Outlook | Analysis
May 18, 2018 at 10:41 AM
Every year, forecasters seem to predict that the worst-ever allergy season is ahead. And year after year, the pollen counts indeed get worse, partly because of climate change. Spring allergy season brings 50 million sneezing and wheezing Americans to pharmacy aisles, health food stores and doctors’ offices looking for relief. But the causes and treatments of seasonal allergies are still the subject of some persistent myths. Here are the biggest ones.
Myth No. 1
Taking allergy medicine daily can make it stop working.
Allergists like me constantly confront patients who believe this — and who don’t take their medication properly as a result. The American Academy of Allergy, Asthma and Immunology’s online “Ask the Expert” feature even fielded a question from a physician recently asking if “daily antihistamines . . . can result in tolerance.”
But multiple studies have debunked this concern. While it is a common complaint among allergy sufferers, the reality is that taking daily allergy medications does not lead to tolerance. Patients who think their medicines aren’t working anymore may be finding that their symptoms are getting worse because of new allergies or a move to a new city or home. Longer, more intense allergy seasons may mean medicines that used to work well are no longer as effective. Some allergy sufferers don’t take their medication correctly or believe wrongly that all medications are the same.
There is some overuse of some over-the-counter nasal decongestant sprays, which offer temporary, quick relief of congestion. Doctors often see dependence on these sprays, especially when treating chronic nasal congestion — which can affect sleeping, eating and general quality of life. Continued use of these types of sprays can actually cause rebound congestion and worsening nasal congestion, called rhinitis medicamentosa. To avoid this, people should stop using these sprays after three days. But intranasal steroids, a cornerstone of seasonal allergy treatment, are not habit-forming and can be used throughout the spring.
Myth No. 2
Blooming spring flowers
Media coverage of spring allergy season routinely includes images of allergy sufferers next to bright flowers. “With spring flowers come allergies,” the local NBC affiliate in Helena, Mont., reported last month. Patients often tell me they think pollen from dogwood and cherry blossoms, among other classic spring blooms, is causing their sneezing.
Actually, springtime allergies are caused by tree pollen, not flowers. The most allergenic trees — like oak, birch or maple — don’t have showy blooms. Their impact is significant because they produce a lot of pollen, which is designed to be wind-borne and can travel miles. Trees with pretty flowers, such as dogwoods or cherries; planted bulbs like tulips; and flowering bushes such as hydrangeas, roses and azaleas attract insects for pollination. So their pollen is rarely airborne and doesn’t lead to allergies, though it could be an irritant if someone gets too close.
Myth No. 3
A cold winter and a late spring mean allergies won't be so bad.
This year, as late as mid-April, when allergy season is usually well underway, much of the United States was still tackling winter colds, viruses, even flu. This may have led many to believe that spring allergies wouldn’t be too bad. Local news reports from Wisconsin to Rhode Island declared that tree allergy season was “delayed” or “stalled” by the lingering winter.
In fact, spring allergies start well before spring. The plant life cycle begins in winter, with snow and rain providing moisture essential for growth. Rising temperatures and longer days with more sunlight trigger pollination; by February and early March, U.S. cities are already recording pollen in the air, especially in the South. Studies show that warmer temperatures and higher CO2 levels associated with climate change are contributing to earlier, more robust plant growth and pollination. As a result, one 2013 study at Rutgers University found, allergy season has been increasing in length by about half a day for the past 20 years. A “late” start to spring doesn’t mean much when the Earth is generally warmer, the seasons are longer and pollen exposure is more intense.
Myth No. 4
Allergies aren't a problem
until pollen is everywhere.
This time of the season is the busiest for allergists’ offices, with people tending to wait until allergies truly peak — and they feel truly miserable — to seek help. A 2015 study in the journal Environmental Health found that over-the-counter allergy medication sales correlated with the peak dates of spring allergy season.
But if you see a dusting of yellow pollen everywhere, it may be too late to treat allergies effectively. Most allergists recommend that their patients start treatment at least two weeks before the season begins. The end of winter means the miserable cycle of symptoms we typically associate with spring is already underway. When temperatures first begin to warm, allergy sufferers are exposed to some pollen, which can trigger mild symptoms. Often, temperatures dip again and pollen exposure is minimal, but when warmer temperatures and higher pollen counts return, the body is “primed” and hyper-reactive. Even minimal amounts of pollen can cause a strong reaction upon reexposure. Physiologically, the priming effect is due to increased nasal membrane reactivity with repeated exposure to pollen. Once priming occurs, it can take days to weeks to reverse — hence the benefit of being armed with allergy medications early.
Myth No. 5
Eating local honey
will cure allergies.
The Internet is full of well-intentioned sites repeating the long-standing belief that local honey can soothe allergies. “In order for it to be effective it must fit these criteria,” says DIYNatural.com, one such site, before suggesting that the honey must be raw and must be made from the plants to which allergy sufferers are allergic.
But while honey may have some antimicrobial and anti-inflammatory properties, the idea that it can prevent allergies is a misconception. The theory is that as bees move among flowers, they pick up pollen spores that are then transferred to their honey; gradual exposure to these local allergens allegedly provides immunity. The concept isn’t so off-base: Allergen immunotherapy, or “allergy shots,” works in a similar fashion, but the shots contain a much higher concentration of pollen than the minimal amount in honey. Besides, the pollen that causes allergies is wind-borne and doesn’t come from the flower pollen that bees disseminate.
A 2002 study in the Annals of Allergy, Asthma and Immunology followed three groups of allergy sufferers through the spring allergy season. One group consumed a daily tablespoon of locally sourced honey; another ate commercial honey; a third was given a corn syrup placebo with honey flavor. The subjects’ symptoms were recorded, and after several months, scientists found that honey had no benefits over the placebo.