Ragweed season starts in mid-August and ends at the end of September.

Often, people in the Midwestern United States who suffer from seasonal allergies complain of symptoms in the spring and “in the fall.” However, when asked to specify what part of the fall, they usually mean late August and all of September, not late October when the leaves are on the ground. So, it is more accurate to say “late summer” or “early fall,” when describing this second allergy season of the year. The main allergen responsible for symptoms this time of the year is ragweed. Ragweed is a common weed that grows in many parts of the North America and Central America. Although native to this continent, it has spread to Europe, probably starting in the 1900s during WWI. Unfortunately, for those of us with allergies, it is also a potent allergen.

In Southwest Michigan, ragweed starts to pollinate in mid-August, peaks around Labor Day weekend, and continues till the end of September. There is no detectable ragweed by October 1. As a potent allergen, it is responsible for most of the itchy eyes, running nose, nasal stuffiness and sneezing this time of year. Ragweed pollen levels tend to peak midday and can literally fly for hundreds of miles. So, it doesn’t matter that your yard is a perfectly manicured model of Midwestern grass. You can’t escape ragweed pollen.

Treatment for ragweed is basically the same as for most environmental allergies. The triad of avoidance, medications, and immunotherapy are the hallmark of treatment. Avoidance involves staying indoors, keeping the windows closed, and bathing every night before going to bed (you need to wash that ragweed out of your hair…). I am often asked if there is someplace one could move to avoid ragweed. The short answer is no – unless you’d like to move to Antarctica. However, spending ragweed season on an ocean or large lake (eg. Lake Michigan) shoreline can be helpful. Medications involve allergy eye drops, oral antihistamines, and allergy nasal sprays. Please refer to the previous posts detailing use of OTC allergy medications. Finally, immunotherapy, either via allergy injections or allergy oral drops, probably offers the most effective treatment available.

Michael Park, MD

Honey bee collecting nectar and pollen

Eating local honey has been considered a natural way to treat one’s seasonal allergies for many years. The rationale is since local honey is made withthe local pollens from the area, eating the honey on a regular basis will naturally desensitize you to those pollens. Sounds nice, but does this really work?

The short answer is no. First of all, honey bees do not use the pollen to make honey. It is the nectar they collect from flowers that is transformed to honey. Honey bees do collect pollen but they consume both the pollen and honey for food. The bottom line is there is virtually no pollen or plant antigen in honey.

Further, the pollen from flowers do not significantly cross react with the various trees, grass, and weeds that cause seasonal allergies. So even if honey contained pollen, it wouldn’t do much good. Even allergy injections with flower extracts will not help those with tree or ragweed allergies.

Honey

Honey is a delicious, natural sweetener, but nothing more. When it comes to treating your allergies, best to leave the bees out of it.

Some people notice a flare in their seasonal allergies in early July, peaking around the 4th of July Holiday. In the mid-west, the most likely reason for this flare is an allergy to grass. In this part of the country, grass season tends to have two peaks: one in early June and another one in early July.

What can be done about grass allergy? Here are a few tips.

Avoid grassy areas as much as possible, especially during mowing or right after mowing.

Wear a good quality mask during mowing.

Take a shower after exposure to grass.

Saline sinus irrigation after exposure to grass.

Use allergy medications (detailed in previous posts).

Allergy immunotherapy for grass in the form of allergy injections or allergy oral drops.

In late May to early June, we often start to see the cottonwood trees shed their seeds. White, fluffy, cotton-like material can be seen floating all over the place. Some people get itchy and sneeze right around this same time of the year. Naturally, they blame the cotton. Their symptoms must be due to cottonwood tree allergies, right? Wrong.

Cottonwood trees (also known as poplar trees) actually pollenate in April. Their large fluffy seeds that we see in late May and early June are NOT the allergen people react to. So, if it’s not the cottonwood, then what is it? It turns out that Hickory trees, Walnut trees, Sheep Sorrel weed, and mid-western grass all start to pollenate at the same time that the cotton-like seeds are released. In all likelihood, the allergy symptoms are caused by one or more of those 4 culprits. So, don’t blame the cotton!

