For some reason, it seems spring allergies get all of the credit. The commercials, the medications, the pop culture… They all seem to love talking about spring allergies. But, what about us fall allergy sufferers? Fall allergies to ragweed and mold spores are just as tortuous, if not worse, for some, than those well known spring allergies, for some. So why are the ailments of autumn less discussed? Let’s change that.
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Fall Allergy Symptoms
As one who suffers each fall herself, I know just how annoying and sometimes debilitating fall allergies can be. Once the leaves change color and start to drop, I am already feeling the symptoms. From a scratchy throat, to a runny nose, my body has plenty of unpleasant ways of warning me fall has arrived.
The most common of allergy symptoms, fall or spring, generally are the same. Some fall allergy symptoms include:
- Stuffy or runny nose
- Scratchy, dry throat
- Irritated or itchy eyes
- Sneezing
In many cases, these symptoms also tend to make sleep feel nearly impossible.
Is It Allergies or Is It COVID?
A big challenge for those with fall allergies is the timing. As we head into cooler temperatures, so too do we begin the cold and flu season. In today’s post-pandemic (but still COVID-prevalent) world, people also worry their symptoms may be COVID and not just allergies. To make matters even more complicated, illnesses such as pneumococcal pneumonia, RSV, or the flu, not to mention the common cold, are also more common in the fall and winter months. So how can you tell the difference?
While some allergy characteristics mimic COVID, there are a few telltale signs that it is something more than allergic sniffles. Firstly, allergies should not accompany a fever. If you have a fever over 100.4 degrees, you are likely suffering from something above and beyond allergies.
Additionally, seasonal allergies do not impact your gastrointestinal systems. However, COVID can often cause vomiting, nausea, and/or diarrhea. If you have some tummy troubles, it probably isn’t just allergies.
In the end, if your symptoms last longer than two weeks, or if you feel that they are worsening, impacting your daily life, or not responding to treatments, it is best to see your doctor. Only testing can truly determine what precise ailment is. Thankfully, prevention measures and treatments for fall infections and allergies are similar with so many symptoms being identical.
On the bright side, studies have shown that those with fall allergies are no more prone to get nor have worsened experiences with COVID.
Climate Change and Longer Allergy Seasons
For those with allergies, it may seem like the seasons, or windows of suffering, seem to be getting longer. It isn’t your imagination. They really are.
“Unfortunately, climate change has exacerbated the intensity and duration of these symptoms, making it even more crucial to be proactive in managing autumn allergies,” says Dr. Shaan Waqar, allergist and immunologist who practices out of ENT and Allergy Associates’ Plainview, NY office.
One 2022 review highlighted that warmer temperatures were clearly worsening allergy seasons and urged world leaders to take action.
“Environmental pollution and increased temperatures have contributed immensely to climate change, and thus have impacted human health significantly,” say the study’s authors.
What is it about environmental changes that impacts allergies? In short, more pollen is created. In warmer weather, those pollinated plants stay around longer. This can increase your likelihood of exposure to them. The change in environment also creates a habitat for faster pollen growth, meaning the start of allergy season can be even earlier. More pollen lasting longer equals a tougher allergy season for you and me.
Researchers found similar results in a 2020 study: climate change is making allergy season worse. In fact, the scientists found that the pollen season starts 20 days earlier, lasts 10 days longer and even includes 21% more pollen than it did in 1990.
The study’s lead author, William Anderegg of the University of Utah School of Biological Sciences, shared his findings with the National Institute of Food and Agriculture. He and his researchers found that “human-caused climate change” does play a significant role in pollen season lengthening and a partial role in pollen amount increasing.
“The strong link between warmer weather and pollen seasons provides a crystal-clear example of how climate change is already affecting peoples’ health across the U.S.,” says Anderegg.
So what is a sufferer to do?
Be Proactive for Fall Allergies
One solid way to prevent your fall allergies from taking you down is to plan ahead. Don’t wait for your nose to start dripping before you remember it is fall. Consider marking your calendar around the time your symptoms usually start to show up so you can treat your allergies ahead of time.
“If you suffer from seasonal allergies, you never want the changing seasons to catch you off guard,” says Waqar. “If you plan ahead, there are a number of steps and strategies you can employ to make this year’s fall allergy season far more manageable, regardless of your environmental conditions or the region you live in.”
Some tips to prepare for allergy season before it gets to you include:
- Keep windows closed overnight.
- Monitor news resources for pollen counts.
- Avoid morning activities when counts are highest.
- Keep your space clean, dust- and mold-free.
