My Doctor Online The Permanente Medical Group

Symptoms

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Common symptoms of allergic rhinitis include:

• Sneezing 
• Runny, stuffy, or itchy nose
• Itchy, watery eyes
• Temporary loss of smell
• Sinus pressure and facial pain
• Swollen, blue-colored skin under the eyes
• Cough
• Headache
• Postnasal drip

These symptoms may seem like the common cold, but there are some differences:

• Colds last 5 to 7 days, while hay fever lasts as long as you are exposed to the allergen, which may include pollen, dust, or grass.
• Colds are often associated with a fever. Hay fever is not.
• Colds occur 1 to 3 days after being exposed to the virus. Hay fever symptoms occur immediately after being exposed to allergens.

Causes

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A family history of allergies increases your risk for developing allergic rhinitis. The following allergens may cause or trigger allergic rhinitis:

• Dust mites or cockroaches
• Dander from pets, such as dogs, cats, or birds
• Spores from fungi or molds
• Tree pollen, common in the spring
• Grass pollen, common in late spring and summer
• Weed pollen, common in the fall
• Spores from fungi and molds, worse during warm weather

Prevention

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You cannot avoid getting allergies, but you can avoid the things that trigger your reactions. You can help to prevent your symptoms or make them less severe by becoming aware of how to avoid certain allergens. It is very helpful to know what may trigger your allergies, so that you can take steps to limit your exposure.

If you are allergic to the following allergens, take these steps.

For indoor mold:

• Clean bathroom and kitchen surfaces and windowsills often with a mild bleach solution to reduce mold growth (1 part bleach to 10 parts water).
• Use a dehumidifier to reduce indoor humidity, which will decrease mold growth.
• Fix water drips and leaks.

For pollens and outdoor molds:

• Close doors and windows during the pollen season.
• Avoid hanging laundry outside because pollen will stick to clothing.
• Use air conditioning in your house and car to avoid opening the windows.
• Use a HEPA or allergy-grade filter in your ventilation system.
• Avoid going outdoors in the early morning when the pollen count is high.
• Stay indoors on dry, windy days.
• Avoid mowing grass or doing yard work. If you must work outdoors, wear a pollen mask.

For dust and dust mites:

• Use allergy-proof covers on mattresses, box springs, and pillows.
• Wash sheets and blankets each week in hot water.
• Reduce indoor humidity.
• Vacuum carpets and rugs with a vacuum cleaner containing a HEPA filter.
• Remove carpeting in the bedroom if possible because carpet collects dust.
• Change heating and air conditioning filters every 2 to 3 months.

For pet dander:

• Bathe pets weekly.
• Keep pets out of the bedroom.
• Keep your pets outdoors as much as possible.
• Remember, there are no pets that are hypo-allergenic.

For cockroaches:

• Block cracks where roaches can enter.
• Fix leaky pipes and faucets.
• Clean dishes and empty garbage regularly.
• Sweep crumbs from counters and floors into enclosed garbage container.
• Store food in sealed containers.
• Use a professional exterminator if possible.

Diagnosis

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We will diagnose allergic rhinitis based on the symptoms you've been having. However, you may need further allergy tests if:

• You have severe symptoms, and treatment is not helping.
• You have other health problems such as asthma.
• You are considering allergy shots.

Allergy testing, performed by a specially trained doctor called an allergist, may include:

• Skin prick test. During these tests, the skin of your arms or upper back will be pricked with small amounts of the substances that may be causing your allergies. You are then observed for a reaction. A small red swelling or hive will form at the test site if you are allergic. This is a very sensitive test.
• Allergy blood test. These tests are called RAST or radioallergosorbent tests. They measure the amount of allergy-causing antibodies in your bloodstream. A sample of your blood is sent to a laboratory for testing for sensitivity to possible allergens or irritants. We prefer skin testing. A blood test is done only if we cannot do skin testing.

Treatment

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You may wish to seek treatment if hay fever is affecting the quality of your life. If you feel like you are always fighting the symptoms, it is important to seek treatment. Other reasons for treatment include:

• Sinus infections may occur due to the inflammation of your mucus membranes.
• Ear infections in children may occur due to congestion.
• Asthma control can be negatively affected by allergies.

