Autumn allergies and sinusitis
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October 10, 2022
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Fall is here and you’re not feeling so good. You can’t stop sneezing and sniffling. The return of cool weather doesn’t make you feel invigorated, but miserable.
What’s happening? You may have a pollen allergy, also known as allergic rhinitis or hay fever. Thirty million Americans do this, and symptoms typically appear in the fall.
Like all allergies, hay fever is caused by a malfunction in the immune system. Instead of attacking harmful foreign substances like bacteria and viruses, it tries to neutralize normally harmless “invaders” – in this case, pollen grains that fill the air from August to October (until the first frost).
For someone with hay fever, inhaling these tiny particles triggers a cascade of biochemical reactions that result in the release of histamine, a protein that causes the all-too-familiar symptoms. In addition to sneezing, constipation, and fatigue, histamine can cause coughing; postnasal drip; itchy eyes, nose and throat; dark circles under the eyes; and asthma attacks.
Ragweed: The main cause of fall allergies
Many plant species can cause hay fever, but the 17 ragweed varieties that grow in North America pose the greatest threat. Three out of four people who are allergic to pollen are also allergic to ragweed.
Ragweed is a hardy annual ragweed that thrives almost anywhere lawn grasses and other perennials have not taken root—along roads and riverbanks, on vacant lots, and so on. In the course of a single year, a ragweed plant can produce a staggering one billion grains of pollen. And it doesn’t fall harmlessly to the ground. It floats on the breeze. Pollen has been found hundreds of miles at sea and two miles in the atmosphere.
Given the abundance of pollen, what can you do to limit your symptoms?
It is popularly said that people with hay fever should stay indoors in the morning hours because that is when the pollen load is highest. Not so, says Neil Kao, MD, an assistant professor of medicine at the University of South Carolina School of Medicine in Greenville. “I have reviewed 50 years of medical literature on the subject and there is simply no evidence that hay fever sufferers can minimize their symptoms by staying indoors or going outside at certain times of the day. This is a myth that even many GPs believe in.”
But there are effective ways to control hay fever symptoms, including avoidance strategies and, when that’s not enough, medical therapy. Here are six proven strategies:
1. Make your home a pollen-free paradise
During ragweed season, try to keep the windows closed and the air conditioning on (and do the same in the car). “Operating the air conditioner also helps remove moisture from the air, which prevents mold growth,” says James Stankiewicz, MD, chair of the Department of Otorhinolaryngology at Loyola University Chicago Stritch School of Medicine. “Mold can make hay fever symptoms worse.”
HEPA air filters can be helpful, especially if your home is carpeted. One per room is best, says Christine Franzese, MD, an assistant professor of otolaryngology at the University of Mississippi Medical Center in Jackson. If that’s not in the cards, get one for the room you spend most of your time in – presumably your bedroom. You might also consider getting a HEPA vacuum—otherwise, vacuuming might just stir up pollen instead of removing it.
2. Wear a mask
A surgical-style face mask isn’t going to protect you 100% from pollen — “You’d need a full-body hazmat suit for that,” says Franzese. But a mask can significantly reduce your exposure and is worth putting on if you venture outside into the garden, mow the lawn, play sports and so on.
Look for a face mask that is rated N95 by the National Institute for Occupational Safety and Health (NIOSH). You should be able to purchase one at a drug store or hardware store.
“I know wearing a mask isn’t fun, but it really helps breathe in all the pollen and mold,” says Kao. “The key is in the right application. It should fit snugly around your mouth and nose – feel around to make sure air doesn’t get in around the edges.
3. Wash off
Whenever you come in from outside, wash your face and hands. If you have been exposed to the outside air for a long time, shower and change into fresh clothes.
If you share your home with a furry friend who ventures outdoors, brushing and bathing outdoors will help prevent pollen from pursuing the inside.
4. Watch what you eat
Because they contain proteins similar to ragweed, certain foods can make allergy symptoms worse. Avoid bananas, melons and chamomile.
5. Rinse your nose
Using a salt water solution to wash pollen out of your nostrils and sinuses – can be very effective in curbing hay fever symptoms. A quick spritz in each nostril isn’t enough, experts say. Use a neti pot or an over-the-counter irrigator.
6. Track pollen counts
Stay indoors if possible on days with a particularly high pollen count. For reliable pollen (and mold spore) counts in your area, go to https://www.aaaai.org/nab/index.cfm.
If these pollen avoidance strategies do not bring relief, drug therapy may be appropriate. Over-the-counter antihistamines like Claritin and Zyrtec are generally the first choice for mild to moderate symptoms (no need for brand name premiums as generics cost less and work just as well).
If you suffer from congestion as well as sneezing and a runny, itchy nose, adding a decongestant like Sudafed should help. There are also combinations of antihistamines and decongestants. These products generally have a “D” in their name, as in Tavist D. (If you have high blood pressure, ask your doctor if it’s okay to take a decongestant. Some cause potentially dangerous increases in blood pressure.)
For severe or persistent symptoms, a steroid nasal spray (Flonase, Nasonex, etc.) may be helpful. If you have developed a sinus infection, a course of antibiotics may be necessary. Another option that works well for some patients is a leukotriene inhibitor such as Singulair or Accolate. These drugs block the release of leukotriene to reduce inflammation and other symptoms of allergic rhinitis. If symptoms are particularly bothersome, you may need immunotherapy (allergy shots).
Experts say the best approach may be to start treatment early and combine different therapies. Whatever prevention strategy and medication you choose, don’t wait until the last minute to start using it.
If you’ve had hay fever in previous years, Kao says, chances are you’ll have it again this year. Starting medications before symptoms appear can make them less severe and not last as long.
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