Jo S. Reed, MD
Jo S. Reed, MD, specialist in adult and pediatric allergy and immunology with Ochsner Medical Center in Baton Rouge. Ochsner.org
If it seems like allergy season runs from one season right into the next, it’s not your imagination. Bottom Line Personal asked Jo S. Reed, MD, a specialist in adult and pediatric allergy and immunology, what’s going on…and, more important, how to feel better.
In the past, grasses and trees that pollinated in late winter and spring led to spring allergies…then the pollination of various weeds in late summer and fall led to fall allergies. But now that we’re experiencing warmer temperatures as a result of climate change, the time frames for spring and fall allergy seasons have become longer and longer. Pollen from the three primary sources—trees, grasses and ragweed—can come in successive, sometimes even overlapping, waves starting in spring and going straight through to fall. If you live in a part of the country that never gets a true winter frost or if you also happen to have perennial allergies (to animal dander, cockroaches, dust mites or indoor mold, for example), you might never get a reprieve.
Seasonal allergies strike in many ways. It’s possible to have been affected by spring allergy symptoms in the past, say from tree and grass pollen, and now find that you’ve developed fall allergy symptoms from ragweed as well. Many people with seasonal allergies have been dealing with them since childhood, but other people started sneezing and wheezing only in adulthood, perhaps because they moved to a different part of the country and now are exposed to a new set of allergens—it could take a year or two of this new exposure for symptoms to start. It’s also possible that, as you get older, you experience non-allergic rhinitis—pollen or other particles in the air act as irritants, causing nasal symptoms such as a runny nose.
If your itchy eyes and nasal congestion are making you miserable…if your allergy symptoms are preventing you from getting restorative sleep so you find it hard to focus or you even fall asleep during the day…if you’re missing days of work because you’re so uncomfortable…it is time to talk to your doctor or an allergist about testing to pinpoint the specific allergens bothering you and get the right allergy treatment.
Allergy testing is done two ways…
Skin-prick testing is the gold standard. Tiny pricks are used to place a small amount of up to 40 allergens along your forearms. If you’re allergic to any of the substances, you’ll get a reaction akin to a mosquito bite within 20 minutes. A full panel of allergens will include cat and dog danders, dust mites, cockroaches and molds as well as 30 types of pollen. These allergens will vary depending upon what part of the country you live in. Many people are surprised to find that they are allergic not just to pollen. For results of this testing to be accurate, you need to be off any antihistamines for the seven days leading up to the test. The test can cause itchy skin, runny nose, itchy eyes and, in extreme but rare cases, anaphylaxis (severe allergic reaction).
Blood draw testing can be done for the same allergens if you can’t function without your allergy medication for the seven days—but this test is not as sensitive and specific as the skin test.
There are many things you can do to help yourself feel better, starting with lifestyle choices and supplements for allergies. While these therapies lack any significant control studies and there is limited literature about them, you can try the following…
Avoidance. Although you don’t want to be confined to your home, it can help to limit outdoor activities on peak pollen days. Phone apps and websites offer daily pollen reports from sources such as the Allergy & Asthma Network (AllergyAsthmaNetwork.org/weather).
Butterbur. This herb, taken daily in tablet form, has strong antihistamine and anti-inflammatory effects. It also helps with non-allergic rhinitis. Take it during allergy season or when you are having symptoms. Follow dosing directions on the package.
Change of clothes. Pollen sticks to skin and clothing. Drop your clothes in the washing machine after being outside, and take a shower. When pollen settles on your car, hose it off to avoid inadvertently picking it up and bringing it inside your car or home.
Cold compresses and eyedrops. These can help itchy, watery and puffy eyes. There also are over-the-counter eyedrops made specifically for taming allergic reactions—look for one that contains the antihistamines ketotifen or olopatadine.
Eucalyptus oil. This natural substance, extracted from leaves of eucalyptus trees, reduces the inflammation caused by exposure to pollen. Add a few drops to a bowl of steaming water, and inhale deeply. Relief can last several hours.
Green tea. Research has found that catechins, a type of polyphenol in green tea, block certain allergic responses in the body. A daily cup or two may reduce sneezing and itchy eyes.
High-efficiency particulate air (HEPA) filters. Vacuuming your floor and furniture regularly will help pick up pollen. Using a HEPA filter in your vacuum will trap a greater amount of pollen and dust mites. Use HEPA filters in your heating and cooling system, too. Also: Dusting is more effective when you use a damp cloth that can trap pollen—a dry cloth often just stirs it up.
