Pollen allergy explained in details

Pollen is a very fine particulate material produced by trees, flowers, grasses, and weeds to fertilize other plants of the same species. It reaches other plants through air or through insects like honey bees. Many people have an adverse immune response when they breathe in pollen. This is called a pollen allergy.

What is pollen allergy?

In an earlier post we have described an allergic reaction. Pollen allergy is a form of allergy in which a person suffering from it gets allergic symptoms or allergic reaction when they breath in pollen. 

So pollen allergy is induced by aeroallergen that is allergen coming through air and entering inside your system when you breathe.

Many people have this problem and they experience the allergic symptoms when they are exposed to pollen in the season of pollination.

At what does age pollen allergy start?

At first exposure to pollen your body gets primed to them. Usually it takes 2-3 seasons of pollination for priming.

Priming can be described as an introduction to the immune system. In this phase the antigens here pollen are introduced to your immune system. Your immune system recognizes those pollen and it attacks against them. First 1-2 seasons this attack is mild.

After this priming when you come in contact with allergen this attack by immunity is more stronger and you also experience its effect on your own body.

So pollen allergy usually becomes symptomatic at age 2-3 years of life after getting exposed to pollen for 2-3 seasons. It is likely to continue for years and becomes annoying for the sufferer.

What are the symptoms of pollen allergy?

Pollen usually enters our body when we breathe, So first symptoms to appear are usually respiratory tract symptoms. They are symptoms like hay fever or may be more severe symptoms than hay fever.

Pollen allergy signs and symptoms can include:

  • Runny nose and nasal congestion
  • Watery, itchy, red eyes (allergic conjunctivitis)
  • Sneezing
  • Cough
  • Itchy nose, roof of mouth or throat
  • Swollen, blue-colored skin under the eyes (allergic shiners)
  • Postnasal drip
  • Fatigue
  • Fever
  • Headache
  • Ear pain
  • Breathlessness

Now let’s see the details of symptoms as you would like to know about your condition.

Runny nose and nasal congestion

One of the most annoying complaints you may experience is runny nose. This runny nose may affect your day to day function.

The nasal discharge from runny nose of allergic rhinitis is watery thin and profuse. It is more annoying when a person is sitting or standing.

Literally those who have pollen allergy need to clean their nose every few minutes. It affects the concentration and working capabilities.

The people working in public or going to school or class may feel ashamed and they may be blamed by others as they disturb the entire class while cleaning their noses.

Nasal congestion may be associated with the condition. It may occur in night time too to disturb the sleep of the patient. 

Watery, itchy, red eyes

Other common complaints associated with running a runny congested nose is itching of eyes.

There is a feeling of itching in the eyes and there is a strong urge to rub the eyes. Person is found vigorously cleaning his nose and rubbing his eyes

Eyes become red called conjunctival congestion. Sometimes sticky eye discharge may be found with eyelids sticking together..

Eyes typically as if they have got conjunctivitis. As there is no infection causing conjunctivitis in these cases so they are called as allergic conjunctivitis.

Sneezing

Sneezing is typically present in allergic rhinitis. The characteristic of sneezes is identifiable and generally similar in pollen allergy.

The person with pollen allergy usually has loud explosive sneezes and that come in rapid succession like a machine gun. 

You may experience episodes of anywhere 4-5 sneezes or may be as many as 25-30 sneezes. Additionally there are many such episodes present.

Cough

Cough may be present in patients with pollen allergy. The cough may be dry or with expectoration. 

The cough may be because of post nasal drip or may be because of irritation in nose and throat.

Sometimes pollen allergy may be associated with asthmatic attacks too. In such cases cough may indeed be a prominent symptom with difficulty in breathing and wheezing sound from the chest.

Patients with pollen allergy are more likely to get asthmatic symptoms and vice versa is true.

Itchy nose, roof of mouth and throat

With the above symptoms already the person is annoyed and more to that there is an uncomfortable feeling of itching of nose, roof of mouth and throat.

