Seasonal Allergies

By: Ira Finegold, MD
Last Reviewed on: September 6, 2005
Spring, usually the beginning of many good things, is a treacherous time for patients with seasonal allergies. While others are carefree, strolling through fields of daffodils, seasonal-allergy sufferers are strolling through the pharmacy looking for relief from sneezing and itchy eyes.

A Red-and-Itchy Case Study
Mr. G., a 27-year-old accountant, had mild allergies in past years, particularly in the spring. When his eyes itched and he started to sneeze, he took an over-the-counter antihistamine. The medication helped his allergies but made him feel drowsy. So he took it at night, and though he felt a little groggy in the morning, that wore off before anyone noticed at work.

But this year was very different for Mr. G., and he knew it on the first day of allergy season. First, when he arrived at work after his customary walk through the park, he could not stop sneezing. His eyes were red, itchy, burning, and tearing, and by the time he was able to stop blowing his nose, his sides were sore. His boss suggested that he go home for the day to "take care of himself." So Mr. G. headed over to the pharmacy where he bought some cold-allergy pills, and the next morning he was in fact worse. In addition to his runny nose and itchy eyes, he now had chest congestion and couldn't breathe comfortably. He even noticed funny, high-pitched accordion noises in his chest. Finally, he went to his physician, who informed him that he did not have a bad cold, but in fact was having a serious seasonal allergy attack, and referred him to an allergist. That's when I met Mr. G.

What are Seasonal Allergies?
Plants reproduce by releasing millions of pollen spores that travel to other plants. . Some plants have beautiful, scented flowers that attract insects that will spread the pollen around as they move from flower to flower. Other plants produce ugly, unscented flowers that do not attract insects; instead, these plants rely on the wind for pollen movement. When plant pollen bursts into the air, it is inhaled by humans and animals. If you are one of the 40 million Americans who have the genetic tendency to be allergic, then this pollen is not merely flower dust, but the cause of major illness.

When does it begin and when will it end?
In the temperate zones of the United States, trees are the primary pollen producers in the spring. The farther south you live, the earlier the allergy season begins. For example, the tree-pollinating season in Florida starts in January, while in New York it begins in mid-March. Grass-pollen allergy is caused by weed-like grasses or cultivated grass that is allowed to flower. If you are allergic to grass pollen, sometimes sap from cut grass can cause symptoms. Again, the start of grass-pollen season depends on where you live. It can begin in April in southern states, or in early June in northern areas. By July, pollen allergies generally subside. But in some areas of the country, summer may be a time for airborne mold spores. In order to reproduce, certain molds and fungi unleash spores that can cause allergic reactions. By late summer, ragweed pollen takes flight, and the troubles start all over again for those who are sensitive. Frost finally puts an end to the pollen and outdoor mold season until the next spring, when it starts all over again.

What are the Treatment Options?
Before you think about treatment, first you have to determine whether you have a seasonal allergy. Here are some of the common symptoms:

sneezing,
runny nose,
sore and itchy throat
itchy and watery eyes
wheezing
coughing,
fatigue,
headaches
Allergy attacks can be mild, causing only a couple of the symptoms above, or incapacitating.. For some, allergies lead to ear and sinus problems. If you tend to have these symptoms at the same time each year, and they last longer than a cold (about a week), then you probably have seasonal allergies.

See your physician
If you suspect you have a seasonal allergy, see your physician or an allergy specialist. An examination of your symptoms may be all that is needed for a diagnosis. Illnesses associated with seasonal allergies are allergic rhinitis, which affects the nose and throat; allergic conjunctivitis, which results in red, itchy eyes; and allergic asthma, which causes wheezing and chest congestion and tightness. You could also experience a combination of these conditions.


Get tested
It is important to find out what is causing your symptoms. An allergy specialist is equipped to do some simple, accurate and painless allergy tests. It may take only 15 minutes to identify the culprit behind your allergies.

Reactions to oak, maple and birch are among the most common tree-pollen allergies. Some of the grass pollens that trigger allergies are the Timothy, June, orchard and Bermuda varieties. Ragweed is the most common offending weed pollen, but others such as English plantain, chenopodium, cocklebur and mugwort can cause problems as well.
Get treated
In general, allergy treatment begins with avoidance of these triggers. Then we add medication, and if neither avoidance nor medication are effective, we consider allergy shots, which immunize the patient to the pollen itself. Avoidance: It is often hard to avoid tree pollen when it's in the air we breathe. But here are some basic avoidance tips:

Close your house and car windows.
Wash pollen off you hair and skin after you've been outside..
Wash pets that have been outdoors.
Still, for most seasonal allergy sufferers, avoidance is impractical and doesn't do the trick. The good news is that there are very effective medications that address a range of symptoms.
Antihistamines: Antihistamine pills are the best example of anti-allergy medications that treat a wide range of symptoms, such as runny nose, sneezing and hives. The older, over-the-counter antihistamines, such as Benadryl, make people drowsy, but newer antihistamines cause little or no drowsiness. Claritin OTC and Allegra (prescription only) do not cause drowsiness. Zyrtec, another prescription antihistamine, may make a few individuals sleepy but can be taken at night.

Sprays and drops: Other effective medications come in the form of sprays and drops that soothe specific affected symptoms. Some nasal sprays contain corticosteroids, which quell inflammation. Flonase, Nasonex, Nasacort, Nasarel, Nasalide and Rhinocort are all effective corticosteriod sprays.. Another good nasal spray is Astelin, which is an antihistamine. Antihistamines block the effects of the immune system chemical histamine, which causes sneezing, itching and wheezing. There are also a number of eye drops that can help control allergic conjunctivitis.

Allergy shots: A person with allergies has an immune system that's working overtime.. Allergy shots can help get your immune system on the right track. The treatment involves a series of injections-usually weekly at first-that expose the body to small amounts of an allergen (any substance, such as pollen, that triggers an allergic reaction). The body slowly builds a tolerance to the allergen and eventually no longer treats it as a foreign invader. Sometimes allergy shots are so effective, they remove all traces of allergic illness. Recent studies show that symptom improvements can continue for three or more years after treatment ends.


Not everyone with seasonal allergies needs allergy shots, but if symptoms are making your life unbearable, you should discuss this treatment option with an allergist.

Get better! Gone are the days when people needed to put up with allergy symptoms. From simple one-pill treatments to multiple medications and allergy shots, there are solutions for mild and severe allergy sufferers alike. Don't be a sneezy, silent sufferer. Get tested, get treated and get better!

A Case Study Happy Ending
Remember our seasonal-allergy sufferer Mr. G.? Through skin testing, I found that not only was he allergic to tree pollens (oak, birch, maple, elm, sycamore and cottonwood), but he was also allergic to grass and ragweed pollen. He mentioned to me that he was allergic to many fruits and nuts and that eating them made his mouth itch. I told him that many patients who are allergic to birch pollen have these types of food reactions.

After starting on a non-sedating antihistamine, a steroid nose spray and eye drops, Mr. G. was able to return to work that day and has not had a bad allergic reaction since. He and I have discussed allergy shots as an alternative to seasonal medication, and we will begin shots at the end of the fall allergy season. Next spring Mr. G. will be better.