Allergy Types: Seasonal Allergies: Fall Allergies
Autumn has arrived, and you don’t feel so good. You can’t stop sneezing and sniffling. The return of cool weather leaves you feeling not invigorated but miserable.
What’s going on? You may be suffering from pollen allergy, a.k.a. allergic rhinitis or hay fever. Thirty million Americans do, and symptoms typically flare in fall.
Like all allergies, hay fever stems from a glitch in the immune system. Instead of attacking harmful foreign substances such as bacteria and viruses, it tries to neutralize “invaders” that ordinarily are quite harmless — in this case weed pollen grains that fill the air from August through October (up to the first frost).
In someone with hay fever, inhaling these tiny particles triggers a cascade of biochemical reactions, resulting in the release of histamine, a protein that causes the all-too-familiar symptoms. In addition to sneezing, congestion, and fatigue, histamine can cause coughing; post-nasal drip; itchy eyes, nose, and throat; dark circles under the eyes; and asthma attacks.
Fall Allergies: Understanding Allergens
“Inhalant allergens are substances that can trigger allergy symptoms when inhaled by sensitive people,” explains Bruce Gordon, MD, an ear, nose, and throat allergy specialist at Cape Cod Hospital in Hyannis, Mass., and an instructor at Harvard University in Cambridge, Mass.
“Inhalant allergens are divided into two types on the basis of their persistence: perennial and seasonal,” Dr. Gordon says. “Perennial allergens are present throughout the year, with little variation. Seasonal allergens have distinct periods of time in which they are present in the environment in large quantities.”
Gordon says that plants typically pollinate in three seasons: “These seasons vary in length as a function of the growing season. In the spring, trees pollinate. In the summer months, especially in early summer, grasses pollinate. Finally, in late summer and into fall, weeds pollinate.”
Fall Allergies: Ragweed
One of the main contributors to fall allergies is the ragweed plant. A single plant can produce one billion pollen grains per season. Ragweed grows abundantly throughout the South, North, and Midwest, and its lightweight pollen grains can travel up to 400 miles in the wind.
“Ragweed pollen has a very distinct season from late summer to mid-fall,” says Gordon. “East of the Rocky Mountains, ragweed is the predominant cause of outdoor fall allergy symptoms.” Ragweed can be found growing in vacant lots, along the road, and in open fields. “In areas with colder temperatures, the first frost usually occurs at about the time ragweed pollination ends. In Southern regions, ragweed may pollinate through the winter,” notes Gordon.
Fall Allergies: Other Weeds
In various parts of the country, goldenrod, curly dock, lamb’s quarters, pigweed, sheep sorrel, and sagebrush can all cause fall allergies. “Goldenrod blooms at the same time that ragweed does, but it is insect-pollinated [as opposed to wind-pollinated] and is not a significant allergen for most individuals,” Gordon says. “The bright goldenrod flower, however, does alert everyone that the more inconspicuous ragweed is also blooming.”
Fall Allergies: Molds
Outdoor molds are another cause of fall allergies. They first appear in early spring, but thrive until the first frost. They are common in soil, compost piles, and in the leaves that cover the ground during the fall. “In temperate climates, mold spores form a distinct fall season in mid to late fall, after ragweed season is over. Mold spores are common airborne allergens. They are light, very small, and easily inhaled into the lungs. Spores rise high in the atmosphere during the warming of the day, falling back to the ground with the cool of evening,” says Gordon.
Two key steps in the process of allergy diagnosis are the medical history and allergy test selection. Allergists use their skills in these areas to help more patients feel well, stay active during the day, and rest at night. And that’s nothing to sneeze at.
Why Take a Medical History?
When it comes to human allergic disease, an individual’s medical history is as important as the results of an allergy test. Medical history is the critical link between allergy test results and allergic disease itself.
Allergy skin testing is the gold standard and is used along with the medical history to establish a diagnosis. Both blood and skin allergy tests can detect a patient’s sensitivity to common inhalants like pollen and dust mites or to medicines, certain foods, latex, venom, or other substances. Generally skin testing is the most accurate and preferred method used by trained allergists. Allergy blood tests may be ordered in certain specific situations, such as severe skin rashes, or if it is impossible to stop a medication that interferes with the interpretation of the skin test.
