If you’re like me, you’re spending portions of your day rubbing your eyes and blowing your nose. It’s fall, which means ragweed is releasing pollen into the air — and people with ragweed allergies are trying to cope.
If you’re like me, you think that by taking an antihistamine every day, you are doing all you can to keep your symptoms at bay. But otherwise, you muddle through your days, tissues by your side, secretly hoping for a hard frost to kill all those pollen-producing weeds.
What else can you do?
Plenty, as it turns out. There are new treatments for people with seasonal allergies to ragweed and grasses (which release pollen in late spring and summer). And there’s relatively new advice regarding the over-the-counter allergy medications. There are also reminders for ways to avoid pollen or combat it once you’re exposed.
I was glad to learn about some of the newer fixes for my itchiness and sneeziness. I was less pleased to learn that my allergies are likely to get worse with climate change.
“Botanists say that for birch and ragweed, with increasing average temperatures, the amount of pollen produced is increasing,” says Sandra Lin, an otolaryngologist at Johns Hopkins University. (Birch tree pollen is an early spring allergen.) In addition, allergy seasons are longer and plant distributions are broadening and moving northward.
At the drugstore, the allergy aisle offers up the old-school antihistamines, such as Benadryl and Chlor-Trimeton (doctors call them first generation), which are effective at reducing allergy symptoms but also cause significant sedation. “Benadryl is really sedating,” says Janna Tuck, an allergist and pediatrician in Santa Fe, New Mexico. “It inhibits higher cognitive function, which means it impairs your ability to work, to think and to drive.”
The doctor-preferred drugs are the newest ones to the pharmacy shelves: the nasal steroids, such as Flonase and Nasacort, approved for over-the-counter use within the past four years. Lin, who co-wrote the clinical practice guidelines for the American Academy of Otolaryngology-Head and Neck Surgery in 2015, says that for moderate to severe seasonal allergies, these are the most effective treatments. Used by spraying directly into the nose once a day, they are good at reducing all the symptoms of allergy during pollen season, including runny nose, nasal congestion, sneezing and itchy nose.
“You need to use the nasal steroids daily,” says Flavia Hoyte, an allergist and immunologist at National Jewish Health in Denver. “It takes time to work. Try it for a couple of weeks before you give up.”
Almost as good are the second-generation antihistamines — such as Allegra, Claritin and Zyrtec — and some people prefer taking a pill over spraying something in their nose. These drugs don’t reduce nasal congestion as well as the other nonprescription options. For that reason, most have “D” versions that combine the antihistamine with a decongestant, pseudoephedrine. But the decongestant means more potential for side effects, such as blood pressure problems, difficulty sleeping and urinary retention, Lin says.
When pollen counts are high and your symptoms flare up, can you double up on these over-the-counter medications? You can do it, Tuck says, such as taking a Benadryl at bedtime to help you sleep despite your runny, stuffed-up nose. But most studies show that combining nonprescription allergy meds generally don’t provide you more relief.
“Most people use their pills every day, and nasal spray only as needed. It’s much better the other way around,” she says. That’s because the nasal sprays are more effective when used daily, they’re more effective than the pills and they cover more symptoms.
In addition, Tuck says, “If you’re using two medications every day, that’s a sign that you should see a doctor. They may have a better solution for you.”
“If you’re miserable every fall, allergy shots can help,” Tuck says. The more technical term is allergen immunotherapy, which involves a regimen of exposure to the allergen, which eventually changes the underlying immune response.
“Immunotherapy is the only treatment that changes the underlying immunology,” Lin says. The drugstore meds treat only symptoms.
The new new thing is immunotherapy by tablets instead of shots. Currently, there are four tablets approved by the Food and Drug Administration, says Hoyte, who co-wrote a 2018 paper on recent advances in the field. Two are for allergies to specific grass pollens, one is for ragweed allergy and one is for allergy to dust mites.
“The big plus is that you take them at home,” Hoyte says. “The shots have to be done in the doctor’s office.”
A typical shot regimen is weekly for seven to eight months, and then monthly for up to five years. With the tablets, the dose is much smaller — you take it daily — and the risk of reaction is very small.
“Local side effects can occur, such as itching or tingling in the mouth,” Hoyte says. Hoyte administers the first dose in the office so she can watch for any untoward reactions. And she sends patients home with an EpiPen, a device that delivers an injection to treat a possible reaction.
Another plus is that you can use the daily tablets seasonally, rather than year-round. The recommendation is to start 12 weeks before your pollen season starts.
But there are downsides. The tablets are so new that insurance coverage is spotty. Doctors have less experience with them, so effectiveness and side effects are still being assessed. And tablets aren’t available for a range of other allergies, such as mold, pet dander or tree pollens.
With allergy shots, a change is noticeable in the first year, and can be sustained after three to five years of therapy. Hoyte says not everyone responds to immunotherapy; about 85 percent of patients experience at least some improvement.
Avoiding pollen means keeping it outdoors when you’re indoors. Close your windows and rely on your home’s air conditioning to filter out pollen. “For avoidance measures to be effective, you have to do multiple things,” Lin says. Other things might be to shower, or at least change your clothes when you come in from outdoors; wear a mask while outside doing yard work or gardening; and if you have outdoor pets, keep them out of your bedroom.
Indoor air filters aren’t that helpful with plant pollen, Tuck says. “Pollen is relatively large, so it falls onto surfaces,” she says. “Pet dander is different. It’s light enough [to float around in the air] so an air filter helps.”
Saline rinses are effective at preventing allergic reactions because they wash the pollen out of your nose.
“Saline is your friend,” says Tuck, who is also a spokeswoman for the American College of Allergy, Asthma & Immunology. “Use it when you come in from outside.” Also, she says, “It can be mildly decongesting and it’s pretty immediate.”
You can make your own saline solution to use with a Neti pot or small squeeze bottle. Instructions abound on various websites. The FDA has a version on its website. Go to fda.gov and search for neti pot.