Spring Fever

Fight the pollen! Tips to beat your seasonal allergies when the weather warms

WRITTEN BY Stratton Lawrence

PHOTOGRAPHS BY (Becky Royal) Scott Henderson & (Dr. Bennett) Niki Nero

A runny nose, sneezing and general fatigue have never been less welcome than in the age of COVID-19. But as spring blooms in the Lowcountry, thousands of people will begin their annual struggle with seasonal allergies. Eight percent of U.S. adults suffer from allergic rhinitis (also known as hay fever). In Charleston, where tree species like live oak, birch, maple and black willow release prolific amounts of pollen, that figure may be even higher.

“Lots of what makes Charleston so appealing can also be why it’s considered an allergy hot spot,” says Dr. Greg Bennett, an allergy and immunology specialist affiliated with Roper St. Francis Healthcare. He credits the short winter, as well as the occasional lack of a hard frost all year long, for our booming pollen numbers. Add to that an influx of new residents unaccustomed to allergens like live oak pollen, and it’s a recipe for a lot of unwelcome sneezing.

The Science Behind Hay Fever

Even for people who suffer from allergic rhinitis, factors that trigger a reaction vary significantly. “An allergen has to be the right size to enter the nose or respiratory tract, as well as abundant enough and dispersed widely enough,” explains Dr. Bennett. “Some are too big; some are too small. They have to be just right.”

Dr. Greg Bennett

Allergies are commonly triggered by Immunoglobulin E (IgE), an antibody that we produce to allergens such as pollen, mold or dust. When these antibodies react with an allergen, mast cells in our tissue and basophils in our bloodstream respond by releasing chemicals called histamines. This causes symptoms like mucus production and swelling in the sinuses, resulting in sneezing and itchy, watery eyes. Allergies can also exacerbate other conditions like asthma and eczema.

Some people develop allergies during childhood and either outgrow them or deal with them for life; others develop allergies as adults. The symptoms, however, are the same at any age. “In general, allergic disease can manifest at any time in a person’s life,” says Dr. Bennett. “Changes in environment, like moving to a new city, can lead to new exposures and new allergies.”

Pollen isn’t the only culprit. In cold weather, allergens like dust mites and pet dander are still prevalent. During summer, grasses release pollen, and fall brings spikes in weed and mold allergies. But in the spring, when the trees release their pollen, a collective reaction ensues. Fortunately, if you dread April allergies in the Lowcountry, there’s hope.

Diagnosing Seasonal Allergies

Allergic reactions and common colds share many symptoms, so the first step to dealing with allergies is to confirm that they are, in fact, the culprit behind the discomfort. “If you experience itchy or watery eyes, it’s likely allergies,” says Dr. Bennett, as these reactions are not typically seen in a common cold. Likewise, fever, a sore throat and body aches can be present in colds but rarely with allergies. Cold symptoms may fluctuate and change, while allergic reactions remain constant. Finally, colds generally clear up within seven to 10 days, while seasonal allergies will linger as long as the environmental allergens remain.

People with consistent, bothersome allergies should visit an allergist. Treatment for any reaction begins by determining exactly what’s causing it. Allergists typically do that through a series of skin prick tests. Potential allergens are placed on or just beneath the skin. Those that cause a localized reaction are then identified as likely offenders. Although many tree pollens are similar, a patient may only react to the mulberry tree in their yard, for example, and not the maple. Blood tests are an alternative method for pinpointing allergy triggers. “We help to identify causes and guide patients so that they can start by knowing what to avoid as best as possible,” Dr. Bennett explains.

The best treatment for an allergy is to steer clear of the irritant, of course, but environmental allergens can be hard to escape. If you need to be outside, masks can offer a protective barrier. “Masks help to decrease our exposure to various environmental allergens, including pollen,” says Dr. Bennett. Now that they’re a common sight, masks may become an everyday tool to combat seasonal allergies.

Treatment Plans

Patients have multiple options for short-term and more permanent medical treatment. After identifying and attempting to avoid specific allergens, the next step is to optimize medications. These may include eye drops, nose sprays and oral medicines that prevent the body from becoming inflamed when it encounters an allergen.

Short-Term Solutions

Most patients will recognize antihistamine names like Claritin, Allegra and Zyrtec, which are common over-the-counter medications that help many seasonal allergy sufferers find relief in the spring. While still effective, older drugs, like Benadryl, are more likely to have side effects such as sleepiness. For those whose allergies persist for months or impede day-to-day activity, prescription antihistamines may provide a stronger anti-allergic reaction, though they can also come with side effects such as drowsiness, dry mouth, restlessness and blurred vision.

“In general, all antihistamines work via the same mechanism, in that they block the effects of histamines on your body,” says Dr. Bennett. “Most of the time, you’re choosing between branding.” Just be sure to follow the dosing recommendations precisely, stresses the doctor, as antihistamine poisoning can be life-threatening. Symptoms of an overdose include dizziness, blurred vision, confusion, nausea or vomiting, an increased heart rate and loss of balance.

Other over-the-counter options may also alleviate symptoms, but they’re only temporary solutions. Decongestants might relieve symptoms but can make conditions worse if used beyond a few days. Likewise, steroids decrease inflammation and relieve allergy conditions but need time to take effect and can be dangerous if used for lengthy periods. While antihistamines can be used all season long to alleviate symptoms, they’re more of a band-aid than a cure.

For patients that don’t gain effective relief from these common medications, doctors may prescribe a leukotriene inhibitor such as Singulair. Another inflammatory chemical released by the body in response to an allergen, leukotriene causes constricted airway muscles and nasal congestion. Leukotriene inhibitors, which are also used to treat asthma, block that activity to keep bronchial tubes open and may reduce mucus secretion.

A Long-Term Fix

Patients with serious seasonal allergies may be “cured” using another avenue of treatment called immunotherapy. This method gradually desensitizes a patient to an allergen by exposing them to small but increasing amounts of the allergen over time. This is accomplished via shots or oral exposure (called SLIT, for sublingual immunotherapy). “The immune system learns to tolerate the allergen rather than causing bothersome symptoms,” explains Dr. Bennett. After three to five years of regular exposure through immunotherapy, a patient may be completely desensitized to their allergies.

Breathe Deep

Allergy sufferers today are fortunate to have options that were unavailable to prior generations, such as nasal sprays, antihistamines with fewer side effects and highly specific immunotherapy. There are also more opportunities for reducing allergens within the home, including vacuums with high-efficiency particulate air (HEPA) filters. Dr. Bennett warns that many home remedies, including raw honey and probiotics, have limited scientific evidence showing their effectiveness. However, he does recommend nasal irrigation with a saline solution.

Treating allergies begins with knowing what you’re allergic to and then finding the best option for immediate or permanent relief. “We’ve never been more effective at identifying and treating allergies,” says. Dr. Bennett. “We want to help patients do the things they normally like to do, and if that includes being outside enjoying the Lowcountry, we don’t want allergies holding them back.”

Allergies & the COVID-19 vaccine

The past year hasn’t been a good time to cough or sneeze in public. Many allergy sufferers may feel compelled to avoid interaction with others due to their cold-like symptoms. Compounding the problem, people with severe allergies may have concerns about getting the COVID-19 vaccine. In general, these concerns are unwarranted. “Individuals with common allergies to medications, foods, inhalants, insects and latex are no more likely than the general public to have an allergic reaction to the COVID-19 vaccine,” says Dr. Bennett. Patients who have a history of severe allergic reactions to injectable medications, vaccines or components of the currently available COVID-19 vaccines should speak with an immunologist about balancing their specific benefits and risks.