By: Todd Green, MD, Division of Pulmonary Medicine, Allergy & Immunology at Children’s Hospital of Pittsburgh of UPMC
“Spring is nature’s way of saying, ‘Let’s party!’” – Robin Williams
It’s as certain as crocuses appearing, robins returning, or pitchers and catchers reporting—it’s the sound of sneezes. If you or someone you care about has tree pollen allergy, you know that the reappearance of spring often brings with it itching, sneezing, coughing, and wheezing. Typically tree pollen season in this part of the country lasts from the middle of March until the end of May, but this year along with the early spring we have been seeing fairly high tree pollen counts throughout the month of March, and many of our patients and their families don’t need a pollen report to tell us that.
Studies indicate that up to about 30% of adults, and 40% of children have allergic rhinitis (aka hay fever), which is the medical term for nasal symptoms (most commonly runny nose, itching, sneezing, and congestion) that are due to an environmental allergy. Frequently eye symptoms are also involved, and eye itching and redness are among the most bothersome symptoms for patients. While all of us are exposed to the same or similar factors in the environment, not everyone’s immune system makes allergic proteins, or antibodies, against things such as pollen; it is the presence of these antibodies that causes some people’s bodies to release histamine, which is the chemical that leads to the allergic symptoms.
In addition to nasal and ocular symptoms, allergic triggers may lead to worsening of eczema and asthma in patients who suffer from these. And while nose or eye symptoms may not be perceived as significant by those not experiencing them, these are often very bothersome and have been shown to affect sleep, daytime functioning (leading to decreased school and work productivity), and overall quality of life. And for those with asthma, allergic triggers can lead to a potentially life-threatening situation.
So what are the culprits here? Pollens are microscopic particles that plants release as part of the fertilization process. The pollens that cause the majority of allergic symptoms in people come from trees, grasses, and weeds. Tree pollen season precedes grass pollen season, which lasts from about the middle of May through the end of June. Ragweed and the other weeds pollinate towards the end of the summer, generally from the beginning of August until the first hard frost. These small, light pollen grains are carried by the wind, and can travel for hundreds of miles, so that it doesn’t necessarily matter whether the tree pollen you are allergic to originates in your backyard or not.
As allergists, when we see patients with symptoms suspicious for pollen allergy, we will typically do a test to confirm the diagnosis, both to be more precise about what a patient is allergic to, and so that medications are not used unnecessarily. We then move on to designing a treatment plan. One of our primary goals is to help our patients lead full, active lives. The most effective way to prevent an allergic reaction is to avoid exposure to what one is allergic to. Unfortunately, while there are some measures that can be taken to minimize pollen exposures (avoiding outdoor activity in the morning when counts tend to be highest, using air-conditioning, and keeping windows closed when possible, etc.), these exposures to a large extent are inevitable during the pollen seasons, and our goal is to design a treatment plan that will not restrict our patients’ activities.
Generally speaking, we aim to use the minimum amount of medications that will lead to maximum relief of symptoms and improvement in quality of life. Fortunately, we have a lot of good options available, and there are many medications that are effective for symptoms. In certain cases we also treat patients with immunotherapy, which is a way of redirecting the immune systems of allergic individuals through low-level, regular exposure to their allergens. These are the “allergy shots” that many have heard about. When effective, immunotherapy is the only tool we have that “cures” patients of their allergies by inducing tolerance of allergens, and typically over time the need for medications lessens. This does require a significant time commitment on the part of patients and families, however, and carries a small amount of risk, so is not typically our first option. Injection immunotherapy has been used for over 100 years, and is currently the only FDA-approved immunotherapy treatment, but research is ongoing into oral methods of immunotherapy, and will likely be a good option for some patients in the future as well.
So, while some feel the need to run for tissues at this time of year while others are running for their sneakers, bicycles, and fishing rods, my hope is that even those with significant pollen allergies will be able to work with their physicians to come up with an effective treatment strategy that will allow everyone to participate in the party!
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