Hay Fever in Winter? Yes, But There’s Help

**By David Jeong, MD**

David Jeong, MD

David Jeong, MD

Although many think of spring as the time of year when most people are bothered by allergic rhinitis, or hay fever, the condition can affect folks year round depending on what an individual is allergic to at any given time.

As an allergist, I see and treat children and adults with allergic rhinitis 12 months out of the year.

What is allergic rhinitis?

Hay fever is the group of uncomfortable symptoms that occur when your body is exposed to a specific allergen. An allergen is a typically harmless substance that causes an allergic reaction.

When your body comes into contact with an allergen, the immune system recognizes it and signals the release of histamine, among other natural chemicals, from the body. Unfortunately, an excess of histamine can cause uncomfortable symptoms.

As a result, it is important to seek treatment since this condition can interfere with your everyday quality of life.

Types of allergens

Common allergens that can cause this condition include:

  • Grasses and weeds
  • Dust mites
  • Animal dander (old skin) and saliva
  • Mold
  • Pollens (Pollens are the biggest allergen culprit during certain seasons – trees during early and mid-spring, grasses during summer and weeds in fall)

Risk factors for allergic rhinitis

Although allergies can affect anyone, they are often genetic. You are more likely to develop allergic rhinitis if your family has a history of allergies.

Other risk factors for developing hay fever include:

  • Being male
  • Born during pollen season
  • Being the firstborn in your family
  • Early use of antibiotics
  • Maternal smoking exposure in the first year of life
  • Exposure to indoor allergens, such as dust mites

Hay fever symptoms

The most common symptoms of allergic rhinitis include:

  • Runny nose
  • Sneezing
  • Itchy nose (also eyes, ears and throat)
  • Stuffy nose
  • Postnasal drip
  • Coughing
  • Dark circles under eyes
  • Eczema-type symptoms (e.g., extremely dry, itchy skin)
  • Excessive fatigue
  • Frequent headaches

Allergic rhinitis is often associated with asthma, eczema (atopic dermatitis), allergic conjunctivitis, repeated sinus infections and chronic ear congestion (Eustachian tube dysfunction).

Diagnosing allergic rhinitis

Minor allergies usually only require a health history and physical exam. However, your primary care provider may refer you to an allergist for allergy testing to identify your triggers and develop an individualized treatment plan.

Skin prick testing is the most reliable and fastest testing method available. During this test, your doctor uses a prick method to introduce individual allergens onto the surface of your skin (usually the arms and/or back) and watches for a skin reaction at the test site. A small red bump develops if you are allergic to something.

Another often used allergy test is a blood test, which measures the amount of immunoglobin E antibodies (the allergic antibody) to particular allergens in your blood. This blood test is slightly less accurate than the skin test, but is often used when a skin test cannot be done for certain reasons.

When it is diagnosed, allergic rhinitis may be classified as seasonal and/or perennial (year-round).

Treating hay fever

Allergic rhinitis is treated with one or more of the following items:

  • Antihistamines
  • Decongestants
  • Eye drops
  • Nasal sprays (various types)
  • Antileukotrienes (help block inflammatory response)
  • Immunotherapy (allergy shots)

Antihistamines can effectively treat allergies. They can also help prevent allergic symptoms.  Most antihistamines are available over the counter.

Oral decongestants are used over a short period to help with sinus pressure and stuffy nose. If you have high blood pressure or heart disease, be sure to ask your physician before taking a decongestant.

Nasal corticosteroid sprays are the single most effective therapy in treating allergic rhinitis. Some have moved to over the counter in the last couple of years, but the rest are still only available through a prescription. Nasal antihistamine sprays can also be very helpful. Over-the-counter nasal decongestants (e.g., oxymetazoline, Afrin, Zicam, etc.) can be immediately effective but cause physiologic dependence when used over extended periods. These should not be used long term.

If you have severe allergies, your physician may recommend immunotherapy. This treatment plan, which is usually referred to as allergy shots, is used to desensitize you or decrease your immune response to specific allergens over time.

Deciding which allergy medications and treatments are the most effective and safest can be overwhelming. Make sure to speak with your health care provider and/or allergist to find the most appropriate treatment for you.

Preventing allergies

As the saying goes, “Prevention is the best medicine.” This is especially true when it comes to allergies. The best way to avoid allergy symptoms is to manage allergies before your body has a chance to negatively react to substances.

In fact, the American Academy of Allergy, Asthma and Immunology recommends beginning medications ahead of seasonal allergy attacks. For example, if you are affected by tree pollen in the spring, you might want to start taking your allergy medications just before the season hits and the allergic reaction has a chance of happening.

