If you suffer from seasonal allergies, you probably thought last year was a mild season. Chances are the precautions you took to protect against COVID-19—spending more time indoors, wearing masks outside—helped bring down your allergy symptoms a few notches. Also, with so many people beginning to work at home in the spring of 2020, fewer cars on the road also meant less air pollution being inhaled.
But last year was an unusual interruption of what experts say has been a rising pollen count trend.
“This year I’m hearing a lot of patients say their symptoms are very severe,” says Stephanie Leeds, MD, a Yale Medicine pediatric allergist.
“The tree pollen has been particularly intense,” says Florence Ida Hsu, MD, a Yale Medicine allergist who has seen patients with lots of nasal congestion, sneezing, coughing, and red, itchy eyes—and in the most serious cases, allergic symptoms that have led to asthma flares.
A combination of at least two things could be contributing to these miserable symptoms. One small part is that more people are going outside without masks (which can also protect against pollen), now that the Centers for Disease Control and Prevention (CDC) has relaxed mask guidelines. The other—and bigger—reason is that many are facing an onslaught of pollen.
“With climate change, the general trend has been that we’re getting higher levels of pollen and longer pollen seasons, whether that’s due to warmer temperatures or increased carbon dioxide emissions; it’s probably multifactorial,” says Dr. Leeds. A study published in February in the journal Proceedings of the National Academy of Sciences (PNAS) backs this up: It reported a lengthening of the pollen season by 20 days and a 21% increase in pollen concentrations between 1990 and 2018.
Seasonal allergies: What you need to know
Pollen is an airborne substance that comes from grass, flowering plants, trees, and weeds. In the past 12 months, 19.2 million adults and 5.2 million children under 18 were diagnosed with hay fever, the name given to allergic rhinitis caused by pollen. When someone has hay fever, their immune system identifies pollen as a threat and releases signals that lead to congestion, itchy eyes, runny nose, and sneezing, as well as problems like sinus pressure and allergic conjunctivitis (itchy, watery, and red eyes).
The amount of pollen in the air depends on the season and the geographic area in which you live. The study reported in PNAS found the most pronounced effects in Texas and the Midwestern United States. However, the Northeast can have a significant spring allergy season as well, Dr. Leeds says. Tree allergies are especially common in New England—particularly due to birch and oak. Pollen allergies can also cause a cross-reaction with certain foods in some people; symptoms include an itchy or tingling mouth and throat after eating raw fruits and vegetables, seeds, and nuts.
People may also have allergic reactions to grass pollen in the late spring to early summer and weed pollen in the fall. “Many people are multi-sensitized, so they are allergic to more than one type of pollen, and they can be symptomatic through all of the warm weather seasons,” Dr. Leeds says. “Pollen can be carried by the wind, so windy days are the worst.”
Seasonal allergy symptoms are not life-threatening, but people do miss work over them, says Dr. Hsu. “There is a theory called 'the unified airway’ in which the nose is connected to the lungs, so if you have a lot of inflammation in the nasal passages and the sinuses, that can then lead to ‘lower respiratory’ symptoms such as cough, shortness of breath, and wheezing as well,” she says. “You’ll find people with allergies getting recurrent sinus infections, and both can lead to respiratory symptoms, asthma, and bronchitis.”
Periods of high pollen have also been linked to susceptibility to respiratory viruses, although the CDC says there is not enough information to know whether it also puts people at higher risk of contracting COVID-19 or having more severe COVID-19 symptoms.
Is it an allergy or COVID-19?
When COVID-19 and seasonal allergies are circulating at the same time, every sniffle can lead you to worry that you might have the virus. “From the perspective of a parent, one of the biggest issues is when kids in school have allergy symptoms that are poorly controlled, and then the school system sends them home or says they need a physician’s note,” Dr. Leeds says.
The CDC has a Venn diagram that shows symptoms the two conditions have in common. These include congestion, cough, difficulty breathing, fatigue, runny nose, sore throat, and shortness of breath. But comparing the most common symptoms reveals clear differences. Seasonal allergies usually cause itchy or watery eyes and sneezing, while COVID-19 is characterized by fever and chills, muscle and body aches, new loss of taste and smell, nausea and vomiting, and diarrhea.
“Because of COVID-19, people are afraid of you when you’re sniffling,” says Dr. Hsu. “But it goes both ways—a lot of people are sniffling and sneezing and coughing, and they are not getting tested for COVID-19, because they assume it’s allergies. And they are probably correct.”
Often the distinction is clear—people with allergies itch more, and they don’t have the fatigue, malaise, and fever that comes with COVID-19. But anyone who is concerned should call their doctor, she says.
