said Dr. Kay, a board-certified ear, nose and throat (ENT) specialist and the founder of Princeton Otolaryngology Associates. The challenge with limiting exposure to tree pollen, he adds, is its wind-borne pervasiveness, a phenomenon well known to anyone who has left the house one fine March or April morning to find that their black or red or white car has been “painted” green overnight.
While the grass allergies that hold sway from June through September typically become more bothersome with prolonged time outdoors, tree pollen is so ubiquitous in the spring that it is hard to avoid even if you’re not spending the day on the golf course or working on your lawn, he said. Nonetheless, Dr. Kay said, basic steps such as greater reliance on air conditioning rather than open windows in the home and car can help — particularly if you clean the air conditioning vents at the start of the season.
Along with time of year, time of day plays a role in terms of exposure, according to Dr. Kay. He said that tree pollen counts tend to rise with the sun, climbing through the morning. As a result, people particularly bothered by tree pollen may want to make some adjustments to their daily routines, such as switching from a pre-work jog to a post-work run.
2) Engage in smart self-care. Patient education is a major component of the care Dr. Kay provides when seasonal allergy sufferers come to see him at Princeton Otolaryngology Associates’ offices in Monroe and Plainsboro, and the ENT specialist said that his counseling emphasizes the importance of consistent, proper use of allergy medications.
“There are some excellent over-the-counter allergy medicines available, but their effectiveness can be diminished by the way people use them,” he said. “If you find an allergy medication that works for you, it’s important that you take it every day throughout the allergy season. Too often, people start an over-the-counter medication when their symptoms are really bothersome but stop taking the medication once they feel better. This puts them on a roller coaster of symptoms going up and down. You are better off staying on what works for you until the season has passed.”
And what works for most people? Dr. Kay recommends starting with an over-the-counter steroid nasal spray. He said that proper technique is important. “In spraying the medication into your nostril, you want to direct the flow away from the center of your nose. While ensuring that all of the medication is delivered inside the nostril itself, you want to aim up and at an outward angle, totally within the nostril, but in the general direction of the eyes’ tear ducts.” He added that this approach minimizes the likelihood of irritating the septum in between the nostrils, which can result in nosebleeds.
Dr. Kay said that the “next best” over-the-counter medications for seasonal allergy sufferers are antihistamines, including non-sedating options such as Claritin (loratadine) and Allegra (fexofenadine) and antihistamines that may have a modest sedating effect, such as Zyrtec (cetirizine) and Xyzal (levocetirizine).
“Antihistamines are a lot like types of flowers or flavors of ice cream — whichever one you like best is the one that’s right for you,” Dr. Kay said. He added that antihistamines known to be sedating can have highly varied effects from one person to the next, with some people not noticing any drowsiness and others feeling quite sleepy.
Besides which medications to use and how to use them, Dr. Kay said that attention to overall health is an important component of self-care for allergies, as it is for so many medical conditions. “Our susceptibility to allergies is determined in part by the degree to which our bodies are experiencing inflammation, which in turn can be driven by stress,” said the physician, who has been honored as a “Top Doctor” for more than a dozen consecutive years.
3) Know when to see the doctor. Many people obtain adequate relief from seasonal allergies by limiting their exposure to pollen and using over-the-counter medications, Dr. Kay said. But when those approaches provide no or minimal improvement, there’s nothing to be gained and a lot of quality of life to be lost by deciding to “just live with it,” the otolaryngologist said.
Barring very pronounced symptoms or a complicated medical history, a primary care physician is the best doctor for most people to see initially, he added. If the approach recommended by a primary care physician doesn’t yield meaningful improvement after it has been given adequate time to work, seeing a specialist may be in order.
“Both ear, nose and throat specialists and allergists/immunologists have extensive experience treating seasonal allergies, and the choice of which type of specialist to see involves both practical and clinical considerations,” Dr. Kay said. The ENT physician explained that he works closely with area allergists, referring patients to those colleagues and receiving referrals from them based on patients’ specific situations and needs.
