By Robert W. Sugerman, MD | Contributor
Ahhh, springtime! The season brings back life to nature, longer days, gentle breezes, and signals the lazy summer days ahead… However, for roughly 15% of people, spring can be a time of suffering due to pollen allergies, which manifest as a runny nose, sneezing, congestion, and itchy, watery eyes.
In North Texas, “pollen season” begins with cedar trees pollinating in January and February, followed by tree pollination from February through April. Once spring thunderstorms clear away the remaining oak pollen in mid-April, pasture grasses sprout vigorously, releasing large amounts of pollen, which can persist through most of June. Thus, if you are allergic to common pollinating plants like cedar, oak, and grasses, expect to feel the effects during outdoor activities in bright and breezy conditions from January to June.
The plants that primarily trigger allergies are non-flowering varieties that emit large quantities of tiny pollen grains, most of which are too small to be seen. This detail is significant for two reasons. Firstly, pollen carried by the wind can travel long distances, meaning that removing a majestic live oak from your yard will barely affect your total pollen exposure—and it could even decrease your property’s value significantly. Secondly, what’s visible in the wind isn’t necessarily the cause of your allergies. For example, while cottonwood fibers may be annoying during May and June, they do not contain pollen and thus aren’t the culprits. Grass pollen, which is not visible but is prevalent in May and June, is the true offender.
POLLEN AVOIDANCE:
Avoiding pollen can be challenging! As mentioned, uprooting flowering plants on your property is not particularly beneficial. Even relocating to another area won’t help, as your allergic tendencies will follow you, leading to sensitivities toward local plants. The only certain places that might be safe are Mars and Antarctica. Staying inside and keeping windows shut on beautiful spring days is the most effective method to avoid pollen, but I don’t recommend this approach for various health and social reasons. Washing your face and rinsing your nose with saline after being outdoors during high pollen counts can be beneficial. If you plan to skip a shower that evening, consider wiping your hair with a damp towel before bedtime to avoid transferring pollen to your pillow.
MEDICATIONS:
Fortunately, many of the effective medications for allergy relief can be bought over the counter at low prices and are generally safe for long-term use. However, it’s essential to note that Flonase™ has a warning suggesting it should not be used for more than two weeks. In reality, when used correctly, these medications usually don’t lead to side effects with prolonged use, with nosebleeds being the most common concern. Other over-the-counter topical corticosteroid nasal sprays include Nasacort™ and Rhinocort™. When used regularly, these can help decrease the allergic inflammation that causes most nasal allergy symptoms. Newer non-sedating antihistamines (like Claritin™, Zyrtec™, and Allegra™) and their generics (loratadine, cetirizine, fexofenadine) can be bought without a prescription. Ideally, these should be taken before exposure to allergens to counteract the effects of histamine. Minimal sedation is linked to these, allowing you to take them in the morning before outdoor activities. Older antihistamines (like Benadryl™ and Chlor-Trimeton™) effectively relieve allergy symptoms but tend to cause drowsiness, so it’s best to take them when you plan to rest. Combination antihistamine-decongestant products labeled with a “D” are more costly and require I.D. for purchase since pseudoephedrine (a key ingredient) can be used in illicit drug manufacturing. The decongestant can relieve nasal congestion, unlike antihistamines, which do not address this issue. Side effects may include insomnia, increased blood pressure, and difficulties urinating for older men with prostate enlargement.
DESENSITIZATION (ALLERGEN IMMUNOTHERAPY):
For over a century, allergists have effectively managed allergy symptoms with allergenic extracts through injections targeting common allergens like tree, grass, and weed pollens, dust mites, molds, and dander from cats and dogs. Typically, treatment involves an escalation phase with weekly injections lasting 6 months to reach maintenance doses, followed by maintenance injections every 2-4 weeks for 3-4 years. Many patients report significant improvement within three months of reaching maintenance doses, with effects lasting 5 years or more following treatment completion. There are rapid escalation protocols, but maintenance injections are generally recommended for 3-4 years. Due to the risk of serious allergic reactions (anaphylaxis) from allergy shots, these must be given in a medical setting under professional supervision. Home administration of allergy shots is generally not advised by board-certified allergists. Recently, a trend has emerged for using commercial allergenic extracts sublingually (as “allergy drops” under the tongue) daily at home. The doses needed to replicate the effectiveness of allergy shots range from 10 to 50 times greater than those used in injections. Because sublingual allergy drops involve off-label use of injection-formulated extracts, insurance typically does not cover this therapy. Currently, four FDA-approved sublingual allergen tablets target allergies to dust mites, ragweed, and certain northern pasture grasses (not local varieties). These prescription products require daily consumption for three months before pollen season begins and must be taken throughout the pollen season.
If your allergy symptoms disrupt your sleep or daily activities and don’t respond well to medications, consider consulting an allergist for further assessment and options for allergen immunotherapy.
Editor’s Note: For more information, contact Robert W. Sugerman, MD at Allergy Partners of North Texas. www.allergypartners.com/northtexas
Editor’s Note: This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment, and does not constitute medical or other professional advice.
