Spring is a wonderful time – the sun finally peeks out from behind those persistently rainy clouds, a fresh floral smell fills the air and everything seems happy and bright. Enjoyment of this glorious weather can be hampered, however, for allergy sufferers. All the sneezing, itching and runny eyes can take its toll. The good news? With the right plan, there is hope.
Step 1: Identify
Exactly what is triggering your allergies? Determining the answer isn’t always simple. “Right now, we are entering the grass pollen season, which typically coincides with the flow of white fluffs in the air from cottonwood trees,” says PeaceHealth’s Dr. William Anderson. “These are the seeds from the trees which actually pollenate in the springtime around March. People see the fluffs, experience allergy symptoms and assume they are due to the fluffs. Allergy symptoms now are due to the grass pollen that people can’t see.”
According to Dr. Anderson, grass pollen is released from buds on top of tall grass blades. “I advise my patients – particularly children – to avoid playing in the tall grass as their face is at the same level of the grass pollens being released,” says Dr. Anderson. “The exposure can lead to severe allergic symptoms including nasal obstruction, eyelid swelling and eye itching, and asthma symptoms – even in those who don’t have asthma.”
Dr. Anderson recommends oral steroids such as prednisone for severe symptoms, for a few days to relieve symptoms, along with antihistamine therapy. Improvement then can usually be maintained by anti-inflammatory nasal sprays. “Grass pollen season typically starts in mid to late May and progresses through late June,” he says. “Weed pollen starts up in mid-summer and may persist through late summer. Those who have mold allergy may notice symptoms from mid-summer through the fall time, especially when working outdoors raking leaves.” The first season of the year is the tree pollen season which starts in January for cedar pollen but for most trees later, in February and March.
Step 2: Prevent
Grass, weed and residual tree pollens are kicked up when mowing the lawn or weed whacking, which can also lead to severe allergy symptoms. Prevent this by wearing a mask and frequently washing your face, hair and body. Using a NeilMed sinus rinse can also keep your nasal passages free of pollen and irritants.
Dr. Anderson recommends that those with known grass pollen allergy begin treatment on May 1 of each year, even if they aren’t yet experiencing symptoms. This may seem counterintuitive but when it comes to allergies, prevention is best. For those with allergy symptoms due to tree pollens which peak in March, he advises starting allergy medications in February, sooner if cedar pollen is a trigger for symptoms.
“There is an immunologic process called priming where a few pollens that land on the mucous membrane early in the season may not cause symptoms, but initiate the allergic inflammatory response that then ramps up over days to the first few weeks of the pollen season leading to severe allergy symptoms,” says Dr. Anderson. “If one can stop this priming process with an anti-inflammatory nasal spray such as Flonase/fluticasone, Nasacort/triamcinolone or Rhinocort/budesonide with one to two puffs in each nostril daily, patients can often proceed through the pollen season with minimal symptoms.”
Dr. Anderson also advises daily antihistamine such as Claritin/loratadine or fexofenadine/Allegra. “Zyrtec/cetirizine is a very good option and has good antihistamine properties but may be sedating,” he says. “This is often taken at night time.”
Being proactive about treatment helps ensure allergy sufferers get the best results. Waiting until allergy symptoms are at their peak often means that nasal passages are irritated and swollen to the point of obstruction, rendering intranasal anti-inflammatory treatment ineffective. “At the peak of severity, the over-the-counter anti-inflammatory nasal sprays may not work unless one is vigilant and utilizes a therapy on a regular basis,” says Dr. Anderson.
Step 3: Treatment
Nasal allergy sufferers can find relief in prescription nasal sprays. “Anti-inflammatory nasal sprays must be used daily,” says Dr. Anderson. “Prescription add-on nasal sprays are advised for those not optimally controlled [on regular antihistamine medications].”
Dr. Anderson says Patanase and Astelin can be added to, but not replace, intranasal anti-inflammatory therapies. These are antihistamine nasal sprays and also act on inhibiting release of histamine. “Over-the-counter Nasalcrom is available and may be used up to four times daily, added on if needed, although usually not as effective as Patanase and Astelin.”
For those with itchy, runny eyes, Dr. Anderson recommends over-the-counter eye drops containing ketotifen, like Zaditor, Alaway and other generic options. These can be used up to three times daily as needed. Those planning to spend time outdoors should use this treatment in the morning.
If these methods don’t optimally control your allergy symptoms, Dr. Anderson recommends allergy shots or subcutaneous immunotherapy. This entails three to five years of regular immunotherapy injections once per month, after a weekly six-month buildup phase. “These are very effective but require significant time commitment especially during the buildup phase,” he says. “Some people choose to pursue allergy shots to reduce all the medications they need to control symptoms.”
Now there is also a sublingual immunotherapy tablet for those with grass pollen allergy that can mostly be taken at home. “Most don’t realize that this therapy is available,” says Dr. Anderson. This therapy is also available for dust mite allergy.
Don’t let allergy symptoms get you down – take the steps you need to enjoy spring and summer in the great outdoors today!