Because of this itching sensation which is uncomfortable the person looks annoyed and keeps on rubbing his nose vigorously. This act of rubbing the nose frequently with an annoyed face is called an allergic salute.

This itching affects the working capability of the students and they feel annoyed and disabled.

Allergic shiners

Those who have frequent symptoms for prolonged periods may have swollen skin below the eyes.

That swollen skin may look bluish slightly and may be identified typically as it is strongly associated with allergic rhinitis.

This appearance of the skin in people with hay fever is an important sign and it is called as allergic shiners.

Post nasal drip

If you have pollen allergy the nasal secretions may come out from the nose as seen by you externally.

These secretions are so profuse and large that they also drip into the pharynx from the back side of the nose. 

This secretion can be viewed when the patient opens the mouth with tongue out and depressed with tongue depressor. This visible flow at the back was of oropharynx is called as post nasal drip.

This is typically very common in children.

Fatigue

With these ongoing symptoms you feel fatigue.

The fatigue comes as part of the condition itself or as a consequence of symptoms. 

If the person with pollen allergy experiences the symptoms at the time of the sleep and is not able to sleep, may feel fatigued at the workplace. There is a feeling of the decreased energy and decreased capacity to work.

With this fatigue you may experience pain in limbs. You want to take rest but you are unable to do so due to symptoms.

Fever

There can be fever along with above symptoms. The fever is typically mild grade and occurs when there are other symptoms.

There is feeling of fatigue and loss of energy along with this fever.

Headache

Above all symptoms are usually associated with feeling mild headaches.

This headache occurs when you feel fatigue with symptoms. It is typically mild grade and in the frontal region above your nose.

If you have sinusitis along with pollen allergy the headache in this condition is moderate to high grade. Headache typically decreases when other symptoms also decrease.

Ear pain

Suffering from all above symptoms you are trying vigorously to get rid of them. You try to clear your nose in the process.

In vigorous attempts to blow your nose forcefully there is a feeling of blockade in the ear with decreased capability of hearing. This symptom may suddenly come after blowing your nose.

You can experience ear pain in this process and need treatment for the same.

Breathlessness

Some people may feel breathless when there is a nose block. This is especially the case in small children and infants.

Some have a tendency to get bronchospasm like asthma when they have symptoms of hay fever and they may get wheezing and difficulty breathing needing immediate intervention.

If the symptoms like breathlessness are severe, it can become life threatening and a person severely allergic to pollen may die if not treated.

Which are pollen grains that cause allergy?

The list is extensive in case of pollen grains that can cause pollen allergy. Here we will see some most common causes of pollen allergy.

Most common causes of pollen are as follows:

Birch pollen allergy

Birch trees causing pollen allergy.
Birch trees

These are generally small to medium-sized trees or shrubs, mostly of northern temperate and boreal climates.

Birch pollen is one of the most common airborne allergens during the spring. These trees release huge amounts of pollen during flowering season into the air.

These pollen can travel a few meters in air and can enter when you breathe in.

Oak pollen allergy

Oak tree can cause pollen allergy
Oak tree can cause pollen allergy

Like birch trees, oak trees send pollen into the air during the spring.

Grass pollen allergy

green grass field beside body of water under blue sky during daytime
Grass pollen can cause allergy

This is the primary trigger of pollen allergies during the summer months.

Additionally grass can induce the contact dermatitis when you come in contact with grass. Open skin coming in contact may also show symptoms of contact dermatitis.

Ragweed pollen allergy

Ragweed can cause pollen allergy
300Ragweed can cause pollen allergy

Ragweed plants are the main culprits of allergies among weed pollens. They’re the most active between the late spring and fall months.

How to diagnose pollen allergy?

Your doctor can easily diagnose pollen allergy. Your doctor asks you a detailed history of symptoms and timing of the year it occurs.

History and physical examination helps to diagnose the pollen allergy.

Further tests are useful for the confirmation of the diagnosis. 

Skin prick test is useful for the diagnosis and allergist perform this test on you.

Additionally detecting LgE levels and eosinophil levels also hints at the diagnosis.

