Seasonal allergies, also known as allergic rhinitis, are nothing to sneeze at: They not only cause unpleasant symptoms but also can lead to difficulty sleeping and harm performance at work or school. Columbia otolaryngologist David Gudis, MD, joined the CUIMC Newsroom to explain seasonal allergies and offer strategies to help patients cope.
Seasonal allergies are an immune reaction
Seasonal allergies are caused by “a confused immune system reacting to things in the atmosphere,” Gudis says, adding that in the springtime, the trigger is usually tree pollen. “The immune system reacts by releasing molecules in the body that cause uncomfortable changes. For example, it releases histamines, which can cause itching, swelling, and watery eyes, runny nose, and congestion.”
Why do some people have seasonal allergies, but others don’t? The leading theory is that allergen exposure during childhood affects immune system development, so the environment someone is raised in can make a big difference. “If you grew up on a farm, the chances of you developing something like hay fever or springtime allergies are extraordinarily rare,” says Gudis. “If you grew up in New York City, chances are very, very high. Here we’re exposed to fewer antigens and microorganisms that are a natural part of the environment.” The early exposure allows the immune system to adapt.
Three categories of coping strategies
Gudis recommends a tiered approach to dealing with seasonal allergies. First, allergy sufferers should reduce their exposure to the trigger. Inside the house, helpful measures include keeping windows shut, vacuuming and dusting frequently, using an air conditioner with a filter, changing sheets regularly, and showering before bed. Nasal irrigation can also be effective because it washes out allergens and stimulates the cilia, which are tiny hairs in the lining of the nose and sinuses that propel mucus and foreign substances out of the nose.
If symptoms persist, Gudis suggests turning to pharmacotherapy; options include nasal sprays, topical steroids, topical antihistamines, and oral antihistamines. “Taking allergy medication for a long period of time is generally pretty safe. The risks come when people are taking the decongestants because decongestants are usually stimulants, which can cause palpitations or high blood pressure,” he says. A letter “D” on the packaging is often used to denote that a medication has a decongestant.
The third category is allergy shots, or immunotherapy, in which patients receive progressively higher doses of the substance they are allergic to. This treatment leads the body to attack allergens with an immune response that interrupts the allergic reaction pathway and blocks histamine release. “Allergy shots are extremely effective, but they are time-consuming and labor-intensive,” says Gudis. “You have to go through formal allergy testing first, to figure out what you’re allergic to, and then go for a series of repeated allergy shots. So I don’t recommend people going down that road until they have failed the other measures.”
David Gudis, MD, is an assistant professor of otolaryngology/head & neck surgery at Columbia University Vagelos College of Physicians & Surgeons.