- Add hypoallergenic covers for mattresses or pillows
- Routinely wash bedding, jackets, shoes to remove pollen
Some small steps now can prevent bigger problems down the road. If you do choose to take medication, you can start to take it a week or two ahead of when you typically notice your allergy symptoms.
Treatment Options for Allergies
Depending on the type, severity, and life impact of the allergies, there are multiple options for treatment. Some sufferers noted they simply prepare their environment for the seasonal impacts of their allergies. Others seek more medically-focused approaches.
Non-Medicinal Allergy Treatment Options
Not every treatment for allergies includes a medication or doctor office treatment. Instead, sometimes simple lifestyle changes or environmental options may work to alleviate your symptoms.
Some non-medical options to treat allergies may include:
- Try staying indoors when possible, especially when pollen counts are high or at their peak.
- Keep windows of your home, workplace, and car closed during peak pollen seasons.
- Replace HVAC filters each month.
- Wash your hands and face to remove pollen.
- Shower and shampoo your hair at bedtime to wash off accumulated pollen.
- Wear glasses or sunglasses when outdoors to minimize pollen getting into your eyes.
- Wash bedding once a week using hot water.
- Leave outdoor shoes outside the door, so as not to track in pollen.
- Avoid hanging clothes to dry outdoors.
Additionally, some sufferers turn to nasal washes for clearing out pollen and debris in the nose’s air passageways. Small teapots, sold under the brand name of Neti-Pot, can help to flush the nose. The U.S. Food and Drug Administration (FDA) warns patients to use proper techniques with such products to avoid complications.
Typically, these products use saline or distilled water to flush out the nose. They are not medicated solutions and may be a safer option for those seeking a non-medicinal route. Caution is required, as unique infections or bacteria can enter via the nasal passages should distilled water or saline not be used.
Other allergy symptoms may be alleviated without the use of medication through the use of an N-95 mask that is snuggly fit to your face. Such protection covering the mouth and nose can prevent some allergy trigger particles from entering your system in the first place.
Over-the-Counter Medications
If you’ve turned on a television lately, you’ve likely seen countless advertisements for both prescription and over-the counter allergy medications. Even without a prescription, there are many options allergy sufferers can turn to during the worst of their symptoms.
Antihistamines
When most people hear “allergies,” they immediately think of the tiny pink pills sold under the brand name of Benadryl (diphenhydramine). These antihistamines are taken orally and generally bring about drowsiness for many. These medications are often called “first-generation antihistamines.”
The newer products on today’s market are being called “second-generation antihistamines,” which include name brands such as Claritin, Allegra, Zyrtec, or Xyzal. These tend to cause low or no drowsiness, which is a major side effect complaint of users of its predecessors.
How Do Antihistamines Work?
Histamine is a naturally occurring chemical in the human body. It serves a number of purposes. Histamine is an important chemical that has a role in a number of different bodily processes, such as stimulating gastric acid secretion, inflammation, dilation of blood vessels, causing muscle contractions in the intestines and lungs, and affects your heart rate. Additionally, histamines also help to transmit messages between nerve cells and help fluids move through blood vessel walls.
So, how does blocking these histamines help in combating allergies? Histamine is released if your body encounters a threat from an allergen. Histamine causes vessels to swell and dilate, leading to allergy symptoms.
For example, when your body encounters an allergen, histamines flood that area. If you breathe the allergen through your nose, your nostril may fill with mucus. If your site is the skin in the case of a mosquito bite, histamines may cause a red, itchy bump. The histamines cause that “exposed” tissue to swell. If the tissue in your nose swells, it can be harder to breathe, which is why you feel stuffy.
Over-the-counter medications such as Benadryl and Allegra are antihistamines, meaning they block or prevent the histamine from reacting.
Antihistamines “block the effects of a substance called histamine in your body. Histamine is normally released when your body detects something harmful, such as an infection. It causes blood vessels to expand and the skin to swell, which helps protect the body.”
In the case of those suffering from allergies, the body thinks that a trigger is actually a real threat. The best way to use these OTC medications is to take action ahead of time.
The UK’s National Health Service website explains, “Antihistamines help stop this [threat detection from] happening if you take them before you come into contact with the substance you’re allergic to, or they can reduce the severity of symptoms if you take them afterwards.”
Common Side Effects of Antihistamines
In addition to the aforementioned drowsiness many people experience with antihistamines, there are still more side effects to consider. Most reported symptoms such as:
- reduced coordination, reaction speed, judgment
- dry mouth
- blurred vision
- difficulty peeing
Even the newer generation of antihistamines, designed to avoid the drowsy side effect, still comes with risk. Side effects of non-drowsy antihistamines can include:
- headaches
- dry mouth
- nausea
- mild drowsiness
As with any medication, it is best to read all packaging and warning labels before consuming the treatment. Be sure to take a recommended dosage and reach out to a doctor or pharmacist if you have questions.