Are allergies in kids different than in adults?
It can be especially difficult to control allergies in kids, Dr. Leeds says, adding that kids tend to spend more time outdoors and, thus, are exposed to more pollen. “A high pollen count day is not going to deter them from going to the playground,” says Dr. Leeds. “That’s unlike an adult who might say, 'I’m going to drive my car to work, keep the windows rolled up, and not take that walk during lunch.'”
Another difference is that allergies in adults are usually well-established, while in kids there is the hope that they will outgrow them, Dr. Leeds says.
“With kids, we talk about the concept of ‘atopy,’ which is an allergic predisposition,” she says. For a child with a strong family history of any allergies—and especially for those who develop symptoms early in life—doctors look out for the four main allergic diseases: eczema, food allergies, nasal allergies, and asthma. “These allergic diseases, in general, are increasing in prevalence,” she says.
What allergy treatments are available?
Treatments can help a great deal, says Dr. Hsu. “Allergy treatment has changed over the past 10 years, with a number of first-line medications now available over the counter,” she says. “So, while we have lots of consultations with patients, we don’t necessarily send a prescription to the pharmacy. We often advise people on what to buy—but we want to be very specific, because there are certainly a lot of over-the-counter medications that we would not recommend as first-line treatments.”
For instance, she might start with antihistamines for itching and runny nose, steroid nasal sprays for nasal passage congestion, and antihistamine eye drops for ocular symptoms. If a patient is still uncomfortable, she might recommend a decongestant, but not for daily use, since it’s a medication patients can become overly reliant on. Likewise, some patients should avoid antihistamines that are excessively sedating, she says.
It’s helpful when patients have a skin or blood test to find out exactly what they are allergic to. “If you are really symptomatic, it’s helpful to get tested at least once. I don’t think you need to be re-tested year after year, but at some point, establishing the specific triggers can be helpful, because then you can take steps to avoid exposure,” Dr. Leeds says.
Patients whose allergies aren’t well-controlled—or who prefer to avoid medications—may benefit from allergy shots, Dr. Hsu says. “It’s the only therapy we have that goes to the root of the problem, where we actually try to change and decrease your allergic response to the allergens,” she says. “This requires a degree of planning and forethought.”
For shots, patients go to the allergist over a period of weeks, then transfer to monthly injections; small doses are used initially, then increased over a period of time. “People have found tremendous relief from environmental allergies with allergy shots—not just seasonal, but also pet dander, dust mites, and other inhaled allergens,” she says.
Non-medical allergy solutions
Medications aren’t the only way to help solve the problem. If you are having seasonal allergy symptoms, the CDC and Yale Medicine doctors offer the following non-medical strategies to help both adults and children:
- Stay in the house if you can, particularly on windy days. Keep the windows closed (in the car, too). Run the air conditioner, which should have a clean filter on it.
- Wear a face mask when you go outside to prevent you from inhaling larger particles of pollen (note that smaller particles can still get through). Wash the mask after each use because it may have pollen on it.
- Wear a hat and sunglasses to avoid getting pollen in your hair and to protect your eyes.
- Avoid outdoor activities such as mowing lawns or raking leaves, as they stir up pollen.
- If you spend time outdoors, brush off any pollen once you go back inside. “If you are pollen-sensitive, it’s a good idea to take a bath, wash your hair, and change your clothes, especially if you’re going to bed,” says Dr. Hsu. “Try to minimize the amount of pollen that goes from your head to your pillow, because you will be breathing it in all night.”
- During the COVID-19 pandemic, the CDC suggested ways to create a cleaner air space at home that can also be helpful in protecting against outdoor air irritants. A portable air cleaner/purifier can help; it works best when run continuously with the doors and windows closed.
- If your home has a forced air system, consult a qualified heating, ventilation, and air conditioning (HVAC) professional about filters (HEPA or MERV-13 or higher) and settings (“Recirculate” and “On” rather than “Auto”) that can be used to reduce indoor air irritants.
Check the daily pollen count (the number of grains of pollen in a cubic meter of air based on a sample taken in a 24-hour period) before you decide to spend time outdoors. The measure is reported as low, moderate, high, or very high. You can sign up with the National Allergy Bureau for notifications with information for your area.
Both doctors also tell people who know they are prone to allergies to talk to their doctors before their worst season hits so they can be prepared. “I think the problem is that some people have a couple of weeks when they are miserable, and then the rest of the year they are fine, so they think they’ll just grin and bear it,” Dr. Leeds says. “But there is a better way. You can take steps to minimize those weeks of misery.”