Primary care clinics throughout Hawaii are filled with people complaining of itchy, stuffy noses, red and watery eyes, scratchy throats, chronic coughs from post-nasal drip and asthma. Meanwhile, annual sales of allergy medications have skyrocketed. People complain that insurance for pharmaceuticals seems to cover less and less, requiring sufferers to reach ever deeper into their wallets to get relief.

Allergies develop when the body identifies something we may have inhaled or eaten as a foreign invader. It then manufactures proteins called antibodies that react every time we come into contact with the agent. That reaction is what ultimately causes us to sneeze and wheeze and scratch.

When we experience continuous allergies, our body is in a chronic state of inflammation, which can cause fatigue, irritability and a foggy mind. Inflammation when combined with grease, in the form of high cholesterol, can also cause our plumbing to plug up with plaque that results in heart disease and stroke.

The chances are that our immune systems were better suited to more primitive times when we survived by hunting and gathering. The industrial and now the technical age have introduced so many new allergens that our immune systems often become confused and overwhelmed. Reactions the body mounts to protect us are bothersome and, at times, harmful. The longer we live, the more antibodies we develop, and as the years go by we find ourselves to be increasingly sensitive.

Pharmaceuticals obviously cannot eliminate the environmental trigger. They can only hold back our trigger finger. They will, at best, prevent symptoms and more often simply help to mitigate complaints. These medicines also have side effects such as dry mouth, fatigue and insomnia.

Again, allergic symptoms usually come from something we eat, breathe or contact with our skin. Among the most common triggers in Hawaii are dust mites, mold and pollen. Foods, including shellfish, wheat, eggs and peanuts, are also frequent offenders.

To minimize the cost of medication and get at the source of the problem:

First, determine the trigger.

If you think you might be allergic to something, you probably are. To check it out, simply avoid the item for a while and see if you improve. A simple blood test can be ordered by your primary care doctor that will check for the most common causes. An allergy specialist can do additional testing.

Second, focus on environmental control. If your problem is dust mites, try a new pillow. For mold, remove that old carpet. Avoid troublesome foods.

Use medication only if steps one and two are unsuccessful.

Obviously, not all of us are in a position to move to the dry side of the island, stop working in that stuffy, old building or to give our family a long list of what we will not eat. Few people are willing to part with a pet even if it makes them sneeze. That’s the time for medication, but remember, it should be a last resort for both body and wallet.

Ira Zunin, MD, MPH, MBA, is medical director of Manakai O Malama Integrative Healthcare Group and Rehabilitation Center and CEO of Global Advisory Services Inc. Please submit your questions to info@manakaiomalama.com.