Health Illustration

Illustration by Gloria Diianni

When the ice melts and the weather begins to warm up, you might be excited to resume outdoor walks, runs or bike rides. But if you’re one of the more than 25 percent of American adults who reported having a seasonal allergy to the Centers for Disease Control, re-entering the great outdoors could pose a health risk. While we can’t prevent seasonal allergies, there are some precautions you can take and allergy treatments on the market that could make spring more bearable for the adults who suffer.  

Dr. Erin L. Reigh, M.D., M.S., F.A.C.A.A.I., staff physician in the Section of Allergy & Clinical Immunology at Dartmouth Hitchcock Medical Center, answers some of the most common questions about spring allergies here.

What are some of the most common spring allergies in New Hampshire, and when do they typically present?

In our area, allergy symptoms typically start around April. Common symptoms include stuffy nose, runny nose, sneezing fits and itchy, watery eyes. If you have asthma, you may also get wheezing and shortness of breath.

When spring allergy season starts in New Hampshire, the first thing that comes out is tree pollen. Some of the most allergenic tree pollens we see in New Hampshire are birch, oak, maple and elm. People often talk about pine pollen causing their allergy symptoms because pine pollen is easy to see — it’s the yellow dust that coats everything in the spring. But pine pollen is actually one of the weakest tree pollen allergens. The reason we can see it is because it’s a big pollen that settles out of the air faster than the other tree pollens. 

Birch pollen, on the other hand, comes out at the same time, but it’s so small that it can float in the air for hundreds of miles. So, the next time you see pine pollen on your car, think of it as a warning sign that birch and other tree pollens are out, which are probably the real cause of your symptoms, not pine!

Is there anything you can do to prevent allergies in the first place?

There are things you can do to reduce your risk, you cannot fully prevent allergies. Some studies show that keeping allergen levels down in your home can reduce the risk of developing allergies and asthma. 

You can start by removing carpets and rugs, which can collect allergens over time. If you can’t remove these (or don’t want to), vacuum them at least once a week with a HEPA filter vacuum. 

Don’t let pets on your bed even if you aren’t allergic to them — they can track in pollens from outside. 

Taking a shower at night can help by rinsing pollen off your body before you get into bed. 

Get allergy covers for your mattress and pillows to prevent allergens from building up over time — we spend a lot of time in our beds, so it’s worthwhile to keep this area free of allergens. Wash your sheets once a week to help with that. 

Finally, keep windows closed when the pollen counts are high.

If you already have seasonal allergies, start your allergy medications about a month before allergy season to prevent or reduce the severity of symptoms when the pollens come out. It’s better to prevent symptoms than try to control them after they’ve started.

There is also evidence that people with seasonal allergies can reduce the risk of developing asthma by going on allergy shots, which desensitizes them to their allergens.

If you think you might have allergies, how should you go about getting them tested?

The best way to test for allergies is with a skin test, which you can get done in an allergist’s office. This involves scratching a droplet of allergen against the skin and waiting about 15 minutes to see if the patient develops an itchy bump there. A positive test looks a bit like a mosquito bite. There are also blood test panels that can be done to look for allergies, but they aren’t quite as sensitive as the skin test and are more likely to miss an allergy. 

What are some common allergies that present later in life? Can they be serious?

Allergic rhinitis is very common. It causes nasal congestion, sneezing, itchy nose and runny nose. Allergic rhinitis isn’t life-threatening, but it can have a big impact on quality of life. Many patients describe it as feeling like they are “always coming down with a cold,” which is a terrible way to feel every day! Allergies can interfere with sleep quality, leading to fatigue. 

Allergies can also lead to nasal polyps, which are balloon-like areas of swelling in the nose. Nasal polyps make it very difficult to breathe through the nose and can reduce someone’s sense of taste and smell. Imagine not being able to taste your favorite foods anymore — these are some of the ways allergies can affect your quality of life even when they are not dangerous.

There are also a few conditions caused by environmental allergies that are more serious. Many people get itchy, watery eyes with their allergies. Most of the time, this is uncomfortable but not dangerous. However, in rare cases, eye allergies can be severe enough to affect someone’s vision. If you ever experience blurry vision, eye pain, a gritty sensation in your eyes, or thick mucus drainage from your eyes with your allergies, you should be evaluated by a doctor because it could be a sign of a more serious condition.

Finally, asthma is another condition that can occur with seasonal allergies that is more serious. Asthma symptoms include wheezing, trouble breathing, chest tightness and cough. Asthma “attacks” or “flares” can be triggered by exposure to allergens such as pollens, which can cause an increase in wheezing and shortness of breath. Sometimes this is severe enough to require a trip to the emergency room to get symptoms under control. Fortunately, we have a lot of great medications to control asthma that reduce the risk of this happening. If you think you have asthma, you should see a doctor so you can be started on medications to control it. 

Are there any new, noteworthy allergy treatments available?

We’ve seen a lot of amazing therapies come out in the past 10-15 years to help treat asthma. These new medications, called biologics, are very targeted medications that block allergic inflammation and can be highly effective. Unfortunately, they are incredibly expensive — often costing more than $30,000 per year without insurance. Because of the price tag, most of our patients don’t go on these medications unless traditional therapies, such as inhalers, aren’t working.

Some biologics have also been approved for nasal polyps. Nasal polyps often require sinus surgery, tend to come back over and over again, and can be really frustrating to live with. These new drugs have been life-changing for some of my patients with nasal polyps. The price tag limits our use, though, which is unfortunate.

There are also a few oral desensitization options that have been approved by the FDA. Desensitization is a process where we slowly expose a patient’s immune system to their allergen and essentially train it not to react to the allergen anymore. Traditionally, if someone wanted to be desensitized to their allergens, they would have to come into the allergy clinic for shots. This is a huge time commitment, especially for people who live hours away from the nearest allergy clinic. There are now three FDA-approved oral desensitization tablets: dust mites, grass pollen and ragweed. These tablets can be taken at home, which is great for people who don’t have the ability to come in for shots.

Is it possible to suddenly become allergic to something at an older age? Why is this so?

It is possible to become allergic to something at any age, but it’s much more common to develop allergies in childhood — 80 percent of people who develop allergies do so before the age of 20. 

Why people develop allergies is still one of the biggest questions in the field of allergy. It’s probably a combination of factors, including genetics and your environment. Having eczema, for example, increases the risk of developing allergies. With eczema, the skin can get very inflamed and irritated. When allergens like pollens touch the inflamed skin, your immune system is already primed and ready to attack, so it’s more likely to see the allergen as a threat and react to it. There is also data that shows higher allergen levels in the home increase your risk of developing allergies, so how much allergen you are exposed to can be a factor, too. However, there are still a lot of unknowns when it comes to why we develop allergies. 

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