AARP Smart Guide to Seasonal Allergies

 

10. Don’t blame the city planners

Male trees have long been preferred for planting because they have no seeds or pods to drop. While this results in less cleanup and yard work, the trees do produce pollen, leading some on social media to call out city planners. “You may have heard a lot of people talk on social media about this idea of botanical sexism — where a lot of major cities planted male trees because they didn’t want to deal with the fruit that was going on the streets,” Rubin says. This, many noted in their posts, was why the pollen count was so high in your neighborhood. But that’s not the whole picture. “There’s a lot more pollen now in general, but to say that that’s directly because of that is a little bit misleading. It’s not the only reason why people are having worsened allergies,” Rubin says, noting it’s only partially true.

 

11. Pollen can travel far

“A lot of people think, ‘Oh, do I need to cut down the tree that’s by my house to help with my allergies?’ [But] that doesn’t really help for the vast majority of people, because the pollen grains blow all over the place,” Rubin notes. Pollen grains could be miles away, and in some cases even 100 miles away, he says. So removing one tree from your backyard won’t help at all. 

 

HEALTH RISKS

 

12. Higher risk of infections

Treating allergies isn’t just for comfort. People with seasonal allergies are at a higher risk for sinusitis, a bacterial infection that can occur due to stagnant mucus, notes Rubin: “If you have enough swelling [in your nasal passage], then secretions can become stagnant and allow for viruses and bacteria to thrive, leading to sinus infections.” Additionally, allergies are a known trigger for asthma flares in people who have it, and allergies can also cause asthma symptoms in people who may not have generalized asthma. If you experience shortness of breath, wheezing or severe cough, talk to a doctor about treating asthma along with your allergy symptoms.

 

13. Brain fog and sleep apnea

Because symptoms can disturb sleep, allergy sufferers often complain of fatigue, says Mark Moss, MD, an allergist in Madison, Wisconsin, and director of the allergy and immunology clinical research program at the University of Wisconsin Medical School. Losing shut-eye can also cause cognitive difficulties — such as impaired attentiveness, concentration and focus — that some people call “brain fog.” “All of those have been shown to be affected adversely when people have worsening nasal allergies,” Moss says. People with sleep apnea might notice worsening symptoms if they have a stuffy nose, says Matthew C. Altman, MD, associate professor of allergy and infectious diseases at the University of Washington Medical School. Plus, it’s hard to use a CPAP machine when air can’t properly flow through your nasal passages.

 

14. Gum disease

There are two ways allergies can lead to dry mouth, which is when your salivary glands fail to produce enough saliva to keep your mouth moist. One, if your sinuses are congested, it’s likely that you’re breathing through your mouth more often. And second, a dry mouth can be a side effect of taking antihistamines (which is why people who take antihistamines might also suffer from bad breath). When there’s no saliva to wash away food and bacteria from your teeth, it can result in cavities and gum disease. If you experience seasonal allergies, tell your dentist to look at your mouth carefully.

 

15. Eye infections

Untreated allergic symptoms in your eyes — also called allergic conjunctivitis — can cause a serious condition called keratoconus. “It’s very severe inflammation in the cornea of the eye,” says Louisias, and can lead to visual impairment. Check in with your health care provider if you have swelling in your eyelids, which could indicate allergic conjunctivitis.

 

PREVENTION

 

16. Irrigate your sinuses

Congested? Use a bulb syringe, neti pot or sinus rinse kit to help clear mucus from your nasal passages with saline water. “If you can tolerate it, a nasal saline rinse is really good as a nonmedicated way to flush out anything that sits in your nose,” says Rubin. “And I typically have people do that at nighttime.” Always use distilled, filtered or cooled-down boiled water to prevent spreading bacteria to your nasal passages, and thoroughly wash your neti pot with antibacterial soap and water after use. “You can develop irritation in your nasal passages if you overuse it, so I recommend once or twice a day as needed,” adds Mili Shum, MD, an allergist and immunologist with U Health in Utah.

