Fall environmental allergies and how to manage them

Many people’s bodies react to Mother Nature and the outdoors as though they were true enemies. An allergic reaction is our body misunderstanding or essentially mistaking a usually harmless environmental item as a threat or danger. The body overreacts, creating an inflammatory response that at times can lead to anaphylaxis, a serious, life-threatening allergic reaction. 

Common environmental allergens include dust mites such as found in common household dust, molds, pollen, grasses, hay, ragweed, as well as animal dander such as from cats, dogs, rabbits and horses.

Symptoms of environmental allergies include nasal congestion, rhinorrhea (commonly known as a runny nose), difficult nasal breathing, sneezing, itchy eyes, skin rashes, red eyes, shortness of breath, facial and/or generalized body swelling.

How do allergens get into our bodies?

Allergens in the environment are most often inhaled, but they can also get into our bodies to cause a reaction by contact or ingestion.

Diagnosing environmental allergies

Environmental allergies are diagnosed using skin testing or blood testing, namely RAST (radioallergosorbent) and ELISA (enzyme-linked immunosorbent assay). Skin testing is done in many forms including:

• Skin prick testing — the skin is prepped with a needle or pin containing a small amount of the allergen.
• Skin patch testing — a deep dermal scratch is performed with use of the bottom of a small blade.
• Intradermal testing — a hypodermic syringe and needle are used to inject a tiny quantity of the allergen under the skin.
• Skin scrape testing — a needle is used to remove the superficial layer of the epidermis with subsequent application of the allergen. Minimal pain is associated with this form of skin testing.
• Patch testing — a patch containing the allergen is applied directly to the skin. The skin scratch test is not used very commonly because of the increased risk of infection. By making a small trauma to the skin with a microscopic amount of the potential allergen to see if there is a hyperactive response, multiple potential allergens can be tested with separate skin trauma or prep for each of them. 

With any skin testing, there is a very small risk for severe allergic reaction, so testing should only be done by qualified specialists. If the person is allergic to the allergens, the immune response is seen with development of a rash, hives, wheals, itchiness or anaphylaxis (body swelling, shortness of breath). 

While many of the allergic reactions occur within a few minutes, others may take several days to develop. If there is no reaction, there is still the possibility of a true allergy existing, and the concentration of allergen used may need to be adjusted. 

Positive and negative controls are also placed with proven allergens such as histamine to which most people react and glycerin to which most people do not have a reaction. If the person’s skin does not react appropriately to these controls, then it most likely will not react to the allergens being tested. 

With RAST and ELISA testing, about 10 cc of blood is drawn and sent to the lab where the blood is then tested for multiple different allergens. Since the individual has no exposure to the allergen, there is no risk for an allergic reaction occurring. 

Treating environmental allergies

While many medications are used to treat environmental allergies, many interventions are also available to minimize symptoms prior to considering medications. These include:

• Avoidance

While avoidance may mean not being outdoors as much as one would like, this decreases the level of exposure and may be effective for someone with limited allergies such as only to ragweed. If their allergy is to ragweed, then avoiding the outdoors as much as possible in the fall would be helpful. 

Closing windows to the outside during peak allergy season would also be helpful. Also when outdoors, once coming inside a quick shower with hair washing and a change of clothes would also help to decrease the amount of allergens present.

• Saline nasal irrigation

Using saline sprays in the nose topically decreases the concentration of the inhaled allergens so that the body has less antigen to respond to. Saline nasal sprays can be done multiple times a day and even when outdoors to reduce exposure.

• Take off shoes

Leaving shoes by the entrance or exit of your home will help track less allergens into your home, especially to the bedroom.

• Change clothes

Avoid sleeping or lying in bed in clothing that you wore outdoors, as allergens will stay trapped on your clothing and transfer to your bed.

• Brush pets

If your pet is outdoors with you, then at minimum do a brush-down or sponge bath to minimize trapped allergens on them, causing you symptoms.

• Cover bedding

Use hypoallergenic pillow and mattress covers to decrease exposure to dust mites and other allergens that get trapped into bedding.

• Clean bedding

Wash bedding often, at least weekly, especially during your high-allergy season to minimize bedding-trapped allergens.

• Clean air

Change the air conditioning and furnace filters often to effectively remove allergens from the air.

• Get routine sleep 

When you are well-rested, your ability to handle any body reaction or stress is much improved.

​​​​​​​Allergy shots

A small amount of your allergen is injected weekly over the years, with the body then sensing and reacting to the allergen by eventually producing antibodies so that the allergens do not produce the same symptoms. While many people will notice improvement in their allergy symptoms within months of starting allergy shots, they should anticipate receiving allergy shots for three or more years.

Allergy drops

Small amounts of your allergen are taken sublingually (under the tongue) three times a day. The advantage is that only the first and any escalation dose are administered in the physician’s office or monitored; the remaining doses are done at home three times daily.

Medications

Nasal steroid sprays such as fluticasone and oral antihistamines such as loratadine are effective over-the-counter medications that are used to treat environmental allergies symptoms.

Prescription medications such as additional steroids, antihistamines, or mast cell mediators are available when the over-the-counter medications are ineffective. Grastek is an oral pill that is used to treat grass allergies, generally starting three months prior to the onset of the season.

Overall, these are key things to do to live more happily with your environmental allergies. 

Dr. Inell Rosario was born and raised on Andros, an island in the Bahamas. She graduated from Macalester College in 1987 with a Bachelor of Arts and went on to attend medical school at the University of Minnesota. She is board-certified in otolaryngology, head and neck surgery, and sleep medicine. She is the president of Andros ENT & Sleep Center. When she isn’t working at the clinic, Dr. Rosario likes to exercise, play basketball, and do mission work. She is married and has two children.