Welcome to our Spring newsletter. Today’s topic is allergies and nasal steroid use.

First, some big announcements....

After 2.5 years of serving our Berkeley clients, we are now open in Mountain View. And, Oakland is due to open in the next few weeks. We are particularly excited about Oakland because the Berkeley clinic is not large enough. The Oakland site is over double the size with more rooms and the conference space we need to hold meetings and lectures.

Let’s talk about seasonal allergies....

Now that flu season is coming to an end, allergy season is upon us. Symptoms can range from making you miserable with a stuffy, itchy, runny nose (allergic rhinitis) and watery itchy eyes (allergic conjunctivitis) to worsening asthma symptoms making it difficult to breath. When you have allergies, your immune system mistakes an otherwise harmless substance (like pollen) as an invader. This substance is called an allergen. The immune system overreacts to the allergen by producing antibodies which travel to cells to release histamine and other chemicals responsible for the allergy symptoms.

Other things that are not necessarily seasonal can cause allergies too, such as pet dander, mold, dust and dust mites, chemicals, medicine and foods, but by far the most common is pollen.

Intranasal steroids have long been the most effective treatment for allergic rhinitis as well conjunctive treatment for some allergy induced asthma. Nasal steroids like Nasocort, Flonase, and Rhinocort are now available over the counter (OTC). Because they are OTC, most insurances no longer cover them. The good news is there are years of safety data compiled about these medications which led the FDA to make them OTC.

Direct Urgent Care recommends that you talk to a health care professional about the use of nasal steroids especially in children, the elderly, those with a family history of glaucoma or if you plan to use them for a prolonged period of time.

Nasal steroids are great for the duration of the allergy season but tend to take one to two weeks to reach their full potential. So, if you know you are prone to allergic rhinitis, start early - do not wait until you have full blown symptoms.

Antihistamines are also an effective adjunct to intranasal steroids or stand alone treatment for mild symptoms. The most sedating and common antihistamine is Diphenhydramine (Benadryl). It should be avoided during the day when you want to remain functional as it can cause severe drowsiness. The less sedating antihistamines that are also OTC are: Fexofenadine (Allegra), Loratadine (Claritin) and Cetirizine (Zyrtec). These 2nd generation antihistamines usually do not impair mental or physical tasks.

There are also some OTC allergy medications that we at Direct Urgent Care recommend you avoid or use with caution. If you are not pregnant and have no tendency towards high blood pressure the OTC decongestants such as Pseudoephedrine (Sudafed) are probably safe to take. Although they are often very effective temporarily, they can cause insomnia, anxiety, headaches and urinary retention. If you are pregnant or have high blood pressure they are not recommended. These medications are sometimes combined with an antihistamine so please read your labels carefully.

Oxymetazoline (Afrin), a decongestant nasal spray should only be used for a few days as it will cause rebound (worsening) nasal congestion after prolonged use. 

Although it is difficult to completely prevent allergies, using nasal saline daily, saline eye drops, and showering off before bed may help to remove some of the pollen causing your symptoms. Direct Urgent Care is committed to getting you through this allergy season. Make an appointment online, by phone or just walk-in. Thanks