Medications

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There are a number of effective over-the-counter and prescription medications available for hay fever symptoms. Many times using a combination of different types of medications, such as antihistamines or decongestants, may be more effective.

If your child is having symptoms, it is best to discuss treatment with your child's pediatrician. Read the labels carefully if you choose to give your child over-the-counter medications. Some are only for adults.

Nasal corticosteroid sprays, available by prescription, are the most effective treatment for allergic rhinitis. It may take a few weeks of use in order to achieve the full effect of the medicine. Commonly used nasal steroids include:

• Flonase (fluticasone)
• Nasarel (fluninide)

Antihistamines are available over-the-counter. Newer drugs cause less sleepiness but cost more. They include:

• Claritin/Alavert (loratidine).
• Zyrtec (cetirizine).
• Cromolyn sodium: NasalCrom is a spray. It prevents the release of histamine.
• Allegra (fexofenadine) comes in pill form.

Older drugs can make you drowsy. Common over-the-counter ones are:

• Benadryl (diphenhydramine)
• Tavist (clemastine)
• Chlortrimeton (chlorpheniramine)

Prescription antihistamines include:

• Astelin (azelastine) comes in spray.

Decongestants are available by mouth, Sudafed PE (phenylepherin), or nasal spray. We do not recommend the use of decongestant nasal sprays for treatment of allergies because they can only be used for 2 to 3 days and allergies last longer than that. If overused, or improperly used, they can even make your symptoms worse.

Sinus rinses are nasal saline rinses such as Ocean Mist, which can be used to moisten or rinse your nose. A sinus rinse may help you with your nasal symptoms, such as congestion. Sinus rinsing may also help remove the allergens from your nose.

Other medications that may be helpful in treating hay fever include:

• Leukotriene modifiers. Singulair is a prescription drug used to block the action of leukotrienes, chemicals made by the immune system that cause allergy symptoms. It is also used to treat asthma.
• Nasal atropine. Atrovent is a prescription nasal spray. It prevents glands in your nose from producing excess fluid. It does not treat congestion, sneezing, or postnasal drip. It should not be used if you have prostate problems or glaucoma.
• Eyedrops. Artificial Tears, Zaditor, or Opcon-A can help treat irritated, itchy eyes.

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Immunotherapy (allergy shots)

Allergy shots (also known as immunotherapy) may be recommended if tests show you have specific allergies that cannot be avoided, and symptoms cannot be controlled with medications.

Allergy shots are helpful in many ways. They are regular injections of purified extracts of the substance that you are allergic to. These work by desensitizing you to your triggers or allergens. They can:

• Reduce your symptoms and decrease your need for medications.
• Increase immunity to your allergens by giving your body a chance to build a tolerance to them.
• Start at low doses with increasing amounts injected every week, until a maximum dose is reached.
• Be given every 2 to 4 weeks once the maximum dose is reached.
• Have benefits lasting many years after you discontinue receiving the shots.
• Usually, be discontinued around the end of the second year.
• Provide relief. Up to 80 percent of our patients who get the shots get significant relief from their allergy symptoms.

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Alternative medicine

Some people try herbal remedies, supplements, and alternative treatments for hay fever with varying results. There is not much scientific evidence about how well they work. Be careful of substances such as bee pollens. Some people have experienced severe allergic reactions. If you would like to try any alternative approaches, please talk with us first.

Your Care with Me

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If you are having symptoms that concern you, your first contact will typically be with your personal physician, who will evaluate your health and symptoms.

If specialty care is needed, your personal physician will facilitate the process of scheduling an appointment in my department. If appropriate, she or he might call me or one of my colleagues while you are in the office so we can all discuss your care together. If we decide you need an appointment with me after that discussion, we can often schedule it the same day or soon thereafter.

Before your first office visit, we need for you to complete an Allergy new patient questionnaire. This will be provided by your personal physician when she or he schedules our visit. It is also available online, or you may arrive 15 minutes early and complete the form before your appointment.