 

17. Allergy-proof your home

Do your best to keep allergens out of your home during allergy season. Sanjay C. Patel, D.O., an allergist and immunologist at Desert Center for Allergy and Chest Diseases in Phoenix suggests keeping windows shut, and if you’ve spent a lot of time outside, change your clothes and take a shower before sitting down on furniture or lying in bed. Putting on fresh clothes after being outside or exercising outdoors can help to remove allergens from your skin and hair and minimize symptoms.

 

18. Check the weather

A pollen count is a real-time measurement of the pollen grains in the air per cubic meter, and a pollen forecast is a prediction of future pollen counts based on historical data and weather forecasts. Pollen counts of 50 or less are considered low, while 1,000 or more is considered very high. Many free weather apps, including My Pollen Forecast, Allergy Plus and WebMD Allergy App (iOs, Android) include pollen counts, air quality and humidity levels — which all can make allergy symptoms feel worse. Shum says pollen is usually worse on dry and windy days, but people notice improvements when it’s rainy, because the precipitation pushes pollen to the ground.

 

19. Wear a mask

Windy, cold or dry weather can trigger or worsen symptoms. Consider wearing a mask or bandana to prevent the inhalation of allergens. If you’re also going into fragrant stores, like Lush, Bath & Body Works, and Sephora, it might be beneficial to keep the mask on to not trigger a reaction. “Fragrances can irritate anyone. Not everyone who has seasonal allergies are bothered by fragrances but not everyone who is bothered by fragrances have seasonal allergies,” notes Rubin.

 

20. Stop using essential oils

Mint, lavender and eucalyptus essential oils may smell good — and even seem as though they are opening your nasal passages — but they can be very irritating to the nose, eyes and lungs, Rubin says. On your skin, they can cause contact dermatitis — an itchy, red rash that may lead to blistering and peeling. “Even if you feel better temporarily, in the long run, it’s not treating the underlying problem,” Rubin says. “I really don’t find significant benefits from them.” Bonus: They aren’t good for your pets, either, so everyone will be breathing easier in your home by nixing them.

 

21. Watch what you eat

Some proteins in fruits and vegetables are similar to the ones in pollen. If your body thinks the food is the pollen you’re allergic to, you may experience oral allergy syndrome, which is characterized by an itchy mouth. “As the protein gets altered through normal digestion, this changes the food protein so it no longer resembles the pollen protein,” says Chinthrajah. Typically, only raw foods trigger symptoms; if the food is cooked or canned, people usually don’t notice symptoms, Chinthrajah says. (You can learn more about cross-reacting foods through the American Academy of Allergy, Asthma & Immunology.)

 

22. Add friendly bacteria to your gut

If you don’t already take probiotics, consider starting now. Multiple studies identify a connection between gut and immune health. A 2017 study, for example, found healthy bacteria in the GI tract due to probiotic supplements can help alleviate allergy symptoms. Patients who took probiotics reported fewer allergy-related nose symptoms and overall better quality of life during allergy season than those taking a placebo. Even if probiotics don’t cure your allergies, they have plenty of other well-studied health benefits and few risks.

 

23. Think twice about that air purifier

Studies suggest air purifiers equipped with high-efficiency particulate air (HEPA) filters can trap allergens and reduce symptoms, but there’s a catch. Effectiveness is limited to the room you’re using it in, rather than the whole home. “Air purifiers work, but they filter for such a small area that it has to be right by your head to remove enough,” Altman says. In that case, you’ll probably want to choose a quiet air purifier, but avoid ozone air generators, which have been associated with lung damage and other health risks.

 

24. Pay heed to your humidifier

Adding moisture to the air with a humidifier can help cough and congestion, but too much humidity can have the opposite effect for some people. Dust mites, Shum says, thrive in moisture, so if you have a known allergy, skip the humidifier. (And be careful not to over-mist or water your houseplants.) Humidifiers can also increase the risk of mold in a home, especially if you don’t follow the manufacturer’s instructions to clean yours properly. If you need a humidifier, Shum recommends investing in a hygrometer, a tool that measures humidity. Ideally, your home humidity should be lower than 50 percent at all times. (A dehumidifier can help regulate moisture levels if needed.)

