Prairie Doc Perspective Week of February 8th, 2026
“Spring into Seasonal Allergies”
By Jill Kruse, DO
The groundhog may have seen his shadow, but Spring will be here soon.  While many of us look forward to warmer days and blooming flowers, those who suffer from seasonal allergies know that the return of grass, budding trees, and blooming flowers can lead to more sneezing than smiles.  Welcome to the Spring allergy season.  
If your seasonal allergies seem to be getting worse each year, it is not in your head.  A Study from the National Academy of Sciences in 2021 found that over the last 30 years the North American pollen allergy season has increased by approximately 20 days.  Pollen concentrations have also risen 21%.  The Spring tree pollen season has been starting earlier and the Fall ragweed season has been ending later.  
Seasonal allergies can develop at any time in one’s life.  The most common risk factor for developing seasonal allergies is family history.  If have family members with allergies, you have an increased risk of developing them as well.  Seasonal allergies are the sign of an overactive immune system that has mistakenly identified harmless substances, like pollen, as dangerous threats to the body.  This triggers an inappropriate defense response that leads to the common symptoms of allergies like runny nose, congestion, watery eyes, itching, and sneezing.  The immune system is trying to fight pollen like it would fight a cold. This is why it can be difficult to differentiate between allergies and illness.  
There are a few ways to help decrease the risk of children developing allergies.  Several studies have shown that children who visit a farm in their first year of their life or have furry pets have a lower risk of allergies.  In that first year of life, the immune system is busy trying to figure out what things the body needs to defend against and what things are safe to ignore.  The environment on the farm has so different allergens, that it allows the immune system to become tolerant of the harmless pollen and animal dander. However, once someone has allergies, and the immune system is sensitive to these substances, further exposure to allergens that are on a farm will not help.  It will just make the allergy sufferer more miserable.  
The first line over-the-counter treatment for seasonal allergies is intranasal corticosteroids such as Fluticasone (Flonase), Mometasone (Nasonex), and Budesoninde (Rhinocort).  These nasal sprays have been shown to be more effective than over-the-counter oral antihistamines such as Loratidine (Claritin), Fexofenadine (Allegra), and Cetirizine (Zyrtec).   If the spray does not give adequate control, then adding an oral antihistamine can help. 
If these medications are not effective, then seeing an Allergist is the next step to enjoying everything that comes with April showers and May flowers.  The groundhog says we have six more weeks to prepare for Spring.  Regardless of when it comes, everyone can enjoy Spring if they understand seasonal allergies and how to treat them.  
Dr. Jill Kruse is a hospitalist at the Brookings Health System in Brookings, SD. She serves as one of the Prairie Doc Volunteer Hosts during its 24th Season providing Health Education Based on Science, Built on Trust. Follow The Prairie Doc® at www.prairiedoc.org, Facebook, Instagram, YouTube, and Tik Tok. Prairie Doc Programming includes On Call with the Prairie Doc®, a medical Q&A show (most Thursdays at 7pm on  YouTube and streaming on Facebook), 2 podcasts, and a Radio program (on SDPB, Sundays at 6am and 1pm).

Prairie Doc Perspective Week of February 1st, 2026
“Insomnia”
By Kelly Evans Hullinger, MD, FACP
Difficulty sleeping is an common concern we hear about in primary care. Many of us will have trouble sleeping on occasion, but when that is a persistent pattern causing distress or functional impairment, we call it insomnia. Insomnia can mean difficulty falling asleep, difficulty maintaining sleep, or waking early unable to fall back asleep. 
First and foremost, is the difficulty sleeping causing problems? If it is not resulting in problems with daily functioning, we may need to manage expectations around sleep. Not every person needs 8 hours per night, and if your imperfect sleep is perfectly tolerable, it is probably best to leave it alone. As we age, we need less hours of nighttime sleep; again, as long as you feel well during the day, that is just fine.
For those whose poor sleep is resulting in intolerable drowsiness or difficulty functioning at work or home, I have more questions. Is an acute illness or stressor contributing? Might there be another sleep disorder like sleep apnea or restless leg syndrome? Is pain, an urge to urinate, or some other physical symptom causing your awakenings? Is there underlying depression, anxiety, or other mental health concerns? Are you taking any medications or substances that might cause sleep disruption? Addressing any of these may significantly improve sleep. Alcohol is a common culprit; often assumed to help people fall asleep, alcohol actually yields poor quality rest.
Most patients with insomnia can be helped with behavior changes alone, or “sleep hygiene.” There are a few basic tenets, some more intuitive than others. First, optimize the sleep environment; ideally this means a dark, cool, quiet bedroom. Second, a consistent bedtime and wake time are very important, even on the weekends. This is particularly difficult for our patients who have jobs requiring rotating shifts. Next, find a bedtime routine which helps your brain wind down; think less screen time, and more reading, meditating, or listening to calming music. 
Finally, and less intuitive to most, if you do find yourself lying in bed for 20 minutes without falling asleep, get out of bed, try a calming routine over again, then get back into bed. More time spent not sleeping in your bed is more time your brain spends learning the bed is a place to be awake. Furthermore, it fuels anxiousness when we lie awake yearning for sleep, so it is best to break that cycle.
I see a lot of people tracking sleep with their smartwatch or other wearable device, and my advice is to be aware of potential pitfalls. We don’t have good evidence that the information all devices provide on sleep is accurate, and for most people tracking those statistics actually tends to increase anxiety around sleep which may worsen the problem.
Have you followed all the above advice but still suffer from insomnia? The gold standard treatment is cognitive behavioral therapy for insomnia (CBT-I) provided by a mental health professional. Beyond that we do have pharmacologic options, but medications for sleep can be fraught with potential problems, especially for our patients over age 65. Even some over-the-counter sleep medications can have significant risks in older patients, so please use caution and talk you your primary care provider.
Dr. Kelly Evans Hullinger practices internal medicine at Avera Medical Group in Brookings, SD. She serves as one of the Prairie Doc Volunteer Hosts during its 24th Season providing Health Education Based on Science, Built on Trust. Follow The Prairie Doc® at www.prairiedoc.org, Facebook, Instagram, YouTube, and Tik Tok. Prairie Doc Programming includes On Call with the Prairie Doc®, a medical Q&A show (most Thursdays at 7pm, YouTube and streaming on Facebook), 2 podcasts, and a Radio program (on SDPB, Sundays at 6am and 1pm).