Transcript of "Hay Fever (Seasonal Allergic Rhinitis)" Podcast

Josh Davidson, MD: Welcome to the National Jewish Medical and Research Center podcast number three. Today's topic will be seasonal allergic rhinitis, commonly called hay fever. I would like to welcome Dr. Rohit Katial who will be speaking today about seasonal allergic rhinitis.

Rohit Katial, MD: Thank you for having me.

JD: Now what causes seasonal allergic rhinitis or hay fever?

RK: So hay fever, or the medical term being allergic rhinitis, is caused by a variety of pollen that tend to peak at different times of the year. In individuals that are allergic, or have hay fever, their immune systems have become very sensitive to these various pollens. So when exposed, the consequences are that you develop the typical symptoms; the itchy eyes, the runny nose, the nasal congestion, and sneezing. More specifically, the medical term is that these individuals develop an antibody known as IGE against the pollen and that's what starts the whole process of developing the seasonal symptoms.

JD: What is the best way to manage seasonal allergic symptoms?

RK: The treatment for allergic rhinitis really begins simply with a measure that is non-medical, and that is washing out the nose with salt water. There are various types of formulations that are available that one can use to do nasal irrigations with salt water, but that is a good place to start. After the saltwater treatment, there are a variety of medicines available, or allergy shots are a treatment option as well. And which one is more appropriate for a given patient really needs to be discussed with their healthcare provider, but they both really do provide very good alternatives to really getting the seasonal allergy symptoms under control so the patient can go out and do what they enjoy doing in the summer, spring, and fall times of the year.

JD: In regards to the pollen season, what kinds of pollens dominate during certain times of the year?

RK: What pollens predominate during some times of the year really depends on where you're at in the country. However, there is a general pattern that holds true nation wide, and that is when it begins to warm up and go into the spring, the trees are the first set of plants that do pollinate. So, depending on where you're at, in March or April, you see tree pollen counts. Then going into late April and early May, the tree pollen counts begin to decrease and the grass begins to pollinate and into June you begin to see peaks of grass pollen. In some warmer climates, the grasses will continue to pollinate throughout the summer. In places like Colorado, where we are, one sees a decrease in the grass pollen counts at the end of June and then patients will get a little bit of a reprieve in July. Then in mid-August, the weeds begin to pollinate until the first frost.

JD: Now, as people age, do they tend to develop new or different allergies or if they move to a different environment, does that change what they may be allergic to?

RK: Individuals can develop allergies as they get older-it's not true that if you have allergies you must have developed them as a child. However, it is more common to develop them earlier in life, but one must not forget that you can develop new allergies as you get older. If you move and you have a new exposure and you tend to be an allergic person, you can develop sensitivity and allergy to that new pollen or allergen in your new location. So indeed, in the summer, people can develop new allergies.

JD: In some of our elderly patients, we get complaints about eyes watering and becoming itchy. Are these symptoms always due to allergies?

RK: That's a great question. There are other conditions and systemic illnesses that can result in eye symptoms, or ocular symptoms as we refer to them in the medical arena, and one has to be careful not to attribute all eye symptoms to just allergies, but to make sure that you rule out some of these other conditions. There are connective tissue diseases that can give you ocular symptoms and a whole host of other conditions that one needs to be aware of so that the patient does not get falsely diagnosed.

JD: Two of our most common therapies are antihistamines and nasal steroid sprays. Can we use these concurrently and feel safe about it?

RK: Absolutely, and that's how we frequently prescribe them. The antihistamine gives you some immediate relief, rapid onset in providing symptom relief whereas the nasal cortisone or steroid sprays are really maintenance medications. They take a couple days to really feel their full effects-sometimes a week or two to really have optimal effect-so to get that immediate sense of relief, that antihistamine's really nice, and then the nasal cortisone spray can really carry you throughout the season. In addition, patients will frequently use the antihistamine on an as-needed-basis, but the nasal steroid sprays were not really designed to be used on an as-needed-basis.

JD: We spoke about an elderly patient earlier...another common complaint refers to our younger patients with eczema. We often get asked if eczema is always followed by seasonal allergies when kids get older. What are your thoughts about this?

RK: Kids that have eczema as a young child... the allergic variety of the eczema, which is sometimes referred to in the medical arena as atopic dermatitis or atopic eczema, those patients are at an increased risk of developing other allergic diseases such as hay fever or allergic rhinitis. Additionally, they're at increased risk of developing asthma. The exact percentages are hard to quote as far as increased risk because it depends on what studies one reads. But clearly, those patients have an allergic tendency, their genetics are such that they have the propensity to develop allergies and therefore the eczema may be the first manifestation, and the term we use is the "atopic march," meaning that you start with eczema and you potentially go on to develop asthma or hay fever (known as allergic rhinitis).

JD: Our last question pertains to whether and how it impacts pollen levels; does a bad winter or a good winter impact pollen levels during the allergy season?

RK: Weather clearly has an impact on the pollen counts and when we look in the Denver area, for example, where we looked at eight years worth of counts, eight consecutive years, and interestingly enough, we've looked at the correlation with weather. Year to year, it was pretty consistent regardless of what the weather was doing. Day-to-day, you see some fluctuations if it's a rainier, early spring or later winter then you see some early peaks in the pollen that you may not ordinarily see, but the general pattern of the trees pollinating around March or April, as I stated earlier, and the grasses coming later in the springtime, and the weeds coming in the fall, that doesn't really change. And the time in the spring when you see the peak in the tree counts doesn't alter all that much though we would think that it should depending on how wet or dry it is or how much snow or rain we've gotten, but sure enough, as nature has it, the pattern stays pretty consistent. Although you may seem to see some day-to-day variation, the overall pattern stays consistent.