By Robert W. Sugerman, MD | Contributor
Ahhh, springtime! Renewal of dormant life, lengthening of daylight hours, gentle breezes, and the promise of lazy summer days ahead… But for some people (approximately 15% of the population), the arrival of spring brings misery in the form of runny nose, sneezing, congestion, and itchy, watery eyes caused by pollen allergies.
Owing to a combination of climate and geography, “pollen season” in North Texas actually starts with cedar pollination in January and February, which overlaps with spring tree pollens February through April. And immediately after spring thunderstorms wash away the last remnants of oak pollen in mid-April, pasture grasses start to grow rapidly, dispersing large quantities of pollen, which continue through most of the month of June, or even longer if we have a cooler, wetter summer. So, if you are allergic to exactly three common pollinating plants in North Texas (cedar, oak, and grasses), you can expect to experience discomforting allergy symptoms with outdoor activities in bright, breezy conditions during the months of January through June.
In case you didn’t notice from the brief tour of allergenic pollens above, the kinds of plants that bother allergy sufferers are non-flowering varieties that produce large quantities of very tiny pollen grains, most of which are individually invisible to the naked eye. Why is this important? First, wind-borne pollens may travel long distances. Thus, removing that majestic live oak tree from your yard will not only have little effect on your total pollen exposure, but it will also set you back thousands of dollars in property value. Second, what you see blowing in the wind is not necessarily what you’re allergic to. Take, for example, those cottonwood fibers that you see floating around in May and June. These fibers may clog your pool filter, but they do not contain pollen and thus are not responsible for your misery. Grass pollen, which is invisible but abundant in bright, breezy conditions during the months of May and June, is the real villain.
So, what can be done to alleviate the misery of spring pollen allergies? There are only three treatment strategies: allergen avoidance, medications, and desensitization (allergen immunotherapy).
POLLEN AVOIDANCE: Easier said than done! As noted above, removing pollinating plants from your property won’t help a bit. Even if you decided to move to a different part of the country, you would simply take your allergic tendencies with you and soon become sensitized to native pollinating plants that you’ve not previously encountered. Mars and Antarctica are the only safe bets that come to mind. The most effective pollen avoidance method on planet Earth involves staying indoors and keeping your windows closed on some of the most beautiful days of the year. For a number of health and social reasons, I do not recommend this approach. You may, however, benefit substantially from washing your face and rinsing your nose with saline immediately after outdoor activities during high pollen conditions. If you do not plan to shower that evening, wipe your hair with a damp towel before going to bed in order to avoid tracking pollen into your pillow.
MEDICATIONS: Fortunately, some of the most effective medications for alleviating and preventing allergic symptoms can be purchased inexpensively over the counter, and most are safe for long-term use. Unfortunately, the OTC status of Flonase™ comes with a required warning to limit the use of this medication to no more than 2 weeks. In truth, when taken properly these medications rarely cause any side effects with long term use, nosebleeds being the most common problem. Other topical corticosteroid nasal sprays available OTC include Nasacort™ and Rhinocort™. These medications, when taken routinely, reduce allergic inflammation in the nasal membranes that gives rise to most of the symptoms of nasal allergies. Newer, non-sedating antihistamines (e.g., Claritin™, Zyrtec™, Allegra™) and their respective generic equivalents (loratadine, cetirizine, fexofenadine) can be purchased in bulk without a prescription. Ideally, antihistamines should be taken before anticipated allergen exposures in order to block the effects of histamine release. The very low rate of sedation associated with these products permits morning dosing before you go outdoors to meet and greet the pollens. Older antihistamines (e.g., Benadryl™, Chlor-Trimeton™) are highly effective in alleviating allergy symptoms, but at the expense of sedation. Plan to go to sleep after taking these medications. Combination antihistamine-decongestant products (any of the above followed by “D”) are considerably more expensive and may be purchased only in limited quantities with a government I.D. (because pseudoephedrine is the starting material for crystal meth). The decongestant component alleviates nasal congestion, whereas antihistamines do not address this symptom. Side effects include insomnia, aggravation of high blood pressure, and impairment of urination in older men with enlarged prostates.
DESENSITIZATION (ALLERGEN IMMUNOTHERAPY): For more than 100 years, allergists have successfully treated allergy sufferers with injections of allergenic extracts for a variety of common aeroallergens, including tree, grass and weed pollens, dust mites, molds, cat and dog dander. The treatment course typically involves 6 months of weekly injections to build up to maintenance doses (escalation phase) followed by maintenance injections administered every 2-4 weeks for 3-4 years (maintenance phase). Significant improvement in allergic symptoms and medication requirements is typically seen 3 months after achieving maintenance doses and may persist for 5 or more years beyond the completion of maintenance therapy. Rapid escalation protocols are available, but the recommended duration of maintenance injections remains 3-4 years. Because allergy shots may occasionally cause serious allergic reactions (anaphylaxis), injections should be administered in a medical setting supervised by a medical professional trained and experienced in the recognition and management of such reactions. Home administration of allergy shots are almost never recommended by board certified allergists. During the last 10 years or so there has been a trend toward use of commercial allergenic extracts administered sublingually (“allergy drops” under the tongue) on a daily basis at home. The doses of sublingual allergy drops required to achieve a degree of clinical effectiveness approaching that of allergy shots are typically 10-50 fold greater than doses used in injection therapy. Because sublingual allergy drops involve off-label use of extracts formulated for injection, insurance cannot be billed for this therapy. There are currently 4 FDA approved sublingual allergen tablets on the market that specifically treat allergy to dust mites, ragweed, and northern pasture grasses (but not our regional southern varieties). These prescription products, which are intended to be taken at home, need to be taken on a daily basis for 3 months prior to the start and continued for the duration of the specific pollen season.
If allergy symptoms are interfering with your sleep or activities and not satisfactorily managed with judicious use of medications, you should consider seeing an allergist for additional evaluation and consideration of allergen immunotherapy.
Editor’s Note: For more information, contact Robert W. Sugerman, MD at Allergy Partners of North Texas. www.allergypartners.com/northtexas
