Allergy | Mount Sinai Today

Will Using A Steroid-Based Nasal Spray Increase My COVID-19 Risk?

Updated on Jun 30, 2022 | Allergy, Cold and Flu, COVID-19, Ear Nose Throat, Health Hub, Your Health

The Centers for Disease Control and Prevention considers those who are actively being treated with high-dose corticosteroids to be immunocompromised. Most nasal sprays for allergies do not fall into this category. Consult your primary care physician regarding the specific medication you are taking.

Allergy sufferers are hyperaware of every cough, sneeze, and sniffle entering the height of this allergy season. Those with allergies are not only concerned with distinguishing their allergy symptoms from the novel coronavirus that causes COVID-19, but many are now worried that the medications they take to manage their symptoms might put them at increased risk.

Steroid-based nasal sprays have come under particular scrutiny because the active ingredient—corticosteroids—can reduce the strength of the body’s immune system, which is concerning during a pandemic. Fortunately, nasal spray users need not worry. Anthony Del Signore, MD, PharmD, Director of Rhinology and Endoscopic Skull Base Surgery at Mount Sinai Downtown-Union Square, explains why allergy sufferers should keep using their medications.

Should I stop using my steroid-based nasal spray?

If patients are getting the relief that they usually receive from taking these medications, I typically say to continue using them. Often, symptoms of nasal drainage, nasal obstruction, or sinus infections will increase if you come off of the medications.

It is also important to remember that with topical intranasal sprays, as well as topical nasal rinses with steroids in them, the absorption of the steroid is quite low. And, there is conflicting evidence as to whether or not steroids taken this way will actually cause any decreased defense against the virus.

A lot of the data and recommendations that we’re getting is for systemic steroids, which are steroids taken by mouth or administered intravenously. That’s where we are seeing the decrease in the immune system.

As a result, I am staying away from prescribing oral steroids for the time being. But topical nasal sprays, as well as topical rinses, I’m okay with.

I take an allergy pill. Are there steroids in my medication?

We do not typically give oral steroids to patients complaining about the typical symptoms of seasonal allergies. Instead, we recommend nasal rinses/netipot, oral antihistamines, and intranasal antihistamines as well as intranasal steroids, with pretty good effect and results.

Oral steroids are usually reserved for more serious conditions like asthma, lupus, or severe systemic allergic reactions. And, if you have a more serious condition that requires the use of these oral steroids, you have to weigh the risks and the benefits. I would counsel these patients to practice social distancing, good hygiene, and taking other precautions. These preventative measures can often tip the scale so that the benefits outweigh the risk of the steroids.

What should patients do if they are concerned that their medications will decrease their ability to fight off COVID-19?

There’s a lot of information out there, and patients may be having a tough time finding the right answers. If patients have any questions during these tumultuous times, they should consider setting up an in-person or telemedicine appointment to talk with their health care provider. After getting a global view of the patient and seeing what other risk factors they have, proper recommendations can be made that may at least help to put fears at ease at a time that’s very uncertain for many.

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August Allergies Fall Into Autumn

Updated on Jun 30, 2022 | Allergy, Your Health

A cold spring and wet summer can produce a ragweed season that wreaks havoc for many New Yorkers, says Anthony Del Signore, MD, PharmD, Assistant Professor, Otolaryngology and Director of Rhinology and Endoscopic Skull Base Surgery at Mount Sinai Downtown-Union Square.

Ragweed grows best in wet conditions, producing enough pollen to affect allergy sufferers when the weather turns warm and dry. Typically, the ragweed season begins in August, peaks in September, and can last until November. As summer winds down, and global temperatures continue to increase, pollen counts rise. Warmer temperatures in the autumn, which often persist well into the winter, present a host of issues for allergy sufferers as these conditions contribute to a lengthier ragweed season. The ragweed pollen grain is fine and light, allowing for easy dissemination by wind. Given its low weight, pollen has been known to remain airborne for many days and travel hundreds of miles. Elevated pollen counts are most visible on warm, windy days, and daytime hours when plants are in full bloom. Cool, rainy, wet days can provide some respite with low pollen counts.

Ragweed Allergy Symptoms Not everyone is a sufferer, but approximately 20 percent of the population can be sensitive to ragweed pollen. Symptoms include:

Inflammation of the nasal cavity, nasal lining, and structures within the nose, leading to difficulty breathing, pressure, pain, and congestion
Nasal drip
Runny nose
Itchy, watery eyes
Scratchy throat

Some people can also experience difficulty breathing, asthma exacerbation, sinus infection, and cough. Ragweed allergies can also cross-react and cause itching, burning, and swelling in the mouth with certain foods, including bananas, melons, beans, potatoes, celery, and cucumbers.

