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Coping with Seasonal Allergies

How do you tell the difference between allergies and a spring cold?

Are there treatments to consider besides over-the-counter allergy medications?

Learn more from Dr. Monica Lawrence, a UVA specialist in seasonal allergies.
Coping with Seasonal Allergies
Featured Speaker:
Monica Lawrence, MD
Dr. Monica Lawrence is board certified in internal medicine; her specialties include seasonal allergies.


Melanie Cole (Host):  How do you tell the difference between allergies and spring cold? Are there some treatments to consider besides all those over-the-counter allergy medications? My guest today is Dr. Monica Lawrence. She’s board certified in internal medicine at UVA and her specialties include seasonal allergies. Welcome to the show, Dr. Lawrence. What are some of the common seasonal allergies people face in the spring and the summer? What do you see the most?

Dr. Monica Lawrence (Guest):  Hi, good morning. The most common springtime allergies are actually trees and grasses. That yellow coating you see in your car when you come out in the morning is all tree pollen primarily. Right now, we’re in the midst of tree pollen season and heading into grass pollen season. 

Melanie:  How do people know? When they start to get the sniffles or the itchy eyes—because in the spring and the summer, Dr. Lawrence, colds start coming up, too; we’ve got those wicked spring colds—how do they know that those symptoms are not just the cold, that they are in fact allergies?

Dr. Lawrence:  That’s a great question, and that’s a question we talk about in the office quite a bit with our patients as it can be really hard to tell the difference between a cold and allergies. There are a few things though that I try to get out with patients that kind of tell them apart. The first thing is if it’s a cold you usually will have a fever and just kind of feel more achy, rundown, and you really shouldn’t get either of those with allergies. With allergies, another big thing that we look for is the eye symptoms. The reason you get itchy, watery eyes is because the pollen is blowing. Because it’s air-borne in the wind, it blows right onto your eyes and that causes that itching and watering. Whereas the colds, it can cause a little bit of watering eyes, but not usually the itchy, red symptoms you get with your allergies.

Melanie:  These differences are something that would lend someone to think that this is something that maybe they’re going to get every season at this time. Then what do you do about them? First thing people think is to go to the pharmacy and get one of those over-the-counter antihistamines and start using those. What do you recommend we do? 

Dr. Lawrence:  That’s actually a great place to start. Really, the over-the-counter antihistamines that are available now, drugs like Allegra and Claritin or Zyrtec, all used to be prescription. They are prescription strength and they’re very effective. The other thing that just came over-the-counter in the last year are the nasal steroids, things like Flonase and Nasacort, which also until recently were prescription. Those are really great tools that patients can access themselves without having to come in to see a physician. 

Melanie:  Do we have a problem with those nasal sprays? Do people kind of overuse them? Can they make that inflammation worse? 

Dr. Lawrence:  I’m really happy you brought that up. The nasal sprays like Flonase and Nasacort are nasal steroids. When used as directed on the box, there’s really not a problem with those in terms of making things worse. What we do run into trouble is with drugs like Afrin, the decongestant nasal sprays. What can happen with repeated use is that your body can actually become, I use the word, “addicted” to the sprays. In other words, if you try to stop using those sprays after you use them for weeks on end, your symptoms will flare and be worse than when they started. So, the cycle is you go back and use them again. We do see patients in the office who have been on a spray like that for 20 and 30 years and haven’t been able to ever stop. So we really encourage people: Read those package labels. If it says to wean them after a few days, really take that seriously.

Melanie:  That’s what we look for on the label, the difference between a corticosteroid nasal spray such as Nasacort and the decongestant like Afrin. 

Dr. Lawrence:  Exactly. Afrin is a great drug but only when used in very brief spurts, no more than five days—it’s what I tell my patients—whereas, Flonase and Nasacort are safe to use year-round.

Melanie:  What can we do besides medications? Do you like nasal lavage? Do you like one of these kinds of things to kind of clear everything out? What else can we do? 

Dr. Lawrence:  Nasal lavage which is what we refer to when we rinse our noses with salt water or saline solution is one of the most effective ways to help with your nasal congestion. I liken it to giving your nose a shower. You have all that nasty pollen that’s deposited on the inside of your nose and you really need to rinse that out. The only way to effectively do that is with a nasal lavage. Once you’ve done that, then you’ve got a clean surface and when you use your nasal sprays, they have a much greater chance of actually being able to be effective. Some people find benefit from just using the nasal saline lavage alone. A lot of times I tell people to follow it 30 minutes later by their nasal spray. Again, these are all treatments that are available over-the-counter for patients just at their local drug store. 

Melanie:  Then what else can we do? You know, triggers, seeing what bothers us the most, and is there any way to work on prevention? 

Dr. Lawrence:  Absolutely, and that’s where coming in to see an allergist is really important. We can do symptomatic treatment that’s sort of a general symptomatic management by using the stuff that’s available over-the-counter, but very, very often, we’re seeing this especially this season where the pollen levels are very high, that’s not enough. If you come in to an allergist’s office, we offer comprehensive testing for all the environmental allergens that are found indoors and outdoors. Once we know what you, in particular, are allergic to, we can talk to you about how to specifically avoid those allergens because there are some very specific things you can do, for example, for dust mites that are found indoors and there are things that you can do to avoid pollen. We talk to patients about that. If their symptoms aren’t controlled with avoidance strategies and some of the over-the-counter medications, then we often talk about prescription strength medication or doing what we call allergen immunotherapy or, more commonly known, allergy shot. That’s a great tool for patients because it provides a lifetime benefit in the majority of patients who do allergy shots. There are definitely additional tools available for patients if you find that the over-the-counter stuff just isn’t enough. 

Melanie:  In just the last few minutes, Dr. Lawrence, if you would, give your best advice for people suffering with seasonal allergies, including washing their bedding or watching those pollen counts, and why patients with allergies should come to UVA for their care. 

Dr. Lawrence:  Sure. This time of year, as I said, tree and grass pollen are our biggest concerns. I would encourage people to keep your windows shut, use the air conditioning if possible. Avoid being outside when people are cutting the grass, or if you’re cutting the grass yourself, wear a mask. When you come in from outside, think about changing clothes and rinsing off in the shower so you’re not bringing that pollen inside your house. Try all the over-the-counter remedies that we discussed, the saline rinses, the nasal sprays. If those aren’t enough, then go in to see your local allergist so that you can be tested and be treated. I think the advantage that a center like the University of Virginia offers is because we really do have comprehensive care. There are many more complex diagnostic tests that we offer that not every practice is going to be able to offer, so it’s sort of a one-stop shopping. The other thing I think that’s really a huge advantage is that we have researchers that are doing cutting-edge research in all of the areas of allergy and food allergy and chronic sinusitis and aspirin allergy and asthma and viral triggers of asthma. We really have a lot of folks with very specific expertise, and when you come in to see one of our doctors, you benefit from that doctor being able to collaborate and talk about the latest in research from here at UVA. It’s a really fantastic experience for patients to be able to come in and not have to be referred elsewhere.

Melanie:  Thank you so much, Dr. Lawrence, what great information. You are listening to UVA Health Systems Radio. For more information, you can go to That’s This is Melanie Cole. Thanks so much for listening.