Seasonal Fall Allergies: Don’t Let the Fall Bring You Down

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Autumn is arriving soon which means the change in season can bring an onset of sneezing and sniffles.  

Allergist, Dr. Kenneth Johns shares expert advices about fall allergies and the types of allergic reactions that thirty million Americans experience during the fall season.

Use these top tips to avoid the fall from bringing you down with possible seasonal allergies.
Seasonal Fall Allergies: Don’t Let the Fall Bring You Down
Featured Speaker:
Kenneth Johns, MD – Allergy and Immunology
Dr. Kenneth Johns specializes in allergy and immunology and practices at Allina Health Coon Rapids Clinic and Allina Health Maple Grove Clinic. His professional interests include child and adult asthma, seasonal allergies, hives and skin rashes.

Learn more about Dr. Kenneth Johns
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Transcription:

Melanie Cole (Host):  Autumn is arriving soon which means the change in season can bring an onset of sneezing and sniffles. My guest today is Dr. Kenneth Johns. He specializes in allergy and immunology and practices at Allina Health Coon Rapids Clinic and Allina Health Maple Grove Clinic. Welcome to the show, Dr. Johns. What kind of allergies are we seeing most in the fall? Up to 30 million people suffer from these.

Dr. Kenneth Johns (Guest):  The biggest problem in our falls is the fall wheat pollens with ragweed probably being the most important. Sometimes, a little later in the fall it could be outdoor mold but our ragweed is probably our worst. There’s a very predictable season. It starts about August 15th every year until there’s a hard frost and that usually ends it. Those outdoor molds can start a little earlier and last a little longer than that.

Melanie:  In the fall, people also come up with colds at the end of the summer. How do we tell the difference between the sniffling and the sneezing that we’re getting and maybe what’s just turning out be a fall cold?

Dr. Johns:  It can be really hard to tell them apart. In general, when it’s allergy it itches more--there’s more itching of the eyes and nose. Basically, it’s the duration. A cold, a viral upper respiratory infection, it might last a week or ten days whereas an allergy, for example, if you’re allergic to that ragweed, that can go on for weeks or even a month or so. So, really, it’s the duration that helps you tell them apart. It can be tough.

Melanie:  How do you test a child or an adult for allergies?  Are we still doing--because people think of allergy tests as being a ton of little shots--and what are you doing now?

Dr. Johns:  We have two basic ways that we test for allergies. There’s the traditional skin testing which, I think, we’ve fine-tuned over the years. Mostly epicutaneous is the technical term for what’s sometimes called “scratch tests” or “skin tests.” Drops of materials that you might be allergic to are put on the skin and then scratched and we look for a welt to develop that would indicate a positive skin test. They are not as painful, not as uncomfortable, as you might think. Our second option is the blood tests that are done. It’s a way to measure sensitivity to specific allergens using blood, which there are different types, but they are, basically, equally accurate. In most cases, they are the same accuracy as the skin test. Sometimes there are patient preferences over one type of test or the other but, again, I’m going to say they are equally accurate. So, either method is fine.

Melanie:  People go outside in the fall and they rake leaves and it’s such a beautiful time of year. How do we treat those fall allergies aside from staying inside?  We want to be out in it but there’s those triggers. So, what are the treatments for fall allergies?

Dr. Johns:  Well, we, most of the time, really discourage people from staying indoors but we have good treatments for seasonal allergies. Medication-wise, we have a variety of antihistamines, both prescription and over the counter, which help a lot with the sneezing and the itching. I would say the gold standard for medication is the topical steroid nasal sprays which are extremely effective for most of the allergy symptoms. They are a little bit tricky to use. You have to use them daily and they may take a couple of weeks to have full effect. So, you do want to anticipate and start them early in the season. They can be very effective and with good medication, people can participate in outdoor activities fully. When medications fail, we have the traditional allergy shots. They are a type of allergic desensitization where very small amounts of the allergen, let’s say the ragweed, for example, is given as a shot to desensitize a person against the ragweed pollen when they encounter it. This is a very time consuming treatment and, basically, the shots are given year round for four or five years to give tolerance to the allergen. The newest wrinkle in immunotherapy or inducing tolerance is oral immunotherapy. I’m going to quote Lauren Michaels here and say, “Not quite ready for prime time.”  The oral immunotherapy is really only good for a couple of our allergens including the ragweed and we’re not quite sure where that’s going. It’s been sort of a tricky type of treatment to study. It is approved and it is available. We’ll see where that one goes.

Melanie:  Are there any all-natural remedies that you recommend to treat allergies?  Do you like nasal lavage, doing Neti pots?  Anything?  Do you believe in air filters or certain allergy reducing pillows?  Or, is there anything that you like to tell your patients to do for behavior modification and lifestyle?

Dr. Johns:  Well, there are certainly a lot of things that have been discussed and certainly a lot of treatments that are suggested but the data is not great for a lot of those things. For example, air filters and air cleaners, it stands to reason that you should be able to remove the pollen from the air indoors and I’m going to say that it’s not clear if we can really do that with air cleaners and air filters.  A Neti pot--a saline lavage--is very helpful for other conditions. For example, a viral illness or sinusitis, but for allergy, not so much. Obviously, you can have a combination of the two problems but my allergy patients are not as impressed with saline lavage or Neti pot as my sinusitis patients are. The other treatments that you alluded to, again, some people find some improvement but the data isn’t really there to support them, for the most part.

Melanie:  Are allergies something that you are going to take with you for your whole life?  If you’ve got them as a child and you’re allergic to things in the fall is this something that you’re ever going to outgrow or is it something that you can look forward to every year?

Dr. Johns:  Most people do outgrow their pollen allergies. The most common natural history is where they sort of come on in the late teens early 20s and peak in the 20s and 30s and then just sort of just gradually fade away, so most people will outgrow them. Sometimes, those specific allergies can be replaced by other conditions that sort of sound like allergy, vasomotor rhinitis or the other non-allergic nasal conditions can sometimes worsen over time and kind of sound like allergies but really aren’t and do respond to different treatments which is very frustrating to patients and doctors alike. But, I’m going to say that most of us will outgrow our pollen allergies.  

Melanie:  In just the last minute, Dr. Johns, if you would, give us your best advice on how to reduce fall seasonal allergies or treat them if we just must endure them.

Dr. Johns:  Again, our medication options are quite good. We can significantly reduce symptoms and, again, my goal is to get people outdoors and doing whatever activities they want to do outdoors. We have good treatments for that. Again, immunotherapy allergy shots are sort of our last resort and for the right patient with the right allergy they can be very helpful.

Melanie:  Thank you so much. You’re listening to the WELLcast with Allina Health and for more information you can go to allinahealth.org. That’s allinahealth.org. This is Melanie Cole. Thanks so much for listening.