Pollen Allergies: Is There Any Hope for a Lasting Relief?

For approximately one in four adults with seasonal allergies, spring is a time of itchy, watery eyes, sneezing, and congestion. While avoiding pollen exposure helps, it's often challenging. Medications provide temporary relief, but for lasting results, immunotherapy stands as the most effective long-term allergy management strategy.

What are pollen allergies?

Otherwise known as hay fever or allergic rhinitis due to pollen, pollen allergies are the body's response to otherwise harmless pollen particles mistakenly considered dangerous by the immune system. Symptoms are caused when the immune system over-responds to fine, powder-like grains of pollen produced by weeds, grasses, trees, or even flowering plants. These particles can trigger itchy, watery eyes, sneezing, and a runny nose.

When the symptoms of hay fever persist, it can be very uncomfortable. When first exposed to an allergen, your immune system may show no reaction or only a mild one, but over time, the body responds more vigorously and signals chemicals such as histamines to be released into your bloodstream, leading to increased symptoms. When moving from one area to another, new allergies can develop following new exposures.

Types of pollen allergies

Pollen allergies can be caused by plants that release pollen, such as trees, grass, weeds, and flowers. Tree pollen allergies tend to be highest in the spring and early summer, while grass allergies are more common in the summer months. Late summer and early fall are associated with weed allergies caused by ragweed, sagebrush, and tumbleweed. Flower allergies also tend to be more common during the spring and summer.

Symptoms of a pollen allergy

The incidence of pollen allergies has tripled in the past 25 years, according to a study published in the International Archives of Allergy and Immunology. These pollens can cause a runny nose and itchy and red eyes, which could potentially lead to allergic conjunctivitis, an inflammation of the outer layer of the eye caused by allergen exposure.

Some of the common symptoms of pollen allergy include:

  • Runny or stuffy nose
  • Congestion
  • Sneezing
  • Itchy eyes and nose (sometimes ears and mouth)
  • Red, watery eyes (sometimes with swelling around the eyes)

Can pollen cause asthma?

Allergies and asthma often occur together. For those who have asthma, pollen granules can potentially trigger an asthma attack. In fact, airborne pollen starch dispersion may be associated with a rare phenomenon called thunderstorm-triggered asthma, an acute asthma attack potentially requiring hospitalization immediately following a thunderstorm.

A unique cascade of events creates thunderstorm asthma. Cold downdrafts sweep up pollen particles into the air where humidity is high. Lightning and wind break up the pollen, releasing starch granules that become concentrated by wind gusts and can readily enter the lungs.

People who have severe allergies or asthma can prevent a 'pollen bomb' asthma attack when thunderstorms strike by paying attention to peak pollen counts and weather forecasts. Staying indoors and continuing to use allergy or asthma medications as prescribed can help reduce the risk of this rare event.

How to get rid of pollen allergies

The first step in managing pollen allergies is to minimize exposure to pollen by following pollen counts in your area and organizing outdoor activities and exercise during times when the pollen count is lower. When seeking greater relief, pollen allergies can be addressed using over-the-counter (OTC) or prescription medications. Additionally, natural remedies such as herbal supplements may offer potential benefits. Modifying your nutrition may also help reduce inflammation.

Finally, immunotherapy can help your immune system change its reaction and lessen symptoms over time.

Allergy medications

The most common OTC medications can be taken daily, but it's important to read labels carefully and take them as your healthcare provider recommends. If the OTC medications are not enough to help with symptoms, a prescription medication may be recommended by your clinician.

  • Antihistamines. Available in pills, nasal sprays, and eye drops, these medications block histamine from binding to histamine receptors or block the release of histamine, which is the chemical that your immune system releases in response to the allergen. By blocking the action of histamine, the symptoms of allergies (e.g., sneezing, itchy eyes, runny nose) can be reduced.
  • Decongestants. Available in tablets, liquids, and nasal sprays, these medications are meant only for short-term use. Decongestants reduce inflammation and mucus production in the tissues of your nasal passages, making it easier to breathe. Using a nasal decongestant for more than 2–3 days can make your symptoms worse; if this happens, check with your clinician for other options. Because decongestants narrow blood vessels (and thus reduce stuffiness), people with high blood pressure should use caution and only take decongestants as recommended.
  • Corticosteroids. Available as nasal sprays, tablets, or injections, corticosteroids help reduce inflammation that drives the immune overreaction to pollen.
  • Mast cell stabilizers. Available as eye drops, nasal sprays, and oral tablets or capsules, these medications can help prevent the cascade of histamine-generated symptoms.
  • Leukotriene inhibitors. These prescription medications block leukotrienes, inflammatory mediators that are produced by the immune system in response to an allergen. Leukotriene modifiers include Singulair, Zyflo, and Accolate.

Natural remedies

Certain herbal remedies may potentially offer some benefits, but there's limited evidence to support their use. In a recent meta-analysis of 20 studies, butterbur was the most widely investigated natural remedy, followed by nettle and Ceylon cinnamon. The low quality of clinical trials to date makes it difficult to clearly assess the benefit of herbal remedies.

Additional studies are needed to establish dose-response relationships, safety, and timing of administration. To be on the safe side, if you are new to using herbal remedies, seek guidance from an expert and discuss any potential drug interactions with your clinician prior to starting an herbal regimen.

