What causes seasonal allergies, and what can you do about it? | Five questions

Catherine Monteleone sometimes jokes that her patients are among the few who aren’t happy when their test results are negative.

She’s an allergist-immunologist at Rutgers Robert Wood Johnson Medical School, and people with allergies want to know what’s causing their symptoms — what, precisely, they’re allergic to — so they can take steps to lessen the misery.

“It’s like a puzzle,” she said of treating a person suffering from allergies. Being able to figure out what’s causing an allergy and fix it is gratifying, she said.

We spoke to her recently about seasonal allergies and how to cope.

It started early, with people coming in with their normal spring allergy symptoms. It’s nasal congestion. It’s eye symptoms. You can get itchy eyes, swollen eyes even. This time of year, with tree allergies, which start early in spring, we’re seeing wheezing.

The tree pollen is first. By late spring, it’s grass. Then in mid-August to the first frost, you’re getting pollen from ragweed and other weeds. In addition, you always have mold, especially in the spring and fall, when it’s moist.

Most of the antibodies that our bodies produce are to fight infections. And normally, when you get exposed to pollen in the environment, your body should ignore it. But if you have an allergy to pollen, your immune system reacts to the pollen by producing a specific antibody called Immunoglobulin E, or IgE. That antibody binds to cells that release histamine. In subsequent exposures, these cells release their histamine, causing allergy symptoms. That’s why we take antihistamines.

Researchers have concluded that allergy season is starting 19 days earlier than it did 20 years ago. Half a month earlier is a lot for people who suffer from allergies.

And the season is continuing longer. In the Northeast — all this varies by section of the country — there are more frost-free days than there used to be.

With all this, pollen counts have gone up by a third. The plants are producing more because of increased carbon dioxide and increased warmth in the atmosphere. And since there is more pollen, more people are becoming sensitized to it. Normally, allergies peak in late adolescence. But now, we’re seeing plenty of adults having new onset allergies.

There are not a lot of new medications, and that’s a problem. One recent medication is a nasal antihistamine, although it requires a prescription. Sometimes, putting the antihistamine directly in the nose is more effective than taking an oral antihistamine.

The problem is that while antihistamines block the initial effects of an allergic response, they don’t treat congestion. That’s why some medications add decongestants. But oral decongestants can be harmful to the elderly. They can cause heart palpitations. People can get shaky. So we tell them to use another over-the-counter medication, a nasal steroid, such as Flonase, Rhinocort, and Nasacort for congestion.

A lot of the current research is aimed at figuring out where in the pathway — it’s an immunological response, remember — we can stop this whole response, this whole cascade. But that research is not coming to fruition yet.

It’s helpful to get tested so you can find out exactly what you’re allergic to. Then you can use avoidance plus timing of medication use to get the best relief.

Avoidance for pollen involves keeping your windows closed and your air conditioner on. This includes your car and your home. It might even include driving children to school; school bus windows sometimes don’t close very tightly. Children get to school, and they’re already feeling the effects of the allergies.

Wear a hat; wear sunglasses; wear a mask. Have designated outdoor clothes and then, when you come inside, take a shower and change to your indoor clothes. All this keeps the pollen off you. (The hat keeps you from having to wash your hair every day.)

Pollen is sticky. It sticks to the mucosa of your eyes. It sticks to your nasal passages. Then those cells that have the histamine interact with it. Remember that flowers aren’t the problem. They are pollinated by bees. It’s the wind-pollinated plants — trees and grass. Their pollen has to be sticky to make a new plant. That’s why it sticks to you.

The key to all of this is to start it early. The medications work best if you start at the first sign of symptoms or at the first sign of pollen counts going up.

It’s good to check weather apps or other online forecasts, like pollen.com, or asthmacenter.com, which posts counts for the Delaware Valley. People can use these to decide, well, maybe today’s not the best day for a picnic. In general, dry, windy days are the worst. That’s when the pollen is remaining airborne and really spreading. Tree pollen may travel for miles. Ragweed is very light and may go 100 miles. None of these have to be right outside your door for you to feel it, that’s for sure.

One more thing people can do for relief is to wash their eyes and use a nasal saline to get the pollen out of their nose. But remember to use only saline. Don’t ever put tap water up your nose. You could get an infection.

It may be time for allergy shots. These are for people for whom the medications haven’t worked. Or they’re on medicine almost all year because they have so many allergies.

The shots work almost like a vaccine, helping your body to tolerate the allergen. But they’re not for everyone. They’re a long-term commitment. You have to come into the clinic on a regular basis for several years. After five years, some people want to stop and see how they do. For some, the relief lasts. For others, the symptoms come back.

Still, just because the over-the-counter medications aren’t working doesn’t mean you have to suffer. It’s worth having a conversation with your doctor.