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A woman wearing a mask in a room

What is Paxlovid Rebound?

Written by Leann Poston, MD. on . Posted in Respiratory illnesses. Leave a Comment

According to the Centers for Disease Control and Prevention, Paxlovid is recommended to treat mild-to-moderate COVID-19 in its initial stages of the disease when people are at elevated risk that their disease may progress in severity. Paxlovid treatment helps reduce the risk of disease progression, hospitalization, and death.

Whether or not you have been vaccinated, for some people who take Paxlovid, COVID-19 symptoms seem to diminish and then return. Symptom rebound typically occurs between 2 and 8 days after symptoms appear to improve. Sometimes, people do not report a return of symptoms but test positive for COVID-19. This rebound in symptoms also occurs in people who do not take Paxlovid, and it is not considered to be a side effect linked to Paxlovid.

If you have a recurrence of your symptoms and test positive again, whether or not you took Paxlovid, follow the CDC guidelines for isolation. You should restart isolation for a full five days after the positive test result (the next day). End isolation after five days if you are fever-free (without taking fever-reducing medications) and your symptoms are improving. Following this, you should wear a mask for a total of 10 days, starting from the time your symptoms started.

What Is Paxlovid?

Paxlovid (nirmatrelvir tablets; ritonavir tablets) is a prescription oral antiviral drug used to treat mild-to-moderate COVID-19 infections in people at increased risk for more severe disease. The U.S. Food and Drug Administration issued an Emergency Use Authorization (EUA) to Pfizer to manufacture Paxlovid to treat adults and children over the age of 12 who meet the prescribing guidelines.

Paxlovid is not authorized to be used:

  • To treat patients requiring hospitalization for severe or critical cases of COVID-19
  • For pre- or post-exposure prophylaxis to prevent a COVID-19 infection
  • To be used for longer than five days

Paxlovid clinical trials were conducted, and 2,113 participants were randomized to receive either Paxlovid or placebo, one dose (300 mg nirmatrelvir and 100 mg of ritonavir) by mouth every 12 hours for five days. Anyone with a history of COVID-19 infections or who was vaccinated against COVID-19 was excluded from the trial, as were people taking medications that may adversely interact with Paxlovid.

Clinical trial data supported Paxlovid’s efficacy. It reduced the proportion of adults who were hospitalized or died by 86% when compared to placebo. Patients in the study were treated within five days of symptom onset, and they did not receive monoclonal antibody treatment.

On May 25, 2023, the U.S. Food and Drug Administration approved Paxlovid for treating mild-to-moderate COVID-19 in adults who are at high risk for progressing to severe disease.

COVID-19 coronovirus

Signs of Paxlovid Rebound

Symptoms associated with a Paxlovid rebound would be the same as with an initial COVID-19 infection. The symptoms are typically described as mild to moderate in severity:

  • Cough
  • Fatigue
  • Headache

Whether you believe you have a new-onset COVID-19 infection or a rebound infection, take a COVID-19 test. If your at-home COVID-19 test is positive following a negative one, follow the CDC isolation guidelines. Contact a doctor on the TelegraMD platform to receive access to a doctor 24 hours a day. They can discuss your COVID-19 test results and symptoms and determine whether a prescription antiviral medication is an appropriate treatment.

How Common Is Paxlovid Rebound?

According to data from the two Phase 2/3 Paxlovid clinical trials, Paxlovid rebound occurs in 1% to 3% of patients.

According to a preprint article published in medRxiv that examined the rates and relative risks of COVID-19 rebound in 92 million patients treated with Paxlovid or Molnupiravir between January and June 2022, researchers found rebound rates were as follows:

Paxlovid

  • 7-day COVID-19 rebound rate: 3.53%
    • with symptoms: 2.31%
    • hospitalized: 0.44%
  • 30-day COVID-19 rebound rates: 5.4%
    • with symptoms: 5.87%
    • hospitalized: 0.77%

Molnupiravir

  • 7-day COVID-19 rebound rate: 5.86%
    • with symptoms: 3.75%
    • hospitalized: 0.84%
  • 30-day COVID-19 rebound rates: 8.59%
    • with symptoms: 8.21%
    • hospitalized: 1.39%

Results from the EPIC-HR, EPIC-SR 2021 (pre-Omicron), and EPIC-SR 2022 (Omicron) study data that Pfizer shared with the FDA showed that rebound rates after taking Paxlovid ranged from 10.4% to 15.8%. Rebound rates in the placebo group ranged from 13.6% to 14.1%, leading researchers to theorize that the viruses that cause COVID-19 cause a waxing-waning symptom course.

How Long Does Paxlovid Rebound Last?

In one study, after 28 days, 68% of participants reported their symptoms had resolved. Of these, 44% reported at least one symptom came back. For the most part, these symptoms were described as mild. None of the participants who had symptom relapse reported severe symptoms, had a hospitalization, or were treated with Paxlovid.

Is Paxlovid Rebound Worse Than the Original Symptoms?

No, most sources report that the symptoms related to Paxlovid rebound are mild to moderate. Symptoms may feel more severe because they are unexpected.

Side Effects of Paxlovid

Based on the results of two Paxlovid clinical trials, the most common side effects were:

  • Dysgeusia: a change in taste
  • Diarrhea: runny, frequent bowel movements

Other side effects that were reported after Paxlovid was granted EUA include:

  • High blood pressure
  • Stomach (abdominal) pain
  • Nausea
  • Vomiting
  • Fatigue
  • Headache
  • Severe skin rashes
  • Hypersensitivity reactions
  • Anaphylaxis

Other Antiviral Treatments for COVID-19

Other antiviral treatment options are available to treat COVID-19, including:

  • Remdesivir: This antiviral medication is an FDA-approved alternative to Paxlovid. It requires intravenous (IV) infusion for three days.
  • Tocilizumab: This medication is approved to treat hospitalized adults with COVID-19 who receive systemic steroids and require supplemental oxygen.
  • Baricitinib: This medication is approved to treat hospitalized adults with COVID-19 who receive systemic steroids and require supplemental oxygen.

If you have mild-to-moderate COVID-19 symptoms and are unsure whether you qualify for antiviral therapies, contact a doctor on the TelegraMD platform to receive an online diagnosis. They can help you with COVID-19 screening and testing and, if appropriate, transmit an online prescription to your local pharmacy to treat your COVID-19 symptoms. You will probably find it more cost-effective to consult a doctor online than other on-demand options, especially if you do not have insurance.  

Viral particles and a person graphic with his hand up

Why Prevention Is Still Important

Vaccination is the most effective way to prevent COVID-19. Ask your doctor or healthcare provider whether you are a suitable candidate for the booster vaccine.

COVID-19, influenza, and respiratory syncytial virus are all respiratory viruses that spread through close contact with the respiratory secretions from a person infected with the virus. All three classes of viruses have vaccines that reduce the risk of severe disease. Everyone’s immune system is different. We will all respond to vaccination slightly differently, and we will all respond to COVID-19 infection slightly differently as well. Talk to your doctor to better understand your risk versus benefits ratio for vaccination and if you have COVID-19, for treatment.

Considerations for Healthcare Businesses

COVID-19 and other pathogens are constantly evolving. New medications and treatment options come on the market all the time, challenging businesses such as online pharmacies and labs to continually review the most recent clinical trial and prescribing information so they can advise patients on such topics as COVID-19 rebound.

Disclaimer

While we strive to always provide accurate, current, and safe advice in all of our articles and guides, it’s important to stress that they are no substitute for medical advice from a doctor or healthcare provider. You should always consult a practicing professional who can diagnose your specific case. The content we’ve included in this guide is merely meant to be informational and does not constitute medical advice.

A person sitting at a desk

Short- and Long-Term Health Effects of a Sedentary Lifestyle

Written by Leann Poston, MD. on . Posted in Conditions. Leave a Comment

Your body was made to move! Today’s lifestyle makes it hard to keep your body moving throughout the day. Many people sit all day at work and then go home to use technology or watch television. But a sedentary lifestyle can contribute to health problems such as type 2 diabetes, obesity, high blood pressure, and premature mortality.

According to a study published in JAMA:1

  • About 1 in 4 adults sit for over 8 hours daily.
  • About 4 in 10 adults are physically inactive.
  • About 1 in 10 adults sits for over 8 hours daily and is physically inactive the rest of the day.

According to data collected by the Centers for Disease Control and Prevention, more than 25% of adults are physically inactive. Exercising or engaging in physical activity for a few hours and then sitting meets the criteria for exercise. However, according to researchers, it is still not healthy. Prolonged periods of sitting are associated with an increase in all-cause mortality. Sitting for less than 30 minutes at a time decreases your risk of an early death.2

What Is a Sedentary Lifestyle?

Several organizations have defined a sedentary lifestyle or sedentary behavior. According to the Sedentary Behavior Research Network, some of these definitions include:3

  • A class of behaviors characterized by low energy expenditure.
  • Sedentary behaviors such as TV watching, computer use, or sitting typically fall in the energy-expenditure range of 1.0 to 1.5 METs (multiples of the basal metabolic rate).
  • Behaviors that do not increase energy expenditure substantially.
  • Non-upright behaviors.
  • Any time spent sitting or lying.

Putting these together: A sedentary lifestyle is defined by an increased amount of sitting, lying, or reclining that has very low energy expenditure, which is typically defined as 1.0 to 1.5 METs.

Characteristics of a Sedentary Lifestyle

Your day can be divided into three parts:

  • Sleep: During the 6 to 10 hours you sleep each night, you are either sitting, reclining, or lying down. This portion of your day is appropriately sedentary.
  • Physical Activity: During this part of your day, you are in motion and can be engaged in light, moderate, or vigorous physical activity. Increasing your time moving will improve your overall health and reduce your risk for chronic disease. Light exercise is better than sedentary behavior, moderate activity is better than light, and vigorous activity can be even better depending on your fitness level.
  • Sedentary Behavior: Any time spent lying, reclining, or sitting throughout your day.
A doctor explaining heart disease to a patient

Why Do Sedentary Lifestyles Negatively Affect Health?

When your body doesn’t move, you:

  • Burn fewer calories and can more easily gain weight.
  • Increase your risk for blood clots in your legs.
  • May lose bone density and mass more quickly.
  • Lose muscle mass and endurance.
  • Lose cardiovascular fitness.
  • May experience anxiety and depression.
  • May find it harder to get quality sleep.
  • Have increased fatigue.

In one study over 12 years that enrolled 17,000 Canadian adults, it was found that adults who spent most of their time sitting were 50% more likely to die than those who sat the least. The researchers controlled for age, smoking, and physical activity levels.4

Possible Short-Term Health Effects

Lack of exercise and physical movement throughout the day increases your risk for:

  • Weight gain
  • Poor exercise endurance
  • Low mood
  • Constipation
  • Decreased energy
  • Back pain

These short-term effects of sedentary behavior can be reversed by incorporating physical activity into your day.

Possible Long-Term Health Effects

When a sedentary lifestyle becomes a habit, you increase your risk for:5,6

  • Obesity: Your body burns calories daily as you fidget and move around. However, most obesity risk comes from diet. Research is inconclusive on how much a sedentary lifestyle affects your weight.7
  • Mortality: Seven systematic reviews indicate that sedentary behavior is associated with increased all-cause and cardiovascular mortality, independent of physical activity and body mass index.
  • Heart disease: In one study, researchers found that sitting just two hours a day was associated with a 5% increase in cardiovascular disease.5 Having obesity is another risk factor for heart disease. Physical activity can help you manage your weight and improve your cardiovascular health. Learn more facts and common myths about heart disease.
  • High blood pressure: Sedentary behaviors may increase your risk of hypertension.6 Physical activity improves cardiovascular health and lowers blood pressure. High blood pressure does not have symptoms. Learn how to protect your cardiovascular health in this hypertension guide.
  • Osteoporosis: Osteoporosis is decreased bone density and mass. Adolescents and young adults build their lifetime supply of bone. Pounding exercises like walking and running increase bone density as bone responds to stress.
  • Falls: When the stabilizing muscles in your core become weak from sitting too much, it increases your risk of falls.
  • Blood clots: If you have a genetic predisposition for blood clots, sitting for long periods can increase your risk.
  • High cholesterol: Sedentary behavior increases LDL (bad cholesterol) and triglycerides. Physical activity increases HDL or good cholesterol. Read more about the differences between good and bad cholesterol.
  • Certain cancers: Sedentary behavior may increase your risk for colorectal, breast, endometrial, ovarian, and prostate cancers.6 However, the results are inconclusive and may be influenced by time spent in physical activity and body mass index.
  • Type 2 diabetes: Research suggests that sitting for 2 hours per day is associated with a 20% increase in risk for type 2 diabetes.
  • Depression and anxiety: Some studies show an association between sedentary behavior and depressed mood.8,9 However, more evidence supports how physical activity boosts mood and reduces stress. Stress can also have a significant effect on heart health.

While many studies on the health effects are inconclusive, the studies that demonstrate the benefits of physical activity for overall health are not. It is challenging to design studies that measure the health effects of sedentary behavior and exclude possible confounding variables. However, there is a growing body of evidence that sedentary behavior is a risk factor for multiple adverse health outcomes in adults, regardless of whether they exercise.10

A person using an exercise tracker.

