Dr. Fred Little shares the difference between seasonal allergies and illness, what over-the-counter medications to look for, and ways to identify and manage triggers.

Featured Speaker:

Frederic F Little, MD

Fred Little, MD

Fred Little, MD is the Medical Director of Pulmonary, Allergy, and Critical Care at Boston Medical Center. He is also an Associate Professor of Medicine at Boston University's School of Medicine. Clinically, is areas of special interest include allergy, asthma, and critical care. Learn more about Fred Little, MD.

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Melanie Cole (Host): Well, it’s that time of year again and if you are someone who suffers from seasonal allergies; you know that some people dread it. They dread the coughing and the sneezing and the running nose and the watery eyes and everything that goes with allergies, that are really common at certain times of the year. My guest today, is Dr. Fred Little. He’s the Medical Director of Pulmonary, Allergy and Critical Care Medicine at Boston Medical Center. Dr. Little, tell us a little bit about seasonal allergies and how can someone determine the difference between those types of allergies and say a spring or fall cold?

Fred Little, MD (Guest): Well, that’s a great question. So, seasonal allergies as they are sort of termed, usually come in different seasons depending on what people are allergic to. I would say that the main difference between an allergy sort of worsening because of somebody having what we commonly call hay fever versus a cold. There are a lot of common symptoms, you know scratchy throat, some cough, nasal congestion, just basically sort of feeling miserable all around. 

But some of the key things that can help differentiate the two are usually people who have hay fever symptoms or allergies really don’t have a fever. They certainly can have cough and some of those other symptoms. And the other thing is that a common cold usually will sort of run its course over five to seven days. Some people can have a little cough for longer than that. Whereas people that have seasonal allergies really once they are in their season; they continue to have symptoms throughout that season. 

And so it’s sort of like the cold that doesn’t go away.

Host: That’s an excellent description of it and a good way for people to tell what it is. Then how does a seasonal allergy differ from other allergies like to food or products? Seasonal allergies are more to things that are in the outside, right, not necessarily pet dander or dust mites and that sort of thing.

Dr. Little: Yeah sure. So, that’s exactly right. So, when we think of seasonal allergies that happen at least in the Boston area, in the warm times of the year; they are to airborne so called air allergens. So, things that are triggers in a susceptible individual that would lead to allergy symptoms and those main things are pollens in the outside, mold spores that can be in the outside. There can also be some indoor air allergens which tend not to be so seasonal. So, people can be allergic to pet dander, house dust mites, mice and other things that.

So, seasonal allergies which are during the seasons, although there can be other causes of airborne allergy that can happen year round that are due to things that are inside the house; differ definitely from food or other product or medication allergies. And the main difference is while the allergic response, like what’s happening in the body can be quite similar; it’s happening in different places. So, one is happening more in the lungs and the nose and the sinuses. 

The other is happening and can happen throughout the body and can affect the lungs as well. And those symptoms tend to be a little bit riskier. So, if somebody has an allergy to shellfish or to a peanut or to penicillin and they were to inadvertently eat or take one of those medications; the symptoms can be a little bit more severe and they can get more of a full blown allergic reaction. That’s pretty unusual for people having seasonal allergies, although they can be quite miserable because their symptoms can be quite significant. 

Host: Dr. Little, one of the things that I hear often from people with allergies or people that maybe suffer from asthma or things like that is how do you know about the pollen levels or how do you identify those triggers? Because isn’t that one of the keys to managing this type of an allergy?

Dr. Little: Yeah so, that’s a great question. The truth is that it’s easier to control exposure to allergies that are seasonal and year round due to airborne allergens. It’s a little bit easier to control that for things that are in the indoor environment. So, if somebody is allergic to a cat or has bad house dust mite allergy; there are things we can do in the home to regulate that.

It’s pretty hard in our regular daily life to control exposure to pollens. They are everywhere. They are all around. I will make a note that the pollens that we normally can see like the yellow sort of dust that’s on cars in the springtime; is caused by pine pollen which actually it turns out isn’t so much of an air allergen that people are sensitized to. The main sort of spring pollens that people are allergic to are related to tree pollen and those are extremely small. They go up 20,000 to 30,000 feet. It doesn’t matter whether you have a tree outside your window or whether you live in the intercity with very few trees. Because they are very pervasive. 