Treatment for Ragweed Allergies

Treatment for ragweed allergies often begins with prevention and avoidance. Frequent household cleaning, changing linens, and washing bedding and clothes can minimize daily exposures. Nasal saline washes are extremely important to decrease pollen levels within the nasal cavity. Medications become an important part of surviving the season. Over-the-counter medications are often the first line of defense. Antihistamines, decongestants, and nasal steroid sprays are the most popular options. Staying ahead of the pollen levels is extremely important, so pre-treatment with antihistamines and nasal sprays may help. For those with persistent symptoms, prescription-strength oral medications and nasal sprays may be needed to control symptoms and provide relief. For those with an allergy verified through skin or blood testing, allergy shots or drops can be used to slowly help patients become immune to yearly symptoms.

When Allergy Sufferers Should See a Physician

Allergy sufferers should seek the care of a physician if symptoms persist for more than three months or the sufferer experiences;

Worsening nasal obstruction
Nasal bleeding
Sinus infections
Watery nose
An increase in asthma An allergist and ENT (ear, nose and throat) doctor can help provide relief.

Allergists can arrange for a testing of allergens, with either blood tests or skin-prick testing; provide advice on avoidance; and administer allergy shots. ENT doctors can help with persistent nasal obstruction, congestion that is not improving, or worsening symptoms by providing oral and nasal medications. More importantly, an ENT can help rule out structural abnormalities within the nasal cavity that may exacerbate symptoms.

Commonly seen issues include;

Nasal polyps that block the nasal airway
A deviated septum causing airway obstruction
Inferior turbinate hypertrophy, which can decrease the amount of space available for air to pass through in the nose.

Allergy sufferers should be clear to ask their doctor the following important questions:

What medications are best to control my symptoms?
Are there structural issues within my nose that may be leading to more symptoms than usual?
Is the source of my nasal drip allergies or should I be concerned about something more?

During allergy season, sufferers should track pollen counts in their geographic area. Pollen.com, both a website and mobile app, tracks pollen counts year-round. In addition, it can alert sufferers as to which seasonal allergens are most important in certain geographic areas. For information regarding allergy symptoms and treatments, American Academy of Allergy Asthma and Immunology is an excellent resource.

Anthony Del Signore, MD, PharmD

Assistant Professor, Otolaryngology and Director of Rhinology and Endoscopic Skull Base Surgery at Mount Sinai Downtown-Union Square

Dr. Del Signore’s specific clinical interests include endoscopic minimally invasive management of chronic sinusitis, paranasal sinus and skull base tumors, cerebrospinal fluid leaks (CSF), and allergic disease. His current research is focused on health outcomes following skull base surgery and the implementation of sinus treatment protocols and surgical intervention.

Make an appointment with Dr. Del Signore

Is My Nasal Congestion Allergies?

May 24, 2017 | Allergy, Ask the Doc

Sometimes it’s hard to know if nasal congestion and sneezing are from an allergy or a cold. Many people have seasonal allergies or pet allergies, so they’re familiar with these symptoms and they usually know what’s causing them. In other cases, when people haven’t had severe allergies in the past, we usually start to consider allergies as a cause of congestion when the symptoms have lasted for over a week and haven’t responded to other types of treatment. If that’s the case, I’d ask the patient about things they may be exposed to, like a new pet in the house, for example. Or think about what might be flowering in that particular season that they might be reacting to, and recommend that they take an antihistamine on a trial basis to see if that helps their symptoms. If they’re still not getting better, and the symptoms have been lasting longer than a week, I’d recommend they see a doctor. Mount Sinai has urgent care centers in Manhattan and Brooklyn that are open every day, 365 days a year with extended hours, and you don’t need an appointment. So, just walk in and we’ll be happy to see you.

Judah Fierstein, MD is a board-certified emergency medicine physician at Mount Sinai Doctors, seeing patients in the Upper West Side, Brooklyn Heights, Dumbo, and Inwood. Trained in New York City, he is certified by the American Board of Emergency Medicine. He was awarded his medical degree from the Icahn School of Medicine at Mount Sinai, where he also completed his residency in Emergency Medicine. He is the Medical Director of Mount Sinai Doctors Urgent Care. Dr. Fierstein is fluent in Spanish.

Make an appointment with Dr. Fierstein

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Is it a Cold or Do I Have Allergies in the Winter?