How To Change Your Sedentary Lifestyle

Research suggests that even people who meet the recommended physical activity guidelines are still at risk if they sit for the rest of the day. It will take a conscious effort to develop new habits that involve moving your body regularly throughout the day.

At Home

Try to incorporate some of these heart-healthy exercises and physical activity into your daily schedule:

  • Pace while you talk on the phone.
  • Save TV watching for when you are using a treadmill or other exercise equipment or if you sit, get up, and walk during each commercial.
  • Set a timer when you sit down.
  • Listen to recorded books so you can walk while you listen.
  • Space out your chores so they include more walking.
  • Play with your pets.

At Work

Increase your physical activity at work by trying to incorporate some of the following behaviors into your day:

  • Park further from the building.
  • Take the stairs instead of the elevator.
  • Set reminders on your phone or watch to get up and move every 30 minutes.
  • Go for a walk on your breaks.
  • Use restrooms on a different floor.
  • Pace in your office when you are on the phone.
  • Invest in a standing desk or a walking pad.
  • Organize walking meetings.
  • Stand while riding the bus.
  • Walk to work.
  • Make it a habit to get up and do quick exercises periodically throughout the day.

When To Seek Help From Health Professionals

If you are concerned about your risk for chronic disease, cannot exercise, or are excessively fatigued, make an appointment with a Telegra MD doctor to discuss your symptoms and health history. TelegraMD doctors are available 24 hours a day, so you can get help when you need it. They can provide an online diagnosis and develop an individualized treatment plan. However, if you have shortness of breath, chest pain, or any other signs of a medical emergency, see a local doctor for urgent care.

Disclaimer

While we strive to always provide accurate, current, and safe advice in all of our articles and guides, it’s important to stress that they are no substitute for medical advice from a doctor or healthcare provider. You should always consult a practicing professional who can diagnose your specific case. The content we’ve included in this guide is merely meant to be informational and does not constitute medical advice.

References

1. Ussery EN, Fulton JE, Galuska DA, Katzmarzyk PT, Carlson SA. Joint Prevalence of Sitting Time and Leisure-Time Physical Activity Among US Adults, 2015-2016. JAMA. 2018;320(19):2036–2038. doi:10.1001/jama.2018.17797

2. Diaz KM, Howard VJ, Hutto B, et al. Patterns of Sedentary Behavior and Mortality in U.S. Middle-Aged and Older Adults: A National Cohort Study. Ann Intern Med.2017;167:465-475. [Epub 12 September 2017]. doi:10.7326/M17-0212

3. Tremblay, M.S., Aubert, S., Barnes, J.D. et al. Sedentary Behavior Research Network (SBRN) – Terminology Consensus Project process and outcome. Int J Behav Nutr Phys Act 14, 75 (2017). https://doi.org/10.1186/s12966-017-0525-8

4. Katzmarzyk PT, Church TS, Craig CL, Bouchard C. Sitting time and mortality from all causes, cardiovascular disease, and cancer. Med Sci Sports Exerc. 2009 May;41(5):998-1005. doi: 10.1249/MSS.0b013e3181930355. PMID: 19346988.

5. de Rezende LF, Rodrigues Lopes M, Rey-López JP, Matsudo VK, Luiz Odo C. Sedentary behavior and health outcomes: an overview of systematic reviews. PLoS One. 2014 Aug 21;9(8):e105620. doi: 10.1371/journal.pone.0105620. PMID: 25144686; PMCID: PMC4140795.

6. Park JH, Moon JH, Kim HJ, Kong MH, Oh YH. Sedentary Lifestyle: Overview of Updated Evidence of Potential Health Risks. Korean J Fam Med. 2020 Nov;41(6):365-373. doi: 10.4082/kjfm.20.0165. Epub 2020 Nov 19. PMID: 33242381; PMCID: PMC7700832.

7. McGuire, K. A., & Ross, R. (2011). Sedentary behavior is not associated with cardiometabolic risk in adults with abdominal obesity. PloS One, 6(6), e20503. https://doi.org/10.1371/journal.pone.0020503

8. Sanchez-Villegas, A., Ara, I., Guillén-Grima, F., Bes-Rastrollo, M., Varo-Cenarruzabeitia, J. J., & Martínez-González, M. A. (2008). Physical activity, sedentary index, and mental disorders in the SUN cohort study. Medicine and Science in Sports and Exercise, 40(5), 827–834. https://doi.org/10.1249/MSS.0b013e31816348b9

9. Zhai L, Zhang Y, Zhang D. Sedentary behaviour and the risk of depression: a meta-analysis. British Journal of Sports Medicine 2015;49:705-709.

10. Thorp, A. A., Owen, N., Neuhaus, M., & Dunstan, D. W. (2011). Sedentary behaviors and subsequent health outcomes in adults. American Journal of Preventive Medicine, 41(2), 207–215. https://doi.org/10.1016/j.amepre.2011.05.004

A woman with mold allergy symptoms

A Guide to Mold Allergies

Written by Leann Poston, MD. on . Posted in Allergies. Leave a Comment

Mold (fungal) allergies can cause congestion, headaches, coughing, wheezing, itchy, watery eyes, and skin rashes. Molds are common in indoor and outdoor environments, where they thrive in high humidity and moisture. However, not all mold spores cause allergy symptoms.1 The American College of Occupational and Environmental Medicine estimates that about 10% of people have a mold allergy, with about 5% having symptoms, and that 10% to 30% of the population may be sensitive to mold allergens. Depending on your geographic location, outdoor mold allergies may peak in the fall or be year-round.

Symptoms of a Mold Allergy

Mold allergies can develop at any age. The symptoms associated with mold allergies are similar to those of other allergies. They can develop immediately or be delayed. Common mold allergy symptoms include:

  • Nasal congestion
  • Runny nose
  • Headache
  • Sneezing
  • Sore throat
  • Watery eyes
  • Dry cough
  • Shortness of breath
  • Wheezing
  • Hives
  • Nausea
  • fatigue

Mold seems to cause more respiratory symptoms than other allergens, increasing the risk for severe allergies and asthma in susceptible people.

How To Prevent Mold Allergy Symptoms

According to the Environmental Protection Agency, getting rid of all molds and mold spores in your home is impossible. However, the following steps can help reduce mold spores:

  • Reduce indoor humidity to 30% to 60%.
  • Vent bathrooms, dryers, and other moisture-generating sources to the outside.
  • Use dehumidifiers and air conditioning to reduce humidity.
  • Increase ventilation throughout your home and use HEPA filters.
  • Use exhaust fans when cooking.
  • Wipe counters and other hard surfaces with water and detergent, and dry thoroughly.
  • Leave wet shoes and clothing in a mudroom.
  • Ensure your home has adequate insulation to prevent condensation.
  • Avoid carpeting in areas of the home that are prone to collecting moisture, such as bathrooms.
  • Remediate any mold safely.

When prevention is not enough to control your symptoms, antihistamines, decongestants, corticosteroids, and asthma medications may be needed to control your symptoms. Contact a doctor on the TelegraMD platform to receive a diagnosis, a personalized treatment plan, and, if appropriate, an online prescription transmitted to your local pharmacy.  

A child getting allergy testing

How To Treat Mold Allergy Symptoms

The first step in treating mold allergies is to reduce your exposure. While molds are ubiquitous, reducing moisture and humidity in your home can help relieve symptoms.

The next step is to take allergy medications to control your symptoms:

  • Antihistamines reduce itching, watery eyes, sore throat, and post-nasal drip.
  • Decongestants reduce nasal congestion and headaches.
  • Steroid nasal sprays reduce nasal congestion.
  • Nasal saline rinses remove allergens from the nose and sinuses.

If environmental remediation and medications are not enough to control your symptoms and your symptoms worsen or persist, you may want to consider immunotherapy. After having allergy testing, your doctor can prepare an allergy serum that will be used to help your immune system become less sensitive to mold allergens.

You will receive escalating doses of the allergy serum. You will notice decreased symptom severity as your immune system becomes less sensitive to your allergen.

Places Where Mold May Be Present

Mold is typically present in moist, dark areas, inside and outside the home, where there is organic matter, such as wood, for them to grow on. Look for mold in these locations:

  • Poorly vented bathrooms, look around showers and sinks
  • Wet basements in corners and any exposed wood or insulation
  • Poorly vented laundry rooms
  • Around windows
  • In kitchens, under the sinks, refrigerators, and dishwashers
  • Attics with poor ventilation and roof leaks can accumulate moisture
  • Crawlspaces that accumulate moisture
  • Air ducts that are not properly maintained
  • Wet carpeting
  • Along damaged roofs or clogged gutters
  • Along exterior wall cracks
  • Leaf piles or garden waste
  • Wooden decks and fences
  • Outdoor furniture

Remove moisture sources, caulk, and check for gaps in walls and cabinets. Clean up spills promptly, improve house ventilation, check the integrity of your windows, roof and gutters, clean appliances that use water, check for condensation, use dehumidifiers, and remove plants to reduce mold in your home.

Mold remediation

Types of Mold Allergies

Types of molds causing allergies and human diseases include:2,3,4

  • Alternaria: An outdoor mold found in soil, plants, and decaying vegetation.
  • Cladosporium: found on plants, soils, and HVAC systems.
  • Aspergillus: found on decaying leaves and compost piles
  • Penicillium: found in damp homes.
  • Mucor: found in soil, plant surfaces, and decaying leaves.

All mold species have the potential to cause sensitization and allergies, but compared to other environmental allergens, the allergenic potential of each mold species is low.4

Mold Allergies vs. Seasonal Allergies

Mold allergens are common anywhere there is moisture, inside and outside the home. Like other indoor allergens, such as dust mites and pet dander, mold allergies can cause symptoms year-round.

Seasonal allergies are caused by outdoor allergens that peak at certain times of the year. Seasonal allergies, like mold allergies, are common. Both seasonal allergies and mold allergies cause similar symptoms. It may be easier to diagnose seasonal allergies than mold allergies based on the time of year in which you have symptoms. Treatment for seasonal and mold allergies is the same and includes reducing exposure, using medications, and considering allergy testing. Unlike seasonal allergens, mold is more likely to cause asthma and allergy symptoms.

Colds and pink eye have symptoms that overlap with allergies, so it is essential to get an accurate diagnosis before starting treatment.

Are Mold Allergies Genetic?

Both environmental factors and genetic predisposition can influence your risk of developing mold allergies. Specific genetic markers have been linked to mold allergies. However, more research is needed to determine whether specific gene variants cause allergies. Your risk of developing allergies increases if one or both of your parents has allergies.

Who Is Most at Risk of a Mold Allergy?

At the highest risk for mold allergies are people:4

  • Who work or live in warm, moist climates
  • With asthma or allergies
  • Who with immunosuppression
  • With respiratory diseases such as cystic fibrosis
  • At the extremes of age
  • Who work in construction, agricultural fields or gardening, mold remediation, library archives, breweries or wineries, paper processing, feed production, ventilation/air conditioning maintenance

Can You Develop a Mold Allergy?

Yes, it is possible to develop a mold or other type of allergy later in life. Changes in your environment, immune response, or overall health can increase your sensitivity to allergens.

Can You Outgrow a Mold Allergy?

It is possible to outgrow a mold allergy, but it is uncommon.

When To Consult a Doctor

If you are unsure whether allergies are causing your symptoms or you have more severe allergies or asthma symptoms, consult with an online doctor on the TelegraMD platform. Doctors are on call 24 hours a day to provide an online diagnosis, prescribe appropriate treatment, and provide an individualized treatment plan to combat your allergy symptoms.

Disclaimer

While we strive to always provide accurate, current, and safe advice in all of our articles and guides, it’s important to stress that they are no substitute for medical advice from a doctor or healthcare provider. You should always consult a practicing professional who can diagnose your specific case. The content we’ve included in this guide is merely meant to be informational and does not constitute medical advice.

References

1. Borchers, A.T., Chang, C. & Eric Gershwin, M. Mold and Human Health: a Reality Check. Clinic Rev Allerg Immunol 52, 305–322 (2017). https://doi.org/10.1007/s12016-017-8601-z

2. Portnoy JM, Jara D. Mold allergy revisited. Ann Allergy Asthma Immunol. 2015 Feb;114(2):83-9. doi: 10.1016/j.anai.2014.10.004. PMID: 25624128.

3. Singh, M., & Hays, A. (2016). Indoor and outdoor allergies. Primary Care, 43(3), 451–463. https://doi.org/10.1016/j.pop.2016.04.013

4. Hurraß J, Heinzow B, Aurbach U, Bergmann KC, Bufe A, Buzina W, Cornely OA, Engelhart S, Fischer G, Gabrio T, Heinz W, Herr CEW, Kleine-Tebbe J, Klimek L, Köberle M, Lichtnecker H, Lob-Corzilius T, Merget R, Mülleneisen N, Nowak D, Rabe U, Raulf M, Seidl HP, Steiß JO, Szewszyk R, Thomas P, Valtanen K, Wiesmüller GA. Medical diagnostics for indoor mold exposure. Int J Hyg Environ Health. 2017 Apr;220(2 Pt B):305-328. doi: 10.1016/j.ijheh.2016.11.012. Epub 2016 Dec 5. PMID: 27986496.

The words dry eyes and a bottle of eye drops.