 

25. Honey for coughs, not for allergies

The old adage about eating local honey at the start of allergy season to stave off symptoms is not completely sound. Moss says honey typically contains microscopic grains of pollen from surrounding plants, but it’s probably not enough to change how your immune system responds to allergens. Honey, on the other hand, has been shown in studies to control cough as effectively or better than cough suppressant medications in some people, so it may be worth adding some to your tea or eating a teaspoonful if you’ve got postnasal drip. “Honey is something that helps with a cough — there’s no doubt about that,” Rubin says. But as far as taking local honey to help with allergies, well, it was based on one very small study and hasn’t proven it helps. Another small, similar study found no difference for those who took honey or a placebo. “[It’s] a complete myth,” he adds.

 

26. Bathe your pet more often

Even if you don’t have a pet dander allergy, your pet can carry pollen from outdoors to indoors and worsen your symptoms. Patel suggests bathing your pet more frequently during allergy season to prevent worsening symptoms. The Humane Society of the United States recommends talking to your vet or other animal care professional to see what they recommend for shampoo and soap. Keep Fido out of your bed and couch if you’re concerned about pollen (or pet dander) on your furniture.

 

27. Skip dryer sheets

Dryer sheets can be potentially irritating to those with allergies, asthma or skin issues, Rubin notes. Instead, use wool dryer balls or spritz white vinegar on a washcloth and put it in the dryer.

 

28. Keep the dust under control

For people allergic to dust mites or concerned about pollen from outside, vacuuming more frequently can help. Fabric upholstery, rugs and carpet can harbor dust mites, so design and clean your space accordingly. But using a vacuum without a HEPA filter can make allergies worse, by kicking up the dust. A vacuum with a HEPA filter contains the allergens more efficiently. Another spot that collects dust you may not always see — your plant leaves. Clean them periodically to help them continue to absorb the light they need to grow. And change your home’s air filter regularly, or if your furnace can handle it, use an allergy furnace filter.

 

29. Zero in on your bedroom

Altman usually suggests people with dust mite allergies take additional steps to allergy-proof their bedroom. Change your bedding frequently, and consider investing in dust mite encasements for your pillows and mattress. “These products are tightly woven fabric that’s too small for dust mites to fit through,” he says. Look for bedding, mattress covers and box springs that are feather-free, down-free and include “dust mite protector” and “allergen barrier.” And wash all bedding in hot water at least once a week.

 

30. Consider moving

It’s a drastic decision, but one that may bring relief. Moving to a region with different plant species may also change your symptoms. “Everybody’s pollen season is different depending on where you live. So it starts earlier in the south and starts later as you go further north,” Rubin says. According to Patel, it usually takes two full seasons to develop a new allergy. “Beware of the honeymoon period, that first two years where you think your allergies are better,” he says. This can also happen on vacation — you might not have any allergy symptoms during a time your allergies are usually high. But if you visit that location frequently, your body might develop an allergic response.

 

TREATMENT OPTIONS

 

31. Treat individual symptoms as needed

Only have eye or nose symptoms? Local treatments are your best bet. Moss recommends over-the-counter allergy eye drops for relief of itchy, watery eyes. Corticosteroid nasal sprays, or steroid nasal sprays, such as Beconase, Flonase and Nasacort can reduce sneezing, runny nose and congestion by decreasing inflammation in the nasal passages. But these take longer to work. “I recommend starting a nasal steroid spray about two weeks before allergy season commences, and then starting oral antihistamines and eye drops when people start to notice symptoms,” Moss says. Rubin agrees that you’ll need to use these regularly to see results. “It's not something that you can take for a day and expect it to work well, because steroid medications take a while to work, because they're actually trying to change how the cells operate. That takes time. So usually, you're not going to see an effect for anywhere between three to up to seven days or so.” Always consult with your physician and mention these types of medications when you talk to your doctor.