If the results of skin and blood allergy tests are not clear or are inconsistent with the patient’s medical history, allergists rely on their training and experience along with a patient’s medical history and a physical examination—not test results—to make the final diagnosis.
Research confirms what allergists already know: Allergy tests are valuable for their ability to give accurate and reliable results that confirm information gathered in the medical history.
Why Is Allergy Test Choice Important?
An important related consideration is for health practitioners to choose the right test, the one best able to aid the diagnostic process. For many reasons, that’s not an easy job. Allergy patients are often sensitized to many allergens, but are only clinically allergic to one or more specific substances. Allergists are trained to select tests that pinpoint the relevant allergen, which enables them to develop optimal therapies for each patient.
Board-certified allergists recognize that not all allergy tests are alike. They regularly review the scientific literature to learn which testing systems work better than others and the laboratory practices that may affect test results.
Allergy tests should not be ordered randomly, either. They are chosen based on symptoms, environmental and occupational exposures, age, and even hobbies. All results are then interpreted in the context of the patient’s medical history.
Get the facts: Make an appointment with a board-certified allergist in your area.
How An Allergist Diagnoses Allergies
If you have never been diagnosed with allergies but think you might have them or aren’t sure what causes your allergy symptoms, see an allergist.
- Allergy skin tests and testing standards
When you visit an allergist, the doctor will:
- Take a medical history. You will be asked about your health, your symptoms and whether members of your family have asthma or allergies such as hay fever, hives or skin rashes like eczema.
- Ask you about your symptoms. The doctor will want to know when symptoms occur, how often they happen and what seems to bring them on. The allergist will also ask about your work, home and eating habits to see if these can provide clues to help pinpoint your allergy.
- Do a physical exam.
- Conduct allergy tests.
Tests can be done for common allergens such as plant pollens, molds, dust mites, animal dander, insect stings and various foods such as peanuts, eggs, wheat, shellfish and milk. Testing also is available for some medicines, such as penicillin. There are two types of skin tests:
- The prick test pricks the surface of the skin with a tiny amount of the allergen. The test is done on your back or the inside of your arms with several allergens tested at once. If you’re allergic, redness and swelling appear at the site of the prick.
- The intradermal test injects the allergen with a very fine needle under the first few layers of the skin. This type of skin test may be used when the result of a prick test is not clear.
Allergy Blood Tests
Skin tests are more sensitive than blood tests, but an allergist might use a blood test to diagnose allergies if:
- You’re taking a medicine that could interfere with allergy test results.
- You have very sensitive skin or a serious skin condition.
- You had a previous reaction to an allergen that suggested you were very sensitive and should avoid more exposure.
After drawing blood, the sample is sent to a lab to look for the antibodies of specific allergens that show if you have allergies. It takes a few days to receive blood test results.
No matter what type of allergy test is given, allergists are experts at selecting which allergens should be tested, reviewing the results, and helping you find the right treatment for relief.
- Allergies themselves are not serious. However, infections—such as a sinus infection characterized by fever, pain, and green or yellow nasal discharge—can mimic allergies.
Over-the-counter (OTC) allergy medications may ease your discomfort. Antihistamines can stop the itching and sneezing caused by the release of histamine that the body produces in response to allergens. Antihistamines block the action of histamine. There are many over-the-counter varieties, including diphenhydramine (Benadryl) and clemastine (Tavist).
Although OTC antihistamines are effective in minimizing hay fever symptoms, they can cause extreme drowsiness. In fact, some people use antihistamines as a sleeping aid. Dry mouth is another common side effect. Less common are confusion and blurred vision. Over-the-counter antihistamines all have warning labels urging users not to operate heavy machinery or drive while taking the medication. Pilots are prohibited from using an OTC antihistamine. Some people are able to will themselves to stay awake and remain semi-functional, but do not be fooled by a false sense of well-being. Even if you think you are alert, your coordination and reaction skills are still impaired while on OTC allergy medication.
