Dark Circles Under Your Eyes?

Along with sneezing, stuffy nose, cough, and sore throat, seasonal allergies can also affect your eyes. Itchy, red eyes may respond to an oral antihistamine, but often they are better treated with a prescription eye drop that prevents the release of histamine (which is what causes the redness and itch to begin with.) Olopatadine ophthalmic solution, brand name Patanol, is applied twice daily, and is generally well tolerated. There is also a newer preparation, Pataday, by the same pharmaceutical company that is only once daily-newer, more convenient, likely more pricey (depends on your insurance.) Both work well.

I find many of my patients try to use over-the-counter eye drops that "get the red out"...only to find that they need more and more of these drops to accomplish the same results. The only time that I recommend these OTC products (with vasoconstrictors to eliminate red eyes) is for extremely short-term use, such as if you are giving a presentation or taking pictures. If you use these products for more than a couple days, you will develop rebound symptoms of increased redness, and risk getting pulled into the cycle of red eyes, use drops, worse red eyes when drops "wear off", more drops, etc.

What about BELOW the eye-those dark black circles that make you look a hundred years old? Those are called "allergic shiners" in the medical world. Congested sinuses slow down return of blood through the small veins under your eyes, causing them to swell and make the skin above them appear purple or black.
What helps? Oral antihistamines, plus or minus a decongestant, will often do the trick if it is mild. For people who suffer for weeks at a time, I'd recommend talking to your doctor and considering prescription nasal steroid sprays. "Spa" treatments like cucumbers and frozen tea bags work very transiently- I'm not sure it isn't just the coldness of these objects that cause vasoconstriction (shrinking of the veins), but they do seem to have non-scientifically proven positive effects, with few to no negative side effects.

BOTTOM LINE: If you have chronic issues with dark circles or "bags" under your eyes, talk to your doctor about treatment options.

Sneeze, Cough, Stuffy Nose...and LOTS of Medicines

Allergy season is in full swing, and there are so many allergy remedies out there. How do you decide what you need? Do you understand the difference between an antihistamine and a decongestant? And where does an expectorant fit in? It's often tough to figure out when to take which drug might help. Here are the basics:

1. Decongestants simply narrow the blood vessels in the lining of the nose, allowing air to pass more easily. Use these when your nose is "stopped up". Caution: do not use if you have high blood pressure, as they can potentially raise your pressure.

2. Antihistamines block the release of histamine, the chemical in your body that cause cells to swell and leak fluid, resulting in itchy eyes, sneezing, and runny nose. Use these to DRY UP (but not when you are simply "stuffy")

3. Expectorants are all medications that include guaifenesin. This drug breaks up mucus, allowing it to drain down from sinuses or be coughed up from your lungs. It wont work if you are dehydrated, so drink extra water- especially if you are also taking an antihistamine, because they DRY UP mucus and that makes it tougher to break up and clear. Use these when you have sinus and ear pressure, or if you have a cold "go to your chest." There is little evidence-based medicine to support the use of these, but clinically I have seen them help a great deal to relieve head congestion, and often avoid the use of antibiotics.

The AAFP a great website with more detail: http://familydoctor.org/online/famdocen/home/otc-center/otc-medicines/857.html

BOTTOM LINE: Don't always grab the "do everything" medicine for your stuffy, sneezy, coughy, itchy symptoms- understand which drug works for which complaint!

April Showers Bring May...ALLERGIES!

Greetings from Austin, Texas, where-ACHOO!-those of us with allergies are collecting sneezing our heads off! In our case, the scant April showers still managed to kick up the MOLD pollens enough to wreak havoc on allergy sufferers, so I thought today I'd talk about seasonal allergies.

What are signs and symptoms of allergies?

At the risk of sounding like an antihistamine commercial, it's sneezing (often in fits of sneezes), itchy eyes, itchy throat, scratchy throat, drainage down the back of your throat (which creates early morning sore throats that often fade mid-morning), stuffy eyes, ear pressure and the lovely dark circles under your eyes.

What is recommended for treatment?

We usually start with the non-sedating antihistamines,which used to be prescription but are now available over the counter (OTC). These include Loratadine (Claritin), Fexofenadine (Allegra), and Cetirizine(Zyrtec), to name a few of the most popular. Which is BEST? In my experience, they are clinically equal. What works for you this year may not work as well next year, and there is not great science to explain why. Antihistamines will DRY you up and STOP ITCH. If you are mainly stuffy, you are better off with just a decongestant such as phenylephrine (Sudafed) or if you have both, grab a combination product.

If you are suffering regularly in a particular season, or perhaps year-round from something like molds, your doctor may recommend more preventative therapy such as nasal steroid sprays. These sprays are prescription, and they are not "addictive" like the OTC ones. The OTC sprays that give immediate relief are fine for a day or two, but beyond that, you will get rebound nasal congestion and be chasing your tail with symptoms/spray/more symptoms/more spray. Nasal steroids are minimally absorbed (so no turning into Arnold, gaining weight, or weakening your bones.) They are very safe, and decrease swelling while creating kind of protective barrier against entering irritants, so you don't turn on the histamine system that causes allergy symptoms.

What more prevention can you do?

Well, it's May 1st, so like every first of the month, I recommend changing out your home's air filters! That disgusting air filter pictured above came out of our home this morning- yuck!This "central" or "media filter" type should be changed at least three or four times per year, despite manufacturer recommendations of annual replacement. Yes, that is expensive, but cheaper than many allergy medications, and no other side effects! If you look at your filter (set your calendar to remind you) and you see it looking like this- CHANGE it! HEPA air cleans and vacuum bags are of unclear efficacy, but may help. Limit your outside exposure (get on the exercise bike or treadmill indoors.) If you really suffer, consider getting rid of carpet and drapes in your home, and restricting pets to outside the bedroom.

BOTTOM LINE: If you can't stop sneezing or are having other signs of seasonal allergies, schedule an appointment with your doctor and find out what she can do to help! There are many interventions before considering allergy shots- though for severe sufferers, those shots may be an excellent option.