And in fact, the tree pollen season in Boston, in the Boston area starts well before our trees here start to have flowers. People often say they is snow on the ground, but my spring allergies are bothering me. The reason for that, is because since they are so small, they can travel so far, the trees that are in Georgia, South Carolina or Virginia, the lower and mid-Atlantic coast; those trees pollinate a lot earlier. 

So, as a result, those small little pollens can climb up to 30-35,000 feet, follow the jet stream and then get dropped on the Boston area. And in fact, right now, we already have relatively moderately to high tree pollen counts even though our trees are barely starting to make any leaves, not to mention flower. And so, as a consequence, the spring pollen season starts before our local trees start to produce pollens,

In terms of finding out where you can get that information; there are a lot of media outlets like the Weather Channel and others that will give an idea of pollen counts. But I should warn people that the way in which they grade low, medium or high pollen counts to certain things are compared to pollen counts in general. So, a high pollen count doesn’t necessarily mean that people are more likely to have allergy symptoms to those specific pollens because it’s determined more by what people are individually allergic to. 

So, pollen counts when you see them in media outlets have to do – they are sort of graded based on prior averages in the range of pollen counts that are out there and don’t necessarily predict whether somebody will have more serious symptoms. It really depends on how sensitive an individual is to those pollens. 

Now one could say if somebody is sensitized and allergic to spring pollens and we are in September when weed pollens are high; they are probably not going to be affected by that. 

Host: Wow, what a great description Dr. Little. What a great educator you are. 

Dr. Little: Well thank you.

Host: Certainly you are. That was really a great explanation of it. So, if somebody has these kinds of allergies; do they need to get them specifically diagnosed? And if they do, what do you recommend as far as treatments? Boy there are so many over-the-counter treatments. You could stand there in front of that wall, it’s dizzying. How do they know what to pick?

Dr. Little: Yeah. So, in terms of diagnosing the allergies; it’s a little bit easier for seasonal allergies than it is for people that have allergy symptoms that are truly allergy symptoms and not just a long cold that occur year round. So, in seasonal allergies; there are sort of three main seasons in the Boston and New England area. The spring season is tree pollens. The middle of the summer starting sort of in late May leading through mid to late August are grass pollens. And then starting in late August through the first frost are weed pollens. 

There’s some overlap amongst those seasons but for the most part; those are the main seasons. 

So, if somebody comes to see me and says, you know I have miserable allergies in the spring; I have a pretty good guess that what they are allergic to are tree pollens. And whether they need to get tested specifically for what they are allergic to; it depends a little bit on whether the symptoms can be controlled with medicines or not. Because there isn’t much mystery if somebody says to me you know, in the middle of July my seasonal allergies are terrible. I know they are allergic to grass pollen. And it doesn’t really make much difference to figure out what specific grass they are allergic to if their symptoms can be controlled with medications.

If, despite medications, their symptoms are poorly controlled; then we can start to think about the next step which is typically allergy shots which is a fairly significant time commitment but can have a very good effect. And that’s really where we need to find out okay what exactly is somebody allergic to. Are they allergic to birch pollen but not ash pollen? Are they allergic to ragweed, but not other weeds? Because that would dictate the way we would put together a prescription for their allergy shots.

Now, in terms of the treatments; you’re right, there’s a lot of stuff that 15 years ago wasn’t available over-the-counter, now it is. The main classes that are available over-the-counter are antihistamines, like Zyrtec, Allegra, Loratadine, Claritin, etc., etc. as well as some of the nasal steroids which includes fluticasone, budesonide, Flonase, Veramyst. I’m kind of giving the range of both generic and brand names that are available. 

I usually will tell people to start using an antihistamine. So, an antihistamine helps some of those itchy, scratchy kind of uncomfortable feeling that people can have during their allergy season including some symptoms in their eyes as well. There are also some eye drops that are available that can be bought over-the-counter. If people are well enough controlled with that and some people are; then that’s good enough. 