Nasal decongestants come in two basic forms.  One is oral pseudoephedrine, better known as Sudafed.  This drug causes vasoconstriction of the blood vessels.  Since nasal stuffiness is caused by vasodilation of the nasal blood vessels, you can see how it can be an effective treatment.  Since antihistamines alone are not good at treating nasal stuffiness, drug companies quickly came out with combination products like Claritin D, Allegra D, and Zyrtec D.  The D stands for decongestant.  And the decongestant is pseudoephedrine.  The problem with this drug is its potential side effects which include increased blood pressure, racing heart, jitteriness, insomnia, and … it can make men pee in their pants.  Regular use of pseudoephedrine will often result in one or more of these side effects.  The other OTC nasal decongestant is oxymetazoline and comes in a nasal spray.  The most well known version is called Afrin, but I have seen “Meijer Nasal Spray With Saline” which is basically the same thing with different packaging.  This drug is a powerful, topical decongestant.  It improves nasal stuffiness effectively and quickly.  The problem, once again, lies with side effects.  People develop tolerance to this drug quickly, meaning it becomes less and less effective with continued use.  This is the spray that people can “get hooked on.”  Such patients often end up using this spray 6-12 times a day just to keep their nasal passages open a crack.  You should never use oxymetazoline more than 3 days in a row.  Most package inserts contain this warning.  And of course everyone reads package inserts, right?

Overall, I do not recommend either of these products on a regular basis.  As long as you are aware of its potential side effects, brief use may be helpful.  For patients with chronic nasal stuffiness, the best OTC treatment is the allergy nasal spray, discussed in Part 2 of this series.

Michael Park, MD

The next topic will be treatment for allergy eyes.  Unfortunately, allergy eye symptoms are among the most difficult to treat.  If you are a contact lens wearer, it is even worse because pollen just sticks to those lenses like glue.  There are two basic types of medications used in allergy eye drops.  One is a vasoconstricting drug which makes the blood vessels smaller.  This is how it “gets the red out.”  Unfortunately, people usually develop tolerance to this type of medication, meaning “you get used to it,” and it has a weaker and weaker effect the more you use it.  This type of medication is not healthy for the eye with daily use.  The other type of medication is an antihistamine in solution.  So, it works just like oral antihistamines work – they block histamine, the major substance involved in allergic symptoms.  Antihistamine eye drops are the preferred treatment for allergy eyes.  I usually recommend ketotifen.  This medication is available by a variety of different brands including Zaditor and Alaway.  I have also seen Meijer and Walgreens versions of ketotifen eye drops.  Other helpful tips for allergy eyes include NOT wearing contact lenses, and using lubricating drops to gently flush the pollen out of the eyes.  It also helps to keep the bedroom windows closed, wash your hair before you go to bed, and change your pillow case often.

In Part 1, I discussed oral antihistamines.  In this post, I will review OTC allergy nasal sprays.  The main OTC options are Nasacort (triamcinolone), Flonase (fluticasone propionate), Rhinocort (budesonide), and Flonase Sensimist (fluticasone furoate).  These allergy nasal sprays are far more effective compared to oral antihistamines when it comes to treating classic allergy symptoms.  So, if you have tried oral antihistamines but still suffer from allergy symptoms, you should try an allergy nasal spray.  Further, they are effective for nasal stuffiness, whereas oral antihistamines are not.  All of the 4 products above are topical steroid sprays.  They work best if used on a daily basis.  They are not as effective if used intermittently.  Further, they usually become more effective after 3-4 days of use.  Even though they are steroids, they are safe and most are FDA approved down to the age of 2 (Rhinocort is approved down to the age of 6).

In general, I usually recommend Nasacort as I feel it offers the best combination of effectiveness and tolerability.  Nasacort is odorless and gentle on the mucous membranes.  Flonase is effective but not as well tolerated as Nasacort.  It has an odor (artificial flowers) and seems to cause more irritation compared to Nasacort.  Rhinocort is effective, has a mild odor, and is fairly well tolerated.  Flonase Sensimist is the best tolerated of the four, as it is odorless and has the smallest volume compared to the rest.  However, that small volume comes with a price – less medication.  Flonase Sensimist only contains 27.5 mcg of medication per spray compared to 50 mcg for Flonase and 55mcg for Nasacort.