During your office visit, we will discuss your medical and family history and I will perform a physical exam. I will explain the findings of your exam and answer any questions or concerns you may have. We will discuss treatment options, and together we will create a treatment plan that is right for you.

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If you need to talk with me after your visit or procedure, please call my office. If you are a Kaiser Permanente member, you can also send a secure e-mail message to me with nonurgent issues from this website whenever it is convenient for you.

If you have urgent concerns or issues while my office is closed, or need general medical advice, you can call the Appointment and Advice line, available 24 hours a day, 7 days a week. You will be connected with a nurse who can give you immediate advice.

If you are experiencing an emergency, call 911 or go to the nearest Emergency Room.

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Coordinating Your Care

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Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology and specialists, makes getting your care easier for you.

Another major benefit is our comprehensive electronic medical record system which allows all of the doctors and clinicians involved in your care to stay connected on your health status and collaborate with each other as appropriate.

When every member of the health care team is aware of all aspects of your condition, care is safer and more effective.

If you call the Appointment and Advice line

• Our call centers are open every day of the year around the clock. If you need advice, we will transfer you to one of our skilled advice nurses (RNs). They can help you determine when you need to be seen.
• The advice nurse can often start your treatment by telephone depending on the situation and has access to your electronic medical record.

If you come to an office visit

• At the beginning of your visit, you will receive information about our Occupational Health Department. If you are a Kaiser Permanente member we will also discuss and review your preventative health needs, and schedule any preventive tests that you need. 
• At the end of your visit, you may receive a document called the “After Visit Summary” that will summarize the issues we discussed during your visit. You can refer to it if you forget what we discussed. You can also view it online under Past Visits.
• If you were seen for a work related injury, you will also receive a Work Activity Status Form, which details my recommendations for any activity restrictions, which should be followed at home and at work, to help you recover optimally from your injury.
• To help you prepare for your visit, please see additional details under Office Visit. 

If I prescribe medications

We will work together to monitor and assess how your medications are working and make adjustments over time.  Prescriptions can be filled at any Kaiser Permanente pharmacy, or we may need to send them to an outside pharmacy, depending on your workers' compensation insurance carrier.

If lab testing or imaging is needed

For lab or radiology tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory or radiology department. Certain studies, such as an MRI, require authorization from your workers' compensation insurance carrier, so it will be scheduled for you once authorization is received. When the results are ready, I will contact you with your results by letter, secure e-mail message, or phone.  In addition, if you are a Kaiser Permanente member, you can view most of your laboratory results online, along with any comments that I have attached to explain them.

If I refer you to another specialty colleague

If we decide together that your condition would also benefit from the care of other types of specialists, my care team will facilitate the process of getting authorization from your insurance carrier, and getting an appointment for you.

If surgery or a procedure is a treatment option

I will recommend you review educational information and tools to help you prepare for your procedure or surgery. The information will often help you decide whether surgery is right for you. If you decide to have a surgery or procedure, the information will provide details about how to prepare and what to expect. My care team will facilitate the process of getting authorization from your insurance carrier.

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Convenient Resources for You

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As your occupational health specialist, I have a goal to provide high quality care, to help you resume your regular work duties, and to offer you choices that make your health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.

My Doctor Online is available to you even if you are not a Kaiser Permanente member, and at any time that is most convenient for you. With My Doctor Online you can:

Learn more about your condition

• Read about causes, symptoms, treatments and procedures
• Find interactive health tools, videos, and podcasts to help you manage your condition
• View programs to help you decide on or prepare for a surgery or procedure

If you are a Kaiser Permanente member, there are additional features on my home page that you can take advantage of:

Manage your care securely

• View and compose secure e-mail messages
• Manage your prescriptions
• View your past visits and test results
• View your preventive services to see whether you are due for a routine screening or updated immunization
• Manage your family’s health by setting up access to act on their behalf. Learn how to coordinate care for the ones you love. 

Stay healthy

• Locate health education classes and support groups offered at every medical center
• Explore interactive programs, videos, and podcasts that focus on helping you stay healthy
• View your Preventive Services to see whether you are due for a routine screening or updated immunization
  

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