Spring is here — and if you’re among the estimated one in four adults in the United States who suffer from seasonal allergies, your sneezing and scratching may have already begun.
As climate change affects temperatures and plant growth, you may need to be on the lookout earlier than ever. It can be difficult to distinguish allergy symptoms from those of a cold, but experts point to a few telltale signs.
Is allergy season getting worse?
Spring allergy seasons are starting about 20 days earlier than they used to, according to an analysis of pollen count data from 60 stations across North America from 1990 to 2018.
This change can have important health consequences, said William Anderegg, who is an author of the study and an associate professor of biology at the University of Utah. Other research has shown that the very early onset of spring is associated with a higher prevalence of hay fever, also known as hay fever. When people end up sick or in the hospital from uncontrolled allergy symptoms, he said, “it’s because they weren’t expecting it and didn’t have medication on hand.”
The researchers also found that pollen concentrations have increased about 20 percent nationally since 1990, with Texas and the Midwest seeing the largest increases. Warmer temperatures, higher carbon dioxide concentrations and increased rainfall can all help plants grow and produce more pollen over longer periods of time, Dr Anderegg said.
Dr. Gaylen Marshall, chairman of the department of allergy and immunology at the University of Mississippi Medical Center, said that when he began practicing nearly 40 years ago, allergy seasons were limited to about eight weeks each. Tree pollen was collected in spring, grass pollen increased in spring and summer, and ragweed pollen was collected in late summer and early fall.
Then, people “could at least get some relief” between those cycles, said Dr. Marshall, who is also president of the American College of Allergy, Asthma and Immunology, a professional organization. “Now, those seasons end up being a big season.”
How can you tell if it’s an allergy or a cold?
Many people with nasal congestion or a runny nose may assume they have a cold. Although allergy and cold symptoms can be similar, allergies often cause itchy eyes, nose, throat, mouth or ears, said Dr. Rita Kachru, clinical chief of allergy and immunology at UCLA Health. With allergies, the immune system mistakes a trigger, such as pollen, for a harmful substance. When repeatedly exposed to this trigger, Dr. Kachru said, immune system cells release chemicals, including histamine, that cause itching and inflammation.
Patients often experience congestion and retrograde drip, or mucus dripping down the back of the throat. Some people may experience coughing, wheezing and shortness of breath.
With a viral infection, by contrast, you may have muscle fatigue, joint pain, or a fever.
If your symptoms occur every year around a certain time and last more than a week or two, then there is a good chance that they are caused by allergies. A personal or family history of allergies, eczema or asthma can also be an important clue, doctors said.
What if I have never had allergies before?
Most people first develop symptoms in childhood or adolescence. However, several experts said it’s not unusual for someone to have seasonal allergies for the first time as an adult.
Moving to a different part of the country and being exposed to different allergens can trigger a response, Dr. Kachru said.
New-onset allergy symptoms in adulthood could also be “an inevitable consequence of actually increasing the amount of pollen,” said Dr. Neta Ogden, an allergist in New Jersey.
Increased winds associated with climate change could spread the pollen farther, potentially exposing people to new varieties, said Dr. Mary Johnson, a researcher at Harvard.
Research has also shown that hormones, including estrogen, progesterone and testosterone, can affect how allergic diseases develop.
Boys often have food allergies or eczema as infants and seasonal allergies or asthma in childhood, but then those conditions disappear by the time they reach adolescence, Dr. Kachru said. But symptoms may return when they reach their 30s and 40s.
For some women, major hormonal changes, including those that occur during puberty, pregnancy and menopause and during birth control, can affect the onset and severity of allergy symptoms, said Dr. Kachru.
How do I manage the symptoms?
The first step is to reduce exposure. Keep your windows closed to prevent pollen from blowing into your home.
“The key is to prevent outdoor allergens from becoming indoor allergens,” said Dr. William Reisacher, a professor of otorhinolaryngology who treats allergies at Weill Cornell Medicine and New York-Presbyterian.
To do this, take out the clothes you’ve been wearing outside when you get home and store them outside your bedroom. Then take a shower to wash the pollen off your skin. Doctors recommend saline nasal irrigation to flush pollen out of your nose. (If you make your own, be sure to use boiled, sterile, or distilled water.)
Over-the-counter medications fall into two main categories: antihistamines and steroids. Both work on your immune system’s inflammatory response. Antihistamines are available as nasal sprays, eye drops, and oral pills, such as loratadine (Claritin), cetirizine (Zyrtec), levocetirizine (Xyzal), and fexofenadine (Allegra).
Steroids come as nasal sprays, including fluticasone (Flonase), budesonide (Benacort), triamcinolone (Nasacort), and mometasone (Nasonex).
If you’re having symptoms for the first time and aren’t sure how bad they’ll be or how long they’ll last, Dr. Kachru said, try an antihistamine to see if it helps.
If symptoms persist or you know you’re hit hard with allergy symptoms every spring, doctors recommend nasal sprays. Unlike antihistamines, which should only be used as needed, these steroids work best if you start using them a week or two before symptoms start.
Doctors warn against using products with pseudoephedrine, such as Sudafed, for more than a day or two because they can increase heart rate and blood pressure. In 2020, a physician task force issuing allergy treatment guidelines recommended against using Benadryl to treat allergic rhinitis. doctors said it can have sedative effects and cause confusion.
If avoiding environmental triggers and taking medication don’t work for you, shots or allergy tablets that build your tolerance to allergens may help.
“It’s the only option available that actually makes the body less allergic,” Dr. Reisacher said.