So, if your allergy pill is not doing the job, give an allergy nasal spray a try.

Michael Park, MD

Over the past 5 years, most of the best allergy medications have gone from prescription only to over-the-counter.  So, patients no longer need to go to a physician to receive good, basic treatment for nasal, eye, and skin allergy symptoms.  However, there are a lot of options out there, so it can get confusing.  I will try to clarify things for you.

There are 3 basic categories of OTC allergy medications:  oral antihistamines, nasal steroid sprays, and oral decongestants.  In today’s post, I will review antihistamines.  In future posts, I will review nasal steroid sprays and oral decongestants.

Oral antihistamines are the most familiar type allergy medication to most people.  Such medications include Benadryl, Claritin, Zyrtec, Xyzal, and Allegra.  Like the name suggests, antihistamines block the effect of histamine – the primary substance involved in causing allergy symptoms.  In general, antihistamines are effective in treating itch, sneeze, and drainage.  They are not effective in treating nasal stuffiness.

For adults and larger children, I usually recommend Allegra (fexofenadine) 180mg daily as needed.  This antihistamine is good, strong, and has the fewest side effects in the antihistamine class.  For smaller children who cannot swallow pills, I usually recommend Claritin or Zyrtec.  The dose depends on the size of the child and the clinical situation.

For mild allergies, antihistamines are a good first option.  However, if they are not effective enough, you should try a steroid nasal spray – the topic of the next post coming soon.

Michael Park, MD

ARLINGTON HEIGHTS, IL – (APRIL 2, 2019) – Allergy shots (subcutaneous immunotherapy or SCIT) have been available for more than 100 years. Allergy tablets (sublingual immunotherapy or SLIT) have been approved by the Food and Drug Administration (FDA) for use in the United States for four years. A new study in Annals of Allergy, Asthma and Immunology, the scientific journal of the American College of Allergy, Asthma and Immunology (ACAAI) shows that most American allergists now prescribe the tablets for some patients to treat certain allergies. The study was developed by the ACAAI Immunotherapy and Diagnostics Committee.

“Five years ago, allergy tablets hadn’t been approved by the FDA and weren’t being prescribed for people with allergies in the U.S.,” said allergist Anita Sivam, DO, ACAAI member and lead author. “Allergists were prescribing allergy shots because they were, and continue to be, a proven effective treatment. Once allergy tablets were approved in 2014, allergists began prescribing them for their patients. Of the 268 US allergists who responded to our survey in 2018, 197 (73 percent) reported prescribing allergy tablets.”

Allergy tablets are available to treat northern grass pollens, Timothy grass pollen, ragweed and house dust mite. The northern grass pollens and the Timothy grass pollen tablets are both approved down to age 5 years and the other two for those 18 years and older. The tablets differ from allergy shots because after the first dose is given in an allergist’s office, they can be taken at home. The tablets are placed under the tongue and dissolve.

In immunotherapy, the regular administration of the allergen doses causes your immune system to become less sensitive to the allergen. Reducing your sensitivity reduces your allergy symptoms.

“One of the big differences between shots and tablets is that shots are formulated by your allergist to treat your specific allergy or allergies,” says allergist Mike Tankersley, MD, MBA, vice-chair of the ACAAI Immunotherapy and Diagnostics Committee and co-author of the study. “Tablets target a single allergy, and our study found that was the main barrier for allergists in prescribing tablets. If a patient has more than one allergy and is able to travel regularly to receive allergy shots, an allergist may recommend shots over tablets.”

Both shots and tablets – the only FDA-approved immunotherapy treatments for allergies – are successful because they work by changing your immune system. They decrease some cells, chemicals and antibodies in your system that cause allergy symptoms and increase others that improve health. Allergy shots and tablets allow you to encounter your allergens without having a reaction. Immunotherapy also reduces the inflammation that characterizes hay fever and asthma, so many sufferers find their symptoms improve.

To find an allergist near you who can help create a personal immunotherapy plan for your allergies or asthma and help you lead the life you want to live, use the ACAAI allergist locator.

Citation:  https://acaai.org/news/new-research-shows-73-percent-allergists-prescribe-under-tongue-allergy-tablets?

