April 25th, 2025

Prairie Doc Perspective Week of April 20th, 2025
“Spring is finally here”
Kelly Evans-Hullinger, MD
Spring is finally here, and for many of us that brings the joy of returning to outdoor activities, planning summer vacations, and… well, allergies. Depending on the allergen, people can suffer from allergies any time of year, but spring is a particularly common time in our part of the world to hear my patients complain of seasonal allergies.
Allergic rhinitis most commonly manifests as runny nose, congestion, and sneezing. Other symptoms can include cough from postnasal drip or worsening asthma, hives, and itchy or watery eyes. Sometimes these symptoms can be hard to differentiate from a viral cold, but typically the symptoms are fairly classic and don’t require any testing.
I often have patients inquire about allergy testing. We might refer to an allergy specialist for testing in patients with severe symptoms that aren’t adequately improved with usual care. Testing might include blood or skin patch testing depending on the situation or allergen in question. However, the vast majority of patients can be treated without specialized testing.
Initial recommended treatments for allergic rhinitis are available over-the-counter. Antihistamine medications can reduce many of the symptoms. I recommend using second generation medications such as loratadine, cetirizine, or fexofenadine, which act more specifically for the targeted symptoms. First generation antihistamines such as diphenhydramine or doxylamine are less specific and thus have more problems with adverse effects. Common side effects include dry mouth and drowsiness, but we can see those first generation antihistamines cause more severe adverse effects such as confusion.
Another very effective option is an over-the-counter nasal steroid spray, such as fluticasone or various others. Taken daily these will reduce congestion, mucous, and post nasal drip. They are quite safe for long term use and should not have systemic side effects. Additionally, these can be used along with an antihistamine. 
Take care in the nasal spray aisle, however. Some other nasal sprays are vasoconstrictors, such as oxymetazoline, and while they will alleviate congestion, they should not be used more than three days consecutively. If so they can cause worsening congestion when the medication wears off, or a rebound effect.
In summary, allergies can be a real annoyance and truly make people feel rotten. Basic over-the-counter measures can be very helpful and are worth trying. If those aren’t working, though, time to talk to your primary care provider about other options or the need for further testing.
Kelly Evans-Hullinger, MD. is part of The Prairie Doc® team of physicians and currently practices Internal Medicine at Avera Medical Group in Brookings, South Dakota. Follow The Prairie Doc® at www.prairiedoc.org, and on social media. Watch On Call with the Prairie Doc, most Thursday’s at 7PM streaming on Facebook and listen to Prairie Doc Radio Sunday’s at 6am and 1pm.