 

32. Find the right antihistamine for you

Antihistamines, available over the counter, work by blocking histamine, a chemical that triggers allergic inflammation. Moss suggests taking one as soon as you notice allergy symptoms; you may feel better within an hour or two. “You may need to take [them] for a few days to notice the full effect, but that depends on how severe your allergies are to begin with,” Shum says. Either way, she says antihistamines are safe to take for the entire allergy season, as long as you’re aware of side effects. Diphenhydramine (Benadryl) was once the gold standard antihistamine, but Moss says doctors don’t recommend it as much now because it’s sedating and can cause unwanted psychiatric effects, especially in higher doses, and it may increase the risk for dementia and Alzheimer’s disease if taken long term. Now, the most commonly recommended antihistamines are cetirizine (Zyrtec), loratadine (Claritin) and fexofenadine (Allegra). Shum generally recommends Allegra for older adult patients, because it’s the least sedating (followed by Claritin and then Zyrtec). If your antihistamine makes you sleepy, she recommends taking it at night. Xyzal, another over-the-counter antihistamine, is basically a double dose of cetirizine, says David Corry, MD, a professor of medicine-immunology, allergy and rheumatology at Baylor College of Medicine in Houston. You can take two Zyrtecs to get the same effect, but you should talk to a medical provider before doubling up (and watch out for drowsiness).

 

33. When to use decongestants

Decongestants — available as tablets or nasal spray — can help relieve nasal congestion due to allergies, but they don’t treat the core problem of inflammation. So while Moss says you can try a decongestant, you’ll likely need other treatments. Decongestants can also cause significant side effects, like heightened blood pressure, rapid heart rate, feeling jittery and problems sleeping, according to Moss. Corry adds: “Oral decongestants should not be used by anyone, hypertensive or otherwise, after about the age of 50 due to numerous potentially serious side effects.”

 

34. Take time off if you use nasal decongestants

Decongestant nasal sprays (oxymetazoline or xylometazoline) are known to cause dependence and worse congestion when you stop using them — that’s why Altman suggests using nasal sprays for no longer than three days. “Basically, you sensitize the cells responsible for congestion,” he says. “If you overuse them, the cells can become inert to it, and you need more and more.” If you’re having a hard time stopping your nasal decongestant spray, talk to your health care provider about how to do so safely. “Excessive use of nasal decongestant sprays causes rebound vasodilation that worsens the congestion that was the initial problem, producing the condition formally known as rhinitis medicamentosa (RM),” Corry says.

 

35. If you use montelukast, know the risks

Another oral allergy medication is mntelukast (sold under the brand name Singulair and in generic form). Like antihistamines, this drug works by blocking inflammatory chemicals called leukotrienes. Moss commonly recommends montelukast for people who still have symptoms while taking other medications, but it’s important to know the risks. In 2020, the U.S. Food and Drug Administration warned consumers and health care providers of psychiatric side effects, including aggression, depression, agitation, sleep disturbances, suicidal thoughts and suicide. Moss says this effect is serious, but rare, and it should stop when you stop taking the drug. “Overall, montelukast is probably the most worrisome medication for use in allergies especially in those over age 50,” Corry notes. “If standard medications are not working so that you are thinking of trying montelukast, it is preferred to go to an allergist and try immunotherapy — allergy shots — before resorting to montelukast.”

 

36. Be skeptical of direct-to-consumer allergy tablets

Sublingual allergy tablets, which introduce allergens in oral liquid or tablet form, have been shown in a few small studies to improve allergy symptoms. But they’re not FDA approved, and according to the American Academy of Allergy, Asthma & Immunology, there’s not enough consistent evidence about their safety or efficacy. Allergy drops are typically sold from direct-to-consumer companies rather than prescribed for allergists, which may involve pricking yourself to test for allergies. But relying on the consumer to take data can result in inaccurate treatment. “That’s really concerning,” says Patel. “You’re asking a consumer to do something, and their whole treatment is based on that.”

