September 16, 2022

Environmental Allergies

Environmental Allergies

Do you feel as though you are suffering more through pollen seasons over the last several years? Do pollen-triggered allergy seasons seem to be lasting longer for you, causing you to take allergy meds for longer periods than you typically would? Are your pollen-triggered allergy episodes becoming more intense?

If you can answer yes to any of these questions, I can assure you that you are not alone.

As a board-certified allergist who sees patients daily, hearing a statement like, “Doc, this has been the worst pollen season ever,” is becoming all-too-common.

Find out why environmental allergies are on the rise and what you can do about it.

Why are environmental allergies on the rise?

And now there is data to support why you and many of my patients are suffering so much from the pollen seasons over the years. Researchers have monitored pollen counts over the last three decades (1990 - 2018) in North America and have observed increases in pollen concentrations and longer pollen seasons.

Climate change with its associated higher temperatures and the increased amount of carbon dioxide in the air are fueling this pollen explosion.

Thus, pollen allergy sufferers, especially those with allergic asthma are getting hit the hardest. Increased pollen concentrations have a strong association with allergic asthma flares, especially those requiring ER visits and hospital admissions.

Independent of allergy, pollen exposure has also been shown to weaken our immune system.  As a result, respiratory viruses are more likely to cause infections4. This is not good news with COVID still on the loose.

So what can you do to combat all this pollen?

There are three main strategies that you can use to tackle your pollen allergies: avoidance, medication and immunotherapy.

10 Tips for Avoiding Allergens

Pollen avoidance is difficult, but there are some things that can be done to keep your exposure to it in check.

1. Monitor Pollen Counts

Monitor pollen counts closely and consider staying indoors or pre-medicating with allergy medication when pollen counts are high. This can be done using several different online resources or apps.

2. Avoid Early Morning Outdoor Activities

Avoid early morning outdoor activities if possible. This is when pollen counts are typically the highest.

3. Avoid dry, windy days

Dry, windy days allow pollen to stay suspended and get blown in large quantities, all over. Going outside after a rainstorm is ideal as the soaked pollen is cleared from the air.

4. Keep doors and windows closed

Keeping doors and windows closed — especially during peak pollen times — is key.

5. Wear a mask

Consider wearing a mask if spending a lot of time outdoors when counts are high or if needing to do lawn care or gardening. It may be best to assign those chores to others until the counts are better controlled and the conditions are right.

6. Shower upon entering your home

When you come inside from any outdoor activity, immediately remove your clothes and shower. This will help remove sticky pollen from your hair and skin.

7. Don't line dry clothes

Avoid drying clothes and linens outside since pollen can stick to these and may persist until cleaned again.

8. Keep pets groomed

Pollen can also stick to pet fur. Be careful around furry pets that spend a great deal of time outdoors. If they also spend a lot of time inside, keeping them brushed and bathed regularly will help decrease the amount of pollen they bring with them.

9. Use A/C in the summer

Use air-conditioning regularly while at home or driving. High-efficiency filters that are regularly maintained and replaced will help alleviate pollen allergies.

10. Vacuum regularly

Vacuum regularly using a vacuum with a HEPA filter will help remove pollen brought inside by pets or people. Try to do this once or twice a week at a minimum during the pollen season.

Treat allergy symptoms with OTC and prescription medication

Several medications can be extremely helpful during pollen season and (fortunately) most allergy medications are available over the counter, without a prescription. Here are my recommendations for over-the-counter allergy medications.

Saline Nasal Sprays/Rinses

Saline nasal solutions can clean allergens like pollen as well as other irritants and mucus from your nose, thereby decreasing symptoms. These come in a variety of forms from gentle mists or sprays (i.e Simply SalineTM) to high volume washes using Neti pot devices.

Nasal Steroid Sprays

Nasal sprays are found over-the-counter and are considered an effective allergy medication for most people since they help reduce a variety of nasal symptoms including congestion.

Nasal steroids have also been shown to improve asthma, conjunctivitis, sleep disorders and quality of life impairment. They are approved for children as young as two years of age and are most effective when used daily at least two weeks prior to the pollen season and continuing through the end of the season.

Antihistamines

Oral antihistamines may work fast to help prevent and treat symptoms of pollen allergy including itchy nose, eyes, sneezing and drainage.

Options such as cetirizine (Zyrtec) are approved for children as young as six months of age. Less-sedating, second-generation forms are preferred and include cetirizine, fexofenadine, levocetirizine and loratadine.

Nasal spray options such as azelastine can also help with a variety of nasal symptoms and can be used as add-ons to oral antihistamines or intranasal steroids. They are typically obtained by prescription through your medical provider although azelastine was also recently approved for over-the-counter use under the name Astepro®.

Eye drop options such as Olopatadine (Patanol, Pataday and Pazeo) can do a great job with pesky eye itching, redness and drainage. These are now available over-the-counter.

Treat the root cause of allergies with allergy immunotherapy

If you want to treat the root of your pollen allergy and not just the symptoms, immunotherapy is something you need to consider. Immunotherapy is the process of exposing your body to small, controlled amounts of pollen and other allergens in order to build your body’s tolerance to them. Over time and with diligent use, you are likely to decrease your symptoms and as a result, decrease your need for medications.

Immunotherapy is prescribed by experienced clinicians in two forms: subcutaneous and sublingual.

Subcutaneous immunotherapy (SCIT)

Subcutaneous immunotherapy (SCIT) is an FDA-approved method that has been around for over 100 years.

It involves your physician, typically an allergy specialist, giving you allergy injections regularly to your allergens in their office. This often occurs weekly for several months and is then spaced to monthly over time. All of your pollen allergies among others (i.e dust mite, cat, dog) may be treated.

Although very safe, there is a chance of an anaphylactic reaction. As a result, your physician will typically require you to stay in their office for up to 45 minutes after each injection and have an Epinephrine device with you in the event of a reaction once you leave the office.

Sublingual Immunotherapy (SLIT)  is performed by placing the allergen under your tongue. It can be done from the comfort of your home.

SLIT-T Immunotherapy

SLIT-T is FDA approved; however, these tablets only treat one allergen at a time.

Tablets currently available for pollen allergy include Oralair (5-grass mix), Grastek (Timothy grass) and Ragwitek (Ragweed). There is currently no option to treat tree pollen allergy. The first dose must be administered in a physician’s office but the rest of the treatment can be continued at home. Epinephrine devices are also required as in SCIT but anaphylaxis is much less common.

SLIT-D Immunotherapy

SLIT-D is only prescribed by experienced clinicians in the U.S. but has been prescribed by several European countries for over 30 years.

This method uses the same FDA-approved allergy extracts that are found in SCIT by applying them under the tongue daily. Also, all of your unique allergies can be treated as per SCIT.

Sublingual immunotherapy can be done daily from the comfort of your own home and observation of the first dose is per your clinician's discretion.

Epinephrine is not required but is recommended. Like SLIT-T, anaphylaxis is much less common.

A great way to discuss allergy immunotherapy options is at Curex.

After completing an online questionnaire, you can upload your previous allergy test results or order an at-home allergy test. After your tests are reviewed by one of the experienced Curex-affiliated clinicians, you will have the opportunity to chat with them and discuss your options.

After having an informed discussion with your clinician, if it appears that SLIT-D is your best option this method can be prescribed and shipped to your door. Thus, you can begin treating the cause of your allergies without having to step foot in an allergy office or leaving your couch.

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