Guest Blog by Brian Bizik, PA-C
Relax, it’s just allergies!
COVID-19 and allergy symptoms overlap to some degree and showing up at your local grocery store (with mask on) and sneezing or having a running nose will surely get you some nasty looks.
With that in mind I thought I’d put together some of my best allergy treatment tips you can pass along to your patients. I have been working in allergy for almost 10 years and present to you my tried and true tips to keep your patients from having to explain that “it’s just pollen, I promise!”
1)Antihistamines – strongest is Zyrtec, next Claritin then Allegra. All are VERY cheap on Amazon or at Costco (Kirkland Brand), a year supply is about $15, $30 for Allegra. Allegra is the least sedating however.
The Antihistamine level needs to match the histamine level. So early in an allergy season one Zyrtec might be enough but mid-season they might need two or even three daily for a short period of time. My favorite plan is a Zyrtec D 12 hour in the AM and a Zyrtec at night.
And no Karen, pseudoephedrine does NOT raise BP in this form. The immediate release form can up BP 1-2 points systolic according to The Prescribers Letter but this form does not.
2) Nasal sprays – Most important thing here is to make sure they are not shooting the spray straight up to the olfactory bulb. Shoot in the left nostril with the right hand – toward the left EAR LOBE. And don’t inhale. You don’t need to help the mist get back, just let the mist fall, it’ll get there I promise.
Any steroid spray works and again at Costco or Amazon a 5-pack of fluticasone is $30 or so. Very cheap.
Any nasal spray can be used QD or BID. If they have epistaxis from BID use it’s because the spray is hitting the septum and they are not aiming for the earlobe with the opposite hand.
Don’t forget that marvelous spray ipratropium bromide. This is just a snot stopper. Use alone or with fluticasone. Use this first for senior patients with chronic or non-allergic rhinitis and they will love you forever. Very safe even for those with mild to moderate urinary retention. Nasal Antihistamines are wonderful as well and can be used with or without any of the sprays above. Just use one spray, wait a minute or two and use any other spray. Magic!
3) Eyes – PO antihistamines and nasal sprays do little for eye symptoms. Pataday or any form of the active ingredient olopatadine is great. Pataday just went OTC so is reasonably priced. Keep these drops in the fridge, the cooler drops feel wonderful and the bottle is good for 3 years or so when refrigerated.
4) Steroids – all negative comments about this will cause me to post mean things about you on Facebook! For super miserable adult patients giving a few days of 40 mg of prednisone is reasonable. This does a great job of reducing inflammation and shrinking nasal swelling to allow the fluticasone to get in. They will kiss you when they see you next.
As always, trying to limit the total steroid dose (sprays + inhalers + creams + PO) is good. So just use PO Prednisone (not Medrol dose packs, those are less effective and too long) for a couple days and then transition them over to sprays. I have many patients who use fluticasone nasal 3 days a week and a nasal antihistamine on the other days, super-duper.
5) Allergy Shots – almost all environmental allergies are not made better with allergy shots. . . they are made GONE. Most people on allergy shots report an 80%+ reduction in seasonal allergy symptoms. This is a wonderful option. If you have patients with allergies for more than 3-4 months out of the year allergy shots will literally CHANGE their lives. I promise. It’s the exact same thing that happens when a bad sleep apnea patient gets on CPAP, they feel better, more energy and they love you and give you good a YELP rating.
With so many options for dealing with allergies, ThriveAP includes lectures that make it simple. From cardiology and orthopedics to ENT and dermatology, ThriveAP includes a balanced curriculum to help any new grad advanced practice provider catch up to speed. For more information, please reach out to firstname.lastname@example.org.
Brian Bizik, MS, PA-C, is a Physician Assistant with 18 years of clinical experience. He is a frequent speaker for ThriveAP. Currently, Brian is the Respiratory Care Coordinator for the Terry Reilly Health Centers in Boise and Nampa, Idaho. Brian is also the current Conference Chair and Past President of the Association of Physician Assistants in Allergy, Asthma and Immunology and past member of the Idaho State Asthma Collaborative.