 

37. Talk to your eye doctor about using contacts with antihistamines

Johnson & Johnson received FDA approval in early 2022 for disposable contact lenses called Acuvue Theravision with Ketotifen, which delivers a well-known antihistamine (ketotifen) to the eyes to fend off allergy symptoms. The pros are that they are convenient and effective in controlling ocular pruritus (eye itch) due to allergies. But Corry says recent reports of blindness and death happening to those using eye drops contaminated with pseudomonas (a type of bacterium) is worrisome. “Putting anything in the eyes confers higher risks as compared to the application of medication to other organs,” he says. “The long-term safety of drug-eluting contact lenses is unknown, and it may be best to wait for postmarketing surveillance reports to begin accumulating in a few years.” Your eye doctor, Moss adds, is the best resource if you want to talk it over. You can also use allergy drops in your eyes before putting in your normal contacts, and again after you take them out at night. Wait at least 15 minutes after using allergy drops before putting in your contacts.

 

38. Be wary of alternative medicine

Alternative allergy treatments, including acupuncture and an herbal supplement called butterbur, have been shown in some studies to improve people’s symptoms. But according to Corry, research on alternative remedies is often not as robust or reliable as mainstream treatments — plus, the FDA doesn’t regulate supplements for safety and efficacy — so he generally doesn’t recommend them. Instead, focus on treatments your health care provider recommends.

 

IMMUNOTHERAPY OPTIONS

 

39. Consider immunotherapy

Immunotherapy is a treatment that desensitizes your immune system to allergens you’re allergic to. Subcutaneous immunotherapy — or SCIT —  involves getting injected with small amounts of allergens at an allergist’s office. Studies show it’s highly effective, and that people report decreased symptoms for years after therapy, but it’s a big time investment: Most people go every week for several months, and then receive monthly maintenance shots for three to five years afterward. “I’ll usually offer it to people who aren’t getting any benefit from over-the-counter drugs or prescription medications,” says Louisias. Some clinics offer at-home immunotherapy shots, but Louisias cautions against those. Allergy shots can cause severe allergic reactions, so they’re best done in a doctor’s office. Because immunotherapy involves introducing actual allergens to your body, it isn’t a safe option for everyone. For example, Corry says allergists usually advise against allergy shots for people with lung or heart disease, and people prone to hives. People who take beta blockers for high blood pressure may not qualify for allergy shots, because these drugs may lead to more severe (or even life-threatening) anaphylaxis.

 

40. Try sublingual immunotherapy if you have just one allergy

If you’d rather not spend years getting shots, sublingual immunotherapy — taking a dissolvable tablet at home — is an option. According to Patel, doctors may recommend SLIT to people who aren’t eligible for subcutaneous immunotherapy, such as patients on blood thinners who shouldn’t get shots due to bleeding risk, or people prone to swelling. While subcutaneous immunotherapy can introduce multiple allergens at once, the tablets only include one allergen. “This is a great way to get desensitized from grass, ragweed and dust mites and is safer and more convenient than SCIT (subcutaneous immunotherapy),” says Corry. “Unfortunately, SLIT is only available for a few things and so is less effective for folks with multiple allergies. It’s also more expensive than SCIT.”

 

41. If all else fails, ask about biologics

Patients who aren’t candidates for traditional immunotherapy aren’t out of options. Xolair, a biologic drug, can alter people’s immune response to allergens without exposing them to the actual allergen. When you breathe in an allergen, your body releases antibodies called immunoglobulin E (IgE), which then attaches to the allergen and inflammatory cells. Biologic drugs like Xolair — typically administered as a shot — contain proteins that bind to the antibodies, so they can’t attach to inflammatory cells. Currently, the FDA has approved Xolair for allergic asthma, but not seasonal allergies. Still, Corry says many allergists prescribe it “off-label” for patients who have severe allergies but can’t undergo immunotherapy.