Spring has come. If you're one of the one in four American adults who suffer from seasonal allergies, the sneezing and scratching symptoms may have already started.
As climate change affects temperatures and plant growth, you may need to pay attention earlier than ever. It can be difficult to distinguish between allergy symptoms and cold symptoms, but experts point out some tell-tale signs.
Is your allergy season getting worse?
An analysis of pollen count data from 60 stations across North America from 1990 to 2018 found that spring allergy season began about 20 days earlier than before.
These changes can have serious health implications, said William Anderegg, an author of the study and associate professor of biology at the University of Utah. Other studies have shown that the earlier spring begins, the higher the incidence of allergic rhinitis, also known as hay fever. When people get sick or are hospitalized with uncontrollable allergy symptoms, “it’s because they weren’t expecting it and they didn’t have their medication ready,” he said.
The researchers also found that pollen concentrations have increased nationally by about 20 percent since 1990, with Texas and the Midwest experiencing the largest increases. Warmer temperatures, higher carbon dioxide levels and increased rainfall could all contribute to plants growing larger and producing more pollen over a longer period of time, Dr. Anderegg said.
Dr. M.D., chairman of the Department of Allergy and Immunology at the University of Mississippi Medical Center. Gailen Marshall said when she started her practice nearly 40 years ago, allergy seasons were limited to about eight weeks each. Tree pollen increases in spring, grass pollen increases in spring and summer, and ragweed pollen increases in late summer and early fall.
At that time, people could “at least get some relief” between these cycles, said Dr. Marshall, who is also president of the American College of Allergy, Asthma and Immunology, a professional organization. “Now these seasons end up being one long season.”
How do I know if it's an allergy or a cold?
People who have a stuffy or runny nose often think they have a cold. Allergy and cold symptoms may be similar, but allergies often cause itchy eyes, nose, throat, mouth or ears, said Dr. Rita Kachru, director of clinical allergy and immunology at UCLA Health. When you have allergies, your immune system mistakes triggers, such as pollen, for harmful substances. With repeated exposure to such triggers, immune cells release chemicals, including histamine, that cause itching and inflammation, Dr. Kachru said.
Patients also often experience nasal congestion and postnasal drip, or mucus dripping down the back of the throat. Some people may develop coughing, wheezing, or shortness of breath.
Conversely, viral infections may cause muscle fatigue, joint pain, or fever.
If your symptoms occur during certain seasons of the year and last more than one to two weeks, they are likely due to allergies. A personal or family history of allergies, eczema or asthma can also be an important clue, doctors said.
What should I do if I have never had allergies before?
Most people first develop symptoms in childhood or adolescence. But some experts say it's not uncommon for people to experience seasonal allergies for the first time as adults.
Moving to a different part of the country and being exposed to different allergens can trigger a reaction, Dr. Kachru said.
New allergy symptoms in adulthood may be “an inevitable consequence of soaring pollen levels,” said Dr. Neeta Ogden, a New Jersey-based allergist.
Increased winds associated with climate change could spread pollen farther and potentially expose people to new types of pollen, said Dr. Mary Johnson, a research scientist at Harvard.
Research has shown that hormones, including estrogen, progesterone, and testosterone, can influence how allergic disorders develop.
Boys often develop food allergies or eczema at an early age, and often have seasonal allergies or asthma in childhood, but these symptoms disappear by puberty, Dr. Kachru said. However, symptoms may reappear in your 30s or 40s.
For some women, major hormonal changes, including those that occur during puberty, pregnancy, menopause, and birth control, can affect the onset and severity of allergy symptoms, Dr. Kachru said.
How do I manage my symptoms?
The first step is to reduce your exposure. Keep windows closed to prevent pollen from entering your home.
“The key is to prevent outdoor allergens from turning into indoor allergens,” said Dr. William Reisacher, a professor of otolaryngology who treats allergies at Weill Cornell Medicine and New York-Presbyterian.
To do this, when you return home, take off any clothes you wore outside and store them outside your bedroom. Then take a shower to wash off any pollen from your skin. Doctors recommend rinsing your nose with saline solution to flush out pollen from your nose. (If you make it yourself, be sure to use boiled water, sterilized water, or distilled water.)
Over-the-counter medications fall into two main categories: antihistamines and steroids. Both act on the inflammatory response of the immune system. Antihistamines are available as nasal sprays, eye drops, and oral tablets, including loratadine (Claritin), cetirizine (Zyrtec), levocetirizine (Xyzal), and fexofenadine (Allegra).
Steroids are available as nasal sprays, including fluticasone (Flonase), budesonide (Benacort), triamcinolone (Nasacort), and mometasone (Nasonex).
If you're experiencing symptoms for the first time and aren't sure how severe they will be or how long they will last, try taking an antihistamine to see if that helps, Dr. Kachru said.
If your symptoms persist or you know your allergy symptoms get worse each spring, your doctor may recommend a nasal spray. Unlike antihistamines, which should be used only when needed, these steroids are most effective when started 1 to 2 weeks before symptoms begin.
Doctors caution against using products containing pseudoephedrine, such as Sudafed, for more than one or two days. Because it can increase your heart rate and blood pressure. In 2020, a physician task force issued allergy treatment guidelines recommending against using Benadryl to treat allergic rhinitis. Doctors say it can have a sedative effect and cause confusion.
If avoiding environmental triggers and taking medications don't work, allergy shots or pills that build tolerance to allergens may help.
“It’s the only option that actually makes your body less allergic,” Dr. Reisacher said.