What To Do About Dry Eyes During Allergy Season

Written by Leann Poston, MD. on . Posted in Allergies. Leave a Comment

Dry, itchy, and irritated eyes are common allergy symptoms, but they have other causes as well. When your eyes don’t make enough tears or your tears dry too quickly due to a lack of lipids in the fluid, it can cause fatigue, stinging sensations, redness, blurred vision, and light sensitivity.

The lacrimal gland, which is above the eye, produces tears. Tears coat the surface of the eye, protecting it and keeping it moist. Excess tears drain into the lacrimal duct in the lower corner of your eye.

Dry eye syndrome affects between 16 and 24 million people in the United States.1,2 Older age, having an autoimmune condition, female sex, a lack of vitamin A, decreased blinking, and wearing contact lenses can increase your risk of dry eyes.3

Can Allergies Cause Dry Eyes?

Allergic conjunctivitis causes redness, itching, and dryness due to a sensitivity to allergens in the air. Eye allergies develop when your immune system becomes sensitized and overreacts to harmless substances in the air. These allergens trigger mast cells in your immune system to produce histamine and other chemicals.

Seasonal or perennial allergic conjunctivitis, vernal keratoconjunctivitis, atopic keratoconjunctivitis, contact allergic conjunctivitis, and giant papillary conjunctivitis are the most common types of eye allergies.

Unlike other causes of conjunctivitis, allergic conjunctivitis is not contagious. It typically has a seasonal pattern, depending on what you are allergic to. Many people with allergic conjunctivitis have other allergy symptoms, such as a runny nose, facial itchiness, and a dry cough.

Seasonal allergens that may be causing your dry eye symptoms include:

  • Mold spores
  • Pollen from grasses, trees, and weeds
  • Dust mites
  • Pet dander

Cigarette smoke, perfume, cleaning chemicals, diesel exhaust, and other irritants can worsen your dry eye symptoms.

Other Causes of Dry Eyes

While allergies commonly cause dry eyes, there are other potential causes. These conditions are commonly misdiagnosed as pink eye because they can cause redness, irritation, and tearing.

Common causes of dry eye include:

  • Foreign bodies in the eye
  • Exposure to pollution
  • Medication use, especially antihistamines, antidepressants, and blood pressure medications
  • Health conditions such as autoimmune disorders
  • Laser eye surgery
  • Smoky or dry environments
  • Prolonged computer use
  • Wearing contact lenses
  • Decreased blinking
  • Vitamin A deficiency

To determine whether your dry eyes are due to allergic conjunctivitis or another condition, make an online appointment to talk with a telemedicine doctor and receive an online diagnosis. After receiving your diagnosis, your doctor will provide an individualized care plan to relieve your dry eye symptoms.  

Close-up of a pink eye

Symptoms of Allergic Conjunctivitis

Symptoms of allergic conjunctivitis can vary but commonly include:

  • Blurry vision
  • Burning
  • Feeling like there is dirt or grit in your eyes
  • Itchiness
  • Light sensitivity
  • Redness
  • Stinging
  • Swollen eyelids
  • Watery eyes

How To Treat Dry Eyes from Allergies

Dry eyes from allergies or other causes can affect your physical and psychological health and reduce your quality of life. Treating dry eyes from allergies can improve your vision and reduce your symptoms.4

Try To Limit Exposure to Allergens

Limit your exposure to inside and outside allergens by taking the following steps to allergy-proof your home:

  • Add HEPA filters to vacuums and furnaces to reduce allergens.
  • Avoid exposure to foods, chemicals, perfumes, tobacco, and air pollution.
  • Avoid using window fans that can draw outdoor allergens into the home.
  • Control pet allergens with frequent bathing, brushing, and grooming.
  • Dustproof your home by removing unnecessary carpet, drapes, bedding, and upholstered furniture.
  • Encase mattresses and pillows in a zipped plastic, dust-mite-proof encasing.
  • Keep your hands away from your face and eyes.
  • Leave your shoes and coats in a mudroom to avoid tracking allergens throughout your home.
  • Stay indoors with your windows closed during high-allergen times. Many weather apps report common allergens and their levels in your area.
  • Wash bedding weekly in hot water.
  • Wash your hands after petting or touching animals.
  • Wear glasses or sunglasses, especially outside, to limit contact with wind-blown eye allergens.
A family and pet with allergy symptoms

Use Eye Drops

Prescription and over-the-counter eye drops can reduce irritation, remove allergens, and cleanse an irritated eye. Some prescription eye drops can prevent eye allergy symptoms. Talk to a doctor on the TelegraMD platform about your dry eye symptoms. If appropriate, your doctor can transmit an online prescription to your local pharmacy.

Take Oral Antihistamines

Oral antihistamines reduce histamine, a chemical that causes redness, swelling, tearing, and itchiness. Oral histamines are commonly used to treat allergies but they can worsen dry eye symptoms.

Practice Good Eye Hygiene

According to the Centers for Disease Control and Prevention, approximately 99% of contact users surveyed report not following at least one of the recommended contact lens hygiene behaviors and, therefore, increasing their risk of pink eye.5

When wearing contact lenses, practice these steps to reduce irritation and allergen accumulation on your contacts:

  • Add fresh disinfecting solution to your case before storing your contacts overnight.
  • Add fresh solution each day.
  • Do not top off your disinfecting solution in your contact cases.
  • Keep your contact case clean and dry between uses.
  • Replace your storage case every three to six months.
  • Wash your hands before putting contacts in your eyes or removing them.

Allergens can become trapped between your eyes and contacts, increasing your risk of eye irritation and dryness.

Consider Allergy Shots

If your allergy symptoms are severe and eye drops, allergy medications, and environmental changes do not improve your symptoms, consider allergy shots.

Your doctor may suggest allergy shots after allergy testing to determine which allergens your immune system is sensitive to. This involves injecting a gradually increasing dose of an allergen as your immune system adjusts to it.

Allergy shots can be highly effective at reducing your allergy and asthma symptoms. Typically, allergy shots are given weekly until you reach a maintenance dose. After that, your injection schedule may be spaced out more.

Allergy shots require time and commitment to receive the injection and wait in the office for the required 15 to 20 minutes in case of a reaction. Allergy shots can be expensive, especially if you do not have insurance coverage.

However, if you commit to taking allergy shots, you may see a significant improvement in your symptoms. Talk to your TelegraMD doctor to learn more about allergy shots and whether you would be a suitable candidate for them.

A woman talking to a telehealth doctor

When To See a Doctor

Dry eye causes can vary, so getting an accurate diagnosis and discussing your treatment options is important. Whether you have decreased tear production due to a health issue or as a result of aging, poor tear quality, or tears that evaporate too quickly, an online doctor can help diagnose and treat your condition. Telehealth is a cost-effective way to see a doctor about your dry eye and other allergy symptoms.

Warning signs and symptoms that suggest that something other than allergies may be contributing to your symptoms include:6

  • Bloody nose
  • Difficulty or inability to smell
  • Fever
  • Severe headache
  • Nasal blockage in one nostril
  • Nasal discharge from one nostril
  • Blurred vision
  • Eye pain
  • Blisters or vesicles around the eye

Make an online appointment to get a prescription online if over-the-counter allergy medications are not helping your symptoms or you are concerned that something other than allergies is causing your dry eyes.

Disclaimer

While we strive to always provide accurate, current, and safe advice in all of our articles and guides, it’s important to stress that they are no substitute for medical advice from a doctor or healthcare provider. You should always consult a practicing professional who can diagnose your specific case. The content we’ve included in this guide is merely meant to be informational and does not constitute medical advice.

References

  1. Reza D, Bradley JL, Guerin A, et al. Estimated prevalence and incidence of dry eye disease based on coding analysis of a large, all-age United States healthcare system. American Journal of Ophthalmology. 2019;202:47-54. doi:10.1016/j.ajo.2019.01.026
  2. Farrand KF, Fridman M, Stillman IÖ, Schaumberg DA. Prevalence of diagnosed dry eye disease in the United States among adults aged 18 years and older. American Journal of Ophthalmology. 2017;182:90-98. doi:10.1016/j.ajo.2017.06.033
  1. National Eye Institute. Dry Eye. (n.d.). NIH.Gov. Retrieved September 13, 2023, from https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/dry-eye
  2. Guo OD LW, Akpek E. The negative effects of dry eye disease on quality of life and visual function. Turk J Med Sci. 2020 Nov 3;50(SI-2):1611-1615. doi: 10.3906/sag-2002-143. PMID: 32283910; PMCID: PMC7672346.
  3. Cope JR, Collier SA, Nethercut H, Jones JM, Yates K, Yoder JS. Risk Behaviors for contact lens–related eye infections among adults and adolescents — United States, 2016. MMWR Morb Mortal Wkly Rep. 2017;66(32):841-5.
  4. Asher MI, Montefort S, Björkstén B, Lai CK, Strachan DP, Weiland SK, Williams H; ISAAC Phase Three Study Group. Worldwide time trends in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and eczema in childhood: ISAAC Phases One and Three repeat multicountry cross-sectional surveys. Lancet. 2006 Aug 26;368(9537):733-43. doi: 10.1016/S0140-6736(06)69283-0. Erratum in: Lancet. 2007 Sep 29;370(9593):1128. PMID: 16935684.
A sad woman with a cigarette

How Smoking and Vaping Can Affect Mental Health

Written by Leann Poston, MD. on . Posted in Smoking cessation. Leave a Comment

Almost 70% of the 28.3 million U.S. adults who smoke say they want to quit.1 Smoking poses significant health risks. Cigarette smoking causes over 480,000 deaths in the United States annually, making it the leading preventable cause of death worldwide.2

Vaping and smoking are two alternative methods to deliver nicotine. Concerns about the health risks of smoking have led many people to choose vaping as an alternative. About 1 in every 20 Americans (10.8 million) uses vaping devices, and one in three uses them daily.3 According to the 2022 Gallup poll, 8% of U.S. adults regularly or occasionally vape. One in every four high school students uses vaping products. 

Nicotine is a compound that is rapidly delivered to the brain. It is a highly addictive substance that alters brain chemistry, prompting researchers to look into its potential effects on mental health.

Does Nicotine Cause Anxiety?

Generalized anxiety disorder is characterized by a persistent feeling of worry and anxiety.4 This chronic mental health condition affects all aspects of life, leading many to seek relief by smoking or vaping. Compared to the general population, smoking rates are higher in people with anxiety disorders, and anxiety disorders are more common in people dependent on nicotine.5

Research has shown inconsistent results when exploring the relationship between nicotine use and anxiety. Some studies show that nicotine can ease anxiety, though the effect may be temporary.6 Other studies indicate that, ultimately, nicotine use increases anxiety.7

A study of 2,500 adults and teens found that those who smoke or vape reported more anxiety (60%), depression, and suicidal thoughts than those who did not (40%).  

A person smoking

Can Nicotine Help With Anxiety?

People living with depression or anxiety have a much higher rate of smoking than the general population, leading some researchers to theorize that people who smoke use nicotine to relieve their mental health symptoms,7 but does nicotine use really help with anxiety?

No, nicotine use does not help treat anxiety. Nicotine withdrawal causes uncomfortable symptoms, including anxiety, irritability, and depression. People who stop smoking may mistakenly believe that nicotine is easing their anxiety, but in reality, it relieves symptoms from quitting smoking.7

A sad woman with a cigarette

The Relationship Between Nicotine and Mental Health

Addiction, stress, anxiety, depression, and schizophrenia are mental health conditions linked to nicotine use. Researchers continue to investigate the complex relationships between mental health conditions and nicotine’s effects on the brain.

Compared with the general population, people with schizophrenia, depression, and other mental health conditions are three times more likely to smoke. They also smoke more intensely, drawing more nicotine out with each breath, and are more nicotine-dependent. 8  

The high prevalence of smoking in people with mental health conditions may be because nicotine temporarily reduces symptoms such as poor concentration, low mood, and stress. Ultimately, smoking cessation is linked to reduced depression, anxiety, and stress, as well as better mood and quality of life.9,10

Addiction

Nicotine is a highly addictive substance that changes brain chemistry and leads to cravings and withdrawal symptoms with decreased use. Changes in brain chemistry from nicotine exposure cause tolerance or a need to use higher and higher nicotine doses to get the same effect.

Withdrawal symptoms can cause insomnia, mood changes, cravings, anxiety, restlessness, and depression. 

Stress and Anxiety

Changes in brain chemistry from nicotine exposure are associated with a depressed mood, agitation, and anxiety shortly after smoking. A person who smokes has fluctuations in their psychological state as they go through repeated withdrawal cycles throughout the day. This can worsen mental health. However, according to researchers, a causal relationship between smoking and mental health conditions cannot be supported. In a review of 29 studies, researchers found that quitting smoking and vaping was associated with a decrease in anxiety and stress symptoms.10

Depression

In one study, over half of the 108 participants who were moderately or heavily dependent on nicotine reported moderate-to-severe depression, and 44% reported moderate-to-severe anxiety, as well. Interestingly, the degree of nicotine addiction was inversely related to the severity of anxiety and depression. This illustrates the complex relationship between mental health conditions and nicotine use.11

In a review of 29 studies, the improvement researchers saw in mood disorders when people stopped smoking was similar to using antidepressant treatments.10

Schizophrenia

A strong link between schizophrenia and smoking exists. Some reports suggest that cigarette smoking increases the risk of schizophrenia. However, more research is needed.