Antihistamine Drug Interactions
In addition to side effects, all medications also come with a risk when it comes to combinations. Intermixing medications can often cause unintended side effects or harm.
If you are take antihistamine, use caution and do not mix them with the consumption of:
- Alcohol
- Stomach ulcer medications
- Antidepressants
- Cold medicines also containing antihistamine
Many nighttime cold and cough medications use antihistamines to purposefully cause drowsiness. Many find that it is difficult to get rest and sleep with a troublesome cough or stuffy head, and the drugs are designed to allow you to sleep for recovery.
However, combining an antihistamine with another antihistamine can lead to an overdose of the drug, which can be fatal.
An overdose of these medications can cause side effects, and even death.
An overdose of antihistamines can cause:
- Increased drowsiness
- Blurred vision
- Nausea
- Vomiting
- Increased heart rate
- Confusion
- Loss of balance
Even the non-drowsy antihistamine (second generation), can cause harm if you take too much at one time. These medications often lead to dizziness, headache, drowsiness, and agitation if you take more than the recommended dose. Even tachycardia (when a resting heart rate is over 100 beats per minute) can occur.
While rare, death can occur via overdose. Studies show that less than 0.1% of overdose deaths are due to antihistamines alone. While they may be present in other drug overdose cases, it is typically not the leading cause.
Eye Drops
If your symptoms include itchy, watery eyes, or eye irritation, over-the-counter eye drops may offer relief. No prescription is needed for this treatment option, but that doesn’t mean it is risk-free.
These eye drops, sold under the drug named “ketotifen,” (which contain antihistamines) work much in the same way that other antihistamines do, by blocking the impacts of histamine swelling. Drops may also come in prescription strength.
Eye drops may not relieve all symptoms, and prolonged use of some of these drops may cause your condition to worsen.
The side effects mimic many of the symptoms of allergies, so they may not be a helpful solution for all patients.
Side Effects of Eye Drops
Common side effects for allergy eye drops include burning, stinging, or eye irritation, headache, stuffy or runny nose, a bad taste in your mouth, or an increased sensitivity to light.
Those that wear contact lenses should consult their doctor about their use during your medical need. Depending on your contacts, a doctor may recommend not using them in conjunction with the drops, may recommend waiting 10 minutes or more before putting them in following the drop use, or no changes at all.
Intranasal Steroids
Many allergists recommend using an over-the-counter intranasal steroid. These medications are available without a prescription, with some offering immediate relief. Sold under brand names such as Rhinocort, Nasacort and Flonase, intranasal steroids are sold at your local drugstore.
“Intranasal steroids are the most effective medication for dealing with allergies,” says Lang.
How Do Nasal Sprays Work?
Nasal sprays are not an antihistamine, and thus work in a different manner. Steroids are a man-made version of hormones normally produced by the adrenal glands, which are two small glands above the kidneys.
When sprayed into the nose, steroids reduce inflammation (swelling), which can help relieve symptoms such as sneezing and a runny or blocked nose, while also helping to reduce the size of any swellings (even polyps) in the nose.
The reduced swelling—and more open nasal passages—provide the user with a sense of nasal openness and easier breathing.
Nasal Spray Side Effects
Common reactions to such sprays include nostril irritation, dry nose, throat irritation, itchy nose, unpleasant taste, or bloody nose. Unlike oral steroids, the traditional side effects (such as insomnia, mood swings, increased appetite, face-flushing, or weight-gain) of nasal sprays are mitigated by their method of administration.
Long-term uses of nasal sprays can increase the risk of the side effects.
Immunotherapy for Allergies
The “shots” some try are called “immunotherapy” treatments in the medical circles. These treatment options expose an allergy sufferer to small doses of their trigger, hoping that their bodies will develop immunity to the allergen and, over time, stop overreacting to it.
Though such treatments can take years to become effective, many opt for this treatment as it is viewed as a “cure” for the allergic reaction. The therapy does take long periods of time to work, but if successful, would potentially eliminate the need for other allergy treatments.
Typical immunology treatments include a “build-up phase” which can be three to six months. During this period of time, shots are given from one to three times a week, typically in the upper arm.
Following this more intensive phase, a “maintenance phase” can take an additional three to five years, though injections during this time typically happen only once per month.
Immunotherapy Via Injections
Allergy shots are regular injections over a period of time, often over three to five years, and these aim to stop or reduce allergy attacks. Allergy shots each contain a tiny amount of the specific substance or substances that trigger your allergic reactions.