Functional nutrition

Modifying the diet to include functional foods may have anti-inflammatory effects on the immune system. The gut microbiome interacts closely with the immune system, and this crosstalk appears to influence the likelihood of developing allergies. Certain nutrients and bioactive compounds can help regulate immune function by decreasing the inflammatory pathways that cause the mobilization of immune first responders and the release of histamine.

While the research is mixed regarding the effectiveness of specific functional foods, the science underlying the importance of nutrition in reducing systemic inflammation is solid.

Some examples of bioactive compounds found to be effective in playing a role in inflammation and allergic reactions, as observed in animal models, include:

  • Curcumin, the spice found in curry (turmeric) may inhibit mast cell activation.
  • Piperine found in long pepper and black pepper may inhibit the early phase nasal symptoms of allergies.
  • Baicalin found in leaves and stem bark may decrease the release of histamines.
  • Omega-3 and omega-6 fatty acids found in fish, flax and chia seeds, nuts, eggs, and vegetable oils, affect inflammatory pathways.
  • Quercetin, a polyphenol found in onions and shallots inhibits histamines.
  • Short-chain fatty acids (SCFAs), butyrate and propionate are produced by our gut bacteria when we eat dietary fibers in foods such as chicory root, artichokes, flaxseed, onions, garlic, and asparagus. The SCFAs help modulate the immune response and tighten cell junctions in the gut, preventing allergens from penetrating through the gut barrier and triggering systemic inflammation.

Some antioxidants have evidence of potential benefit in randomized trials among human participants. One example is resveratrol, found in grapes, berries, peanuts, rhubarb, pistachios, plums, apples, pears, and pomegranates. The participants who received resveratrol had fewer nasal allergy symptoms and reduced inflammatory markers compared to those in the placebo group.

Immunotherapy

Although immunotherapy — training the body to avoid its overreaction to an allergen has been used for a century, we are still gaining more knowledge about the underlying mechanisms at play and how to identify specific allergens. Immunotherapy introduces a small amount of the allergen to the body through subcutaneous (under the skin) injection or a newer sublingual (under the tongue) approach. Training the body to tolerate allergen exposures means that you can potentially reduce the amount of medication needed to manage symptoms.

Another important benefit is the potential to prevent other allergies from developing due to cross-reactivity by the immune system. There are some studies that show immunotherapy for allergic rhinitis can also prevent the development of asthma in children.

People who have allergy shots visit the doctor every week or two initially, then the treatment is administered monthly. The goal is to gradually increase the body’s tolerance to the allergen. This build-up phase can take 3–6 months. The maintenance phase lasts 3–5 (or sometimes more) years.

Side effects include a mild rash at the injection site, allergic reactions similar to the pollen allergy, itching and swelling in the mouth, fatigue, and headache.

Food allergies, such as to peanut butter, are also amenable to immunotherapy, reducing the risk of severe reactions, including anaphylaxis. In 2020, the FDA approved Palforzia, a peanut allergen powder for the treatment of children ages 4–17 who have a peanut allergy.

How can I tell if I have a pollen allergy?

Most children have 6–8 colds per year, and most adults have 2–3 colds per year, sometimes making it difficult to differentiate common cold symptoms from a pollen allergy. However, if you or your child have allergy symptoms and experience them each year at a similar time, it is worth checking to see if you have a specific pollen allergy. Frequent rubbing of the eyes and nose can sometimes be a tell-tale sign of allergies in children.

There are two types of tests that are considered accurate for diagnosing patients with pollen allergies.

  1. Skin prick test. A tiny drop of the suspected allergen is placed on your skin then it is scratched into your skin with a needle. If the spot turns red, swells and itches, and a raised, round bump is formed (a hive) within about 15–20 minutes, you may have an allergy.
  2. Immunoglobulin (IgE) blood test. Blood is taken and sent to a laboratory where specific IgE antibody against pollen is measured.

Lifestyle changes to reduce pollen exposures

Recommendations for dealing with pollen allergies regularly focus on checking pollen forecasts and avoiding exposure using strategies such as carefully planning when to go for a walk or on holiday, using a dust mask and air purifiers that filter allergens, cleaning the house and washing pets regularly, and using a clothes dryer instead of drying them outside.

Other lifestyle changes to consider include:

  • Keeping your windows and doors closed to prevent pollen from entering the house during peak pollen counts
  • Changing clothes somewhere other than your bedroom to reduce the pollen count in your room
  • Vacuuming your bedroom regularly
  • Washing bedroom linens at least weekly
  • Removing carpets or rugs which may trap pollen and make it hard to clean
  • Showering before going to bed to prevent pollen from your hair getting on your pillow

For parents whose children have pollen allergies, it's a good idea to pay attention to pollen counts and follow the recommendations for reducing exposure. You may also wish to talk to your doctor about allergy testing and seek professional advice regarding which medication may be best for you or your child.

Consider switching to daily contact lenses

Contact lenses can cause pollen to stick and potentially irritate the eye. A multi-site cross-over study among 128 individuals compared daily to monthly lenses. Two-thirds of the study participants reported that wearing daily disposable contacts improved their symptoms. Some contacts contain a lubricant and antihistamine, which could help reduce burning and stinging.

Although many people suffer from pollen allergies, there are a wide variety of ways to reduce symptoms, from lifestyle changes to over-the-counter and prescription medications and immunotherapy. You may even find some relief from herbal remedies and adopting a diverse diet that improves your gut microbiome. These changes in nutrition have the potential to improve your overall health as well, even if you do not notice changes in your allergy symptoms.

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