Allergies and Congestion

Medical Q&A [Moderated]
1

Hi Austin and Jordan,

I have fairly bad allergies to a wide variety of environmental allergens (grass, pollen, dust, mold, animals, etc.), as confirmed by a skin test. These seem to persist despite the fact that I take Allegra and Flonase every day. Possibly related, I also have constant congestion and frequent headaches. In the last few years, the congestion has gotten bad enough that it often interferes with my sleep and causes gagging or difficulty swallowing. I have a few questions related to these issues that I’m hoping you can help answer.

  1. Are allergy shots likely to have a significant benefit? I tried them about 15 years ago, but the allergist I consulted seems to think they’ve improved since then. Given the fact that the full course of treatment will take years and cost thousands of dollars, I’m hesitant to go this route unless there’s a large potential upside.

  2. Are there any diet or lifestyle interventions that are potentially helpful in this area? My primary care doctor recommended an elimination diet, but I haven’t been able to find good information on whether that is likely to be effective.

  3. Is it worth trying to identify factors that lead to a worsening of symptoms? For example, I’ve observed that my congestion worsens after eating dairy, and that I get a headache when my sister turns on the air conditioning in her car (possibly from mold). However, I’ve never tried to actually record this in a systematic way to see if my casual observations are accurate. On one hand, it would be very useful if I could find a way to avoid problematic triggers, but it also seems like it would be easy to nocebo myself if I start hyper-focusing on my symptoms.

  4. Is there any risk to taking allergy medications like Allegra and Flonase every day for the foreseeable future? My primary care doctor thinks that I should be taking them as little as possible.

Any input you can offer would be greatly appreciated!

2

  1. Unfortunately I am not an allergist and have no experience prescribing allergy shots.

  2. You’ll hear plenty of anecdotal reports from people on this front, but none that I’m aware of that are generalizable across the population.

  3. I think this is a reasonable thing to try.

  4. No, I would no have concerns about this, particularly when your symptoms seem particularly severe. The benefits of controlling these symptoms outweigh the minimal risk of these medications. However, if your symptoms remain uncontrolled, I would also point out that there are alternative/adjunctive medication options beyond antihistamines and nasal steroids that your primary care doctor, an allergist, or an ENT physician can prescribe.

3

Thanks for the response. I had not considered other categories of medications; that seems like a good option to pursue.