09 March 2016
It’s that time of year again! While spring brings the promise of warm weather and beautiful blossoms, it also tends to be the hardest season for many people with allergies. Patients with eye, nose and respiratory spring allergies usually find themselves symptomatic from late March until late May, although symptom onset could be earlier depending on warm weather trends.
Allergies in the spring mainly result from tree pollen
Some of the more common trees that can cause allergies in the Northeast are:
Allergen levels are highest on warm, dry and breezy days, as this is when buoyant pollens get carried through the air most easily. Tree pollen levels tends to be lower on cold and wet days.
Birch is one of the most virulent pollens that affects patients with spring allergies
Along with all other tree pollens, birch can cause classic allergic symptoms including an itchy, runny, congested nose and sneezing. Often, eyes are also affected with redness, itching and tearing. Asthmatic patients who are allergic to tree pollen can also have increased symptoms, including cough, wheezing, shortness of breath and chest tightness.
An additional nuisance for spring allergy sufferers: pollen food syndrome
Besides the classic symptoms of nose, eye and respiratory allergies, people with tree pollen allergy may also suffer from a phenomenon known as pollen food syndrome, previously known as oral allergy syndrome. Pollen food syndrome manifests as an itchy mouth and throat with ingestion of certain raw fruit, vegetables and nuts. Very rarely does the reaction intensify or lead to breathing trouble; however, your allergist may still prescribe an epinephrine auto-injector. The fruits, vegetables and nuts of concern can almost always be safely eaten when fully cooked or processed, as this denatures the food protein and renders it unrecognizable to the immune system. This phenomenon happens because there are similar proteins in these foods and pollens, but distinguishing between a classic food allergy and pollen cross reactivity should be confirmed by an allergist.
Treatment of allergies may involve avoidance, medication and allergy immunotherapy
Avoidance: In terms of avoidance, people with spring allergies should avoid going outdoors for prolonged periods of time on days when pollen counts are high (you can check this online at websites such as www.aaaai.org/global/nab-pollen-counts or www.pollen.com). Outdoor activities should be minimized in the early morning when pollen is usually released from trees and plants, between 5 AM and 10 AM. Children should wear hats and sunglasses when playing outdoors, and they should change clothes/wipe their face, eyebrows, eyelashes, and nose with cold water after coming indoors. Windows should be kept closed, and it is better to use air conditioners that recirculate indoor air rather than drawing in outside air. Additionally, if an indoor/outdoor pet is part of the family, it should be bathed frequently during the spring season to prevent accumulation of pollen on pelt and fur.
Medication: Many medications used to treat allergies are now available without a prescription. Intranasal steroids are considered to be the first line therapy for nasal allergies, and two nasal sprays (Nasacort and Flonase) are available over the counter.* Nasal sprays are safe if used correctly, and they work best if used consistently, instead of on an as needed basis. Long acting, non-sedating antihistamines such as Claritin, Zyrtec and Allegra are also available without a prescription, and these medications can be effective at once daily dosing. Oral antihistamines are considered to be second line therapy for nasal allergies, and they are often used in combination with nasal sprays. Finally, there are both prescription and over the counter eye drops which can be used if your child develops significant eye symptoms.
Immunotherapy. Immunotherapy (allergy shots) should be considered when medical management with nasal sprays, eye drops and oral liquid/pills do not adequately control allergic symptoms. Allergy injections have been used for more than 100 years in millions of patients. In well-selected patients, the response rate can be as high as 90% improvement (compared to medical therapy alone). Allergy shots are initially dosed at a weekly interval. After the “maintenance” dose is achieved, shots are then given every 2-4 weeks. A usual course of therapy is 3-5 years of treatment. When shots are discontinued, most patients do not relapse for at least 5-10 years. While new sublingual (under the tongue) allergy immunotherapy is available for grass and ragweed allergens, there is no FDA approved sublingual immunotherapy for tree pollen.
Although manageable, spring allergies can be troublesome for affected patients
Appropriate diagnosis and treatment can make this rejuvenating time of the year more enjoyable for affected patients. An allergist/immunologist can help to ensure optimal diagnosis and treatment of these conditions.
If your child suffers from spring allergies, please come see me
*Of note: It is possible that prescription intranasal steroids might be cheaper for patients depending on their insurance copay.