Updated on Jun 30, 2022 | Allergy, Your Health

Many people suffer from a runny or stuffy nose, watery or itching eyes, sneezing, and sinus pressure in the winter months. Are these symptoms related to the common cold or allergies? While it may be difficult to tell based on symptoms alone, if your symptoms persist for more than a week, you may have an allergy, according to Shradha Agarwal, MD, Assistant Professor, Department of Medicine, Division of Clinical Immunology, Icahn School of Medicine at Mount Sinai. Although pollen is not present in winter, the powdery substance is not the only cause of allergies.

Dust mites—microscopic eight-legged arachnids found in dust—are a major source of in-home allergen. Mites burrow in soft material; are commonly found in clothing, pillows, blankets, and mattresses; and feed on human skin scales, fungi, yeast, and bacteria. They are sensitive to light and depend on water to survive. Mites are susceptible to water loss at humidity levels below 65 percent; because of this, allergen levels increase in the summer and remain elevated through the winter. Depending on humidity levels and temperature, the average life cycle of a dust mite varies from 60-120 days. Although they live for a short time, the damage is done quickly. Female mites can lay 50-80 eggs in a lifetime. Dust mite allergies are prevalent in children and adults. Symptoms are caused by inhaling airborne particles of dust mite waste. This commonly leads to post-nasal drip, nasal congestion, sneezing, and/or runny nose. Inhaling particles can also trigger asthma-symptoms such as shortness of breath, wheezing, and coughing, and eczema.

Chemicals can be used to kill dust mites; however, this is not recommended. The effect is short term and requires repeated application of and exposure to harmful chemicals. The best strategy is to limit your exposure to dust mites. This is best achieved by:

Keeping the relative humidity in your home between 35-50 percent. This reduces the growth of dust mites. If you plan to use a humidifier in the winter, monitor the humidity with a hygrometer and keep below 50 percent.
Washing your bedding every week. This drowns mites, helping to reduce dust mite numbers and, consequently, mite allergen levels.
Dusting and cleaning wood floors with a clean, damp cloth.
Vacuuming regularly. High-efficiency particular air (HEPA) filtration helps decrease exposure to particles containing dust mite allergen.
Removing stuffed toys, throw pillows, drapes, and carpeting/rugs from the floor.
Using impermeable covers for dust mite on mattress and pillow encasing.
If you have to clean yourself, wear a mask.

Dust mite allergies can be treated with medications such as antihistamines, decongestants, nasal sprays, and eye drops. If your symptoms are not well controlled with allergy medication, your doctor may advise allergy immunotherapy which can be administered by injection (subcutaneously) or orally (sublingual). Visit an allergist to determine if you have a dust mite allergy.

A complete history and skin prick/scratch testing or a blood test for antibodies to dust mite allergens will be performed. If you are interested in more information or testing, please make an appointment to consult with me at the Mount Sinai Doctors Faculty Practice.

Shradha Agarwal, MD

Assistant Professor, Medicine, (Clinical Immunology), Icahn School of Medicine at Mount Sinai

Dr. Agarwal provides comprehensive care of allergic and immunologic disorders in both children and adults. She is the Program Director of Allergy and Immunology Fellowship Training Program and the Medical Director of the Allergy and Immunology Clinic.

Make an appointment with Dr. Agarwal

Learn more about Allergy Care at Mount Sinai

Asthma is No Match for a Great Game

Updated on Jun 30, 2022 | Allergy, Health Tips, Your Health

Blog post written by Sonali Bose, MD MPH, Assistant Professor, Medicine, Pulmonary, Critical Care and Sleep Medicine Division, Icahn School of Medicine at Mount Sinai.

The show is not over yet. If you are like me and spent all summer long mesmerized by the limitless abilities of the summer Olympic athletes, prepare to keep your jaws open, as age-defying tennis stars are about to play their best games at the U.S. Open this fall. While these super-humans are constantly trying to outdo their opponents by a blink of a point, for many of these athletes–for example, four-time French Open champion Justine Henin–their toughest competition is not the player across the net: it is asthma. Other Olympic gold medalists, such as track-and-field star Jackie Joyner-Kersee and swimmer Amy Van Dyken, battled significant asthma symptoms throughout their professional careers. In fact, asthma affects 1 in 12 Olympians, making it the most common chronic illness among these competitive athletes. But having asthma doesn’t stop them from achieving their goals, and it shouldn’t stop you.
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Spring Allergy Season Has Sprung

Updated on Jun 30, 2022 | Allergy

Guest post by Lisa Ellman-Grunther, MD, Department of Otolaryngology – Head and Neck Surgery at New York Eye and Ear Infirmary of Mount Sinai.

Don’t be fooled by the small amount of snow still on the ground and the chilly temperatures. The spring allergy season in the New York City metropolitan area has arrived and the trees have started pollinating! The super harsh winter has created an outdoor environment which is expected to lead to very high pollen counts this season. (more…)

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