He added that real-world factors such as proximity to a doctor’s office, ability to secure an appointment without a long wait, and insurance coverage help shape many patients’ decisions on whether to see an ENT or allergist. In terms of medical considerations, people who have multiple allergies; who have allergy symptoms beyond the ear, nose, and throat; who require allergy shots or other immunotherapy; or who need extensive testing to determine the cause of allergies, may be best served by seeing an allergist. Conversely, Dr. Kay said, when a patient has or is suspected of having an ear, nose or throat condition that can aggravate the impact of allergies, or when the patient is experiencing ENT issues secondary to the allergies themselves, such as sinusitis or hearing issues caused by extensive congestion, an otolaryngologist may be the best choice.
“Regardless of which type of physician you see first or ultimately turn to for care, the most important thing is to get the help you need,” Dr. Kay said. “There is a great deal we can do for people, and if over-the-counter medications haven’t helped, it’s not cause to be discouraged, it’s cause to make an appointment.”
‘There is a great deal we can do for people, and if over-the-counter medications haven’t helped, it’s not cause to be discouraged, it’s cause to make an appointment.’ Scott Kay, MD, Princeton Otolaryngology Associates
Dr. Kay’s Approach to Evaluating and Treating Seasonal Allergies
A thorough medical and allergy history is the first step in Dr. Kay’s evaluation of people who see him for seasonal allergies. This step includes a review of the patient’s year-round allergy experience, the otolaryngologist said.
“New Jersey is a great place to live, but it’s the absolute worst when it comes to seasonal allergies,” Dr. Kay said. “There’s a reason we’re called ‘the Garden State,’ and our abundance of greenery means that different allergies are ‘in bloom’ year-round.” He explained, as noted earlier, that tree pollen is the main culprit from March through June, when it gives way to the grass allergies that dominate the summer months. Ragweed comes to the fore in mid-August, lasting until the first killing frost. In October, as the leaves turn color and begin to fall, leaf mold allergy makes its presence felt. With winter’s arrival, dust allergies are exacerbated by closed windows and forced-air heating systems.
After identifying the type, extent and timing of a patient’s allergies, Dr. Kay performs a physical examination, including using a nasal endoscope to take a close look at the nose for inflammation, infection secondary to the allergies, or polyps or other anatomic features that may contribute to congestion.
When his examination identifies significant inflammation or related issues, Dr. Kay often will prescribe a regimen of short-term systemic steroids along with a nasal steroid spray, a nasal antihistamine spray, and a type of medication called a leukotriene inhibitor. “With this regimen, we’re attacking the problem from four different angles to get control of the situation,” Dr. Kay said, adding that once a patient feels better and the nasal passages look better, he discontinues some of the medicines. “This approach is effective in the overwhelming majority of cases,” he said.
Surgery — A Last Resort, But a Good Option for Selected Patients
After receiving his undergraduate and medical degrees from the University of Pennsylvania and completing a residency in otolaryngology/head and neck surgery at Columbia Presbyterian Medical Center, Dr. Kay completed a year-long fellowship in endoscopic sinus surgery. That specialized training and his 29 years in practice give Dr. Kay deep expertise and extensive experience in performing minimally invasive nasal procedures.
“I always consider surgery a last resort, and the great, great majority of seasonal allergy sufferers and people with similar conditions will never need a procedure, but for those few who do, surgical intervention can have a dramatic impact on their quality of life and well-being,” he said.
Depending on a patient’s situation, in-office surgical options range from removal of nasal polyps to a cryoablation procedure to freeze a nerve that contributes to a condition called vasomotor rhinitis. With this condition, environmental irritants, changes in weather, or even certain foods and drinks can cause the blood vessels in the nose to expand, producing swelling, congestion and, in some cases, mucus drainage.
For more information about the evaluation and treatment of seasonal allergies and the other services provided by Princeton Otolaryngology Associates, or to make an appointment to see Dr. Kay at the practice’s Monroe or Plainsboro offices, call 609-445-4445 or visit www.drscottkay.com