Honey. Because it is made by bees using local pollen, honey can have a desensitizing effect on you during allergy season or when you are having symptoms. You might enjoy it in your morning tea or as part of breakfast. Honey also has some anti-inflammatory properties that can help clear up congestion. Caution: If you have diabetes or any issues with sugar, talk to your doctor about how to incorporate honey safely into your diet.
Humidifier. By putting water vapor into the air in your home, a humidifier can help moisturize dry nasal and sinus passages, reducing congestion and discomfort. But: Make sure you are not allergic to dust mites—dust mites love a humid environment so a humidifier can make symptoms worse. Follow all directions regarding filter changes and cleanings to inhibit bacterial growth in the machine.
Neti pot. This device, which can be used nightly, gives nasal passages a bath and is helpful for clearing a runny nose. If you’re new to the neti pot, it can seem tricky at first. You fill the pot with warm distilled water and the following premade saline solution from the American Academy of Asthma, Allergy and Immunology—mix three teaspoons of iodide-free salt with one teaspoon of baking soda, and store it in a clean small airtight container. Add one teaspoon of the mixture to eight ounces of lukewarm distilled water. If you experience burning or stinging, make a weaker solution by using less of the dry ingredients. For children, use one-half teaspoon of the mixture in four ounces of water. Tilt your head to allow water to flow into one nostril and out the other. Your doctor’s office may have a handout on how to do it, or ask a nurse to walk you through the process. Important: Use only distilled water—there are impurities in tap water that could cause an infection.
Protective gear. Wear a mask if you must mow your lawn or be outside for any reason on peak days. Sunglasses, a wide-brimmed hat and long pants also help shield your eyes and skin.
Spicy food. Capsaicin, the plant chemical in hot peppers such as cayenne, can help relieve allergy symptoms including nasal congestion temporarily. Allicin, a compound in garlic, has anti-inflammatory effects that can reduce swelling and inflammation. If you enjoy cooking with these ingredients, they offer a tasty way to get relief. Just be careful if you have GERD, which can be exacerbated by spicy foods.
If you are prone to traditional seasonal allergies and the above remedies don’t help, the next step is medication. If your doctor gives you the go-ahead, you can start using a nasal steroid spray daily about a month before your symptoms tend to start. This helps to prepare your nose, so you’re less likely to react to allergens when they hit your nasal passages. These nasal sprays work better than antihistamines if you take them daily. Among the over-the-counter options are nasal triamcinolone (Nasacort AQ), budesonide (Rhinocort AQUA) and fluticasone (Flonase). Caution: Nasal steroid sprays that are alcohol-based can cause bleeding. To help reduce that risk, spray away from the center of the nose (the septum). Water-based nasal steroid sprays are far better and less likely to cause the nose to bleed—check the label.
If your symptoms are occasional, consider taking an over-the-counter antihistamine as needed. Newer formulas, referred to as second generation, don’t cause the sleepiness of first-generation ones, which include brompheniramine, dimenhydrinate, diphenhydramine and doxylamine, nor do they have many contraindications. Loratadine (Claritin), cetirizine (Zyrtec), levocetirizine (Xyzal) and fexofenadine (Allegra) are the most common second-generation ones. Caution: If you have kidney or liver disease or high blood pressure, check with your doctor first. Many antihistamines are metabolized by the kidneys, so patients with kidney concerns should consult their physician. Decongestants, which often are taken with the aforementioned medications, can elevate blood pressure.
If lifestyle changes and medications don’t bring significant relief, consider immunotherapy. Given as either sublingual (under-the-tongue) drops or as injections, these treatments expose you to small incremental doses of your specific allergens. Doing this alters your immune system so that eventually your body no longer reacts when you’re exposed to the allergen(s).
The sublingual drops are more convenient because you can take them on your own once your doctor starts you off. Allergy shots need to be given at your allergist’s office, and you have to wait 30 minutes after each injection before you can leave. Studies show that if you are going to have a reaction, it typically occurs within 30 minutes, but you can have symptoms beyond the 30-minute wait. Shots are given weekly for four to six months and, over time, you’ll taper down to monthly.
As a general rule, it takes between three and five years to alter the immune system, though many people start to feel some results at about the six-month mark. Overall, the success rate—meaning that you’ll need to take less medicine or no medicine at all—is between 70% and 90%. You can continue to take allergy medications while doing immunotherapy.
