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Seasonal spring allergies can start as early as February in some parts of the country. More than 50 million Americans are affected by allergies, often triggered by pollen from trees, grasses, and weeds. We interviewed Dr. Erica Glancy, an allergist-immunologist at the Allergy and Asthma Center in Washington, DC, to help demystify some of the causes and symptoms of seasonal allergies. Here, she tells us why being tired could be a sign of seasonal allergies, why kids might have different symptoms than adults, and why Washington’s famous cherry blossoms are rarely to blame for spring sneezes.

The human body is a smart, functional organism, so why do we have seasonal allergies in the first place?

An allergic reaction is a sign that your immune system is being activated. There are many things in the air you breathe that can cause an allergic reaction, such as pollens from trees or grasses. Other common triggers can be molds, dander from cats and dogs, and dust mites.

When most people breathe in those substances, it doesn’t cause any issues, but for some reason, for people who have allergies, their immune system decides that whatever they’re breathing in is harmful to the body. This sparks an allergic reaction. Your body then produces antibodies to fight off those substances it sees as a threat.

Why do allergies cause runny noses and itchy eyes?

When certain cells in your immune system are triggered in response to antibodies, they release what are called mediators. One you’ve probably heard of is histamine. Histamines and other inflammatory molecules are what cause symptoms such as mucus production and swelling.

Besides the classic symptoms of sneezing, running nose, and itchy eyes, are there any surprising symptoms that might be signs of seasonal allergies?

In adults, the first that comes to mind is fatigue. If you’re having seasonal allergy symptoms and you’re very tired, then that could be due to what’s going on with your immune system. Seasonal allergies cause a lot of inflammation. In addition, you’re probably not sleeping very well if your nose is very congested. And you’re probably not getting the rest you normally would. If you treat the allergies, then often the fatigue will improve as well.

Can coughing be a sign of seasonal allergies? Or do I just have a cold?

Post-nasal drip, or mucus draining from your nose down the back of your throat, is often caused by allergies and can lead to coughing. Symptoms of a cold may be similar to symptoms caused by allergies, including a cough, but colds may also include other symptoms not typically associated with allergy, such as fever and body aches. Generally, allergy symptoms last as long as there is exposure to an allergen, while colds typically clear up in a matter of days (although certain infections may last longer). If symptoms seem persistent, seeing an allergist can help differentiate between common causes of a cough.

Do kids have have different seasonal allergy symptoms than adults?

Kids might be less likely to tell you how they feel, so look at how they are acting and the sounds they are making. For example, kids don’t always blow their noses when they have a stuffy nose. Often they snort or sniff or cough because they’re trying to clear their throat. Sometimes their throat or the roof of their mouth itches, so they will click their tongue to relieve it. Other times, they will rub their noses or eyes a lot.

At what point should someone consider seeing an allergist versus a primary care doctor for seasonal allergies?

Most primary care doctors are very experienced with treating patients who have seasonal allergies because it’s such a common problem. They can be a very good resource for explaining what medications will probably be the most beneficial depending on the symptoms. By the time people come to me, often they are at a point where they feel like what they’re doing isn’t working very well. Those patients might want more information about what is causing their allergies, to do allergy testing, or to explore other options about how to treat them.

What often surprises patients on their first visit to an allergist?

Some patients don’t realize we can’t do skin testing if they’ve been on antihistamines. Medicines such as Allegra, Zyrtec, Claritin, or Benadryl, as well as some over-the-counter eye drops, interfere with our ability detect those antibodies in the skin. Typically, you have to be off of antihistamine medications for about a week before we can do skin testing.

What should patients expect from receiving treatment from an allergist?

Once we get the results of allergy testing, the first thing we do to treat allergies is encourage avoidance. When you can’t avoid, medications can be used to treat your symptoms. For patients who aren’t getting good relief from medications, or those who are looking for a different way to manage their allergies, allergy shots or allergen immunotherapy is another option. The goal of immunotherapy is to not just treat the symptoms, but to make your immune system less sensitive to the things it’s reacting to.

Are there certain questions you always ask patients?

The most significant part of any evaluation is going to be history. It’s important to me to listen to a patient’s story. A lot of times I can figure out what may be causing their symptoms and how severely they are impacting their life just by talking to them.

I ask a lot of questions: What kind of eye and nose symptoms are you having? How are they interfering with your life? What things have you tried? What has been helpful? What has not helped? Are your allergies worse during certain times of year or with certain exposures? How patients answer these questions also helps me interpret allergy testing if we go that route.

What’s a common misconception about what causes seasonal allergies?

Here in DC, it’s actually not the cherry blossoms that are likely to be causing allergy symptoms. Typically, trees that make big, beautiful flowers are pollinated through insects, such as bees, who are attracted to the flowers and carry pollen around. Other trees are wind pollinated. These trees are the real problem because their pollen is in the air, and that’s what’s causing you to have horrible nose and eye symptoms.

When is a seasonal allergy an emergency?

Luckily, despite how impactful these symptoms can be, they’re not usually an emergency. Still, they can cause significant burdens on people’s day-to-day life, in terms of doctor’s visits, lost school and workdays. Sometimes seasonal allergies cause an asthma flare-up that can be an emergency because if you have a bad asthma attack, regardless of the cause, that can be life threatening.

Is it better to see an allergist when your symptoms are in full bloom or in the off-season?

Frequently, patients do come to me during their worst seasons. That’s just human nature. If you know that you have symptoms every spring or with certain exposures, and if you start medications and start treatments before you begin to experience symptoms, chances are you’re going to do a lot better because you’re going to stop inflammation from starting in the first place.

If you have severe allergies, allergy shots are a great option for some people, but they aren’t an immediate fix. They’re more of a long-term solution. If you can get something like that started before allergy season, then you’re probably going to feeling better when that bad season does hit for you.

Are seasonal allergies on the rise?

There’s a lot of interesting research about global warming and the environment in general and how that influences our allergies and how our immune system reacts. If there are longer times that plants can pollinate or if they start to pollinate earlier, then that can definitely influence pollen seasons and cause more symptoms.

Allergies, in general, seem to be more prominent than they used to be. One theory why is called the hygiene hypothesis: our immune systems have gotten bored because we’re not fighting the same infections and things that we would have had to a long time ago. Because our immune systems are bored, they start fighting things that aren’t dangerous, like pollen or cat dander or food. Still, a lot of this depends on your genetics and where you live. Different places have different exposures. If you live in a place that has very long, favorable pollen seasons, like Washington, DC, then you may experience symptoms that you didn’t experience when you lived in other parts of the country.

Wondering what to do next? Contact your primary care physician to evaluate your symptoms and find out if seeing an allergist is the right next step for you. Also be sure to check if your health insurance coverage requires advance approval or a referral to see an allergist. Then search Zocdoc for an allergist near you.

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One response to “13 Important Questions for an Allergist, Answered”

  1. Hawi Moore says:

    This is wonderful it has been of great help allergies are very prone and people seem to take it lightly.Thanks for sharing

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