Theories on the association between schizophrenia and smoking include:12

  • Self-medication theory: Smoking increases dopamine levels and may improve symptoms.
  • Causal: Smoking may play a role in developing schizophrenia.
  • Genetic: There may be a shared genetic predisposition for both schizophrenia and smoking.

People with schizophrenia inhale more deeply, have higher nicotine exposure, consume more cigarettes, and have higher levels of nicotine dependence than smokers who do not live with schizophrenia. People living with schizophrenia have a shorter lifespan (by 28 years) than people who do not, and the health effects of cigarette smoking contribute to this.12

Varenicline and other smoking cessation medications can be effective for smoking cessation and can increase the odds of quitting by a factor of 4 to 5 times in people with schizophrenia. Without medication, the smoking cessation success rate is very low.13 More research is needed to develop effective smoking cessation programs for people with mental health conditions.12

A therapist talking to a client

How Quitting Can Benefit Mental Health

Nicotine increases dopamine levels in the brain and changes the metabolism of other brain chemicals. When people quit smoking, they are more likely to experience irritability, anxiety, depression, and memory and concentration problems.

To successfully quit smoking, it is essential to prepare yourself mentally and physically for your first smoke-free day. After quitting smoking, you will experience many long-term mental and physical health benefits. Smoking has a significant impact on heart health, and reducing stress also improves heart health.

What About Depression After Quitting Smoking?

Not only are people who smoke more likely to experience depression than those who do not, but low mood is more common when trying to quit smoking due to nicotine withdrawal.

People who experience depression after quitting smoking are more likely to relapse. However, the first two to three days after quitting smoking will be the worst. According to timelines for quitting smoking, nicotine cravings, irritability, sleep problems, anxiety, and restlessness peak within three to seven days after stopping smoking and using nicotine replacement therapies can make these symptoms much more manageable. The symptoms are expected to resolve within a month.

If you can successfully quit smoking, researchers have found that depressive symptoms significantly improve.14

How To Get Help With Addiction or Mental Health

Nicotine is very addictive, maybe even more so than cocaine and heroin.15 Its addictive quality makes it difficult for people to stop smoking. Behavior, psychological, and medical support can make it easier to successfully quit. Smoking cessation help is available, even online, through the TelegraMD platform.

Talk With a Therapist

Smoking cessation and withdrawal from nicotine can temporarily increase anxiety, stress, and depression. Talk to a good online therapist to develop a plan for managing your addiction and other mental health symptoms. An analysis of over 52 clinical studies and nearly 20,000 patients found that using a combination of behavioral therapy and medication compared to minimal support alone led to more effective smoking cessation success.16

Consult With a Doctor

Online doctors can provide an individualized smoking cessation program and prescribe nicotine replacement therapy as an online prescription and transmit it to your local pharmacy. These prescription and over-the-counter medications ease withdrawal symptoms. The TelegraMD platform provides 24-hour doctor care access so you can get help whenever you need it.

Disclaimer

While we strive to always provide accurate, current, and safe advice in all of our articles and guides, it’s important to stress that they are no substitute for medical advice from a doctor or healthcare provider. You should always consult a practicing professional who can diagnose your specific case. The content we’ve included in this guide is merely meant to be informational and does not constitute medical advice.

References

1. Cornelius ME, Loretan CG, Jamal A, et al. Tobacco Product Use Among Adults — United States, 2021. MMWR Morb Mortal Wkly Rep 2023;72:475–483.

2. Rigotti NA. Strategies to Help a Smoker Who Is Struggling to Quit. JAMA. 2012;308(15):1573–1580. doi:10.1001/jama.2012.13043

3. Mohammadhassan Mirbolouk, Paniz Charkhchi, Sina Kianoush, et al. Prevalence and Distribution of E-Cigarette Use Among U.S. Adults: Behavioral Risk Factor Surveillance System, 2016. Ann Intern Med.2018;169:429-438. [Epub 28 August 2018]. doi:10.7326/M17-3440

4. National Institute of Mental Health. Generalized anxiety disorder: When worry gets out of control. Updated 2022. Accessed September 11, 2023. https://www.nimh.nih.gov/health/publications/generalized-anxiety-disorder-gad/index.shtml

5. Kutlu MG, Parikh V, Gould TJ. Nicotine addiction and psychiatric disorders. Int Rev Neurobiol. 2015;124:171-208. doi:10.1016/bs.irn.2015.08.004

6. Xiao X, Shang X, Zhai B, Zhang H, Zhang T. Nicotine alleviates chronic stress-induced anxiety and depressive-like behavior and hippocampal neuropathology via regulating autophagy signaling. Neurochemistry International. 2018;114:58-70. doi:10.1016/j.neuint.2018.01.004

7. Fluharty M, Taylor AE, Grabski M, Munafò MR. The association of cigarette smoking with depression and anxiety: a systematic review. NICTOB. 2017;19(1):3-13. doi:10.1093/ntr/ntw140

8. Gilbody S, Peckham E, Bailey D, Arundel C, Heron P, Crosland S, Fairhurst C, Hewitt C, Li J, Parrott S, Bradshaw T, Horspool M, Hughes E, Hughes T, Ker S, Leahy M, McCloud T, Osborn D, Reilly J, Steare T, Ballantyne E, Bidwell P, Bonner S, Brennan D, Callen T, Carey A, Colbeck C, Coton D, Donaldson E, Evans K, Herlihy H, Khan W, Nyathi L, Nyamadzawo E, Oldknow H, Phiri P, Rathod S, Rea J, Romain-Hooper CB, Smith K, Stribling A, Vickers C. Smoking cessation for people with severe mental illness (SCIMITAR+): a pragmatic randomised controlled trial. Lancet Psychiatry. 2019 May;6(5):379-390. doi: 10.1016/S2215-0366(19)30047-1. Epub 2019 Apr 8. PMID: 30975539; PMCID: PMC6546931.

9. National Institute on Drug Abuse. Do people with mental illness and substance use disorders use tobacco more often? February 24, 2023. Accessed September 11, 2023. Retrieved from https://nida.nih.gov/publications/research-reports/tobacco-nicotine-e-cigarettes/do-people-mental-illness-substance-use-disorders-use-tobacco-more-often

10. Taylor G, McNeill A, Girling A, Farley A, Lindson-Hawley N, Aveyard P et al. Change in mental health after smoking cessation: systematic review and meta-analysis BMJ 2014; 348 :g1151 doi:10.1136/bmj.g1151

11. Papazisis A, Koreli A, Misouridou E. Heavy Smoking is Associated with Low Depression and Stress: a Smokers’ Paradox in Cardiovascular Disease? Mater Sociomed. 2019 Dec;31(4):268-272. doi: 10.5455/msm.2019.31.268-272. PMID: 32082091; PMCID: PMC7007605.

12. Ding JB, Hu K. Cigarette Smoking and Schizophrenia: Etiology, Clinical, Pharmacological, and Treatment Implications. Schizophr Res Treatment. 2021 Dec 13;2021:7698030. doi: 10.1155/2021/7698030. PMID: 34938579; PMCID: PMC8687814.

13. Cather C, Pachas GN, Cieslak KM, Evins AE. Achieving Smoking Cessation in Individuals with Schizophrenia: Special Considerations. CNS Drugs. 2017 Jun;31(6):471-481. doi: 10.1007/s40263-017-0438-8. PMID: 28550660; PMCID: PMC5646360.

14. Stepankova L, Kralikova E, Zvolska K, et al. Depression and Smoking Cessation: Evidence from a Smoking Cessation Clinic with 1-Year Follow-Up, Annals of Behavioral Medicine, Volume 51, Issue 3, June 2017, Pages 454–463, https://doi.org/10.1007/s12160-016-9869-6

15. Brunette P, Harris S et al. UCSF Medical Center Fontana Tobacco Treatment Center Stop Smoking Workbook. Accessed July 6, 2023. extension://oemmndcbldboiebfnladdacbdfmadadm/https://www.ucsfhealth.org/-/media/project/ucsf/ucsf-health/pdf/fttc-tobacco-workbook-011912.pdf

16. Stead LF, Koilpillai P, Fanshawe TR, Lancaster T. Combined pharmacotherapy and behavioural interventions for smoking cessation. Cochrane Database Syst Rev. 2016 Mar 24;3(3):CD008286. doi: 10.1002/14651858.CD008286.pub3. PMID: 27009521; PMCID: PMC10042551.

High blood rpessure and a stethoscope

Tips for Managing High Blood Pressure

Written by Leann Poston, MD. on . Posted in Heart disease. Leave a Comment

High blood pressure, or hypertension, is diagnosed when blood pressure exceeds healthy limits. When you have high blood pressure, your blood exerts more force on the inner lining of blood vessels. Over time, excessive force and friction damage the inner lining of blood vessels. This increases your chances of developing cardiovascular diseases, such as stroke, heart attacks, kidney disease, vision loss, and sexual dysfunction.

The following statistics about high blood pressure epidemiology are concerning:1,2,3,4

  • Worldwide, about 1.28 billion adults have high blood pressure, including 122.4 million adults in the U.S.
  • In 2021, hypertension caused or contributed to 691,095 deaths in the U.S.
  • Just under half (46%) of people with high blood pressure do not know they have this condition.
  • Less than half of adults with high blood pressure are being treated, and only one in every five adults with hypertension has it under control.
  • High blood pressure is a leading cause of premature death worldwide.
  • The prevalence of high blood pressure is rising due to an aging population and increased exposure to detrimental lifestyle factors.

As these statistics show, the first step to improving your heart health is to learn whether you have high blood pressure. TelegraMD doctors are available 24 hours a day to evaluate your medical history and blood pressure readings and provide an individualized plan for lowering your blood pressure to healthy levels.

High blood pressure is managed by modifying lifestyle factors that increase your risk and taking medications. Whether or not you have high blood pressure, consider changing any lifestyle factors that increase your risk.

What Causes High Blood Pressure?

Blood pressure is a measurement of the pressure exerted by circulating blood on the walls of arteries, similar to the pressure exerted by water on the walls of a hose. Systolic pressure is measured when the lower chambers of the heart contract and push blood into the circulation. Diastolic pressure is the number recorded when the heart relaxes.

Factors that can cause high blood pressure (hypertension) include:

  • Blood volume/cardiac output: Excess blood volume from fluid retention (chronic kidney disease, heart failure, liver disease) or increased salt in your diet can raise blood pressure. Excess sympathetic nervous system stimulation, increased thyroid hormone, and high calcium levels can also increase blood pressure.
  • Compliance: When blood vessels are stiff and non-compliant due to microscopic damage or fat and cholesterol deposits, it can increase blood pressure. Blood vessel compliance decreases with age and cholesterol deposition.
  • Viscosity: Thicker blood from increased red blood cells or blood proteins can increase blood pressure.
  • Vessel length: The longer a blood vessel, the higher its resistance and the blood pressure needed to overcome this resistance. Carrying extra body fat (obesity) increases total capillary length. Obesity is a strong risk factor for heart disease.  
  • Resistance: Narrowing the lumen of a blood vessel increases its resistance, and high blood pressure is needed to overcome this resistance. Smoking, stress, and some medications (stimulants) may narrow blood vessels.

Having a genetic predisposition to high blood pressure can also increase your risk, as can medical conditions that are associated with high blood pressure, such as:

  • Sleep apnea
  • Chronic kidney disease
  • Pheochromocytomas
  • Adrenal gland tumors
  • Thyroid disease
  • Coarctation of the aorta
high blood pressure, cuff and risk factors

Ways To Reduce High Blood Pressure

Lifestyle factors contribute to high blood pressure. Mitigating these factors can reduce your blood pressure and your risk for chronic health conditions associated with high blood pressure. In addition to maximizing the benefits of healthy lifestyle choices, consult with an online doctor to get answers to your questions right away.

1. Get Regular Exercise

Regular exercise can reduce stress, improve mental health and cardiovascular function, and help you shed some extra pounds. Physical activity strengthens the heart, making it more efficient when pumping blood.

Research suggests that physical activity decreases systolic blood pressure by about 11 mm Hg and diastolic blood pressure by 8 mm Hg in about three-quarters of people with high blood pressure. Researchers also noted that:5

  • Exercise reduces blood pressure more in women than in men.
  • Middle-aged adults benefit more from exercise to reduce blood pressure than younger or older adults.
  • Low- to moderate- levels of exercise yield as much or even more benefit than high-intensity exercise.
  • Prolonged exercise improves blood pressure more than shorter episodes.
  • Decreases in blood pressure remain for up to 24 hours after exercising.

The American College of Sports Medicine (ACSM)6 and the U.S. Department of Health and Human Services Physical Activity Guidelines7 jointly recommend:

  • Aim for at least 150 to 300 minutes of moderate-intensity aerobic physical activity, 75 to 150 minutes of vigorous physical activity, or an equivalent combination of moderate- and vigorous-intensity activity throughout the week.
  • Do muscle-strengthening exercises that target every major muscle group at least twice a week.

Choosing a sedentary lifestyle has many potential health effects, including an increased risk for metabolic syndrome, high blood pressure, and obesity. Any physical activity that you incorporate into your daily schedule will pay off in health benefits. The best exercises are ones you enjoy and will continue doing.

Examples of heart-healthy exercises include:

  • Aerobic exercises: walking, jogging, cycling, rowing, swimming, and dancing to improve cardiovascular fitness.
  • Strength training: push-ups, squats, and planks to increase muscle mass.
  • High-intensity interval training to improve cardiovascular fitness and burn calories.
  • Yoga or Pilates to improve flexibility and posture.

