Symptoms, treatment, and prescriptions for seasonal allergies.

October 2022
By: Sesame staff with Dr. Allison Edwards, Medical Director

As spring arrives and the weather warms, millions of people across the country are feeling the ever-pesky symptoms of seasonal and pollen allergies: itchy eyes, a runny nose, dry skin, and more.

When you are exposed to an allergen like pollen, your body prompts an immune response - which causes common allergy symptoms like itchy eyes, itchy or runny nose, and scratchy throat that make allergic reactions troublesome. Most plants tend to pollinate during the spring, summer, and fall, making these especially aggravating times for people who have pollen allergies.

In preparation for the return of allergy season, we asked Dr. Allison Edwards a few questions about pollen allergies, how to treat allergy symptoms, and more.

What should I know about pollen allergies?

What is pollen?
Pollen is released by plants of all kinds -- like trees, grasses, flowers -- and carries the genetic material to create the next generation of plants.

What are some of the most common pollen allergies?
According to the Asthma and Allergy Foundation of America, common pollen allergies are usually split into three categories which are based on the type of plant that is releasing the pollen. These categories are:

Tree Pollen: Trees are often the first plants to pollinate during the new year - meaning they are often to blame for springtime seasonal allergies. In most parts of the U.S., trees tend to pollinate from March to May, although some trees in the South pollinate in late winter or year-round. Some trees that cause allergy symptoms include:

  • Pine
  • Ash
  • Beech
  • Elm
  • Hickory
  • Oak

Grass Pollen: Grass tends to pollinate later in the spring through the early summer. Only a few types of grass cause allergy symptoms. Where you live may change when you experience symptoms of pollen allergies from grass. For instance, in certain regions of the South where weather is consistently warmer, grass may release pollen throughout the year instead of only in the spring.

Weed Pollen: Weed pollen - especially ragweed pollen - is among the most common type of pollen allergy. Weed pollen often appears in the late summer and early fall. Other common types of weed pollen that cause allergy symptoms include:

  • Sagebrush
  • Pigweed
  • Tumbleweed

Ragweed pollen (more on that below) causes allergy symptoms in nearly 15% of Americans, according to the Asthma & Allergy Fondation of America. The Asthma and Allergy Foundation of America estimates that 75% of people who have pollen allergies are also allergic to ragweed. Ragweed grows across the United States but is most commonly found in Midwestern and Eastern states. Ragweed produces up to 1 billion pollen grains, which can travel as far as 400 miles through the air. This makes it especially prevalent throughout the U.S.

What should I know about ragweed allergies?

What is a ragweed allergy?
Ragweed is a plant that makes a ton of pollen; "ragweed allergy" is often used interchangeably with "hayfever" as a catch-all term for allergies that crop up once plants are blooming in the spring and into summer. In reality, people can have allergies to many different pollens out there in the environment and not just ragweed.

What causes a ragweed allergy?
Allergies are your body's overreaction to what should be a harmless substance -- like pollen, in this case. When exposed to the allergen, your body is triggered to release a compound called histamine. Histamine is responsible for causing all of those pesky allergy symptoms like itching eyes, nose and throat, sneezing, and runny nose.

What are the symptoms?
Most allergy sufferers experience a runny nose, itchy eyes, itchy throat or nose, general stuffiness, and sneezing. In rare circumstances, some people can experience hives or even anaphylaxis to allergies (though this is very unlikely for a ragweed allergy).

How is a ragweed allergy diagnosed?
Most of the time, environmental allergies are diagnosed based on a person's history and symptoms during certain times of the year. You can do a quick internet search to figure out if certain environmental allergens -- like ragweed, tree pollen, etc. -- are high in your community on a given day. If you find a pattern between your symptoms and what's elevated in your community, that's usually enough to come to a diagnosis. Occasionally your physician may recommend getting formal allergy testing, but this is usually unnecessary.

How should I treat my seasonal allergies?

How are pollen allergies treated?
The good news is that for the average person, over-the-counter treatments are all that's needed to treat allergies. You can start with a non-drowsy antihistamine medicine taken on a daily basis; there are many options available that all work relatively well. Saline sinus rinses are also excellent at helping decrease allergy symptoms (by "washing" away the allergens from the nasal passages). A topical steroid nasal spray, like fluticasone, can be used in each nostril one to two times a day to decrease inflammation associated with allergies. Additionally, diphenhydramine can help to decrease the effects of histamine in the body but can cause people to get pretty sleepy, so I try to recommend using those at night only. If itchy eyes are your main concern, there are anti-allergy eye drops available that can sometimes be helpful. If you've tried all of these over-the-counter remedies to no avail, there are some prescription options for treating allergies, like allergy shots, that can be coordinated through your primary care provider or allergist.

How does allergy medicine for pollen work?
Pollen can trigger watery and itchy eyes, nose, ears, and throat, runny nose, and congestion by causing the body to release histamine. Sometimes people can develop a cough from allergies or have other illnesses -- like asthma -- triggered by allergies and pollen. Allergy medicines work to counteract this histamine response and help relieve these pesky symptoms.

What are the types of allergy medication for pollen?
There are a few different medicines out there to fight back against allergies from pollen:

Daytime / Non-drowsy options:

  • Zyrtec (generic cetirizine): 10mg – 1 or 2 pills daily (available OTC)
  • Claritin (generic loratadine): 10mg – 1 or 2 pills daily (available OTC)
  • Allegra (fexofenadine): 180mg daily (available OTC)
  • Xyzal (levocetirizine): 5mg daily (available OTC)
  • Flonase (nasal spray): 1-2 sprays per nostril 1-2x daily (available OTC)
  • Astelin (nasal spray): 1-2 sprays per nostril 1-2x daily (Rx only) and combines well with Flonase
  • Singular (generic Montelukast): 10mg daily (Rx only); also effective for asthma

Nighttime / Drowsy options:

  • Benadryl (generic diphenhydramine): 25-50mg at night (available OTC)
  • Atarax (generic hydroxyzine): 25-50mg at night (available OTC)

What are the risks and side effects of pollen allergy meds?
Many anti-allergy medicines can cause drowsiness. There are other, occasional, side effects that are generally mild and self-limiting.

How can someone determine if allergy medicine for pollen is right for them?
The nice thing about over-the-counter allergy medicines is that you can try them without needing to formally consult a physician. Try one of the non-drowsy allergy medicines, and see if it helps. If you suspect allergies and want to run it by your doctor, we always welcome the conversation about how to best manage allergies.

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