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Ask the Expert: Avoiding Seasonal Allergies

People suffer from allergies in different ways because allergies react to the environment.
Dreading the symptoms of hay fever this fall? Dr. Little explains
why pollen allergies feel a lot like the common cold and discusses
treatments to help find relief.

With ragweed season right around the corner, BMC News asked Frédéric Little, MD, attending physician in Boston Medical Center’s Pulmonary, Critical Care and Allergy Department, about ways to avoid the scratchy throat, stuffy nose and watery eyes caused by fall pollen allergies.

BMC News: How common are pollen allergies and what causes an allergic reaction?

Dr. Little: People can be allergic to many things in the environment both indoors and out. Outdoor allergies are very common and are mostly caused by seasonal pollens. There are three main outdoor pollen seasons: spring, summer and fall. Spring allergies are caused by tree pollens including pollens from birch, oak and maple trees. These pollens can travel far distances through the atmosphere, affecting city dwellers just as much as people living in rural areas. Summer pollens come mainly from wild grasses in uncut, untended wooded areas and fields. The fall pollen season, which begins to spread in mid- to late-August and continues until the first frost, is mostly from weed pollens including thistle, mugwort and ragweed. It is important to note that the allergies that people suffer from are dependent on the environment they are in, meaning trees and flora of different regions will affect people in different ways.

Allergens cause an immune response within the body, causing affected areas to release histamine and other substances that irritate and inflame tissues. Symptoms of allergies include a runny nose, an itchy, scratchy throat, nasal congestion and discomfort in the eyes.

BMC News: Beyond discomfort, how serious can allergic reactions be? Do they make asthma worse for example?

Dr. Little: About 60% of adults who have asthma have an allergic trigger to it. Certainly asthma is a serious condition that requires medical treatment. In addition, untreated allergies can cause fluid build-up that puts people at risk for bacterial infection in the sinuses.

BMC News: What are the treatment options for allergies and how do they help?

Dr. Little: It really depends on how bothered you are by your allergies. Short-acting antihistamines like Benadryl® or Alavert® are effective but can cause drowsiness. Over the past five years, some of the longer-acting, non-sedating antihistamines have become available for sale over the counter like Claritin®, Allegra® and Zyrtec®. These antihistamines will relieve some of the annoying symptoms of allergies such as the scratchy throat, watery eyes and running nose but they do not change your body’s immune response to allergens.

People that do not find relief through antihistamines alone may find additional help through anti-inflammatory medications such as nasal corticosteroids. These medications can work to decrease the allergic inflammatory response that is being caused by allergens. When taken consistently, they will help relieve nasal congestion and “stuffiness” associated with allergies.

BMC News: What about allergy shots. Is there a benefit to this type of treatment versus antihistamines?

Dr. Little: Allergy shots, also known as “immunotherapy,” help patients build up immune resistance in the body over time. There is a fair amount of range in practice regarding allergy shots. We typically recommend this treatment to people who do not respond to topical treatments such as nasal steroids or antihistamines. Immunotherapy requires a lot of time commitment from the patient, who must come in once or twice a week for shots in the beginning of treatment. However, if a patient misses some shots, the body’s tolerance to allergens will diminish, and we will have to start the process again. Ideally, immunotherapy for pollen allergies should begin to be administered toward the end of the fall pollen season and then we can capitalize on the time from mid- to late-October through mid-March to build up the patient’s immune resistance before the pollen season begins the next year.

BMC News: Are there other ways beyond medication/immunization to avoid or reduce pollen allergies?

Dr. Little: It is really really hard to control exposure to outdoor allergens. The best thing you can do is to minimize the amount of pollen entering the house. I would recommend that people with severe pollen allergies consider changing their clothing when they come into the house from outside and put used clothing in a hamper or wash it right away. Closing windows and using air-conditioning can also help keep pollens from getting inside the house by dehumidifying and filtering the air, but again it is very hard to control exposure to these tiny pollens.

Boston Medical Center ranked 38th in pulmonology in U.S. News & World Report's 2010-11 Best Hospitals. BMC’s Department of Pulmonary, Allergy and Asthma is committed to making life with lung diseases more livable by providing the highest quality care combined with a commitment to understanding lung diseases through research.