Hay Fever (Seasonal Allergic Rhinitis) FAQ
While most people gratefully welcome the longer days and warmer weather of spring, more than 35 million Americans dread the itchy eyes, runny nose and sneezing that comes with the season’s pollens and mold spores. Fortunately, there are more treatments than ever to relieve these symptoms. New non-sedating antihistamines and nasal steroids can help relieve symptoms of hay fever and other allergic conditions so you can once again enjoy spring.
National Jewish is a world leader in allergy research and treatment. Learn how our doctors, Henry Milgrom, MD, Lanny J. Rosenwasser, MD, and Richard Weber, MD , answer frequently asked questions concerning hay fever (seasonal allergic rhinitis).
What Causes Hay Fever?
How is Hay Fever Diagnosed?
How is Hay Fever Treated?
What Causes Hay Fever?
Question: What causes my allergies to flare up in the spring?
Dr. Weber's Answer: Pollen is the most likely cause. Your immune system has mistakenly learned to remember the pollen released by various plants as potentially harmful, and responds with the familiar allergic symptoms. Each species of plant releases pollen at about the same time every year. Trees are usually the first plants to release pollen, usually in the early spring. Grasses come next in the spring and early summer. Weeds generally release their pollen in late summer and fall. The specific types of pollen and the time of their release depends upon the local climate and varies around the country. People with seasonal rhinitis are often allergic to more than one type of pollen.
Question: What can influence the severity of the allergy season?
Dr. Weber's Answer: Weather can influence the timing and severity of the allergy season. A mild winter often leads to a more severe pollen season. The grass season varies the most. If the spring is warmer and wetter than usual, then more grass grows, which leads to a more severe season during the late spring and summer. However, rain can have benefits, as well. For instance, rain can wash pollen that has already been released out of the air.
Question: My husband suffers from asthma and allergies but hasn't had trouble with either since we moved to Colorado. However, we want to go to a place to dance and we have been warned that it will be smoky. Will he probably need an inhaler for this? What do you suggest?
Dr. Rosenwasser's Answer: Irritating triggers can activate asthma and allergies - even when they are under control. Therefore, if you are going to be exposed to irritants like smoke, dust, or other air pollution it is wise to take along your rescue inhaler and take it at the first symptoms.
Question: I have always had normal nasal (rhinitis) symptoms but this year, I have also developed asthma and food allergies. In the last three weeks, as trees have been starting to bud, I have developed severe skin "itchiness". I am very sensitive to various fabrics - cotton seems to be the only thing I can tolerate. Is this a typical allergic response? What can I do to stop the itching?
Dr. Rosenwasser's Answer: Many people with nasal allergy (allergic rhinitis) and springtime allergies develop significant symptoms such as itchy skin, as you are experiencing. Another phenomenon known as oral allergy syndrome occurs when cross-reactions between allergy pollen and food allergens cause itchiness and swelling in the mouth and throat after eating the food allergen. Antihistamines are a good treatment for this.
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How is Hay Fever Diagnosed?
Question: How can I tell whether I have allergies or just a cold?
Dr. Weber's Answer: Generally, allergies last longer than a cold, often for a few weeks. If you notice a pattern in which you suffer the same symptoms at the same time year after year, you are likely suffering from allergies. Frequent sneezing and itchy, watery eyes are more often associated with an allergy rather than a cold. Also, a clear nasal discharge suggests that you are suffering from allergies. When you have a cold, the mucus is usually greenish or yellowish. A fever is also indicative of a cold. Sometimes it can be hard to tell the difference between seasonal allergies, a cold or another condition. That's when a skin test may be necessary.
Question: I am 68 and seem to be developing allergies to flowers, tree pollen, etc. How do I find out what I’m allergic to, and do I need to start year round treatment?
Dr. Rosenwasser's Answer: The best way to diagnose allergy is skin testing and evaluation and interpretation of your history and skin test results. It would be unusual for someone age 68 to develop new allergies but it is not unheard of. I would recommend an evaluation with skin testing by an allergist.
Question: With mold becoming more of a factor in sinus infections, as well as lung infections, how can you tell the difference between an allergy and exposure to mold?
Dr. Rosenwasser's Answer: To differentiate mold allergies from other types of allergies, an evaluation by an allergist - including skin testing - would be required. The exact role of all molds in causing sinus and lung disease is very complicated and the focus of a lot of research.
Question: Can you please tell me the difference between RAST testing and skin testing? Is one more beneficial than the other?
Dr. Rosenwasser's Answer: RAST testing is a blood test for allergy; skin testing involves needle scratches directly on the skin of the patient. Skin testing is cheaper and more accurate than RAST testing, but occasionally, as in the case of a complicating skin disease or the lack of patient access to an allergist, RAST testing is a better alternative. RAST stands for ‘radio-allergosorbent test’ and measures the amount of IgE anitibody in the blood – the antibody involved in allergies.
Question: What is a skin test? How does it work?
Dr. Weber's Answer: A skin test detects the presence of antibodies to a particular allergen, a substance that causes an allergic reaction. A positive test suggests that you may have an allergy to the particular substance. However, your doctor will review your skin-test results, your medical history and conduct a physical exam to confirm which allergens are causing your symptoms. A skin test is performed by first placing a drop of allergen extract on the skin, then the skin is pricked with a needle. If you have a positive reaction to the extract, a red welt will appear on your skin in about 20 minutes. The size of the welt indicates the strength of the reaction. If you do not react to the extract you are most likely not allergic to the substance.