Park Allergy Center provides both oral drops or tablets for allergy immunotherapy treatment.

Common Seasonal Allergy Triggers

If you sneeze and cough during certain times of the year, you may have seasonal allergies. However, occasional allergies aren’t something you just have to live with. An allergist can pinpoint the cause and help you find relief.

In many areas of the United States, spring allergies begin in February and last until the early summer. Tree pollination begins earliest in the year followed by grass pollination later in the spring and summer and ragweed in the late summer and fall. In tropical climates, however, grass may pollinate throughout a good portion of the year. Mild winter temperatures can cause plants to pollinate early. A rainy spring can also promote rapid plant growth and lead to an increase in mold, causing symptoms to last well into the fall.

The most common culprit for fall allergies is ragweed, a plant that grows wild almost everywhere, but especially on the East Coast and in the Midwest. Ragweed blooms and releases pollen from August to November. In many areas of the country, ragweed pollen levels are highest in early to mid-September.

Other plants that trigger fall allergies include:

  • Burning bush
  • Cocklebur
  • Lamb’s-quarters
  • Pigweed
  • Sagebrush and mugwort
  • Tumbleweed and Russian thistle

While the timing and severity of an allergy season vary across the country, the following climate factors also can influence how bad your symptoms might be:

  • Tree, grass and ragweed pollens thrive during cool nights and warm days.
  • Molds grow quickly in heat and high humidity.
  • Pollen levels tend to peak in the morning hours.
  • Rain washes pollen away, but pollen counts can soar after rainfall.
  • On a day with no wind, airborne allergens are grounded.
  • When the day is windy and warm, pollen counts surge.
  • Moving to another climate to avoid allergies is usually not successful — allergens are virtually everywhere.
    

Allergy shots, or immunotherapy, allergen immunotherapy, is a useful thing to do. It’s useful not only because it helps with your symptoms, but it’s truly disease-modifying. It actually makes you less allergic.

Allergist Richard Weber, MD

Seasonal Allergy Management and Treatment

If you feel like you’re always getting sick, with a cough or head congestion, it’s time to see an allergist. You may think you’re sure pollen is causing your suffering, but other substances may be involved as well. More than two-thirds of spring allergy sufferers actually have year-round symptoms. Your best resource for finding what’s causing your suffering and stopping it, not just treating the symptoms, is an allergist.

Work together with your allergist to devise strategies to avoid your triggers:

  • Monitor pollen and mold counts. Weather reports in newspapers and on radio and television often include this information during allergy seasons.
  • Keep windows and doors shut at home and in your car during allergy season.
  • To avoid pollen, know which pollens you are sensitive to and then check pollen counts. In spring and summer, during tree and grass pollen season, levels are highest in the evening. In late summer and early fall, during ragweed pollen season, levels are highest in the morning.
  • Take a shower, wash your hair and change your clothes after you’ve been working or playing outdoors.
  • Wear a NIOSH-rated 95 filter mask when mowing the lawn or doing other chores outdoors, and take appropriate medication beforehand.

Our allergist’s treatment has unquestionably resulted in a better quality of life for Kealab.

Kealab’s mom

Your allergist may also recommend one or more medications to control symptoms. Some of the most widely recommended drugs are available without a prescription (over the counter); others, including some nose drops, require a prescription.

If you have a history of prior seasonal problems, allergists recommend starting medications to alleviate symptoms two weeks before they are expected to begin.

One of the most effective ways to treat seasonal allergies linked to pollen is immunotherapy (allergy shots). These injections expose you over time to gradual increments of your allergen, so you learn to tolerate it rather than reacting with sneezing, a stuffy nose or itchy, watery eyes.

Seasonally Related Triggers

While the term “seasonal allergies” generally refers to grass, pollen and mold, there is a different group of triggers that are closely tied to particular seasons. Among them:

  • Smoke (campfires in summer, fireplaces in winter)
  • Insect bites and stings (usually in spring and summer)
  • Chlorine in indoor and outdoor swimming pools
  • Candy ingredients (Halloween, Christmas, Valentine’s Day, Easter)
  • Pine trees and wreaths (Thanksgiving to Christmas))

Citation:  https://acaai.org/allergies/seasonal-allergies