Spring Allergies are Here!

Posted on: 04/28/2009

Seasonal Allergies

By: M. Scott Applegate, MD, FAAP

With allergy season upon is it makes sense to review what allergies are, how we diagnose them, common treatments, and ways to lessen exposure.

The term “Allergies” holds a number of different meanings for different people. There are four types of allergies, and they range from pollen allergies and food allergies, to disease like arthritis, to contact allergies like poison ivy. Today we will focus on seasonal allergies to inhaled allergens (also known as Type 1), and in the Spring, this amounts to tree pollen allergies for the most part, but can include allergies to dust mites, molds, and pets as well.

In the Spring, as trees bloom, they release pollen into the air. The pollen then spreads to other trees and serves in the reproductive process of the tree. Each tree species will pollinate at a somewhat different time, but most at some point in the Spring. Somewhat disconcerting is that pollen can travel a great distance in the winds and we can often be exposed to pollen from trees several States away. This means that even if the trees are not pollinating here in Nebraska just yet, pollen from the south may be carried to us through the winds, and cause allergic symptoms. It also means that trying to remove nearby offending trees will not be effective, as the pollen will come from far and wide! Unfortunately, moving from one State to another will not lessen allergic symptoms for the same reason.

Trees drop their pollen most often in the very early morning hours. Those of you with allergies yourself, or with children with allergies, may have noticed that the symptoms of itchy or runny nose, sneezing, stuffy nose, and itching eyes will often awake the sufferer in the very early morning hours as this is when many tree drop their pollen.

Diagnosis of allergic rhinitis is sometimes difficult. We do not have an easy or perfect test for allergies. This time of year, where the common cold is still prevalent, the two are often confused. There are generally three tests that we use to diagnose allergic rhinitis, skin testing, blood testing, and most importantly, by history. Skin or blood testing is somewhere in the range of 80% accurate. This means that if you test positive to a specific pollen or pet dander, there is roughly a 20% chance that you will not actually be allergic! Because of this, we have to rely heavily on the history of symptoms. For example, if every year in May as the weather warms, you have early morning sneezing, and itching eyes, almost certainly you have a tree pollen allergy, regardless of the skin or blood test results.

Children pose a particular problem in that symptoms are often confused with other common problems. Some general guidelines, however, may be helpful. Allergies never cause fever. If your child has a fever, it is not allergies; more likely it is a cold. Spring seasonal allergies are very rare under 2 years of age; look for something else first before coming to the diagnosis of allergies in children of this age group. Fall allergies, more often ragweed and grasses, are unusual in children under 4 years of age.

Seasonal allergies are particularly prevalent, and a number of treatment options are available. The symptoms are generally caused by a chemical called histamine and so, medications known as anti-histamines are some of the most common. They range from older medication like Benadryl, which causes some drowsiness, to Zyrtec or Claritin, which generally don’t have the same side effect. To complicate life, medications that cause drowsiness, tend to be MORE effective. Also effective are nasal sprays that include anti-histamines sprayed directly into the nose and nasal steroids. Of note, nasal steroids are highly effective; however, they will often take several weeks to take effect. For eye symptoms we also have anti-histamine eye drops that can be particularly effective. As a last resort anti-allergy shots can be given over a period of time, often over a 2 year period or more, with varying success. As always, consult with your doctor regarding the diagnosis and what treatment options are appropriate for your particular child.

Avoidance of the tree pollen can be helpful, but trying to completely avoid something that is simply in the air we breathe will prove impractical. There are some measures to take that can be helpful though.

* During the pollen season, keeping windows and doors sealed overnight will lessen the exposure.

* Changing air conditioner and furnace filters is beneficial. The pollen that got caught in your air conditioner filter last season may still be there, and as your system cycles on, it will kick small amounts of that pollen into the air of your home. A new filter will also maximize the prevention of this season’s pollens.

* Trying to stay indoors in the early morning hours, avoiding uncut fields, and taking any prescribed medication regularly rather than after there is trouble may also improve symptoms.

Seasonal allergies are a very common problem, but with some simple interventions we may be able to keep our children comfortable and happy through the season. Although giving over-the-counter medication is a reasonable first step, please do not hesitate to make an appointment with you child’s Pediatrician to discuss any concerns. Part of being a child is getting outside and enjoying Spring! Let’s make sure all of our children get that opportunity.