Fall is in full swing, which means leaf peeping season is beginning to reach its rainbow-colored potential, and pictures of masked celebrities visiting pumpkin patches have begun proliferating on social media. But this year, it also means more-severe-than-usual seasonal allergies. Look closely at your next Zoom call for the poor, suffering square trying to conceal a runny nose in between muted sneezes. “I’m sorry, my allergies are terrible right now,” he or she will inevitably reveal when red, puffy eyes betray them. At least one other person will likely echo the same sentiment.
“The counts have been high this fall for weed pollens,” confirms Sandra Y. Lin, M.D., professor and vice director of the Department of Otolaryngology at Johns Hopkins School of Medicine. Ragweed, which is easily confused with goldenrod, is the biggest offender right now, adds J. Allen Meadows, M.D., the Montgomery, Alabama-based president of the American College of Allergy, Asthma and Immunology who notes that a summer of minimal rainfall, specifically in the Northeast, has created ideal conditions for the plant to thrive. And if what is essentially an over-reactive immune response to outdoor and indoor allergens feels particularly prolonged this year, that’s because it is. “Allergy seasons are getting worse because of climate change,” confirms Caroline Sokol, M.D., Ph.D., a clinical scientist at Mass General Hospital in Boston with a specialty in Allergy and Immunology. “We no longer get to the first frost as quickly in the Fall, and in the Spring the trees are blooming a little bit earlier,” Sokol explains. Like more severe weather patterns, it’s a new reality we’re just kind of “stuck with,” she says.
That’s bad news under normal circumstances, and even worse news under our extremely abnormal current circumstances. After months of waking up with a runny nose, and an itchy throat and eyes that eventually gave way to chest tightness and a dry cough, I began to wonder if my severe allergy symptoms and acute asthma were actually something worse. “This is confusing everybody right now, but we should all err on the side of getting COVID tests,” confirms Sokol, who had bad allergies and a positive COVID-19 diagnosis in the Spring. Symptoms that fall outside of your usual allergy issues—loss of sense of smell or taste, fever, gastrointestinal problems—are further indications that you should get tested, she adds. “And if you get a wicked headache that feels different from a sinus headache, or if you don't usually have allergy-induced asthma but you start coughing like crazy, you should be a little more concerned.” Classic allergy symptoms should also respond to tried and true treatments, which typically fall into the three basic categories below, according to Meadows. So relief is, thankfully, on the way while we wait for temperatures to plunge below 32 degrees Fahrenheit–at which point there will be a whole host of other things to complain about.
Over-The-Counter, or Prescription Medication
Whether your preferred brand is Zyrtec, Allegra, Claritin or Xyzal, over-the-counter antihistamines work the same way by blocking the body’s histamine receptors to temporarily calm an allergic reaction. “OTC antihistamines are, to be honest, no better or worse than prescription antihistamines,” says Sokol, who notes that Zyrtec is the strongest option in the category, in her experience, but it can make people sleepy (Allegra and Claritin are less likely to do so). “The other class of drugs we have are called anti-leukotrienes,” she continues. “Mast cells are the allergy cells that cause all of the trouble, and you can either shut them off with steroids, or inhibit the stuff they dump out, which are histamines and leukotrienes.” Prescription Singulair is the most popular anti-leukotriene, explains Sokol, who points out that it also works really well for allergy-induced asthma.
Topical Nasal Steroids
Also called nasal corticosteroids, these medications contain corticosteroids, which are very effective at reducing inflammation, congestion, and mucous production in the nasal passageways, making them less sensitive to triggers such as pollen, animal dander, or dust mites. Sprays such as Flonase, Nasacort, and Rhinocort “are among the most effective” allergy treatments, notes Meadows, but they typically take 10 days to work—and also tend to work best when you start them before your allergies kick in, adds Sokol, which means there is a lot of room for user error. “Nasal steroids can be life changing but most people don't take them correctly,” she confirms, stressing patience and diligence with proper application.
In-Office Immunotherapy
Allergy shots, which are designed to essentially trick your surveillance immune cells into responding to low doses of specific allergens to prevent a natural response over time, have been around since the early 1900s “and still work really well,” offering long-term remission according to Sokol. "But they are kind of a huge pain in the butt,” she admits of the rigorous timeline of in-office treatments. “They’re also expensive, and need to be administered by an allergist as you could have a bad reaction,” adds Meadows of a typical shot schedule that begins with weekly, or bi-weekly appointments for about six months, before tapering down to once a month appointments for 3 years. “The risk-benefit ratio needs to be weighed by individuals,” he continues, “but it is the best course of action because it gets to the root of things and actually changes your immune system.”