Another way to prevent hay fever is to avoid allergens that prompt your symptoms. For example, change the clothes you have been wearing outdoors when you come back inside and shower to remove pollen from your skin. In addition, consider implementing proper avoidance precautions for dust mites, pets and molds if you are allergic to any one of these triggers.

Prognosis for people with allergic rhinitis

As with much of medicine, the treatment outcome for hay fever is dependent on a person’s unique condition. Allergic rhinitis has a tendency to be a chronic condition and can significantly disrupt quality of life. The good news is that it can be managed and well-controlled with the right treatment plan.

David Jeong, MD, is board certified in allergy, immunology and pediatrics. He specializes in allergy and asthma and practices at Virginia Mason University Village Medical Center, Virginia Mason Hospital & Seattle Medical Center, Virginia Mason Issaquah Medical Center and Virginia Mason Lynnwood Medical Center.

Celebrate Safely with Food Allergies and Celiac Disease

Ah, the holidays – a fun-filled time of good food. That is if you’re free from a food allergy  or celiac disease. Last April, I was diagnosed with celiac disease and joined the millions of others who view the holiday feasting season with more dread than anticipation.

On the bright side of celiac disease, I don’t have to eat any fruit cake.

On the bright side of celiac disease, I don’t have to eat fruit cake.

Food allergies and celiac disease have different causes and reactions. In allergies, the immune system reacts to an outside substance that it normally would ignore. Celiac disease, an autoimmune disorder, causes the immune system to attack healthy intestinal lining when exposed to gluten, a protein in wheat, barley and rye. I may not know for days that I’ve been exposed to gluten, but my cousin, who is allergic to tree nuts and peanuts, could end up with hives, swelling or even an anaphylaxis reaction if he nibbles on a nutty cookie.

In short, those of us with food issues can be hard to have as holiday guests. But, never fear, the Home Food Safety program, a collaboration between the Academy of Nutrition and Dietetics and ConAgra Foods, has tips to keep you from causing your cousins, aunts, uncles or other assorted relatives to have an unhappy holiday. Their tips are:

Safety Starts at the Store

  • Learn which ingredients are problematic and read ingredient labels on foods.
  • When shopping, keep problematic foods in plastic bags or place them in a second cart, and keep them separate at checkout and in the car.
  • Avoid foods from bulk bins,  salad bars and the deli counter, as these are common sites for cross-contact.

Set Up a Storage System
If you can’t keep the entire house free from the problematic food:

  • Label allergen-free and gluten-free foods to avoid confusion and place gluten- and allergen-containing foods on shelves below allergen/gluten-free foods.

Conscious Cooking is Key

  • Use separate sets of utensils, cookware and cooking tools, and small appliances (toasters and blenders).
  • Prepare and cook allergen-free and gluten-free dishes first and in/on cleaned equipment and surfaces.
  • If possible, dedicate a kitchen space to allergen-free and gluten-free preparation.

Wash and Sterilize

  • Wash and sterilize everything coming into contact with the allergen-free and gluten-free foods being prepared.
  • Wash hands with warm, soapy water for 20 seconds.
  • Change gloves and aprons.
  • To clean surfaces and larger appliances, use a dry towel to wipe down crumbs first, then wash or sterilize.

Avoid Cross-Contact While Serving

  • Serve allergen-free and gluten-free guests first and carry their dishes separate from others.
  • Cross-contact with an allergen or gluten through condiments is common due to double dipping with a utensil. Choose squeeze bottles when possible to eliminate double dipping, and clearly label the option that is free from the allergen or gluten.
  • Avoid “make-your-own” dishes with high risk for cross-contact, including sundaes, salads and topping bars.

In addition, I’d like to add some special cautions for celebrating with those with celiac disease. Eight foods account for 90 percent of serious allergic reactions: milk, eggs, fish, crustacean shellfish, wheat, soy, peanuts, and tree nuts. The Food Allergen Labeling and Consumer Protection Act requires that labels must clearly identify the food source names of all ingredients that are — or contain any protein derived from —the eight most  common food allergens. But gluten is not one of the eight. Gluten is also found in barley and rye, so don’t depend on a product just being free of wheat if you have a celiac guest at the table. Gluten can hide in unexpected places: soy sauce, non-dairy whipped toppings, canned soups, gravy mixes, seasonings and even self-basting turkey – the list goes on and on. So before you whip up your famous green bean casserole with cream of mushroom soup, remember that this is a favorite hiding spot for devilish gluten and check your soup can for a “gluten-free” on the label. (Oh, and hold the crispy onions, please.)

Most importantly, despite the backlash against the gluten-free trend and ignorance about food allergies, believe your relatives and friends when they say they can’t eat something. We’re not being picky; we’re being safe.