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For more information about the diagnostic and treatment options for allergies, asthma, and sinus conditions, contact:


Gurdev (Dave) Judge, MD
Board-certified in Allergy, Asthma, & Immunology - Adults and Pediatrics




401 Keisler Drive, Suite 201
Cary, NC 27518
Telephone: (919) 859-5966


10931 Raven Ridge Rd, #111
Raleigh, NC 27614
Telephone: (919) 870-6440


1906 S. Main Street
Wake Forest, NC 27587
Telephone: (919) 562-7195

Spring Has Sprung:
Allergy Season in Full Bloom

Dr. Gurdev (Dave) Judge, a board-certified allergist-immunologist and pediatrician, has an especially busy practice this time of year, with offices in Cary, North Raleigh, and Wake Forest (see box, below). With spring in full bloom, North Carolina is putting on her annual pollen show across the state.

Dr. Judge

For the lucky ones, this simply means more frequent car washing. But for others, pollen and lawn-mowing bring sneezing, congestion, sinus pressure, headaches, and a seemingly never-ending cycle of allergy medications.

“Allergic rhinitis—seasonal allergies—and asthma are relatively common conditions,” Dr. Judge says, “so they may not seem like a major health event. But for those affected, these conditions can be dramatic and severe. Often, not only are the afflicted uncomfortable, but they often experience such complicating conditions as anxiety or depression, which can make basic allergies a much more challenging condition to deal with every year.”

He points out that the connection between allergies and depression may not be entirely obvious, but emphasizes that any condition causing frequent physical stress can leave a person vulnerable to deteriorating mental and emotional states.

“Of course,” Dr. Judge explains, “asthma or allergies and depression are very different conditions affecting different parts of the body. However, they are often linked in important ways. The key issue is compliance. When people are depressed, or when they are having anxiety or panic attacks, they are far less likely to take their asthma and allergy medications as prescribed. Thus, their respiratory and other problems may worsen, which in turn often triggers more severe depression. Sometimes,” he says, “it’s an action-reaction sequence that spirals out of control.

“This can become a vicious cycle of mood affecting a person’s ability to appropriately treat their allergies, and thus worsening allergies affecting their mood.”

Thus, in fact, Dr. Judge emphasizes, “It’s so important to properly recognize and diagnose severe allergies/asthma early on, and get the right treatments started.

“At times, it can actually be difficult to distinguish between an emotional problem and something like asthma,” he says, “because they can manifest in similar ways. For example, someone may come in having difficulty breathing, but when we do a lung function test, we find perfectly normal results. Then, we have to look at the possibility that this is a problem of anxiety or perhaps a panic attack causing the reaction.

“It is also true,” he continues, “that emotional stress can precipitate allergic reactions, and relaxation techniques can moderate these same reactions. Generally, in my work, it seems that allergic reactions very often reflect the mind-body connection.”

Asthma Triggers: Stress, Fatigue

As an example of that connection, demonstrating how stress/anxiety can trigger or exacerbate a physical condition such as asthma, Dr. Judge describes a patient he recently saw in his Cary office.

“A young lady came to us in a state of severe distress from her asthma,” he recalls. “She also, as it happens, suffers from depression, and because of this her compliance with taking her asthma medications was poor. She was here for three hours trying to get her symptoms under control. We gave her medications including nebulizer treatments to improve her condition, but everything we did had very little effect because she was so emotionally upset. The more she cried, the louder and stronger her wheezing became. Finally, I was able to convince her that she had to try to calm herself, to come to some place of quietness and peace, or the medications were not going to be able to work. Eventually, she did this, and then she began to respond to the medications appropriately.”

The take-home message, says Dr. Judge, “is that it was essential for this woman to engage her mind in the treatment process of her physical condition.”

Fatigue is another common problem plaguing those with allergies or asthma this time of year. The days are longer, people are working long hours, for those with allergies who are up at night with congestion, sneezing, blowing the nose and sinus pressure, quality sleep can be an elusive beast. “It’s so important to get a solid eight hours of sleep,” Dr. Judge says, “for both physical and mental health. But allergies can make this really difficult. As fatigue sets in, stamina decreases, and this is just yet another complicating factor that can lead to anxiety and/or depression. Good sleep hygiene is essential for mental and emotional health.”

Just What Are Allergies?

Dr. Judge explains: “When a sensitive person inhales an allergen—something like pollen—the body’s immune system reacts abnormally to that substance, which initiates the chain of events we are all familiar with—runny nose, watery eyes, itching, swelling, etc. Complications of allergic rhinitis can include ear infections, sinus infections, recurrent sore throats, cough, headache, fatigue, irritability, altered sleep patterns, and poor school/work performance.”

But allergy-sufferers, take heart!

There are many treatments, some old and some new, that can greatly alleviate and in some cases may eliminate most of these challenging seasonal symptoms.

“Avoidance is key,” Dr. Judge explains. “Staying away from the things that trigger an allergic reaction for you is the very first thing to do. So for example, if you are allergic to pollen, keep your window closed and use your air conditioner while pollen is abundant. When avoidance isn’t possible or isn’t enough,” he continues, “medications may also help. Antihistamines and decongestants are most commonly used for allergic rhinitis, and there are new medications that inhibit the release of the chemical mediators that cause allergic reactions now too.”

Lastly, for those who simply cannot avoid triggers and for whom medications are not working well enough, immunotherapy may be appropriate. “Allergy shots,” Dr. Judge says, “do not cure allergies, but can be very effective in controlling allergic symptoms.

“I want my patients to understand, they do not have to suffer stoically alone for months of each year,” he says. “There are excellent treatment options available now, it’s simply a matter of finding the thing that will work best for you.”