Written by Tammy Worth for WebMD, Reviewed by Laura J. Martin, MD
Got allergies that don’t seem to get better, no matter what you do? Check these four common reasons why allergies don’t improve — and what to do about it. Tightening up in these four areas may go a long way toward reducing allergy symptoms of all kinds.
Reason #1: Cutting Corners
Nonadherence — that is, not doing all you can, all the time, to control your allergies — is the No. 1 reason people fail to do well with their allergy treatment, says Baruch Friedman, MD, assistant professor at Johns Hopkins University and chief of the allergy and clinical immunology division at Good Samaritan Hospital in Baltimore.
Allergist Myron Zitt, MD, of the Mid Island Allergy Group in New York, agrees. He is allergic to dogs and, though he knows better, owns one. Zitt continues to have symptoms, but is willing to “grin and bear it” because he loves the family pet.
Every day, Zitt treats patients who are in similar predicaments – they can’t bear to lose an animal, quit smoking, or stop eating cheese – and, as a result, they keep having problems with allergies despite treatment.
“They are constantly being bombarded by allergens and are not as responsive to medication,” Zitt tells WebMD. “They are always exposed to the allergens that trigger an inflammatory process.”
Whether keeping a pet, missing allergy shot appointments, or jogging outside on a day with high pollen counts, Friedman sees a lot of patients who have difficulty sticking to their regimen.
“People want a quick fix and don’t want to do some basic, fundamental things that can make them better,” he says.
The fix: Constantly towing the line can be a hassle, but it’s important to be vigilant, Friedman says. If you’ve got pollen allergies, leave car windows up even on nice days and stay inside or walk at the mall when pollen counts are high. If you’ve got a pet allergy and you insist on keeping your pet, keep the animal off the bed and furniture. If you have a food allergy, avoid that food all the time — even on special occasions or when you just want a little bit. Allergies don’t cut you any slack, even just this once.
Reason #2: Medication Mistakes
One of the biggest mistakes people make with their allergy medicine is simply forgetting to take it. To prevent this common problem, Zitt simplifies medication therapy when possible and has his patients link the time they take it to another activity to help them remember. For instance, he tells the patient to take a nighttime dose before brushing their teeth and put a morning medication by their alarm clock.
Taking medicine properly is another challenge. And even little mistakes can make a difference.
For example, the most potent medications used for nasal allergies are intranasal steroid sprays, Zitt says. If used incorrectly or sprayed at the wrong angle, however, they can be rendered ineffective. The same goes for inhalers, which have to be activated and used properly.
The fix: Take all medicines exactly as directed. Some must be taken daily or they aren’t effective. Others should be used regularly when exposure to an allergen becomes chronic, like visiting a relative with a cat, and allergy shots must be received as scheduled.
Read the directions carefully before use. If a medication doesn’t work like it is supposed to, or if you’re experiencing side effects, tell your doctor exactly how you are using it and what you’re experiencing. Also, make sure you can tolerate the results and have appropriate expectations. Some patients will take an intranasal steroid for two or three days, get no relief, and stop usage even though it may take up to two weeks to reduce symptoms, Zitt says.
If cost keeps you from taking your medicine promptly, talk with your doctor about it. Samples, lower-cost medications, and sticking with the drugs covered by your insurance may help.
Reason #3: Botched Diagnosis
Getting a correct diagnosis also plays a big role in keeping allergy symptoms at bay.
Patients often try to self-diagnose when it comes to things like allergies and sinus headaches, but they don’t always get it right. Maybe you’re sure it’s an allergy, and it’s not. Or maybe you think you’ve got a sinus infection, but you really have an allergy.
If your diagnosis is wrong, your treatment may be all wrong. For instance, if you actually have a tension headache, using an antihistamine won’t improve the situation, says Corinna Bowser, MD, an allergist in Narberth, Pa.
The fix: If you have allergic symptoms or suspect you have an allergy, consult a doctor to find out if it really is an allergy.
Reason # 4: Physical Issues
You might have another medical condition that limits your treatment options. Someone with high blood pressure, for instance, couldn’t take a decongestant and would have to substitute a medicine that might not work as well, Friedman says.
Medications you’re taking to treat other conditions may also be culprits. Someone may be taking a drug like Flomax, which can worsen sinus conditions and make allergy medicine less useful, he says.
People may respond unusually to allergy medications based on their genes. Their genetics may also make them exhibit different symptoms for allergies than what are traditional, Zitt says.
The fix: Treatment isn’t a one-size-fits-all case. Doctors have to look at each individual’s case and focus treatment accordingly, and finding the right treatment may take some tinkering.
Allergy patients often have to use a multi-pronged approach for treating their allergies. It is not always easy and doesn’t often happen overnight, but relief can be found.
“People have to get proper care by a specialist [and] have good communication and proper compliance,” Zitt says. “It should be a team effort between the physician and patient, with honesty and a willingness to work together. All of these will increase the likelihood for success.”
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