Allergy sufferers are gearing up for a season filled with sneezing, runny noses and itchy eyes — even before the official start of spring.
In fact, the prolonged moisture in some regions this winter may have laid the groundwork for a bad allergy season, said Dr. John Bosso, chief of allergy and immunology at Nyack Hospital in New York.
"If it's a warm, dry spring following a wet winter, that's usually prime for having high pollen counts," Bosso said. "But if we get a very wet spring, we may not have a lot of bad pollen days."
With weather such an unpredictable factor, it's important to fight seasonal allergies pre-emptively, said Dr. Laura Mechanic, chief of allergy at White Plains Hospital. "We don't know exactly what to anticipate, but the seasons have been lasting longer than they used to, so it should be pretty bad," she said.
Tree pollen season in the Northeast generally starts at the end of March or beginning of April, said Bosso, with grass pollen season starting later, toward early summer. Last year was the fifth consecutive year that grass pollen levels were elevated until the end of September, said Mechanic, an allergist and immunologist with WESTMED in Purchase and Yonkers, N.Y.
According to the American College of Allergy, Asthma & Immunology, close to 50 million Americans suffer from allergic rhinitis, a condition that can last year-round. This winter was particularly bad for people with allergies to dust mites, mold or pets, said Bosso, since most people spent much of the season indoors.
Counteracting seasonal allergy symptoms before they start is a highly effective strategy, Mechanic said.
Why start allergy medicine before the season hits? Antihistamines and corticosteroid nasal sprays, many available over the counter, can block histamine receptors, reducing potential inflammation, Mechanic said. "It's a really good idea to start early, because if you have your armamentarium on board protecting you, the medication will be a lot more effective and you'll feel better," she said. "A lot of people who wait end up suffering longer and on even more medication for a longer period of time."
Should you see a doctor? Many people with mild symptoms limited in duration may not need to see a specialist and can do well with over-the-counter medication, Bosso said. "But when it starts to affect your ability to concentrate, to function, to do the things you enjoy, to get a good night's sleep, that's when it's time to see the allergist," he said.
What can an allergist do? If over-the-counter medications fail to work — or symptoms persist longer than the traditional pollen season — an allergist can offer other forms of treatment, including immunotherapy, in the form of allergy shots or drugs. Allergists may also prescribe other medications, including antihistamine nasal sprays.
New immunotherapy treatments: Two sublingual (under-the-tongue) medications were introduced recently: one that combats grass pollen and one that fights ragweed. Both need to be started 12 weeks before the allergy season — so it's too late to use it for this year's grass pollen season. But now is the time to begin treatment against ragweed allergy, which begins in late summer or early fall, Bosso said.
Over-the-counter medications: Antihistamines with the brand names Claritin (loratadine), Allegra (fexofenadine) and Zyrtec (cetirizine) are taken once a day. It is hard to predict which will work best, Mechanic said, as everyone responds differently to the medications. Decongestant versions of these drugs (Allegra-D, for example) should only be used short-term, she said.
Over-the-counter nasal corticosteroid sprays: Nasacort and Flonase (fluticasone) "work by suppressing some of the allergy inflammatory cells that come into the nasal passages and cause the inflammation and some of the runny nose and sneezing," Mechanic said. "For most people, they can take from four days to two weeks to reach an effective level." Saline sprays, which contain no medication, can also be helpful in flushing out allergens and opening nasal passages.
Over-the-counter eye drops: Formulations with ketotifen, an antihistamine, often work well to fight itchiness, Mechanic said.
Allergy shots: Immunotherapy typically takes from three to five years, Bosso said, with long-lasting results after shots are finished. While it is too late to start allergy shots for this spring's allergies, now is the time to plan ahead. "Younger people, under 40, tend to be more robust responders and have even more long-lasting results," he said. "But we have 70-year-olds doing really well on the treatment."