2. Cut Back on Sugary and Salty Foods

When researchers compared 14 different macronutrient diets, they found all diets resulted in modest weight loss and improved blood pressure over six months, but at 12 months, weight reduction decreased, and blood pressure improvements largely disappeared. Reviewers pointed out that very low-carbohydrate diets were not included in the study.8

Long-term follow-up data from the Framingham Heart Study revealed that compared to normal-weight adult men and women, the relative risks for developing high blood pressure were 1.48 and 1.70 for overweight men and women and 2.23 and 2.63 for men and women with obesity, respectively.9 Losing weight to a healthy body mass index can reverse this risk.10

The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure found that weight reduction by 22 pounds resulted in a 5 to 20 mm Hg reduction in systolic blood pressure.11

Sodium can increase water retention and blood volume, leading to high blood pressure. Reduce sodium intake to less than 2,400 mg sodium per day. Optimally, decrease it even further to 1,500 mg per day. Restricting sodium is expected to decrease systolic blood pressure by 2 to 8 mm Hg.11 Most sodium in the typical American diet comes from consuming processed foods, not from adding salt to foods at the table.

Increasing potassium in your diet can lower your blood pressure. A low potassium-to-sodium ratio is associated with increased blood pressure. The DASH diet recommends a daily intake of 4.7 g of potassium.12

A person using an exercise tracker.

3. Eat More Heart-Healthy Foods

Consuming a diet rich in fruits and vegetables and low-fat dairy products with reduced saturated and total fat, such as the DASH (Dietary Approaches to Stop Hypertension) diet, can reduce blood pressure by 8 to 14 mm Hg.11  Heart-healthy foods are rich in antioxidants and healthy sources of fat and low in saturated fat and sodium.

The DASH diet emphasizes eating:

  • Fruits
  • Vegetables
  • Whole grains
  • Fish
  • Poultry
  • Beans
  • Nuts and seeds
  • Vegetable oils

Besides lowering blood pressure, a heart-healthy diet can lower low-density lipoprotein (LDL) bad cholesterol and increase high-density lipoprotein (HDL) cholesterol.

Foods rich in omega-3 fatty acids

4. Reduce Smoking and Alcohol Consumption

Chemicals in cigarette smoke constrict blood vessels, increasing resistance and, therefore, blood pressure. These chemicals damage the inner lining of blood vessels and can negatively impact heart health. Increased risk of cardiovascular disease from smoking is not life long. After one year of smoking cessation, the risk of coronary heart disease is cut in half and continues to decline. After 15 years of abstinence, coronary heart disease risk is comparable between smokers and nonsmokers.13

Long-term or excessive alcohol consumption can damage the liver and affect the heart. For every 10 grams of alcohol consumed, blood pressure increases by about 1 mm Hg. After 2 to 4 weeks of abstinence, the effect of alcohol on blood pressure declines to baseline. The relationship between alcohol consumption and blood pressure is the same regardless of the type of alcohol consumed.14

Drinking alcohol in moderation, which is less than or equal to two drinks per day for men and one drink per day for women, can reduce your systolic blood pressure by 2 to 4 mm Hg.11

5. Manage Stress to Reduce Blood Pressure

Unmanaged stress stimulates the sympathetic nervous system (“fight or flight”), which releases hormones that narrow blood vessels and increase resistance and, therefore, blood pressure. Stress can have a significant impact on heart health. Unmanaged stress does not directly cause high blood pressure but can increase risk.15

Many people find that some of the following activities can help them manage stress:

  • Meditation
  • Being in nature
  • Exercising
  • Playing with a pet
  • Taking a nap
  • Yoga or Pilates
  • Hobbies

6. Take the Right Medication or Supplements

Lifestyle changes are the first-line treatment for managing blood pressure. Blood pressure medications are frequently needed if lifestyle changes alone don’t reduce blood pressure to a healthy level.

Some potentially heart-healthy supplements that may improve heart health and blood pressure include:

  • Omega-3 fatty acids
  • Magnesium
  • Fiber
  • Folate
  • Coenzyme Q-10
  • Vitamin E

Before taking supplements to improve your heart health or blood pressure, schedule a medical consultation to discuss your best treatment options.

A person taking another person's blood pressure

What Kind of Doctor Manages High Blood Pressure?

Typically, a primary care doctor manages blood pressure. This could be a pediatrician to manage high blood pressure in children, a family medicine or internal medicine doctor for adults, and an obstetrician-gynecologist for pregnant people.

Schedule an online appointment with a TelegraMD doctor to discuss your concerns about your blood pressure and potential risk for heart disease. They will review your medical history and develop an individualized treatment plan incorporating heart-healthy lifestyle recommendations and prescription medications (if needed).

How To Monitor Your Blood Pressure

Blood pressure fluctuates from minute to minute, so it is important to monitor your blood pressure using a wearable device that tracks blood pressure or by taking your blood pressure at home.

When taking your blood pressure:10

  • Avoid caffeine, alcohol, tobacco use, or exercise within 30 minutes of taking your blood pressure.
  • Sit upright with your back against the back of the chair and your feet flat on the floor.
  • Avoid tight-fitting clothing.
  • Wrap the blood pressure cuff around your upper arm, not over clothing.
  • Place your arm on the table with your palm up so the cuff is even with your heart.
  • Push start on the machine and sit quietly until your blood pressure is measured.
  • Recheck your blood pressure on the other arm.

Tracking your blood pressure and making lifestyle changes that are linked to better heart health and lower blood pressure can pay off with a longer, healthier life.

Disclaimer

While we strive to always provide accurate, current, and safe advice in all of our articles and guides, it’s important to stress that they are no substitute for medical advice from a doctor or healthcare provider. You should always consult a practicing professional who can diagnose your specific case. The content we’ve included in this guide is merely meant to be informational and does not constitute medical advice.

References

1. World Health Organization. (2023). Hypertension. Retrieved September 8, 2023, from https://www.who.int/news-room/fact-sheets/detail/hypertension

2. Mills KT, Stefanescu A, He J. The global epidemiology of hypertension. Nat Rev Nephrol. 2020 Apr;16(4):223-237. doi: 10.1038/s41581-019-0244-2. Epub 2020 Feb 5. PMID: 32024986; PMCID: PMC7998524.

3. National Center for Health Statistics. Multiple Cause of Death 2018–2021 on CDC WONDER Database. Accessed September 8, 2023.

4. Tsao, C. W., Aday, A. W., Almarzooq, Z. I., Anderson, C. A. M., Arora, P., Avery, C. L., Baker-Smith, C. M., Beaton, A. Z., Boehme, A. K., Buxton, A. E., Commodore-Mensah, Y., Elkind, M. S. V., Evenson, K. R., Eze-Nliam, C., Fugar, S., Generoso, G., Heard, D. G., Hiremath, S., Ho, J. E., … on behalf of the American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. (2023). Heart disease and stroke statistics—2023 update: A report from the American Heart Association. Circulation, 147(8). https://doi.org/10.1161/cir.0000000000001123

5. Hagberg JM, Park JJ, Brown MD. The role of exercise training in the treatment of hypertension: an update. Sports Med. Sep 2000;30(3):193-206. doi:10.2165/00007256-200030030-00004

6. American College of Sports Medicine. Trending Topic | Physical Activity Guidelines. Accessed September 8, 2023. https://www.acsm.org/education-resources/trending-topics-resources/physical-activity-guidelines

7. U.S. Department of Health and Human Services. 2008 Physical Activity Guidelines for Americans. Accessed September 8, 2023. https://health.gov/sites/default/files/2019-09/paguide.pdf

8. Ge L, Sadeghirad B, Ball G D C, da Costa B R, Hitchcock C L, Svendrovski A et al. Comparison of dietary macronutrient patterns of 14 popular named dietary programmes for weight and cardiovascular risk factor reduction in adults: systematic review and network meta-analysis of randomised trials BMJ 2020; 369 :m696 doi:10.1136/bmj.m696

9. Leggio, M., Lombardi, M., Caldarone, E. et al. The relationship between obesity and hypertension: an updated comprehensive overview on vicious twins. Hypertens Res 40, 947–963 (2017). https://doi.org/10.1038/hr.2017.75

10. Whelton, P.K., Carey, R.M., Aronow, W.S., Casey, D.E. Jr., Collins, K.J., Dennison Himmelfarb, C., DePalma, S. M., Gidding, S., Jamerson, K. A., Jones, D. W., MacLaughlin, E. J., Muntner,  P., Ovbiagele,  B., Smith, S. C. Jr., Spencer,  C. C., Stafford, R. S., Taler,  S. J., Thomas, R. J., Williams, K.A. Sr., Williamson, J.D., & Wright,  J.T. Jr.(2018).  2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol.;71(19): e127-e248. DOI: 10.1016/j.jacc.2017.11.006. Epub 2017 Nov 13. Erratum in: J Am Coll Cardiol.;71(19):2275-2279. PMID: 29146535.

11. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. (2004). National High Blood Pressure Education Program. Bethesda, MD: National Heart, Lung, and Blood Institute (U.S.); Report No. 04–5230.

12. Staruschenko, A. (2018). Beneficial Effects of High Potassium. Hypertension. 71, 1015-1022. https://doi.org/10.1161/HYPERTENSIONAHA.118.10267

13. Puig-Cotado F, Tursan d’Espaignet E, St Claire S, Bianco E, Bhatti L, Schotte K et al. Tobacco and coronary heart disease: WHO tobacco knowledge summaries. Geneva: World Health Organization; 2020. Licence: CC BY-NC-SA 3.0 IGO.

14. Puddey IB, Beilin LJ. Alcohol is bad for blood pressure. Clin Exp Pharmacol Physiol. 2006 Sep;33(9):847-52. doi: 10.1111/j.1440-1681.2006.04452.x. PMID: 16922819.

15. Kulkarni, S., O’Farrell, I., Erasi, M., & Kochar, M.S. (1998). Stress and hypertension. WMJ.; 97 (11):34-8. PMID: 9894438.

Words surrounding heart disease and a heart model

Early Signs of Heart Disease

Written by Leann Poston, MD. on . Posted in Heart disease. Leave a Comment

Early signs of heart disease can vary from person to person. However, it is important to recognize them as quickly as possible to receive early intervention and treatment. Some symptoms, such as chest pain, pain radiating down your arm, and chest pressure, are more easily recognized as heart disease. Other symptoms, such as digestive symptoms, fatigue, and difficulty sleeping, are more difficult to recognize as being associated with heart disease.

If you are currently experiencing symptoms that are associated with heart disease or think you may be having a heart attack, seek emergency care. It is critical to receive treatment as early as possible.

Understanding Heart Disease

According to data from the Centers for Disease Control and Prevention, heart disease is the leading cause of death in the U.S. for men and women and for people of most racial and ethnic groups. About one in every five deaths in 2021 was attributed to heart disease.

The World Health Organization reports that cardiovascular disease is the leading cause of death worldwide. Approximately 17.9 million people die from cardiovascular disease each year.

Heart disease encompasses arrhythmias, heart failure, valve disease, congenital heart disease, and coronary artery disease.

The heart is a four-chambered pump that delivers oxygen and nutrients to the body. Blood is collected and pumped throughout the body by the two upper chambers (atria) and the two lower chambers (ventricles). The left side of the heart pumps oxygenated blood to the body, while the right side pumps deoxygenated blood to the lungs for oxygenation.

When the heart’s muscular pump weakens or loses efficiency, it can cause heart failure. Heart failure is most often caused by cardiomyopathy, which is an abnormality in the heart muscle. Dilated cardiomyopathy, the most common form, occurs when the left ventricular muscle becomes stretched and thins, reducing its ability to pump blood.

Heart attacks, coronary artery disease, hypertension, congenital heart disease, valvular disorders, and endocarditis are all potential causes of heart failure.

If the heart cannot adequately pump blood, excess fluid accumulates in the lungs, abdomen, and lower extremities.

The sino-atrial (SA) node comprises specialized cells in the right atrium. The SA node sets a rhythmic pace for heart contraction. The heart rate varies based on demand. From the SA node, the electrical impulse travels to the AV node at the junction of the right atrium and ventricle. The impulse is slightly delayed at the AV node, allowing time for the atria to contract and the ventricles to fill with blood. Ventricular contraction follows this.

Abnormalities in the heart’s rhythm are called arrhythmias. Tachycardia is a condition in which the heart beats too quickly. Bradycardia occurs when the heart rate is too slow. An arrhythmia can cause some people to feel a racing, pounding, or irregular heartbeat in their chest. Sudden cardiac arrest is due to an electrical problem in the heart.

Blood vessels carrying oxygenated blood supply heart muscle with oxygen and nutrients. When cholesterol and fat (plaque) build up in the inner wall of these coronary blood vessels, the lumen of these vessels narrows, decreasing blood flow to the heart muscle. If a blood clot forms in the narrowed vessel, it can cause a heart attack.

Risk factors for coronary heart disease, such as smoking, high blood pressure, high cholesterol, and diabetes, can increase your risk of coronary heart disease and heart attack.

A graphic of a clogged heart blood vessel.

