I always think of spring as an exciting time of the year. As the weather warms and the rains subside, we see people all across the Sacramento region getting outside and enjoying what makes Northern California a fabulous place to live.
But the mere mention of “Spring” will elicit a completely different reaction in some people. For those who suffer from springtime allergies, it can be a time of dread. They can experience uncontrolled sneezing, nasal stuffiness, runny nose and itching of the nose and eyes. Some will even experience respiratory symptoms like cough, wheeze and asthma attacks.
Allergies are abnormal immune reactions to things we normally don’t react do. Triggers include foods, chemicals and vegetative matter. These abnormal immune reactions are mediated by immune cells that release histamine and a variety of other chemical mediators.
These mediators cause itch, swelling, mucus production and lead to the typical allergy symptoms mentioned above. If these reactions occur in the lungs, they can also cause asthma symptoms like wheeze, cough, chest tightness and shortness of breath. Sometimes asthma symptoms can be so severe that they are life-threatening.
During the warmer months of the year, pollens tend to be the most common trigger for nasal, sinus and lung symptoms even though indoor allergens like animals or dust mites can contribute. While each year is a little different, we typically see tree pollens from February to June, grass pollens from April to July and weed pollens from July to November. So if a patient tells me that there symptoms occur primarily in May through June, then I would suspect a grass pollen allergy. Many times, people can have multiple allergies.
During the wet & cold times of the year, we can also be exposed to mold spores, either in the air or on the ground associated with dying organic material like leaves during the fall, as well as indoor allergens like animal dander, bedding feathers and dust mites.
If a patient comes into The Allergy Station, we first take a full history and perform a physical examination. We learn about the patients symptoms including triggers, timing, duration, severity and whether the patient has used any medications for their symptoms. We also learn about their environmental exposures. For example, it is important to know whether our patients have pets, what type of work they do, their family history of allergies, etc.
Then the fun begins. We often use allergy testing either via skin tests or blood work to confirm our suspicions about what the patient is allergic to. The skin testing exposes the allergy cells in the skin to a small amount of allergen, like pollen or dander, leading to a temporary itchy spot (hive) if positive. In that way, we can give personalized advice to our patient regarding avoidance of proven triggers and come up with a treatment plan tailored to the patient’s individuals experience and needs.
There are three ways to treat seasonal allergies. The first is to avoid what the patient is allergic to, where possible. Most indoor allergen exposures can be modified, such as keeping your pet out of the bedroom at night, using air cleaners, switching out the down pillows for synthetic ones and/or remediating mold damage in the home. Even showering after being out all day can cut down on the pollens or dust on your skin. But when it comes to outdoor triggers like pollens, it is next to impossible to completely avoid them. We cannot enclose people in a hypoallergenic bubble.
Second, we use a variety of medications to mask the symptoms of seasonal allergies. Many of these are now available over-the-counter and are safe to use even long term if necessary. Medication classes we common utilize include nasal steroid sprays (Flonase, Nasacort, Rhinocort, etc), antihistamines (Zyrtec, Allegra, etc), leukotriene inhibitors (Singulair), nasal steroids (Astelin, Patanase), allergy eye drops, etc. Often we will prescribe a combination of medications to gain control of the symptoms and wean down as tolerated once patients are feeling better. One can expect to see results relatively quickly.
The third and best way that we treat allergies is through immunotherapy. There are two main forms of this available in the United States. The first is subcutaneous immunotherapy or SCIT. In SCIT, we make a mixture of the triggers shown to be positive of allergy tests and inject a dilute amount of that mixture into the skin on the upper arm. Over time, we increase the concentration of that mixture. This leads to the immune system responding to allergens in a more normal fashion and come off of their allergy medications. Eventually, after several years, we stop the shots and sometimes patients will experience benefit for even up to a decade after stopping the shots.
Another form of immunotherapy is to use sublingual tablets (SLIT) to induce immune tolerance. There are currently SLIT tablets for grass pollen, ragweed and dust mite approved by the US Food & Drug Administration. These tablets can be taken primarily at home so they offer patients more flexibility than the allergy shots, which need to be administered under observation in the clinic.
You should not have to suffer from your seasonal allergies. Visit a board-certified allergist-immunologist to get a comprehensive evaluation and receive a personalized plan of treatment geared specifically to the things that you are allergic to. We at The Allergy Station want people outside and enjoying the beauty of what Northern California has to offer.
If you are not in the Sacramento area, you can find local board-certified allergist-immunologist at the following links: