Although in the Northeast the spring is the worst season for many people with allergies, the fall is our next important allergy season.
Patients with nasal and eye allergies, as well as asthma, often suffer from late August thru November.

How fall allergies differ from spring allergies

 James A. Pollowitz, MD, FAAAAI, FACAAI

James A. Pollowitz, MD, FAAAAI, FACAAI

Pollen allergies in the fall involve the weeds. Plants produce pollens so that they can reproduce. The pollens that are spread by wind
(as opposed to insects or animals) need to be light and buoyant. These are the pollens that cause allergies.

Ragweed is the best known offender and it pollinates between August 15th and the first frost (usually late September─early October). The peak of ragweed season is often around Labor Day. This pollen is very small and light and can travel up to 200 miles! The usual symptoms of ragweed hayfever involve nasal congestion, sneezing, watery runny nose, eye itching, tearing and redness, throat itchy and post nasal drainage. Asthmatic patients who are allergic to ragweed can also have increased symptoms (cough, wheezing, shortness of breath and chest tightness). Other weed pollens can cause allergies, including Lambs Quarters, Pigweed and Cocklebur.

Molds are another important fall allergen. The mold season is somewhat later than the weeds, and is usually October and November. Molds grow on the dead vegetation (especially fall leaves) and the spores (the mold equivalent of pollen) can be carried by the wind. These spores
cause the same type of allergy symptoms that we see with the pollens. Molds do well with low light and areas of high moisture, conditions that
often occur in the fall.

Being indoors more in the fall often triggers allergies and asthma

In the fall, most of us are back to school or work. We are also indoors more and thus exposed to indoor allergens such as pets (especially dogs and cats) and house dust mites. Infections usually increase during this period and are triggers of asthma attacks and sinus and ear infections.

Asthma often worsens in the fall. Typical asthma symptoms include cough, chest tightness, wheezing and shortness of breath. Patients who have other allergic conditions such as nasal allergies and eczema have a 40% risk of developing asthma. Patients with asthma often have associated allergies. Ragweed, molds, dust mites and molds are often important cause of asthmatic symptoms. Infections (especially viruses), cold air, irritants such as smoke and climatic changes are other important triggers.

How to treat fall allergies

Treatment of fall allergies (or any allergies) involves three important measures:

1) Avoidance or elimination

To reduce the elements that are triggering allergic reactions, use allergen encasings on pillows and mattresses; remove and control mold in your home by frequent cleaning and repair of water leaks or dampness; and remove pets or restrict them to certain areas in the house.

2) Medication

Many medications used to treat allergies are now available without a prescription. OTC medications now include long acting, less sedating antihistamine medications such as Claritin, Zyrtec and Allegra. These products can be dosed once daily and are also available as generic brands as well. These medications can take 1-2 hours to start to work. They should be use on a daily basis during the allergy season.

Two nasal steroids, Nasacort AQ and Flonase OTC have also become available over the past year. These medications are more effective than the anti-histamines, especially for relief of nasal congestion. The nasal steroids can take 2-3 days to control symptoms and should be used regularly ensure effective benefit. It is possible that prescription nasal steroids will be less expensive for some patients since their co-pays might be less than the price paid for these OTC products.

3) Allergy medications and immunotherapy (allergy shots)

Asthma treatment involves appropriate control (and prevention) of asthma symptoms and complications. Rescue medications such as albuterol are important in managing acute symptoms, but they are not meant to be used regularly. Regular use of these medications (more than twice weekly) indicates uncontrolled asthma and the need for asthma controller medication. These medications include inhaled steroids (i.e. Flovent, Asmanex or Qvar) or a non-steroid such as Singulair (montelukast).

More severe asthma is often treated with combined steroid/long-acting bronchodilator inhaled medications such as Advair, Symbicort or Dulera. Persistent asthma requires a treatment action plan and ongoing follow-up similar that with other chronic diseases such as diabetes, hypertension or arthritis.

Allergy shots (immunotherapy) are also a very beneficial therapy. Allergy injections have been used for more than 100 years in millions of patients. In well-selected patients, especially those with pollen, cat and dust mite allergies, the response rate can be as high as 90% improvement (compared to medical therapy alone).

Allergy shots are initially dosed at weekly intervals. After the “maintenance” dose is achieved, the shots are then given every 2-4 weeks. A usual course of therapy is 3-5 years of treatment. When the shots are stopped, most patients do not relapse for at least 5-10 years.

A new type of allergen immunotherapy involves tablets which are placed in the mouth under the tongue and allowed to dissolve for 1 minute. This therapy has been called SLIT (sublingual immunotherapy). There are presently three available products: Grastek and Oralair grass pollen products, approved to treat allergy in patients 5-65 and 10-65 respectively. Ragwitek is a ragweed product indicated to treat patients 18-65.

All of these products are indicated for pre-seasonal use (begin treatment 4 months before the grass pollen season, typically February, and 12 weeks before the ragweed season, usually by June) and to be continued through the allergy season (thru mid-July for grass and late September for ragweed).

It is unclear whether this seasonal therapy allows for discontinuance of treatment with prolonged benefit (as is seen with allergy shots). Grastek is also indicated for year-round therapy and has been shown to give prolonged control of symptoms when therapy is stopped after 3 years of treatment. SLIT is not presently indicated to treat other allergies, although there are ongoing studies for treatment of dust mite allergies. Use of injectable allergen extracts under the tongue has not been shown to be effective, is not approved for treatment by the FDA, and is not covered by insurance.

Even with fall allergies, you can still enjoy the fall

In summary, fall allergies can be troublesome for people who are affected by them. However for these people, appropriate diagnosis and treatment can make this beautiful time of the year more enjoyable. If you suffer from fall allergies (or allergies of any kind), an allergist/immunologist can help to ensure optimal diagnosis and treatment of these conditions.

By James A. Pollowitz, MD, FAAAAI, FACAAI, an allergy, asthma and immunology specialist with Westchester Health Pediatrics.