Allergies Seasonal

By Joshua Davidson M.D.


Spring has arrived, and individuals with allergies are in for a difficult few months. The late February precipitation across much of the US has boosted tree pollen levels, making symptoms even worse than usual. Allergy symptoms are often worse in the early morning, and at night, making sleep difficult for many allergy sufferers.

There are typical symptoms of allergic rhinitis, or hay fever, and they consist of:

1. Itching of the nose, eyes or ears
2. Runny or congested nose
3. Sore throat
4. Post-nasal drip
5. Cough


In addition, individuals with asthma can experience exacerbations due to allergies. In these cases, hay fever symptoms can induce wheezing, shortness of breath, and even chest pain.

Fortunately there are many ways to help people with allergies, including home remedies. Specific recommendations are made based on the allergic trigger. Common triggers include tree, grass and weed pollens, but many people also suffer from dust mite and mold allergies.

For individuals with pollen sensitivity, here are some good recommendations:

1. Stay on top of pollen counts. There are websites available that rank daily pollen counts according to city or zip code. Stay inside, if possible, when levels are high.

2. If you work outdoors, enjoy gardening, or otherwise, use a mask. The best mask for the job is the N95 filter mask, which prevents you from inhaling pollens into your nose or mouth.

3. Manage your stress, if possible. Stress can make allergy symptoms worse, so do your best to maintain your stress levels.

4. Flush out the pollen with a salt-water (saline) rinse. Every pharmacy sells inexpensive kits for mixing salt, baking soda and water. This solution can be used as a spray or rinse, and instilling it into the nose can eliminate most of the pollen. This helps prevent hay fever symptoms, and it’s a nice natural treatment option.

5. If necessary, take an antihistamine like cetirizine (Zyrtec) or fexofenadine (Allegra). These are available as generic medications, and are inexpensive. Zyrtec is available over-the-counter, while Allegra requires a prescription.

6. If all of the above don’t help, consider trying a nasal spray like Flonase or Nasonex. These help to decrease the allergic symptoms, and work very well. They require a prescription, but allergy sufferers find great relief with these options. It’s important to avoid decongestants, as they don’t help with allergy symptoms, and can actually worsen allergies if used regularly.

As you can imagine, I also get many questions regarding allergies, asthma, etc. Here are a few:

How can I get allergy tested?
Fortunately, it’s quite easy to get allergy tested, under the supervision of an allergist. Allergy testing comes in two forms: skin and blood testing. Most allergists begin with skin testing, as it’s simple, quick and accurate. Small amounts of different types of allergens (e.g. pollens, dust mite, pet dander) are placed on small scratches made on the back or arm, and the area is assessed after 15 minutes. A hive represents a positive test, and indicates an allergy to that particular allergen. This method is referred to as skin prick testing.

Additional skin testing can be performed via the intradermal method. This requires placing small amounts of allergen into the dermal layer of the skin. This method is also used for tuberculosis testing, where a small “bubble” is made in the skin. While intradermal skin testing has a use with insect sting and medication allergy, I don’t recommend it for environmental or food allergy testing. With environmental intradermal testing, the trauma from the test itself can generate a false positive reaction. With food allergy testing, the intradermal technique should never be used as it can cause anaphylaxis.

Blood testing is often reserved for food allergies, but can also identify environmental allergies, especially in young children or patients with severe eczema who can’t be skin tested. This method measures levels of allergic antibodies in the blood, known as Immunoglobulin E, or IgE. IgE levels correlate with the likelihood of a reaction. Therefore, the higher the level of antibodies, the greater the chance that an individual will react to that allergen. It is essential to remember that IgE levels do not correlate with the severity of a reaction. That is, a high level to peanut, for example, only implies that the patient will likely react to peanut exposure. However, that reaction may only be mild itching of the mouth, or worsening eczema, and not necessarily anaphylaxis.

Do allergies cause asthma?
Yes, they can. In patients with a history of asthma, allergies can definitely make asthma worse. Sometimes individuals will only experience the wheezing and coughing associated with asthma, without the typical hay fever symptoms. For these individuals it is very important to maintain possession of a rescue inhaler, to be used as needed. See your allergist if your symptoms are difficult to control.

I’ve tried many different sprays and medications for my allergies. What other options are there?
For some people, all the sprays and medications aren’t enough. The symptoms can continue, or even worsen, and it is understandable why people become frustrated due to allergies. Fortunately, there is immunotherapy, otherwise known as allergy shots. This treatment option offers a rare opportunity to permanently effect change. Allergy shots involve repeated injections of allergens, beginning with extremely low levels, and slowly building up to a higher dose. Over time the body becomes tolerant to the allergens, and no longer recognizes them as harmful. The typical course for allergy shots is 2-3 years, but this can be shortened if necessary. The good news is that once allergy immunotherapy courses are completed, people can have decades of relief, never needing allergy medicine again.

Are there any new food allergy treatments available?
Researchers across the country are working hard to find treatment for food allergies. Promising data from several studies of food allergy immunotherapy are being published. The concept behind environmental allergy shots is being applied to food allergy drops in the mouth. That is, patients are receiving extremely small volumes of foods they are allergic to, and the volume is slowly increased over time. Studies from Duke University and Mt. Sinai School of Medicine have shown excellent promise, and I anticipate that in the next 5-10 years we will be treating patients for their food allergies.

Overall, I encourage allergy sufferers to follow these recommendations, and to see an allergist if you’re concerned or have questions. I’m available and happy to answer questions, and I hope this information helps people get the treatment they need. As an allergist and allergy sufferer myself, I know how difficult allergies can be.

About Dr. Davidson: I grew up in the South Bay, and after spending my undergraduate and graduate school years on the East Coast, I returned to Los Angeles for medical school and residency training. I obtained my Allergy/Immunology fellowship training at National Jewish Health in Denver, Colorado, the #1 respiratory hospital in the United States for the past 11 years. I am pleased to return to serve my home community.


If you are interested in finding out the pollen levels in your area,
click on Pollen Today to be directed to our recent pollen report.

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