What is treatment of pollen allergy?

Treatment of the pollen allergy depends on what the symptoms are and how often they make you suffer.

You should take your doctor’s opinion rather than using over the counter medicines again and again.

Acute management

Goal of the acute management is reducing the current symptoms in those suffering from allergic rhinitis. Current symptoms may range from mild to severe.

When the current symptoms are affecting day to day function of the person they should be treated.  Following are the treatment options available in this condition

Antihistamines

Antihistamines are antiallergic in nature. They reduce the secretion of histamines by the histamine secreting cells and histamine is the main allergy inducing agent that causes symptoms of the allergy.

Antihistamines show effects in hours depending on drug. Antihistamines are classified according to the time they were invented. Older generation antihistamines cause more sedation and newer ones are comparatively less sedating.

Hydroxyzine and promethazine and chlorpheniramine are amongst older antihistamines.

Loratadine, fexofenadine, cetirizine and levocetirizine and bilastine are among newer ones.

Antihistamines are useful orally or locally as a nasal spray like azelastine nasal spray. 

These agents though are many available OTC should be used cautiously as they may cause addictions if used in the wrong way and also dangerous if given in overdose.

Some of them like hydroxyzine and fexofenadine may cause arrhythmia in some patients.

The anticholinergic effects which they have helps 

  • Dry up the nasal and pharyngeal mucosa 
  • Reduce the stuffiness of the nose 
  • Itching sensation

Sedating antihistamines is a drug choice in children where sleep disturbance is there along with nasal secretion and stuffiness symptoms.

Adults who need to drive or work at places where attention is needed should be given newer antihistamines which cause less sedation. You should keep in mind though newer antihistamines too may cause decreased alertness with other medications.

Phenylephrine

This is the drug that causes the constriction of blood vessels in the nasal mucosa. Due to this constriction of the blood vessels in nasal mucosa it reduces the blood flow to nasal mucosa.

The secretions on nasal mucosa decrease and mucosa becomes dry. It gives relief from symptoms of nasal secretions and stuffiness.

This is given usually orally in combination with antihistamines. Many OTC cough cold medications contain phenylephrine as a content. 

This should be given in proper dosages and with advice of the doctor as overdoses are dangerous and it may cause high blood pressure.

This drug is not safe to use in pregnant ladies and infants and small children. It can be dangerous in older adults too.

Oral steroids

Steroids are antiallergic and anti-inflammatory effects. They do reduce the symptoms of allergy in pollen allergy..

You can give these medicines orally or by injection or by nasal spray. They show their effect in a few hours and are safe if you fallow doctor’s advice.

Some of the examples are prednisolone for oral use and dexamethasone for injection and fluticasone and mometasone as nasal spray.

Used for prolonged periods these may cause hypertension, diabetes and cataract and kidney failure. They should always be used with the advice of a doctor.

Used in the wrong manner they may cause severe immunosuppression and that can be dangerous to the person. In the long run these can weaken your bone altering your calcium metabolism.

Antiinflammatory drugs

Anti-inflammatory drugs reduce the pain and inflammation. Pollen allergy can cause headache and bodyache and feeling of tiredness.

Antiinflammatory drugs help to reduce those symptoms. They also reduce the fever if present. 

Some of the examples are paracetamol and ibuprofen. Many OTC cough cold medications contain combinations of antihistamines and phenylephrine plus paracetamol. They may have added caffeine to reduce the side effect of sedation.

Nasal sprays of oxymetazoline

Oxymetazoline and xylometazoline give immediate relief of symptoms when sprayed into the nose. They act by constricting the blood vessels in the nasal mucosa.

These medicines give symptomatic relief from the symptoms of nasal secretion and nasal stuffiness. They show their effect within a few seconds.

These medicines though many times available as OTC, do not use them for more than 5-7 days as they have habit forming potential.

They do cause sleepiness and feeling fatigue. They may give you a stingy sensation in your nose.

Those with hypertension and older adults should not use these medicines as they are not safe in this age group. 

