According to the Asthma and Allergy Foundation of America, allergies affect more than 50 million Americans each year. So, we talked to Dr. Halie Anderson to answer a few questions about the country’s most common disease.
Halie Anderson, MD
Rapid City Medical Center
What are seasonal allergies?
Seasonal allergies, like other allergies, develop when your immune system mistakenly identifies a typically harmless substance as an intruder. This substance is called an allergen. The immune system responds to the allergen by releasing histamine and chemical mediators that cause the typical symptoms of allergies in the nose, throat, eyes, ears, lungs and rarely skin.
Common seasonal allergens are pollens from trees, grasses and weeds, as well as outdoor mold spores. Pollen grains that cause allergies are airborne microscopic particles produced by wind pollinated plants. Since these pollens are microscopic, you can’t actually see these pollens! Pollens travel hundreds of miles in the wind. Therefore, it doesn’t necessarily matter what is in your immediate backyard! It matters more what is in a 200 mile radius of where you live.Beginning in late March or early April, flowering trees such as elm, birch, maple, oak, and hickory produce the first pollens of the spring. They usually reach their peak by the first two weeks of May. Grass pollen dominates from Memorial Day to July 4th. Ragweed and other weed pollens are highest from early August until late September. Dry windy days aid pollen dispersal; therefore, dry windy days are worse for allergy sufferers.
Mold spores appear in early spring and peak in the warmer months from July through October. They are particularly abundant in agricultural areas. They are often found on crops – so if you think you may have problems around corn fields, it is actually probably the mold in the corn fields that is causing you the problems! Mold spores are not killed by a frost but typically disappear with a snow cover. Mold may also be found indoors especially in damp humid areas of the house or where water damage has occurred.
Do children get environmental allergies?
Yes, it is common for children to develop environmental allergies. About 5-15% of children will have developed environmental allergies by the age of 15. It is uncommon for children less than 3 years old to develop seasonal allergies, but year-round indoor allergies to animal dander and/or dust mite can develop before age 3. A family history of allergies and personal history of eczema are strong risk factors for the development of allergies in children.
Are environmental allergies dangerous?
Environmental allergies do not cause life-threatening reactions like a food allergy does; however, they can be a severe trigger for people with asthma, which can lead to dangerous asthma attacks or loss of asthma control. Furthermore, allergy symptoms cause significant decline in quality of life for children (and parents). In children with severe allergies, fatigue and disordered sleep are common. Allergies can also be associated with a host of cognitive issues in children and adolescents, including attention deficit hyperactivity disorder, lower exam scores during peak pollen seasons, poor concentration, impaired athletic performance, and low self-esteem.
How do I find out if my child has allergies?
The diagnosis of seasonal allergies can often be made clinically by your medical doctor based on symptoms and physical exam. However, there are also other causes of nasal symptoms that may mimic allergies, so a definitive way to determine if your child is allergic is by getting allergy testing. The ideal way to test for environmental allergies is through skin prick testing at an allergists’ office. This is a process that uses a device to scratch allergens onto the surface of the skin; the allergen material sits on the skin and the allergist will interpret the results after 15 minutes. Allergies can also be tested using a blood test. Children as young as 4-6 months can undergo allergy skin testing, if necessary.
Is there any way to avoid pollen?
The fresh air feels great, but it carries the pollens that can trigger allergies, so keeping windows and doors closed during pollen season may decrease the pollen burden in your home. A few additional tips include: use air conditioning or heat in the home and in car; remove shoes and clothing when coming indoors so that you are not tracking the pollen inside; change clothing after coming indoors; if you have pets, try to wipe down your pet when it comes inside to avoid bringing pollen inside; do not dry clothes outside during the pollen season; avoid being outside in the morning or on windy days. If your child is very symptomatic when coming in from outside, have them take a shower and wash hair. Lastly, rinsing your nasal passages and sinuses with salted water (Saline rinses – netipot/Neilmed bottle) as needed to remove the pollens from your airway may help.
What can be done for allergy symptoms?
There are some good over-the-counter options for treating allergy symptoms. Oral antihistamine can help with sneezing, itching, runny nose, and itchy watery eyes. Examples of antihistamines include: Zyrtec (generic: cetirizine), Claritin (generic: loratadine), Allegra (generic: fexofenadine) and Xyzal(generic: levoceterizine). These antihistamines are very safe and can be given to children. In fact, these are even safer than Benadryl (diphenhydramine) because they don’t cross the blood brain barrier, and therefore cause fewer issues with sleepiness (or hyper-reactivity that can occur in some kids). They also last 12-24 hours, whereas Benadryl typically only lasts 4-6 hours. Oral antihistamines do not work as well for nasal congestion (stuffy nose). The nasal steroid sprays work better for stuffiness. Nasal steroid sprays are primarily all available over the counter. Examples of recommended nasal sprays include the following: Nasacort Allergy 24 (generic: triamcinolone), Rhinocort Allergy (generic: budesonide), Flonase Allergy Relief (generic: Fluticasone proprionate), Flonase Sensimist (fluticasone – no generic available). These sprays need to be used consistently for best efficacy; this medication does not work well if only used intermittently. It may take about 1 week to feel the full effects. Lastly, if allergy symptoms continue despite optimal use of the above, one can consider allergy shots.
What are allergy shots and how do they work?
Allergy shots, also known as subcutaneous immunotherapy or desensitization, are a treatment designed to improve allergic symptoms and to offer long-term benefits, even after the treatment has ended. Immunotherapy works on the principle of tolerance and protection, similar to routine vaccinations. Tiny amounts of the allergy-causing material are administered on a regular basis. The amount is increased as the body ‘learns’ to become tolerant until a maximum (maintenance) level is reached. Over time the body’s immune system develops a tolerance—an acceptance—of the allergen. At the same time, protective antibodies are being produced. That tolerance and protection helps the body to react less to allergen when it is encountered in real life. When Immunotherapy is performed properly (i.e. at appropriate doses for 3 to 5 years), the immune system ‘learning’ typically persists for long periods after the therapy is completed. Allergy shots are a big commitment and also carry some risk, so discussing the risks and benefits with a board-certified allergist is the best way to determine if this is an appropriate therapy for your child.
I’ve heard about oral drops for treating allergies, are those a good option?
At this time allergy drops (also known as sublingual immunotherapy) are controversial. It is not FDA approved in the United States, as the drops are not standardized and there have not been enough studies to confirm efficacy. Also, since they are not FDA approved, insurance will not help pay for the cost of sublingual allergy drops. There are sublingual dissolving tablets that have been FDA approved for grass allergy, ragweed allergy and dust mite allergy, which may be a good option for some people.
What is an allergist?
An allergist is a medical doctor (either a pediatrician or internal medicine doctor) who has done an extra 2-3 years of training (fellowship) specific to treating allergies, asthma and immune system problems in both children and adults. Therefore an allergist has had 5-6 years of additional training after graduating from medical school. To receive the best allergy care, you should find a doctor who is fellowship-trained and board-certified in allergy and immunology.