Warning Signs of Heart Disease

Many people envision a heart attack as crushing chest pain with shortness of breath, weakness, sweating, and pain in the left arm, shoulder, or jaw. While these are classic symptoms of heart disease, they are not found in all people having a heart attack, especially women. Women often develop symptoms of heart disease later in the disease process, 7 to 10 years later in life, and their symptoms are more non-specific.1

In fact, about one in every five heart attacks is silent. This means that heart muscle damage occurs without you even being aware.

Early signs of heart disease in men:

  • chest pain or discomfort
  • lightheadedness 
  • dizziness
  • palpitations
  • fatigue
  • shortness of breath
  • fainting

Early signs of heart disease in women:

  • pain in the arm, neck, shoulder, jaw, or back
  • nausea or vomiting
  • indigestion
  • shortness of breath 
  • fatigue
  • breaking out in a cold sweat
  • sleep disturbances
  • lightheadedness

Chest Pain

Chest pain or discomfort is a common symptom of heart disease for both men and women. The pain location may vary. Many people describe the pain as a sense of discomfort, pressure, fullness, or a squeezing pain.

Chest pain is found in many medical conditions, but it should always be taken seriously because the quicker you seek medical care for heart disease, the more quickly blood flow can be restored to your heart muscle, and the less heart muscle you may lose.

Shortness of Breath

Shortness of breath can indicate insufficient blood is pumped into the lungs to be oxygenated and then distributed to the body cells. Excess fluid can collect in the lungs when the heart does not pump effectively. This makes it difficult for oxygen to diffuse from the inhaled air into capillaries in the lungs.

Shortness of breath when doing moderate exertion, such as climbing a flight of stairs that did not cause symptoms before, can be an early sign of heart disease. New onset shortness of breath or shortness of breath when lying down should also be evaluated.

Fatigue and Weakness

When your heart is not working efficiently, body cells may not get the optimal levels of nutrients and oxygen. This can cause fatigue and weakness.

Heart Palpitations

Heart palpitations are the sensation of having a fast beating, fluttering, or pounding heartbeat. You may experience a flip-flopping sensation. Palpitations can be normal and harmless or caused by temporary triggers such as caffeine, stimulants, or environmental stressors. They may also be an indicator of heart disease.

Dizziness

Decreased blood flow to the brain can cause dizziness and lightheadedness. Many forms of heart disease, including heart attacks and palpitations, can decrease the heart’s ability to pump blood.

When your heart is beating too slow, it can decrease blood flow to the brain, but it can also occur when the heart is beating too fast. Excessively fast heartbeats can mean the heart does not have enough time to fill before it is pumped from the heart.

Edema

When the heart does not pump effectively, fluid collects in the abdomen, lungs, and lower extremities. This is called edema. More fluid leaves the blood vessels and enters the body tissue, collecting in the feet and ankles.

A personal medical history form

Common Risk Factors for Heart Disease

For most medical conditions, both modifiable and unmodifiable risk factors contribute.

Non-modifiable Risk Factors

Non-modifiable risk factors for heart disease include:

  • Older age
  • Sex: Men have a higher risk of heart disease earlier in life
  • Heredity: A family history of heart disease can increase your risk for heart disease

Family history and genetic factors are important to recognize because even though you cannot change them, it is important to know your history to evaluate your heart disease risk.

Some risk factors for heart disease are secondary to lifestyle choices. Modifying these risk factors can reduce your risk for heart disease and improve your overall health.

High Blood Pressure

Blood pressure is the force blood places on the inner walls of blood vessels. Systolic blood pressure is the upper number in blood pressure. It is measured when the heart is contracting. Diastolic blood pressure is the lower number and is measured when the heart relaxes.

Systolic blood pressure increases more steeply in postmenopausal women than in men. This may be related to a decline in estrogen levels post-menopause. Isolated systolic high blood pressure is more common in women over the age of 75. It is an important risk factor for heart failure and strokes.

Moderate to high blood pressure is associated with more risk for blood vessel dysfunction and cardiovascular disease in women than in men.1

High Cholesterol Levels

High levels of low-density lipoproteins (LDL) cholesterol can increase the build-up of cholesterol and fats in the inner lining of blood vessels. This narrows the lumen of arteries and increases the risk that a blood clot may form in the blood vessel and increases the risk of a heart attack or stroke.

Increased cholesterol in blood vessel walls can decrease their flexibility, which increases the risk of high blood pressure.

Low levels of high-density lipoproteins (HDL) cholesterol or “good” cholesterol can reduce your body’s ability to remove LDL cholesterol from blood vessel walls.

Smoking

Under age 50, smoking is a greater risk factor for heart disease in women than men. The risk increases proportionately to the number of cigarettes smoked each day. Smoking increases the risk of a first heart attack more in women than men. Whether smoking remains a higher risk factor for women over men after age 50 is unclear.1

Obesity and Lack of Physical Activity.

Obesity is a risk factor for heart disease and a risk factor for metabolic syndrome, diabetes mellitus, high blood pressure, and high cholesterol, which are also risk factors for heart disease.

Central obesity, organ fat in the abdomen, increases risk and is more common in men and postmenopausal women.1

Unhealthy Diet

An unhealthy diet high in sodium, processed foods, refined carbohydrates, and saturated fats can increase your heart and blood vessel disease risk. Excessive alcohol consumption is also linked to an increased risk of heart disease.

Diagnostic Tests for Heart Disease

Depending on your symptoms and risk factors, your doctor may suggest that you have diagnostic tests to evaluate your heart function and structure.

Electrocardiogram (ECG)

An electrocardiogram is a device that records the electrical activity in your heart. An ECG (also called EKG) is a quick test that can be conducted in your doctor’s office. It is used to diagnose arrhythmias or irregularities in heart rhythm.

Echocardiogram (ECHO)

An echocardiogram is a diagnostic imaging technique that utilizes sound waves to examine the heart’s structure. It can also measure blood flow through the chambers. An ECHO is used in diagnosing heart valve abnormalities, defects in the heart muscle wall between chambers, and cardiomyopathy.

Blood Test

Blood tests can measure heart biomarkers, indicating damage to heart muscle cells. Blood tests may also be used to assess your risk of heart disease. Commonly ordered screening tests include blood glucose and lipid panels, which may include cholesterol levels and lipoproteins.

Magnetic resonance imaging (MRI)

A magnetic resonance imaging machine is used to construct an image of the heart and the surrounding structures. These detailed scans can be used to diagnose various structural heart diseases.

Exercise Stress Test

An exercise stress test uses exercise on a treadmill or medications that increase heartbeat and make the heart work harder to evaluate its ability to respond to increased exercise or stress. It is used to evaluate coronary artery disease.

Coronary Angiography

A coronary angiography or a cardiac catheterization is a test to evaluate blood flow through blood vessels in your heart. A thin tube is threaded through a blood vessel and into the heart. Once in the heart, it can measure pressures in the blood vessels and heart chambers, detect narrowed or blocked blood vessels in the heart, and check the function of heart valves.

A doctor explaining heart disease to a patient

When to Seek Medical Evaluation

Heart disease is preventable. Schedule a medical evaluation if you have risk factors for heart disease. Your doctor will discuss your modifiable and unmodifiable risk factors and run tests to assess the current condition of your heart and blood vessels. Your doctor can help you learn your important heart disease risk numbers, including blood pressure, blood cholesterol, resting heart rate, and body fat percentage.

If you have a family history of heart disease, schedule an online appointment with a TelegraMD doctor on call to discuss your risk factors, receive an online diagnosis, and develop an individualized plan to reduce your risk. If appropriate, your TelegraMD doctor can transmit an online prescription to your local pharmacy for pickup or delivery.

Many people find they can avoid costly doctor visits through telehealth, especially if they do not have insurance and want to discuss their symptoms with a healthcare professional.

TelegraMD doctors are available 24 hours a day, so you can access help when you need it, but they are not an appropriate source of healthcare if you are currently experiencing symptoms you attribute to a potential heart attack.

Disclaimer

While we strive to always provide accurate, current, and safe advice in all of our articles and guides, it’s important to stress that they are no substitute for medical advice from a doctor or healthcare provider. You should always consult a practicing professional who can diagnose your specific case. The content we’ve included in this guide is merely meant to be informational and does not constitute medical advice.

References

1. Maas AH, Appelman YE. Gender differences in coronary heart disease. Neth Heart J. 2010 Dec;18(12):598-602. doi: 10.1007/s12471-010-0841-y. PMID: 21301622; PMCID: PMC3018605.

A close-up of a person with pink eye

How To Treat Pink Eye at Home

Written by Leann Poston, MD. on . Posted in Allergies. Leave a Comment

Pink eye is a common eye infection. It is important to quickly recognize it and take action to treat it. Having pinkeye is uncomfortable and may force you to take a day off work or school while seeking treatment.

Pink eye is a common infection, especially in young children, because it is so contagious. It affects about 6 million people in the United States each year.1

What is Pink Eye?

Pinkeye, a subtype of conjunctivitis, is an infection or inflammation of the conjunctiva, which is the clear membrane covering the surface of the sclera (white part of the eye) and inner eyelids.

Identifying the Type of Pink Eye

Viruses, bacteria, and allergens are common causes of conjunctivitis, as are exposures to chemicals. 

Viral: Viral conjunctivitis typically starts in one eye and quickly spreads to the other. It is the most common cause of pink eye.2 Eye discharge is usually clear to yellow-tinged and watery. Viral infections are contagious and are transmitted to others through respiratory droplets or by touching contaminated objects or surfaces.

Bacterial: Bacterial conjunctivitis typically has a more yellow-to-green discharge that adheres to eyelashes. Bacterial conjunctivitis and ear infections may occur together.

Allergic: Allergic conjunctivitis is characterized by itching, tearing, and swelling. It may co-occur with other allergy symptoms, such as a runny nose and congestion.

Pink eye is easy to recognize. However, it is more difficult to determine the cause. Viruses, bacteria, and fungi are infectious causes of pink eye but require different treatments. Allergic pinkeye is not contagious and is treated symptomatically. To accurately diagnose your pink eye, contact one of the medical professionals at TelegraMD for a professional online diagnosis.

How Do You Know If You Have Pink Eye?

Common signs and symptoms associated with pink eye include:

  • Redness
  • Itchiness
  • Tearing
  • Discharge
  • Burning
  • The sensation of a foreign body in the eye
  • Swelling of the eye and inner eyelid
  • Crusting on the eyelashes
  • Gritty sensation
Close-up of a pink eye

Home Remedies for Pink Eye

Reduce the symptoms of pink eye by using these home remedies. Viral and allergic pink eye are treated with symptomatic care. Bacterial causes of pink eye may require an antibiotic eye ointment or drop. If your symptoms persist or you have pain, fever, light sensitivity, systemic symptoms, or vision changes, call a doctor for treatment advice.

Applying a warm compress

Warm compresses can soothe an inflamed eye and may speed healing by increasing blood flow to your eye. Use a warm compress to gently wipe away any discharge. Do not use the same compress on the other eye or share compresses with another person.

If your conjunctivitis is allergic, use a cool compress instead of a warm one. It will help decrease swelling and itchiness.

Using over-the-counter eye drops

Over-the-counter lubricating drops or artificial tears can reduce irritation, remove allergens, and cleanse your irritated eye.

Avoiding Contact Lenses

About 45 million people in the U.S. wear contact lenses, putting them at increased risk for pink eye.3 About one in every five hundred contact lens wearers develops a serious eye infection that could lead to blindness.4

Wearing your contact lenses when you have an eye infection increases the risk of a more serious infection, increases the risk of complications, and increases the risk of reinfection.

A close-up of a person putting a contact lens in their eye

Cleaning Contacts 

Contact lenses can become contaminated with microorganisms, especially if improperly cleaned, and protein builds up on their surface.

When wearing contact lenses, take these steps to reduce your risk for pink eye:

  • Wash your hands before putting contacts in your eyes or removing them.
  • Keep your contact case clean and dry between uses.
  • Add fresh disinfecting solution to your case before storing your contacts overnight.
  • Do not top off your disinfecting solution in your contact cases.
  • Add fresh solution each day.
  • Replace your storage case every three to six months.

Taking Antihistamines or Decongestants 

Antihistamines can reduce itchiness and drainage if your conjunctivitis is allergic. Antihistamines and decongestants can also relieve other cold symptoms if you have a viral infection.

Getting Rest and Fluids

If you have a viral or bacterial infection causing your pinkeye, get plenty of rest and drink fluids. Support your immune system as it fights the infection.

Keep the Infected Area Clean and Dry

Use cool or warm compresses to wipe away any drainage. Keep your eye dry to reduce irritation to the skin around your eye.

Understanding Transmission

Viral and bacterial causes of pink eye can be transmitted from person to person by coughing or sneezing. Pink eye can also be spread by touching a surface that a person with contaminated fingers has previously touched.

You can also get pink eye from bacteria and viruses in your nose and sinuses or contaminated contact lenses.

Preventing Pink Eye Spread

To reduce the spread of pinkeye:

  • Avoid touching or rubbing your eyes.
  • Wash your hands frequently.
  • Avoid sharing personal items like towels and eye makeup.
  • Stay out of shared swimming pools.
  • Disinfect high-touch surfaces.
  • Cover all coughs and sneezes.
  • Avoid crowded spaces when you have an infection.
  • Use a fresh towel and pillowcase daily.
  • Use a clean towel or tissue every time you wipe your eyes.
  • Wash your pillowcases, sheets, towels, and washcloths frequently to prevent reinfection.
A person writing on a clipboard

When To Seek Professional Care

If you have redness, itching, or early symptoms of conjunctivitis, contact an on-call doctor through the TelegraMD platform to receive 24-hour care. If appropriate, after making an online diagnosis, your telemedicine doctor can prescribe an online prescription to treat your conjunctivitis symptoms. Telehealth can be a great cost-effective alternative for treating your non-emergency medical concerns.