Many determine if this intensive level of treatment is right for them based on the severity of their symptoms.
“If you’re experiencing a level of symptoms that interferes with your desire to pursue activities or your symptoms are interfering with work or school performance, causing sleep disruption or sleep impairment despite avoidance measures and regular medications, you should see an allergist,” says Cleveland Clinic’s allergist-immunologist David M. Lang, MD in a 2020 article.
He also adds that allergy shots, called allergen immunotherapy, are also an option for some patients. Speaking to your doctor about your unique case is best to find your ideal solution.
“The allergy shots offer the potential to affect the underlying allergic potential that drives symptoms,” says Lang.
Immunology may be the answer for you, but it also may not be. Sometimes, it is a mix of over-the-counter, prescription, or environmental options that works best for an individual.
Lang encourages patients to seek out ”the right combination of remedies that can help them, including seeing an allergist.”
“We frequently see patients who are suffering needlessly and [allergists] can help,” says Lang.
Sublingual Immunotherapy Allergy Tablets
For those not ready to have frequent trips to the doctor’s office or have a fear of needles, there is another method to obtain immunotherapy: sublingual tablets. Sometimes abbreviated as “SLIT,” these tablets are designed to work much in the same way as the injections.
Sublingual immunotherapy (SLIT allergy tablets) is another form of allergy immunotherapy which involves administering the allergens in tablet form under the tongue generally on a daily basis.
Currently, however, there are only oral extracts for three of the common allergy triggers:
- Grasses
- House dust mites
- Short, ragweed pollen
However, the tablets have a versatility that offer patients a potentially more efficient solution.
SLIT medications address a broader range of airborne allergens, but must be customized for each patient. Based on the patient’s allergy test results, the physician can formulate a mixture that can include such allergens as:
- Trees
- Grasses
- Weeds, including ragweed
- Cats and dogs
- Molds
- Dust mites
- Feathers.”
Shots or Drops: Which Are Better for My Allergies?
Oftentimes, depending on your doctor’s availability, your insurance coverage, and your own personal preference, either option may work for you.
“Shots are somewhat better than drops for treatment of allergic rhinitis and asthma, with laboratory tests more likely to show favorable immune changes compared to drops,” says Howard Boltansky, MD, an allergy expert at Johns Hopkins Medicine.
He said those that are fearful of the treatments’ potential side effects may prefer shots, as they are administered by a healthcare professional.
“Allergy shots must be given in a doctor’s office under observation so that possible adverse reactions can be treated,” says Boltanksy. “Allergy shots are the right choice for many people, but for others, sublingual immunotherapy offers more comfort and convenience, as well as greater flexibility to travel without the need to return to the clinic for shots.”
Side Effects of Immunotherapies
According to Boltansky, most side effects to these immunology treatment options are mild. The worst risk would be anaphylaxis, though no deaths have ever been reported with the SLIT tablets, according to Johns Hopkins.
Most allergists will recommend having an Epinephrine injection (Epi-Pen) on standby, especially when you begin your first treatments. Doctors also recommend that those with mouth ulcers or cuts inside their mouths or gums not take an under-the-tongue SLIT tablet as it may cause the medication to enter the bloodstream too quickly.
More moderate side effects of immunology that have been documented include:
- Lip, mouth and tongue irritation
- Injection site reaction (swelling, pain, or irritation of skin)
- Nausea, vomiting, abdominal cramping and diarrhea
- Itching or redness of the eyes
- Nasal symptoms (sneezing, itching or congestion)
- Wheezing or difficulty breathing
- Increased severity of asthma symptoms
- Skin reactions (hives, itching or swelling)
Another rarer side effect is an allergic reaction in the esophagus — the tube between the mouth and the stomach. This problem (eosinophilic esophagitis) can feel like heartburn or difficulty swallowing.
Anaphylactic reactions, which can be life-threatening, often occur within 30 minutes of an injection. Most doctors will monitor new allergy patients at least this long, especially during the first few shots.
Anyone experiencing mild side effects should reach out to the prescribing doctor as soon as possible. If you have more severe reactions such as trouble breathing, hives, are unable to swallow, sensations of throat closure, immediately use an Epi-Pen and call 9-1-1.
Understand Your Allergy Options
Not all allergies require medical intervention. Medications always come with side effects. It is important to know your options, and understand the choices available to you. Before taking a new medication, be sure you have weighed its benefits versus its risks. Speak with your healthcare provider about any concerns you may have. MedShadow Foundation does not provide medical advice, diagnosis, or treatment.