Read more information about allergy testing.
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How is Hay Fever Treated?
Question: How do I treat seasonal allergies?
Dr. Weber's Answer: There are three main strategies: 1) avoidance; 2) medication; and 3) immunotherapy.
- Avoidance
Although it can be difficult to avoid pollen, there are several steps you can take to reduce your exposure. First of all, keep your windows closed and use air conditioning - even on days that are not extremely warm. Next, avoid outdoor activities during peak pollen times of the day. Grass pollens are most prevalent during afternoon and early evening, while ragweed pollens are most prevalent during early midday. Pollen counts are commonly high during dry, windy afternoons. Finally, it can be helpful to take a shower and change your clothes after spending time outside. A shower washes off the pollen that sticks to your skin or hair. Keep your outside clothes in the laundry room and away from your bedroom.
- Medication
Antihistamines can reduce runny nose, sneezing and itchy, watery eyes. First generation antihistamines, such as Benadryl, are available over-the-counter but can cause drowsiness. The non-sedating antihistamine, Claritin, has recently become available over-the-counter. Other non-sedating antihistamines are available by prescription from your doctor. Itchy eyes can be helped by antihistamine eye drops, also available by prescription. In moderate or severe cases of hay fever, prescription inhaled steroids are often used to decrease nasal congestion. You should talk to your doctor to decide what medications are best for you.
- Immunotherapy
If avoidance and medications fail to control your symptoms, immunotherapy can usually help. Also known as allergy shots, immunotherapy consists of a series of injections containing the allergen that triggers your symptoms. Over time, the shots reduce your sensitivity to the allergens. Immunotherapy usually begins with injections of a weak solution of the allergen given once or twice a week. The strength of the solution is gradually increased. Once the strongest does is reached, shots continue about once a month until the allergy symptoms are controlled, often three to five years.
Read more information about immunotherapy.
Question: Does immunotherapy cure my seasonal allergies ?
Dr. Weber's Answer: No. Right now, there is no cure for allergies. Immunotherapy can, however, have a protective effect for up to several years.
Question: I have been reading about a six-week program for nasal allergy (allergic rhinitis) . Will allergists soon be able to offer this to their patients?
Dr. Rosenwasser's Answer: Immunotherapy can be given in a rush pattern that is completed in six weeks. Other, more experimental treatments can be given within a season, but they are not yet approved. If you experience only one allergy season, then standard treatment with antihistamines and nasal steroids can work well.
Question: I am extremely allergic to grass, tree, weed pollen, mold, and mites, dogs and cats . I avoid the latter animals but this season is so intense with pollen nothing I take lasts for more than four or five hours . I have tried Allegra, Claritin, Zyrtec, Clarinex, Astelin, Trinilin, and Allerex. All but the Allerex and Astelin are too weak, the Astelin and Allerex are very strong - make me sleepy all day. I also use Flonase nasal spray twice a day. Any ideas? I can't even go outside of my house without a mask - and that doesn't help much--within minutes my eyes, nose and asthma kick up.
Dr. Rosenwasser's Answer: Immunotherapy may help with such numerous and severe allergies. It may help you avoid some of the side effects that you describe from the medicines.
Question: I have hay fever really bad in the spring and the fall, how soon before my bad season starts should I take my allergy meds ?
Dr. Milgrom's Answer: Most medications are effective within a matter of days. Cromolyn takes a full month to be completely effective. Allergy shots may take as long as two years.
Question: I am allergic to oak trees, and of course I live in the woods with only oak trees around. What is the best thing to take besides moving away? I already take Allegra D.
Dr. Rosenwasser's Answer: Outdoor pollens can get indoors so keeping the doors and windows shut is important. When conditions are dry and windy, the pollen counts are usually highest in the afternoon so working in the yard may be better in the morning and evening. But other than moving away, there is no way to completely avoid it.
Question: What would you recommend for treating a severe allergy to Timothy grass for a child under the age of 12 ?
Dr. Rosenwasser's Answer: I’d recommend the standard treatments for a child under the age of 12, which include a non-sedating antihistamine such as Allegra, Claritin or Zyrtec, and immunotherapy. The antihistamines are approved at least to age 6 and above and some forms of antihistamine medication, such as Claritin Readi-tab and Zyrtec syrup, can be given to children as young as 2. Allegra, at a dose of 30mg, is approved for children age 6 and older.
Question: What is the cause and how do I get relief for watery eyes? I am a 70 yr old male with asthma. My eyes water constantly, so much so that tears run down my face. This occurs when I go outside (e.g. grocery shopping, walking, etc).
Dr. Rosenwasser's Answer: Watery, itchy eyes are usually related to allergic conjunctivitis, although other eye conditions can cause these same symptoms. Patanol eye drops can relieve the symptoms of itchy, watery eyes that you describe. Patanol uses a combination of antihistamines and mast-cell stabilizers. Check with your doctor about trying this.
Question: My allergy goes to my eyes and the doctor here in Lima told me not to use drops with steroids . What do you recommend for me to use?
Dr. Rosenwasser's Answer: Patanol eye drops are not steroids and may help.
Question: Could you talk about the effect of the drug Xolair on nasal allergy (allergic rhinitis) ?
Dr. Rosenwasser's Answer: At this point, Xolair has only been approved for use in the treatment of moderate to severe allergic asthma. There have been no studies done on its effect on rhinitis.
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