If you have any of the following symptoms or signs, contact an eye specialist or ophthalmologist for evaluation and treatment:

  • Vision loss or vision changes
  • Moderate or severe eye pain
  • Changes in the surface of your cornea, a part of the eye that covers your iris and pupil
  • Conjunctival scarring
  • No response to treatment within a week
  • A history or concern about herpes simplex or varicella-zoster conjunctivitis
  • Sensitivity to light

Disclaimer

While we strive to always provide accurate, current, and safe advice in all of our articles and guides, it’s important to stress that they are no substitute for medical advice from a doctor or healthcare provider. You should always consult a practicing professional who can diagnose your specific case. The content we’ve included in this guide is merely meant to be informational and does not constitute medical advice. 

References

  1. Udeh BL, Schneider JE, Ohsfeldt RL. Cost effectiveness of a point-of-care test for adenoviral conjunctivitis. Am J Med Sci. Sep 2008;336(3):254-64. doi:10.1097/MAJ.0b013e3181637417
  2. Azari AA, Barney NP. Conjunctivitis: A Systematic Review of Diagnosis and Treatment. JAMA. 2013;310(16):1721-1730. doi:10.1001/jama.2013.280318
  3. Cope JR, Collier SA, Nethercut H, Jones JM, Yates K, Yoder JS. Risk Behaviors for contact lens–related eye infections among adults and adolescents — United States, 2016. MMWR Morb Mortal Wkly Rep. 2017;66(32):841-5.
  4. Dart JK, Radford CF, Minassian D, Verma S, Stapleton F. Risk factors for microbial keratitis with contemporary contact lenses: a case-control study. Ophthalmology. 2008 Oct;115(10):1647-54, 1654.e1-3. doi: 10.1016/j.ophtha.2008.05.003. Epub 2008 Jul 2. PMID: 18597850.
A man refusing a bottle of beer

How Does Alcohol Affect the Heart?

Written by Leann Poston, MD. on . Posted in Heart disease. Leave a Comment

Teasing out the relationship between alcohol consumption and healthy heart function is challenging. The relationship between alcohol consumption and heart disease, especially heart attacks, is controversial and highly debated, which has led to hundreds of scientific studies attempting to better understand whether alcohol is bad for your heart.1  

Small amounts of alcohol, especially red wine, are said to be beneficial because they are high in antioxidants like resveratrol. Consuming moderate to large amounts of alcohol can increase your heart rate, blood pressure, and risk of an irregular heartbeat.

Heart disease risk is higher in women for the same amount of alcohol consumed, likely due to body fat distribution, body size, and alcohol solubility.1 However, research suggests that women who consume one to two standard alcoholic drinks daily have a lower risk of cardiovascular disease. Any more than that increases the risk.2,3

Another global study states that no level of alcohol consumption improves health. The small reductions in heart attack risk associated with low levels of alcohol consumption are offset by an increased risk of other health conditions, including cancer.4

Types of Alcohol and How They Affect Heart Health

The research is pretty clear that consuming more than a moderate amount of alcohol per day, especially in the long term, will increase your risk of heart disease. According to the Centers for Disease Control and Prevention, moderate drinking is defined as one standard drink or none in a day for women and two drinks or fewer per day for men.

A standard drink contains 14 grams (0.6 fluid ounces) of alcohol.

Beer

A standard drink of regular beer is defined as 12 ounces and is usually about 5% alcohol by volume.

Wine

Red wine contains the antioxidant resveratrol, which is associated with a reduction in cholesterol and blood pressure.5 A standard glass of wine is defined as 5 ounces and is typically 12% alcohol by volume.

Spirits

A standard glass of malt liquor is 8 ounces, typically 7% alcohol by volume. A standard shot of distilled spirits is about 1.5 ounces and is typically about 40% alcohol by volume.

Researchers report that a J-shaped risk relationship between alcohol consumption and heart disease is found in all people. Lifetime alcohol abstainers are at increased risk for heart disease, as are people who consume alcohol at a moderate or higher level. The type of alcoholic beverage consumed does not seem to affect heart disease risk.1

Bar with alcohol

Effects of Alcohol on Heart Health

It is important to remember that it is difficult to isolate alcohol consumption alone as a risk factor for heart disease, as other lifestyle factors will also affect risk.

High Blood Pressure (Hypertension)

Blood pressure is the amount of pressure blood puts on the inner wall of blood vessels. Systolic blood pressure (top number) is measured when the heart contracts, and diastolic blood pressure (bottom number) is measured when the heart relaxes.

High blood pressure causes cardiovascular disease by putting unnecessary pressure on the inner walls of blood vessels, leading to damage. Damage to blood vessels can cause a stroke, a heart attack, or an aneurysm, which is an abnormal bulge in the weakened wall of a blood vessel.

Research indicates the relationship between alcohol consumption and blood pressure is causal and reversible. A reduction in alcohol consumption leads to a reduction in blood pressure.6

For every 10 grams of alcohol consumed, blood pressure increases by about 1 mm Hg. After 2 to 4 weeks of abstinence, the effect of alcohol on blood pressure declines to baseline. The relationship between alcohol consumption and blood pressure is the same regardless of the type of alcohol consumed.7

In an analysis of studies that enrolled over 350,000 people from 20 scientific studies, over 90,000 participants had high blood pressure. High blood pressure risk was higher in people who consumed alcohol than in people who did not. The risk for former drinkers declined and was equal to that of people who did not consume alcohol.8

Stroke

Alcohol consumption affects many known risk factors for stroke. Moderate alcohol consumption is associated with an increase in high-density lipoprotein (good cholesterol), improved insulin sensitivity, and decreased levels of inflammatory markers.9 This suggests that low-to-moderate levels of alcohol consumption may reduce stroke risk.

Researchers analyzed 27 medical studies to determine the association between alcohol consumption and three types of strokes:

  • Ischemic stroke: A blood clot cuts off blood flow to a section of brain tissue.
  • Intracranial hemorrhagic stroke: A weakened blood vessel wall leaks blood into the brain tissue.
  • Subarachnoid hemorrhagic stroke: A weakened blood vessel leaks blood onto the brain’s surface.

Researchers found that light and moderate alcohol consumption (2 drinks or fewer) was associated with a reduced risk of ischemic stroke but not a reduced risk of intracranial or subarachnoid hemorrhagic stroke. Heavy alcohol consumption was associated with an increased risk of all stroke types.9

Arrhythmia

Palpitations are the sensation that your heart is flip-flopping or skipping a beat. In some cases, this sensation is due to an abnormality in the heart’s rhythm called an arrhythmia.

Alcohol causes an imbalance in the autonomic nervous system. It increases your body’s “fight-or-flight” response. This is followed by activation of the parasympathetic nervous system to calm things down and restore homeostasis. Activating the parasympathetic nervous system may trigger arrhythmias, such as atrial fibrillation.

High levels of alcohol consumption are associated with abnormal heart rhythms, commonly called holiday heart syndrome.10

Both short-term and long-term alcohol consumption can increase the risk of arrhythmias.11 In one study, researchers demonstrated a causal relationship between acute alcohol intake and atrial fibrillation in patients with the condition.12

Heart failure

Ischemic heart disease, high blood pressure, and cardiomyopathy (changes in heart function due to excessive or weak heart muscle) increase the risk of heart failure. Chronic heavy drinking can weaken heart muscle, leading to a condition called alcoholic cardiomyopathy.

In an analysis of studies that enrolled over 350,000 participants, researchers found that light drinking was associated with a decreased risk of heart failure, but there was an increased risk as alcohol consumption increased above a low level. Heavy drinkers have a substantially increased risk of heart failure.1,13 Former drinkers were also found to have an increased risk of heart failure when compared to lifetime abstainers.13

Cholesterol levels

Light to moderate alcohol consumption is associated with an increase in high-density lipoproteins (HDL, good cholesterol), but heavy drinking can increase low-density lipoproteins (LDL, bad cholesterol), total cholesterol, and triglycerides.

LDL cholesterol is deposited in the inner lining of blood vessels, forming plaques. Cholesterol plaques decrease blood flow to the heart, which can increase the risk of heart attacks.13

A doctor showing a heart model

Proactively Managing Heart Health

It is important to note that the effects of alcohol on heart health are not the same for all people. Besides monitoring your alcohol consumption, make lifestyle adjustments associated with cardiovascular and heart health improvements.

Eating a balanced diet

For optimal heart health, consume a diet rich in fruits, vegetables, whole grains, lean protein sources, and low-fat dairy products. Diets similar to the Mediterranean diet are associated with a reduced risk for cardiovascular disease. Limit added sugars, highly processed foods, sugary beverages, sodium, saturated fats, refined carbohydrates, and processed meats.

Exercising regularly

Overweight and obesity are associated with an increased risk of heart disease. Exercise can reduce stress and blood pressure and strengthen heart and respiratory muscles.

  • Engage in regular aerobic exercise, such as brisk walking, jogging, swimming, or cycling. Aim for at least 150 minutes of moderate-intensity exercise per week.
  • Incorporate strength-training exercises to improve muscle tone and metabolism at least twice per week.
  • Incorporate movement throughout your day. Long stretches of sitting increase your risk for cardiovascular disease.

Limiting sodium intake

Excessive sodium intake can increase your risk of high blood pressure. Increased blood pressure is a major risk factor for heart disease and stroke. Try to limit your sodium intake to no more than 2,300 milligrams per day. Restaurant and processed foods are typically very high in sodium.

Maintaining healthy cholesterol levels

Choosing a healthy diet, exercising regularly, monitoring alcohol consumption, and maintaining a healthy weight can help maintain healthy cholesterol levels.

Current guidelines for cholesterol suggest the following healthy cholesterol levels:

  • Total cholesterol: ideal is about 150 mg/dL, upper limit is 200 mg/dL
  • LDL cholesterol: optimal 100 mg/dL, high above 160 mg/dL
  • HDL cholesterol: 40 mg/dL (1 mmol/L) or higher in men and 50 mg/dL (1.3 mmol/L) or higher in women

Avoiding unhealthy behaviors (smoking, excessive drinking)

If you are concerned about your alcohol consumption or have other risk factors for heart disease, such as being a smoker or carrying excess weight, contact a doctor on call on the TelegraMD platform to discuss smoking cessation or obesity treatment options.

Telehealth doctors are available 24 hours a day to provide an online diagnosis and individualized guidance on how to improve your heart health and reduce any risk factors you may have for heart disease.

If you have been diagnosed with high cholesterol or high blood pressure, TelegraMD doctors can review your medical history and write online prescriptions that are transmitted to your local pharmacy. You may find that telehealth is a better alternative to costly in-person doctor visits.

Disclaimer

While we strive to always provide accurate, current, and safe advice in all of our articles and guides, it’s important to stress that they are no substitute for medical advice from a doctor or healthcare provider. You should always consult a practicing professional who can diagnose your specific case. The content we’ve included in this guide is merely meant to be informational and does not constitute medical advice.

References

1. Roerecke M. Alcohol’s Impact on the Cardiovascular System. Nutrients. 2021 Sep 28;13(10):3419. doi: 10.3390/nu13103419. PMID: 34684419; PMCID: PMC8540436.

2. Piano MR, Thur LA, Hwang CL, Phillips SA. Effects of Alcohol on the Cardiovascular System in Women. Alcohol Res. 2020 Jul 30;40(2):12. doi: 10.35946/arcr.v40.2.12. PMID: 32766021; PMCID: PMC7398617.

3. Kwo PY, Ramchandani VA, O’Connor S, Amann D, Carr LG, Sandrasegaran K, Kopecky KK, Li TK. Gender differences in alcohol metabolism: relationship to liver volume and effect of adjusting for body mass. Gastroenterology. 1998 Dec;115(6):1552-7. doi: 10.1016/s0016-5085(98)70035-6. PMID: 9834284.

4. Burton R, Sheron N. No level of alcohol consumption improves health. The Lancet. 2018;392(10152):987-988. doi:10.1016/S0140-6736(18)31571-X

5. Theodotou M, Fokianos K, Mouzouridou A, et al. The effect of resveratrol on hypertension: A clinical trial. Exp Ther Med. 2017;13(1):295-301. doi:10.3892/etm.2016.3958

6.  Roerecke M., Kaczorowski J., Tobe S.W., Gmel G., Hasan O.S.M., Rehm J. The effect of a reduction in Alcohol. consumption on blood pressure: A systematic review and meta-analysis. Lancet Public Health. 2017;2:e108–e120. doi: 10.1016/S2468-2667(17)30003-8.

7. Puddey IB, Beilin LJ. Alcohol is bad for blood pressure. Clin Exp Pharmacol Physiol. 2006 Sep;33(9):847-52. doi: 10.1111/j.1440-1681.2006.04452.x. PMID: 16922819.