A nasal decongestant such as pseudoephedrine may help relieve a stuffy nose due to allergies. This medication constricts the blood vessels and reduces blood flow to the nasal passages, which reduces swelling. Insomnia, restlessness, and difficulty urinating are among the possible side effects. For some people, however, a simple nasal decongestant is not effective because it will not stop sneezing and a runny nose. The pollen will relentlessly trigger the release of histamines, and a nasal decongestant, depending on the severity of the allergies, may not be able to combat the force of the body’s reaction.
A commonly used nasal decongestant, phenylpropanolamine (PPA), was pulled off the shelves after the FDA issued a warning on its possible side effects. Research has linked PPA (a common ingredient in both cold medicines and appetite suppressants) to a slight increase in stroke risk in women. Occasional reports of hemorrhagic stroke (a type of stroke that causes bleeding in the brain) in people using PPA-containing products prompted a careful look at the drug. The studies found that people taking PPA were more likely to have strokes than those not taking PPA. Although the risk of stroke was very low, the FDA recommends that you not use any products that contain PPA because of the seriousness of a stroke and the inability to predict who will be affected. The risk was found primarily in women, though the FDA notes that men may be affected as well.
Your doctor is the best source of information on the drug treatment choices available to you.
Consider allergy shots if you suffer from allergies for many months of the year, cannot tolerate allergy medications, or develop asthma during pollen season. A series of injections can make you less sensitive to the effects of pollen by helping your immune system become increasingly resistant to it. “Immunotherapy” involves injecting small amounts of the specific allergen you are allergic to and gradually increasing the dose so that you develop a tolerance to it. To be effective, injections must be given a regular basis (determined by your allergist) over the course of three to five years.
Some alternative remedies may be helpful in minimizing allergy symptoms. However none of these remedies have been shown to be effective in carefully controlled studies. The herb ephedra (ma-huang) contains ephedrine, a naturally occurring compound that has been employed by pharmaceutical companies in numerous allergy medications. The FDA has banned sales of the herb because it can be dangerous and has been associated with heart attacks and strokes. Do not take ephedra with allergy medications that contain ephedrine as doubling the dose may cause dangerous side effects.
Nettle is a folk remedy for the sneezing, itching, and swelling associated with allergies. The plant contains quercetin, a substance that has been shown to inhibit the release of histamine. In one study of allergy sufferers, more than half of those who took nettle reported that the herb was at least moderately effective in reducing allergy symptoms compared with a placebo. Nettle is considered to be very safe.
Pregnant and breastfeeding women should speak with their doctors before using allergy medications. Some drugs are not safe to use during pregnancy; others can be passed through breast milk and should be avoided by nursing mothers. Dosages are different for adults than they are for children. Follow your doctor’s instructions.
Do not use an antihistamine that causes drowsiness before doing activities that require alertness, such as driving, operating machinery, or piloting a plane. OTC and older prescription antihistamines can delay reaction time and interfere with concentration.
Allergies may be controlled with OTC medications. Should these fail to bring you relief, see your doctor about switching medications or beginning allergen immunotherapy.
Tips to Manage Symptoms
- Stay indoors with the doors and windows closed when pollen is at its peak (usually in the late morning or midday). Check pollen counts in your area.
- Before you turn on your heat for the first time, clean your heating vents and change the filter. Bits of mold and other allergens can get trapped in the vents over the summer and will fill the air as soon as you start the furnace.
- Use a HEPA filter in your heating system to remove pollen, mold, and other particles from the air.
- Use a dehumidifier if you need to, to keep your air at between 35% and 50% humidity.
- Wear a mask when you rake leaves so you don’t breathe in mold spores.
1.Make Your Home a Pollen-Free Haven
As much as possible during ragweed season, keep your windows shut and the air conditioner on (and do the same while in your car). “Running the air conditioner will also help remove moisture from the air, which helps prevent the growth of mold,” says James Stankiewicz, MD, chairman of the department of otolaryngology at Loyola University Chicago Stritch School of Medicine. “Mold can aggravate hay fever symptoms.”
