Fall Allergies
Posted on: 09/15/2008
by Albert S Hartel M.D.
Though the flowers are no longer blooming and the air has begun turning crisp and cool, many allergy sufferers get no reprieve during the fall months in Western New York. Fall brings with it beauty, excitement, and the start of a new school year, but it also brings a season of increased fall pollens, which in millions of allergic individuals, can cause an onslaught of nasal, eye, sinus, and breathing symptoms, as well as potentially life threatening exposures to insects and food allergies.
For pollen allergic individuals, ragweed is the biggest fall allergy trigger, but other weeds and outdoor molds also reach their peak in the fall months. Ragweed pollen can travel for hundreds of miles in the wind, so allergic individuals can be sure that it will find them, even if it is not growing nearby. Mold thrives in damp areas, both indoors and outdoors. Damp leaves and picked over crops are notorious for harboring mold spores, which become airborne with the fall wind. Symptoms of nasal allergies include nasal congestion, sneezing, sniffling, itching runny nose, and post nasal drip. Eye symptoms can include itchy, watery, puffy eyes and dark circles underneath. Fatigue, decreased concentration, headaches and susceptibility to sinus infections can also occur. People with allergies to ragweed can also develop an itchy throat and mouth when they eat banana, cucumber, melon, or certain other fresh fruits and vegetables, because the body confuses proteins in these foods with similar ones in ragweed.
Asthma is also a major fall concern, with new fall pollens, weather changes and exposures at school. Asthma is dramatically more common in people with allergies, and those suffering with allergies may treat only the nasal symptoms and not realize they may also have inflammation in the lungs. Not all asthmatics will wheeze, and other symptoms such as cough, trouble breathing and chest tightness that occur with exercise, with infections, at night or when outdoors are also highly suggestive of asthma. However, even when symptoms are absent, evidence of lung inflammation can often be found in allergic individuals. Approximately 60-80% of asthma attacks are caused by environmental allergens and irritants such as smoke, pollen and animal dander, but inflammation often remains in the lungs even when symptoms are not present. Any thorough allergy workup should include asthma screening, as people with unrecognized disease are not only at risk for asthma attacks and decreased quality of life, but also for long term permanent changes in the lungs if left untreated. Even people with mild asthma can suffer a life threatening attack caused by environmental hazards. Asthma management needs to be individualized; the key to treatment is to reduce personal triggers, and to find the optimal medication at the smallest amount necessary to control inflammation and symptoms, without side effects. Medication requirements need to be monitored, as using a rescue inhaler such as albuterol more than twice a week means that asthma is not well controlled, and puts someone at greater risk of attacks, and long term consequences. A proper treatment plan should enable people with asthma to participate in normal activities without limitation in any season.
Fall doesn’t need to be spent indoors, but measures should be undertaken to decrease pollen exposure. Allergy sufferers should pay attention to the daily local pollen counts, and try to minimize outdoor activity when counts are high. Pollen levels are generally lower on rainy, cloudy and windless days, and reach their peak daily between 10 am and 4 pm. Windows should be kept closed during the pollen season to prevent outdoor pollen from entering homes and cars. Before turning on heat for the first time, consider having heating ducts cleaned, as particles of mold and other allergens can become trapped in the vents over the summer and will fill the air as soon as New Yorkers need to crank up the furnace. After spending time outside, pollen will accumulate on clothes, skin and hair, so it is important to shower and change clothes when coming inside.
Stinging insects place approximately 5% of Americans at risk of a severe life threatening allergic reaction, and September through October is prime sting season. Anyone who has had a systemic reaction to a sting (such as hives, breathing trouble or throat tightness/swelling) should be tested and properly diagnosed. Carrying portable epinephrine at all times is critical, but not enough, as over 30% of patients will need more than one dose, and all too often these are inaccessible, expired, or the reaction progresses too fast to allow time to administer. Measures which may help decrease insect exposure include avoiding brightly colored clothing and perfume when outdoors, avoiding bare feet, caution when cooking, eating or drinking sweet beverages outdoors, and hiring exterminators to spray and remove nests. Allergen desensitization shots can dramatically decrease risk of a future life threatening reaction in insect allergic individuals, and are the closest thing to a cure to this deadly allergy.
Food allergies are also an issue during the fall. Going back to school means sharing a cafeteria with children who are eating foods which may be life threatening to a classmate. Even Halloween becomes more trick than treat for kids who are allergic to the nuts and other candy ingredients. For 8% of children, and 2% of adults who have food allergies, sometimes even minimal exposure can lead to a severe reaction. People who suspect food allergies should undergo testing to identify sensitivities, and receive counseling on hidden ingredients and related foods to which a sensitive person also may react. Inform schools, friends and all caregivers of food allergies, and make sure they understand the severity of the allergies, and take them as seriously as you do at home. Food allergic children should consider bringing a bag lunch, and avoid sharing any type of food with friends. Accidents are never planned, so every allergic student should have a written action plan in place in case an accidental exposure occurs. Discuss the need for injectable epinephrine with an allergist, and make sure this is available at all times with multiple persons trained to use it.
Fall in Western New York is a wonderful and exciting time of year. Even people with severe allergies can get the most out of fall by testing to properly identify true sensitivities, educating themselves, and taking necessary precautions to avoid triggers. An appropriate regimen of preventative maintenance medications and a plan for treatment of flares will help minimize suffering. Many over the counter and even herbal medications have unwanted side effects, even when used properly, so it is important to coordinate treatments with your physician. It is also possible to reduce how allergic someone is and how severely their body reacts, through immune modifying allergy shots- which often greatly reduce suffering and decrease the need for long term medication, and often can continue to provide long term relief even after they are stopped.
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