Get ready for allergy season

photo of pollen dust being released into the air from grass

Allergy season typically runs from around March through October. Tree pollen dominates in spring, grass pollen in summer, and ragweed pollen in late summer to early fall.

If you have an allergy, when you inhale pollen, your immune system generates antibodies called immunoglobulin E that trigger the release of chemicals like histamine, leukotrienes, and prostaglandins. These chemicals eventually spread to tissues in the eyes, nose, throat, and lungs. Too much pollen exposure can cause the immune system to go haywire and trigger the hallmark allergy symptoms, such as sneezing, watery eyes, stuffiness, scratchy throat, wheezing, and coughing.

Allergies may also cause "brain fog." "Allergy symptoms often disrupt sleep and make people feel tired and groggy," says Dr. Mariana Castells, an allergist and immunologist in the division of Allergy and Clinical Immunology at Harvard-affiliated Brigham and Women's Hospital. "Plus, your body can become weaker as it fights the inflammation triggered by allergies, contributing to fatigue and making it harder to concentrate and focus."

Managing symptoms

Allergy symptoms vary in severity and length, depending on your specific sensitivity to particular pollen, the amount of exposure, and your major symptoms. "This is why some people may experience allergy symptoms only during a certain time of allergy season or only for a few days or weeks," says Dr. Castells.

Reaction to pollen also can vary from year to year because of weather changes. "Pollen levels increase when it's drier and go down when there is more rain," says Dr. Castells.

There are many ways to manage allergy symptoms. Dr. Castells advises treating symptoms at the first sign of a sniffle, scratchy throat, or itchy eyes. "This way, you can help manage inflammation before it rages out of control." (Note that symptoms that affect only one side, like one nostril, ear, or eye, should be checked by your doctor, as this could be something unrelated to allergies such as an infection.)

Here are the most effective methods for treating seasonal allergies.

Over-the-counter medication

Over-the-counter drugs fall into three main categories.

Non-drowsy antihistamines. These come as pills and nasal sprays and work to block the effects of the excess histamine that causes itchy and watery eyes, sneezing, and a runny nose. Sprays also help with congestion and postnasal drip. The less sedating oral antihistamines include loratadine (Claritin), cetirizine (Zyrtec), fexofenadine (Allegra), levocetirizine (Xyzal), and desloratadine (Clarinex).

Decongestants. These are available as pills, liquids, and nasal sprays. They shrink tiny blood vessels, which decreases fluid secretion in the nasal passages, helping to unclog a stuffy nose. Oral decongestants like pseudoephedrine (Sudafed) can increase heart rate and blood pressure, so check with your doctor before taking them if you have heart or blood pressure problems.

Nasal steroid sprays. These reduce inflammation that causes congestion, runny or itchy nose, and sneezing. People with glaucoma should take these with caution, as they can raise pressure inside the eye and lead to vision loss. "Antihistamines and decongestants are sometimes enough to relieve allergy symptoms," says Dr. Castells. "If that is insufficient, then a combination of antihistamines and nasal steroids is the next step."

Rinse and repeat

One drug-free way to get relief from allergies is by rinsing your nasal cavity twice daily using a saline solution. You can do a nasal rinse using a small bulb syringe or a neti pot, which resembles a small teapot with a long spout. Both are found at most drugstores and online. Here's how a nasal rinse is done:

Stir two to three teaspoons of non-iodized salt (not table salt, which has too many additives) and 1/4 to 1/2 teaspoon of baking soda into 2 cups of lukewarm distilled water. (You can use tap water, but always boil it first.) Another option is an over-the-counter sinus mix; add one packet to the neti pot and fill it with distilled water or boiled tap water that has cooled.
Pour the solution into a neti pot or pull it into a bulb syringe.
To rinse your nose, stand over a sink, bend forward, and tilt your head to one side. Insert the tip of the pot or syringe inside one nostril, and gently pour or squeeze the bulb to release about 1/2 cup of the solution. The water will run back out the nostril (or possibly the opposite nostril) and into the sink. Repeat the procedure in the other nostril. Perform twice a day until your sinuses are clear.
Thoroughly rinse (with distilled or cooled boiled water) and dry the neti pot or bulb syringe after each use.

Allergy shots and oral immunotherapy

If your allergy symptoms are severe or not sufficiently relieved by over-the-counter remedies, one option is a preventive regimen of immunotherapy, given in the form of injections ("allergy shots") or sublingual tablets (which are placed under the tongue to dissolve). "These do not eliminate your allergy, but they change your immune response to better tolerate it," says Dr. Castells.

An allergist does skin and blood testing to identify your specific pollen allergy and then develops a personalized vaccine. Allergy shots are done in two phases: buildup and maintenance. The buildup phase involves increasing exposure to the pollen once or twice weekly for three to six months. For the maintenance phase, you get monthly injections for three to five years.

When you've finished this regimen, the protective effect can last several years, says Dr. Castells. Sublingual tablets offer similar protection. There is no buildup period. Instead, you take the tablets daily for a few weeks before and during pollen season.

Reduce pollen exposure

Another way to manage symptoms is to lower your exposure to pollen. For example, keep your windows closed, and occasionally run the air conditioner to help remove pollen from the indoor air. Restrict outside time to the afternoon or evening when the pollen count is lower. (Pollen is usually highest from about 4 a.m. to noon). Check daily pollen counts in your area and sign up for high pollen alerts at www.pollen.com.

If you are outside when pollen is high, wear a mask, which can block 70% to 80% of pollen, according to Dr. Castells. When you come inside, immediately shower and wash your clothes to keep any pollen out of the indoor air.