8. Roerecke M., Tobe S.W., Kaczorowski J., Bacon S.L., Vafaei A., Hasan O.S.M., Krishnan R.J., Raifu A.O., Rehm J. Sex-Specific Associations Between Alcohol. Consumption and Incidence of Hypertension: A Systematic Review and Meta-Analysis of Cohort Studies. J. Am. Heart Assoc. 2018;7 doi: 10.1161/JAHA.117.008202. 

9. Larsson, S. C., Wallin, A., Wolk, A., & Markus, H. S.. (2016). Differing association of alcohol consumption with different stroke types: a systematic review and meta-analysis. BMC Medicine, 14(1). https://doi.org/10.1186/s12916-016-0721-4

10. Samokhvalov AV, Irving HM, Rehm J. Alcohol consumption as a risk factor for atrial fibrillation: a systematic review and meta-analysis. Eur J Cardiovasc Prev Rehabil. 2010 Dec;17(6):706-12. doi: 10.1097/HJR.0b013e32833a1947. PMID: 21461366; PMCID: PMC3065072.

11. Larsson SC, Drca N, Wolk A. Alcohol consumption and risk of atrial fibrillation: a prospective study and dose-response meta-analysis. J Am Coll Cardiol. 2014 Jul 22;64(3):281-9. doi: 10.1016/j.jacc.2014.03.048. PMID: 25034065.

12. Marcus GM, Vittinghoff E, Whitman IR, Joyce S, Yang V, Nah G, Gerstenfeld EP, Moss JD, Lee RJ, Lee BK, Tseng ZH, Vedantham V, Olgin JE, Scheinman MM, Hsia H, Gladstone R, Fan S, Lee E, Fang C, Ogomori K, Fatch R, Hahn JA. Acute Consumption of Alcohol and Discrete Atrial Fibrillation Events. Ann Intern Med. 2021 Nov;174(11):1503-1509

13. Larsson SC, Wallin A, Wolk A. Alcohol consumption and risk of heart failure: Meta-analysis of 13 prospective studies. Clin Nutr. 2018 Aug;37(4):1247-1251. doi: 10.1016/j.clnu.2017.05.007. Epub 2017 May 19. PMID: 28554815.

A woman with pollen allergies, sneezing

Tree, Grass, and Other Pollen Allergy Symptoms and Treatments

Written by Leann Poston, MD. on . Posted in Allergies. Leave a Comment

Pollen allergies are common during times of year when grasses, weeds, flowers, and trees release pollen to reproduce. When your immune system mistakenly identifies pollen as a threat, it causes a range of symptoms, including a runny nose, a sore throat, itchy and watery eyes, and a dry cough. Many treatment options are available for pollen allergies. It is important to know your options and the seasonal pattern of your symptoms so you can minimize their impact on your daily life.

What are Pollen Allergies?

Pollen is released into the air when trees, grasses, weeds, and other plants reproduce. As pollen grains are released and carried in the wind, they come in contact with your eyes and nose and can be breathed into your lungs.

If you are sensitive to pollen, your immune system will overreact to it, mistaking it as a threat and increasing the production of immune cells, such as immunoglobulin E-producing white blood cells and mast cells, and chemicals, such as histamine and leukotrienes.

There is seasonal variation in pollen production. By knowing when pollen levels are high and correlating this to your symptoms, you can get an idea of what you are allergic to. However, many people have cross-reactivity, with symptoms extending across seasons and cross-reactivity between pollen and food. Thirty to 60% of food allergies are associated with pollen allergy.1

Tree pollen is most common in the spring, peaking in April. Grass pollen peaks in the spring and summer, and weed pollen is most common in the late summer and fall. The timing varies by geography, and symptoms can vary by person.

A woman with allergy symptoms

Pollen Allergy Symptoms

Common pollen allergy symptoms include:

  • Sneezing
  • Runny nose
  • Nasal congestion
  • Itchy eyes
  • Watery eyes
  • Itchy throat
  • Itchy ears
  • Coughing
  • Fatigue
  • Postnasal drip
  • Wheezing
  • Shortness of breath
Prick test for allergies

Diagnosing Pollen Allergies

Your doctor may recommend allergy testing to determine which environmental allergens you are most sensitive to.

Common allergy testing methods include:2,3,4

  • Skin prick tests: Skin prick tests involve pricking the skin and applying a small amount of the allergen to the nick. A red bump can indicate an allergic reaction.  
  • Intradermal skin tests: An allergen is injected beneath the skin’s surface, and the areas are monitored for allergic reactions. Intradermal tests are more sensitive and are used when the results of a prick test are inconclusive.
  • Blood tests: Enzyme-linked immunosorbent assay (ELISA) or radioallergosorbent test (RAST) measures the levels of immunoglobulin E (IgE). Increased IgE antibodies directed against a specific antigen can indicate an allergic reaction.
  • Patch tests: Allergens are applied to an adhesive patch and left in place for 48 to 96 hours. The patch is removed, and the area is checked for signs of an allergic reaction. Patch tests identify allergens that cause contact dermatitis, a delayed allergic reaction.
  • Provocation tests: This is a carefully controlled test conducted in an allergist’s office. It entails ingesting a small amount of an allergen and watching for any allergic responses.

Pollen Allergy Management

To reduce your exposure to pollen, consider making the following environmental changes, especially during seasons when your pollen allergies are at their worst.

  • Minimize time outdoors, especially on windy days.
  • Keep home and car windows closed.
  • Use an air purifier indoors.
  • Shower and change clothes after being outdoors to reduce the amount of pollen carried into your home.
  • Sweep with a vacuum with a HEPA filter and dust regularly to reduce pollen in the home.
  • Wear sunglasses and hats when outdoors to reduce pollen exposure.
  • Track pollen reports and avoid high pollen days.
  • Wear a mask outdoors when pollen counts are high.
  • Avoid hanging laundry outside to dry.
  • Start taking allergy medication two to three weeks before allergy symptoms are expected to start.
  • Limit close contact with outdoor pets.
A person using a nasal spray

Pollen Allergy Medicine

Over-the-counter allergy medications treat runny nose, congestion, itchy eyes, watery eyes, itchy throat, fatigue, and skin rashes. Both single-ingredient and combination products are available. Finding an allergy medicine that effectively treats your symptoms with minimal side effects is important.

Antihistamines

Antihistamines block histamine, a chemical that is stored in mast cells, is released when you encounter an allergen you are sensitive to, and causes many symptoms associated with pollen allergies. Antihistamines treat nasal itching, sneezing, and a runny nose. They are less effective for relieving nasal congestion.

First-generation antihistamines, such as diphenhydramine (Benadryl) and chlorpheniramine, are sedating and are not typically used to treat allergies. First-generation antihistamine use can increase your risk for impaired work performance, motor vehicle accidents, and injuries. When taken at night, they can cause drowsiness that persists.5 Long-term use of first-generation antihistamines with strong anticholinergic properties is linked to dementia.6

Second-generation antihistamines are preferred because they are less sedating and longer lasting.

  • Cetirizine (Zyrtec)
  • Desloratadine (Clarinex)
  • Fexofenadine (Allegra)
  • Levocetirizine (Xyzal)
  • Loratadine (Claritin, Alavert)

Cetirizine is thought to work fastest but is most likely to cause drowsiness. Fexofenadine is long-lasting and is least likely to cause drowsiness. Adding a second-generation antihistamine to a nasal corticosteroid is not thought to give any additional benefits.5

Antihistamines are also available in nasal spray form, such as azelastine (Astelin), and as eye drops. These products help reduce sneezing, itchiness, runny nose, and postnasal drip. Many people complain about the bitter aftertaste after using antihistamine nasal sprays. They can also cause changes in taste sensation, bloody nose, headaches, sedation, and nasal discomfort.

Examples of antihistamine eye drops include:

  • Ketotifen
  • Olopatadine
  • Pheniramine and naphazoline

Decongestants

Histamine and other chemicals released in response to allergens cause swollen blood vessels in the nose and sinuses. Decongestants can narrow blood vessels and ease congestion.

Examples of over-the-counter decongestants include:

  • Pseudoephedrine
  • Phenylephrine

Decongestant nasal sprays, such as oxymetazoline and phenylephrine, shrink swollen blood vessels in the nose and sinuses, but they can only be used for a short period because of their potential to cause rebound effects.

Decongestants are not safe for everyone, especially people with high blood pressure, diabetes, hyperthyroidism, closed-angle glaucoma, bladder neck obstruction, and heart conditions. Oral decongestants can cause insomnia, headache, nervousness, decreased appetite, pounding or fast heartbeat, high blood pressure, nausea, vomiting, and urinary retention.5

Corticosteroids

Intranasal corticosteroids are the first-line treatment for nasal and sinus allergy symptoms. They are used to prevent and treat allergic rhinitis. They are also moderately effective in treating eye itching, redness, and tearing.

Intranasal corticosteroids have an onset of action of 12 hours after dosage, but it may take seven days or more to reach their maximum effectiveness. Corticosteroid nasal sprays are typically started about two weeks before the expected allergy season.

Intranasal corticosteroids can cause nasal dryness, irritation, burning, and bleeding. More serious but rare side effects are also possible.5

Examples of intranasal steroids:

  • Budesonide
  • Ciclesonide
  • Flunisolide
  • Fluticasone
  • Mometasone furoate
  • Qnasi
  • Triamcinolone

Steroid nasal sprays can cause nasal irritation, nosebleeds, headaches, sore throats, and an unpleasant aftertaste.

Combination medications

Combination medications are typically second-generation antihistamines and a decongestant. These medications have a “D’ in their name.

The problem with combination medications is that you may be taking more medication than you need, which increases side effects. Antihistamines typically work best when taken regularly throughout the allergy season. Decongestants can increase heart rate and blood pressure and, therefore, should not be taken more than a week at a time without talking with your doctor.  

Immunotherapy for Pollen Allergies

If your allergy symptoms persist or are not adequately treated with over-the-counter medications and making environmental changes, you may want to consider immunotherapy, commonly called allergy shots.

Immunotherapy involves injecting small but escalating doses of your allergen under the skin to teach your immune system to be less sensitive to the allergen. As your immune system becomes less reactive, you will notice a decrease in your allergy symptoms.

Subcutaneous immunotherapy

Small amounts of pollen extracts are injected under the skin in subcutaneous immunotherapy (SCIT) to gradually expose the immune system to increasing amounts of the allergen and desensitize it to pollen allergens. Once the build-up phase is complete, pollen extract is injected less frequently in the maintenance phase.

Sublingual immunotherapy

Sublingual immunotherapy (SLIT) involves placing a small amount of pollen extract under the tongue and holding them there. Long-term clinical trials show that SLIT provides long-term clinical benefits.7

According to the Asthma and Allergy Foundation of America, the Food and Drug Administration has approved SLIT for treating grass and ragweed allergies.

A patient talking with a doctor

When to Seek Medical Help

Ready to talk with an online telemedicine doctor on the TelegraMD platform about your allergy symptoms? After reviewing your symptoms and medical history, your online doctor can provide an online diagnosis and transmit any necessary online prescriptions to your local pharmacy.

Telemedicine makes it possible to find a doctor on call when you need it. A 24-hour physician provides access to help whenever you need it to provide helpful and personalized advice about how to treat your pollen allergies. Telehealth can be more cost-effective than in-person doctor’s visits.

Disclaimer

While we strive to always provide accurate, current, and safe advice in all of our articles and guides, it’s important to stress that they are no substitute for medical advice from a doctor or healthcare provider. You should always consult a practicing professional who can diagnose your specific case. The content we’ve included in this guide is merely meant to be informational and does not constitute medical advice.

References

1. Poncet P, Sénéchal H, Charpin D. Update on pollen-food allergy syndrome. Expert Rev Clin Immunol. 2020 Jun;16(6):561-578. doi: 10.1080/1744666X.2020.1774366. PMID: 32691654.

2. Portnoy JM. Appropriate allergy testing and interpretation. Mo Med. 2011 Sep-Oct;108(5):339-43. PMID: 22073491; PMCID: PMC6188374.

3. Ansotegui IJ, Melioli G, Canonica GW, et al.. IgE allergy diagnostics and other relevant tests in allergy, a World Allergy Organization position paper. World Allergy Organization Journal. 2020;13(2):100080. doi:10.1016/j.waojou.2019.100080

4. Muthupalaniappen L, Jamil A. Prick, patch or blood test? A simple guide to allergy testing. Malays Fam Physician. 2021 May 31;16(2):19-26. doi: 10.51866/rv1141. PMID: 34386160; PMCID: PMC8346756.

5. OTC drugs for seasonal allergies. Med Lett Drugs Ther. 2019 Apr 22;61(1570):57-60. PMID: 31169808.

6. Richardson K, Fox C, Maidment I, Steel N, Loke YK, Arthur A, Myint PK, Grossi CM, Mattishent K, Bennett K, Campbell NL, Boustani M, Robinson L, Brayne C, Matthews FE, Savva GM. Anticholinergic drugs and risk of dementia: case-control study. BMJ. 2018 Apr 25;361:k1315. doi: 10.1136/bmj.k1315. Erratum in: BMJ. 2019 Oct 31;367:l6213. PMID: 29695481; PMCID: PMC5915701.

7. Penagos M, Durham SR. Long-term efficacy of the sublingual and subcutaneous routes in allergen immunotherapy. Allergy Asthma Proc. 2022 Jul 1;43(4):292-298. doi: 10.2500/aap.2022.43.220026. PMID: 35818157.