HEPA air filters can be helpful, especially if your home is carpeted. One per room is best, says Christine Franzese, MD, assistant professor of otolaryngology at the University of Mississippi Medical Center in Jackson. If that’s not in the cards, get one for the room where you spend most of your time — presumably your bedroom. You might also consider getting a HEPA vacuum cleaner — otherwise, vacuuming might just stir up pollen rather than remove it.
2. Wear a Mask
A surgical-style facemask isn’t going to be 100% effective at protecting you from pollen — “you’d need a full-body hazmat suit to do that,” says Franzese. But a mask can cut your exposure substantially, and is worth donning when you venture outside to garden, mow the lawn, exercise, and so on.
Look for a facemask with an “N95” rating from the National Institute for Occupational Safety and Health (NIOSH). You should be able to pick one up at a drugstore or home supply store.
“I know it’s no fun to wear a mask, but it really will help you from breathing in all that pollen and mold,” says Kao. “The key is to use it properly. It should fit tightly around the mouth and nose — feel around it to make sure no air is coming in around the edges.”
3. Wash Up
Whenever you come in from outside, wash your face and hands. If you’ve been exposed to outdoor air for quite a while, shower and change into fresh clothes.
If you share your home with a furry friend that ventures outdoors, brushing and bathing it outside will help prevent pollen from being tracked inside.
4. Watch What You Eat
Because they contain proteins similar to the ones in ragweed, certain foods can exacerbate allergy symptoms. Steer clear of banana, melons, and chamomile.
5. Rinse Out Your Nose
Nasal douching — using a salt-water solution to wash pollen from your nostrils and sinuses — can be very effective at curbing hay fever symptoms. A quick spritz in each nostril is not enough, experts say.
Use a neti pot or an over-the-counter irrigator, such as those sold under the brand names Ocean and Ayr.
6. Track Pollen Counts
On days when the pollen count is especially high, stay indoors. For reliable pollen (and mold spore) counts in your area, go to http://www.aaaai.org/nab/index.cfm.
If these pollen-avoidance strategies fail to bring relief, medical therapy may be in order. Nonprescription antihistamines, such Claritin andZyrtec, are generally the first choice for mild to moderate symptoms (no need to pay extra for brand names, as generics cost less and work just as well).
If you’re bothered by congestion as well as sneezing and a runny, itchy nose, adding a decongestant such as Sudafed should help. There are also antihistamine-decongestant combinations available. These products generally include a “D” in the name, as in Tavist D. (If you havehigh blood pressure, ask your doctor if taking a decongestant is OK. Some cause a potentially dangerous rise in blood pressure.)
For severe or persistent symptoms, a steroid nasal spray (Flonase,Nasonex, and so on) may be helpful. If you’ve developed a sinus infection, a course of antibiotics might be needed. Another option that works well for some patients is a leukotriene inhibitor, such as Singulair or Accolate. These medications block the release of leukotriene to help reduce inflammation and other symptoms of allergic rhinitis. If symptoms are especially troublesome, you might need immunotherapy (allergy shots).
Experts say the best approach may be to start treatment early and combine various therapies Whichever prevention strategies and medications you decide upon, don’t wait until the last minute to start using them.
The symptoms of fall allergy can range from mild to life threatening. If a food or ingredient is easy to avoid, the allergy may interfere very little with daily life. Some foods and ingredients, however, are widespread, and avoiding them will involve careful monitoring. Some food allergies disappear as a child ages.
Common complications of fall allergy include the following:
- Secondary infection: This is a bacterial infection that occurs in tissues such as the mucous membranes of the nose, throat, or sinuses or the ear that have already been irritated and inflamed by the allergic reaction. Ear infection (otitis) or sinus infection (sinusitis) are common secondary infections of hay fever.
- Rebound nasal congestion (rhinitis medicamentosa): This may result from using decongestant nasal sprays more than twice daily for 3 consecutive days.
- Enlargement of lymph nodes in the nose and throat
- Decreased lung function
- Facial changes: Most of the facial changes are because of local inflammation and congestion. These are temporary and resolve with the treatment of the disease. These include facial swelling, redness around the nose, and allergic “shiners.”
- The crease across the top of the nose caused by frequent nose wiping can persist in children with long-term hay fever.