Additionally, avoid these drugs for those below 12 years of age as they are not safe to use in this age group.

Long term management:

As this problem occurs repeatedly and above mentioned drugs give temporary relief we need to do intervention that acts to prevent the symptoms.

Patients suffering symptoms and then treating those is an annoying process. It is better if we stop symptoms from occurring.

So following are strategies that are useful for this purpose.

Steroid nasal spray

Used with medical advice these are useful for keeping the check on symptoms. They drastically reduce the symptoms.

These medicines contain a very minute amount of steroids. They act locally and do not get absorbed into blood. So these cause very minimal or no side effects systemically.

They contain steroid doses which are 10-100 times less than oral or injectable steroids. When oral steroids are given they do get absorbed in blood and then reach to intended areas. So they have more side effects. This side effect is solved in case of local steroids.

The thing is these are useful for prolonged periods and you can take it by nasal sprays so are easy to take.

Some side effects like nasal bleeding and feeling of nasal dryness and stingy nasal sensation can occur in some people.

Those who have vasomotor rhinitis and nasal polyps and respond to this therapy very effectively.

Steroid nasal sprays also help to reduce the frequency and severity of bronchospasm in patients who have asthma symptoms with allergic rhinitis.

Mometasone and fluticasone are some examples of the steroid nasal sprays.

Montelukast

Montelukast is a membrane stabilizer. It reduces the secretion of allergy inducing agents by the cells.

These drugs are useful in chronic allergies and allergic rhinitis. These drugs are useful in allergic rhinitis and Pollen allergy too. 

You can take it once or twice a day. Initially 14 days take it in combination with levocetirizine and then as mono drug therapy or in combination with steroid nasal spray.

This also helps to reduce other allergic and asthma symptoms apart from allergic rhinitis.

Antihistamine nasal sprays

Antihistamine nasal sprays are newer in this category and they have all benefits of oral antihistamines with lesser side effects. 

Newer antihistamines like azelastine can be useful by this route.

Combination nasal sprays

Combination of steroid plus local antihistamines are good for initial control without need of oral medicines.

Combining mometasone and azelastine is available for this purpose. They combine the benefits of both steroids and antihistamines.

Respiratory probiotics

New class of drug called respiratory probiotics is very effective in controlling allergic rhinitis symptoms.

They do show their effect within a few days and 70 percent of patients who take this treatment for 3-6 months are relieved of symptoms for prolonged period time.

One such respiratory probiotic RespiStrong is very effective for this use. You can take it orally as powder that can be chewed or in some cool water and drink.

This new class of drug has less side effects among all above medicine with very satisfactory effects.

How to prevent pollen allergy?

Best way of preventing pollen allergy is avoiding contact. Following are the general guidelines to prevent pollen allergy.

Stay indoor

Staying indoor during the pollen season can protect you from pollen allergy. It helps to reduce the exposure to an environment containing pollen in air.

Masks

Masks can protect you from exposure to pollen grains. It helps to reduce the symptoms. Use clean and washed mask every time you go out.

Gardening work

Avoid gardening and going to the garden during the pollen season of pollens as it may protect you from pollen.

Doors and windows

Keep the windows and doors closed during the season of pollen and stay indoor.

Weed and grass control

If your house has grass and weeds in surrounding causing you pollen allergy get professional help to clean the area.

What are allergy shots?

Allergy shot is a form of treatment for the allergy. It is desensitization treatment of the allergy.

Your allergist can give you this treatment if needed. It is useful for the known allergen.

In this treatment your doctor gives you increasing levels of allergen sequentially and your body learns to tolerate the allergen and you are free of allergy.

It is a form of immunotherapy.




<span class="has-inline-color has-luminous-vivid-orange-color">Dr Yatin Bhole MBBS DCh DNB</span>
Dr Yatin Bhole MBBS DCh DNB

This article was written by Dr Yatin Bhole who is practicing Pediatrician at Bhole Children Clinic, Ravet. This post is for general information and before applying it on yourself, you should meet your doctor or meet us in person.



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