The one symptom that antihistamines don’t really control is that sense of nasal congestion. And this is a person who you meet either yourself or you talk to and it’s not just that they have a runny nose; but they sound like they are congested. It’s like wow your voice has changed. So, nasal congestion, which is really the tissues in the nose, getting not only inflamed, but getting swollen up; that really can’t be controlled with antihistamines and that’s when people would probably reach for a nasal steroid, one of the things that I just mentioned, for example. That really helps treat the congestion and it also helps treat the other symptoms as well. 

So, that’s a reasonable approach to start with sort of antihistamines and then if that doesn’t work; then taking a nasal steroid that’s available over-the-counter. And if despite those two things and it’s pretty consistent like symptom description of allergies; that may be the time to really sort of seek care from an allergist to try to further refine what you are allergic to and then other tricks that we have up our sleeve that go beyond just what’s available over-the-counter. 

Host: What do you want them to do at home? Dr. Little, as we wrap this up and what a great segment. So much usable information. What about lifestyle, Neti Pots, do you like nasal lavage? Do our air filters or opening the windows at this time of the year; do any of those kinds of things matter? Even things like mowing the lawn, washing your hair after gardening. Do any of those things really make a difference? Well I know you’re laughing, but you hear about these kinds of things. Tell us if they are a myth and what you want people to know about seasonal allergies and things they can do.

Dr. Little: No, I’m chuckling because those are all perfectly reasonable steps and the problem is that you’ve given a menu that – the smorgasbord should be as complete as you’ve described it. It’s a question of sort of picking and choosing based on what’s convenient for you. I would say that it’s pretty hard to minimize exposure to pollens during the seasonal allergies because even if you come in your house, you are bringing the pollen in that you have on your clothes etc. But there are some things that can be done. 

One thing I would say that I would not recommend and people that have bad seasonal allergies is to keep the windows open because you are basically letting all those pollens that are outside come in. It may be nice to have a little bit of fresh air and a cross breeze; but that’s letting all those pollens that are making you miserable outside, come into your house. So, trying to keep the windows closed. Air filters can be helpful. Washing clothes soon after. 

Some people who have really bad allergies to pollens; what I will tell them is to have sort of a changing room, so that they can actually get out of their outside clothes and change into some inside clothes and then wash those clothes or rinse them so that the pollens are not being sort of brought into the house as much.

Air conditioning can be helpful for a lot of people that have nasal symptoms as well as allergies because air conditioning does several things. First of all, your windows are going to be closed. Secondly, it dehumidifies the air which tends to make people feel better who have sort of congestion and other respiratory problems that can be related to allergies. And also, air conditioners have these small filters that need to be changed or cleaned once in a while. So, they kind of filter the air as it’s going through. So, air conditioning can be helpful. 

Many people get a lot of benefit from using Neti Pots, nasal saline to kind of clear stuff out. I think a combination like you are suggesting of sort of trying to target the areas of the home environment that you can target as I mentioned, as well as medical treatment is kind of the recipe to try to help people control their allergy symptoms as much as possible. 

Host: And what would you like them to know about when you feel it’s important that they contact an allergist such as yourself?

Dr. Little: I think with the availability of over-the-counter medicines; I think that if the basic treatment that they’ve tried with antihistamine once or twice a day, usually the non-sedating ones that I’ve mentioned, because Benadryl can be very helpful, but it can make people sleepy. The other ones like Zyrtec, Allegra, and Claritin don’t tend to make people so sleepy. If they are taking one pill of those a day or one or two of those a day, not much success and they are taking a nasal steroid which I have to specify; usually takes about three to four weeks to really kick in so, don’t give up after a week or two. 

It’s not like Afrin or other topical decongestants. It takes a while to kind of control that inflammatory response, that allergic response in the nose. If after three or four weeks of taking a nasal steroid plus the antihistamine, you really are not getting much benefit; then I think it’s reasonable to seek help from an allergist. 

Host: Great information Dr. Little. Thank you again for joining us. What a great guest you are. Thank you so much for all that excellent information. This is Boston MedTalks with Boston Medical Center. For more information you can go to www.bmc.org, that’s www.bmc.org. This is Melanie Cole. Thanks for tuning in.