Medical Compass: ACHOO! Hay fever season is upon us

There are alternatives to sealing yourself indoors

By David Dunaief, M.D.

It is officially Spring! Locally, trees are budding, and flowers are beginning to bloom in full force.

If you suffer from seasonal allergies – also known as allergic rhinitis or hay fever – going for a walk is probably a little less enjoyable.

Roughly 25 percent of U.S. adults and 18.9 percent of children were diagnosed with seasonal allergies in 2021, according to the Centers for Disease Control and Prevention (1).

There are quite a few triggers for seasonal allergies. They include pollen from leafy trees and shrubs, grass and flowering plants, as well as weeds, with the majority from ragweed (mostly in the fall) and fungus (summer and fall) (2).

What causes allergic reactions? Seasonal allergy sufferers experience a chain reaction when they inhale allergens (pollen, in this case). The pollen interacts with immunoglobulin E (IgE), antibodies that are part of our immune system and causes mast cells in the body’s tissues to degrade and release inflammatory mediators. These include histamines, leukotrienes, and eosinophils in those who are susceptible. In other words, it is an allergic inflammatory response.

The revved up immune system then responds with sneezing; red, itchy and watery eyes; scratchy throat; congestion; sinus headaches; postnasal drip; runny nose; diminished taste and smell; and even coughing (3). Basically, it feels like a common cold, but without the virus. If you have symptoms that last more than 10 days and are recurrent, then it is more likely you have allergies than a virus.

If your allergic rhinitis is not treated properly, you can experience complications like ear infections, sinusitis, irritated throat, insomnia, chronic fatigue, headaches and even asthma (4).

Do medications really help with allergies? The best way to treat allergy attacks is to prevent them, but this means sealing yourself inside. You will need to close the windows, use your air conditioning and, when you do go out, use the recycling vents in your car.

On the medication side, we have intranasal glucocorticoids (steroids), oral antihistamines, allergy shots, decongestants, antihistamine and decongestant eye drops.

The guidelines for treating seasonal allergic rhinitis with medications suggest that you use intranasal corticosteroids (steroids) when your quality of life is affected (5). Two well-known inhaled steroids are triamcinolone (Nasacort) and fluticasone propionate (Flonase). While inhaled steroids are probably most effective in treating and preventing symptoms, they need to be used every day and can have side effects, like headaches.

If you experience itchiness and sneezing, then second-generation oral antihistamines may be appropriate. These can be taken on an as-needed basis. Second-generation antihistamines, such as loratadine (Claritin), cetirizine (Zyrtec) and fexofenadine (Allegra), have less sleepiness as a side effect than first-generation antihistamines, like Benadryl, but they don’t work for everyone.

Are there alternative treatments for allergies? Butterbur (Petasites hybridus), an herb, has several small studies that indicate its efficacy in treating hay fever. In one randomized controlled trial (RCT) involving 131 patients, results showed that butterbur was as effective as cetirizine (Zyrtec) (6).

In another RCT, results showed that high doses of butterbur — 1 tablet given three times a day for two weeks — was significantly more effective than placebo (7). Researchers used butterbur Ze339 (carbon dioxide extract from the leaves of Petasites hybridus L., 8 mg petasines per tablet) in the trial.

A post-marketing follow-up study of 580 patients showed that, with butterbur Ze339, symptoms improved in 90 percent of patients with allergic rhinitis over a two-week period (8). Gastrointestinal upset occurred as the most common side effect in 3.8 percent of the population.

There are several caveats about the use of butterbur. First, the studies’ durations were short. Second, the leaf extract used in these studies was free of pyrrolizidine alkaloids (PAs). This is very important, since PAs may not be safe. Also, the dose was well-measured, which may not be the case with over-the-counter extracts. Finally, there are interactions with some prescription medications.

Can you treat seasonal allergies with diet? While there are no significant studies on diet, there is one review of literature that suggests that a plant-based diet may reduce symptoms of allergies in teens, specifically rhinoconjunctivitis, affecting the nose and eyes, as well as eczema and asthma (9). In my clinical practice, many patients with seasonal allergies have improved and even reversed the course of allergies over time with a vegetable-rich, plant-based diet. This might be due to its anti-inflammatory effects. Analogously, some physicians suggest that their patients have improved after removing dairy from their diets.

While allergies can make you miserable, there are a significant number of over-the-counter and prescription options to help. Diet may play a role by reducing inflammation, although there are no formal studies. There does seem to be promise with some herbs, like butterbur, although there are caveats. Always consult your doctor before starting any supplements, herbs or over-the-counter medications.

References: (1) CDC.gov. (2) acaai.org/allergies/types/pollen-allergy. (3) J Allergy Clin Immunol. 2003 Dec;112(6):1021-31.. (4) J Allergy Clin Immunol. 2010 Jan;125(1):16-29.. (5) Otolaryngol Head Neck Surg. 2015 Feb;2:197-206. (6) BMJ 2002;324:144. (7) Arch Otolaryngol Head Neck Surg. 2004 Dec;130(12):1381-6. (8) Adv Ther. Mar-Apr 2006;23(2):373-84. (9) Eur Respir J. 2001;17(3):436-443. 

Dr. David Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com or consult your personal physician.