Hylton I Lightman MD DCH(SA) FAAP      

It’s that time of year when allergies can plague us. I’m here to help! Peruse this information and then consult with your pediatrician.

Seasonal allergies often refer to tree and grass pollen and mold.

Symptoms occur when the immune system is sensitive and reacts excessively to a foreign substance called an allergen. Histamine is released from cells and causes sneezing and nasal congestion, itchy and watery eyes and nose, coughing, wheezing and rashes. Some people may suffer a severe life-threatening reaction called anaphylaxis.

The onset of seasonal allergies varies in many areas of the United States.

Spring allergies are usually from February until early summer – mainly trees and grasses. The allergies from mid-August through late Fall are ragweed and other plants. Also, mold spores are present in heat and high humidity areas as well as rotting leaves in the Fall.

Weather patterns are a factor. Hence, we are seeing allergies at “non-traditional” times of the year.

Pollen counts are higher in the morning. Wind is needed to transport airborne pollen. Rain tends to wash pollen away but afterwards, it can increase.

Allergic Rhinitis (runny itchy nose) is often referred to as “hay fever,” which is an anomaly as it does not need hay and there is no fever. Symptoms can be aggravated or triggered by common irritants i.e., cigarette smoke, strong odors (perfume, cleaning solutions, chlorine).

Allergic Rhinitis can be associated with other symptoms – irritability, fatigue, poor sleeping (stuffed nose/snoring), decreased concentration, memory issues. Children during allergy season can suffer as AR can mimic nasal and vocal tics and ADHD. These lead to school and work absences, increased motor vehicle accidents and work injuries.

Regarding children, they can develop allergies. Usually 2 seasons of pollen exposure is required to prime the system. Remember, the nose is a reflection of the lungs.

IgE is an immunoglobulin that sits on certain cells and when a foreign protein (allergen) binds to the immunoglobulin, the cell ruptures and releases chemicals, i.e., histamines, which cause the symptoms.

If allergies last all year round, they are referred to as “perennial.” Some people may be allergic to multiple allergens which then cause symptoms all year round, especially if aggravated by indoor pollens, i.e., dust mites, cockroaches, feathers.

At times, some people can trigger a severe asthma reaction with the narrowing of the airways.

Also, large generalized hives can occur. The most serious is when anaphylaxis occurs with the resultant lower blood pressure and bronchoconstriction. This is potentially life threatening.

How do physicians diagnose allergies?

It is important to establish a good history focusing on the home and work environments. Examples: 1. Shades/blinds/curtains. 2. Carpeting. 3. Central or window air conditioning. 4. Type of heating system – forced air, radiator, baseboard. 5. Pets. 6. Cockroaches.

Also, there are blood tests.

Broadly speaking, there are two types of skin tests:

  1. The “scratch” test whereby a small amount of purified liquid is placed on the skin and then pricked. A positive result is like a hive reaction.
  2. Intradermal test – A small amount of allergen is injected under the skin.

What are treatments for allergies?

Medications should be taken at least 2 weeks prior to the season.

Decongestants and antihistamines are used. To help reduce symptoms of nasal congestion, sneezing and itchy and runny nose.

Corticosteroid nasal spray decreases the nasal inflammation and swelling of tissue. Other nasal sprays help, i.e., azelastine.

Vasoconstrictors should not be used regularly as they temporarily constrict the swollen blood vessels in the nose and can cause a rebound effect (rhinitis medicamentosa).

There are many eye drops available with ability to stop the release of histamine and other chemicals.

In addition, there are oral antihistamines, some with less drowsy side effects than others.

Antileukotriene meds are chemicals that are released but can cause the narrowing of airways.

There are different modalities of immunotherapy. SCIT – subcutaneous immunotherapy – is when a small amount of allergen is injected into the arm. The amount is slowly increased as well as the interval of the shots. Therapy may last 3-5 years.

SLIT or sublingual immunotherapy – is a newer form where small doses are placed beneath the tongue, either liquid or tablets. Presently, it’s approved for grass and ragweed.

Shots must be administered in a doctor’s office as there can be reactions ranging from local hives to anaphylaxis.

There are natural methods of treatments which are easy to implement and can yield could results:

  • Keep windows and doors closed at home.
  • Use air conditioning, making sure to change the air filter monthly. HEPA filters are best.
  • Use a dehumidifier for damp areas, especially the basement.
  • Change shoes and clothes after being outdoors.
  • Shower and wash hair to remove pollen.
  • Avoid the outdoors during peak pollen periods.
  • Some foods are said to have natural antihistamine properties – garlic, apples, onions.
  • Some suggest ingesting 1-2 teaspoons daily of local bee pollen or honey before allergy season as it contains small amounts of pollen.
  • Hot lemon water can soothe scratchy throats.

OAS – Oral Allergy Syndrome – 70% of pollen allergy sufferers can also have a cross-reaction with certain foods during the season. The body’s immune system mistakes a protein in food as pollen. Symptoms: itchy, swollen lips, scratchy mouth and throat, tingling throat, watery eyes. These are from raw fruits and vegetables. The symptoms begin soon after ingestion and last ½ hour; they are not life-threatening.

Grass pollen sufferers should avoid oranges, tomatoes, melons and figs.

People suffering from weed pollens, i.e., ragweed, should avoid bananas, cantaloupe, melons, cucumbers, artichokes, avocado and hibiscus and chamomile teas.

Apples, cherries, strawberry, celery and almonds can also cause OAS.

Questions? Please reach out.

As always, daven.

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