The woman next to me in the checkout line looked upset. Her eyes were red and her nose was running. My first thought was to give her privacy, until I saw her shopping basket filled with supplies to fight allergy symptoms, and then our eyes met. “I can’t believe how bad my allergies are this year!” she said, exasperated.
My fellow shopper isn’t the only one suffering. “Warm weather and a mild winter, as we’ve experienced this year, can stimulate trees to pollinate. The southern U.S., which has a warmer climate, is particularly susceptible to earlier allergy seasons. Other climate factors — such as cool evenings, wind, and rainfall — can also lead to surges in pollen counts, which can exacerbate the impact of the early allergy season,” says Dr. Ahmad Sedaghat, an ear, nose, and throat specialist at Harvard-affiliated Massachusetts Eye and Ear Infirmary.
Waiting until allergens are in the air is a losing strategy in the allergy war. Once spring pollens — typically from oak, elm, birch, poplar, or maple trees — float through the air and reach your nose, the body can overreact. Mast cells in the lining of the nose may mistake the harmless tree particles for dangerous invaders, and summon help by releasing chemicals such as histamine and tryptase, which then recruit more immune system cells to the battle. Those chemicals also trigger watery eyes, a runny nose, sneezing, coughing, and a sore throat.
A better defense
It’s best to turn off your body’s defenses well in advance of the pollen party. This is because some drugs, such as corticosteroid nasal sprays, take a few weeks to become fully effective. It’s also because the reaction to even a few allergens has a snowball effect. “Once it starts, it’s hard to stop,” Dr. Sedaghat explains. “More inflammatory cells are recruited to the nose and sinuses, symptoms become more severe, and it’s difficult to treat them.”
Blocking the reaction before it begins prevents symptoms or lessens their severity, and keeps irritation from progressing to sinusitis or an asthma flare-up.
Choose your weapons
Only certain allergy medications should be used in advance, such as:
- a corticosteroid nasal spray, such as mometasone furoate (Nasonex) or fluticasone propionate (Flonase). Many of these sprays are now available over the counter (OTC). Use the spray every day while allergy season lasts, starting a month in advance of when you expect to get allergy symptoms.
- an OTC oral antihistamine, which counteracts the effects of histamine. Some antihistamines, such as diphenhydramine (Benadryl), can cause drowsiness, leading to falls. Fexofenadine (Allegra) or loratadine (Claritin) are less likely to cause drowsiness.
- prescription antihistamine sprays, such as azelastine (Astelin) and olopatadine (Patanase), may help prevent the symptoms of sneezing and a runny nose while minimizing side effects like drowsiness.
- antihistamine eye drops, such as ketotifen (Zaditor), available over the counter, and olopatadine (Patanol), available by prescription, can be used to prevent watery eyes.
Decongestant pills, such as pseudoephedrine (Sudafed), help reduce nasal congestion, but they can cause problems for people with high blood pressure or heart problems and should not be used to manage allergies. Decongestant sprays such as oxymetazoline (Afrin) should not be used for more than a few days, since long-term use can make congestion worse.
Another option is allergy shots to help reduce allergic symptoms, but that approach can take three to five years to be fully effective.
What you should do
Work with your doctor to develop a pretreatment strategy, including how far in advance you should use medications.
And what if you, like my shopping buddy, were caught off guard with this early allergy season? Dr. Sedaghat recommends medical strategies, such as:
- irrigating the nose with salt water (saline)
- using antihistamines and intranasal steroid sprays, both of which are now available over the counter, under the guidance of a physician.
Dr. Sedaghat also suggests environmental strategies to reduce pollen exposure, such as:
- keeping windows closed
- using an air cleaner with a HEPA filter
- changing clothes immediately upon getting home
- frequently washing clothes in hot water
- wearing a mask for outdoor yard work
- avoiding going outside when pollen levels are highest.
And by all means, prepare for next year’s allergy season before it strikes, especially if a mild winter precedes it.