The Bay Area experiences three pollen spikes throughout the year.  Juniper bushes, cypress, cedar, and other trees release pollen beginning in January.  Pollen from annual grasses increases in April, May, and June. In the summer, there is a surge in summer weed pollen.  The heavy on and off rain this year caused both trees and grasses to pollinate at the same time, making it a particularly bad season for people who have a history of allergies. Even people who haven’t had allergies in the past may have experienced more allergy symptoms than usual. Here are some tips for coping with summer allergies in the Bay Area.   

Alter your lifestyle

To keep your summer allergies in check, there are a few easy tweaks you can make to your daily life: 

• Stay inside in the morning when pollen counts are often at their highest
• Check the local pollen counts here 
• Put a HEPA filter in the bedroom
• Avoid exposure to tobacco, which can exacerbate allergy symptoms
• Wear an N95 mask while doing yard work or spending an extended amount of time outside
• Keep pets outside

Which medications are best for which allergy symptoms?

Nasal congestion, runny nose, and eye symptoms can often be controlled with nasal corticosteroids such as Flonase, Nasonex, or Nasacort. Many are now available over the counter (you can get great prices on a 3-pack at Costco).Sneezing and eye itching can be controlled with newer oral antihistamines, like loratadine (Claritin), cetirizine (Zyrtec), and fexofenadine (Allegra) or levocetirizine (Xyzal).  These are also available over the counter and don’t cause the sleepiness that older antihistamines like diphenhydramine (Benadryl) do.

 

For isolated itchy eyes, you can try ketotifen eye drops (Zaditor), 1 drop in each eye every 12 hours (available over the counter).

Sudafed may help as an oral decongestant but is generally limited by adverse effects. People who have high blood pressure or enlarged prostate shouldn’t take it at all. Also, avoid during pregnancy and while breastfeeding.  

Nasal decongestant sprays like Afrin, work great but if you use them for more than 3 days, they can cause “rebound congestion,” which makes congestion worse. Avoid using nasal decongestant sprays for more than 3 days in a row unless your doctor tells you to. Also, avoid them if you have high blood pressure or an enlarged prostate or are pregnant or breastfeeding. 

Nasalcrom is a very safe anti-allergy compound derived from the khella plant, and available as an over the counter nasal spray. It may help with sneezing and runny nose, and perhaps even nasal congestion.

For patients who have unexpected or unusual reactions to medications, it may be a reaction to a binder or filler instead of the medication itself.  Try a different manufacturer or come into WholeFamilyMD to discuss. We may be able to order a compounded version without commercially used binders or fillers.  

Taking an integrative approach to summer allergies

• Some people with allergic rhinitis also have food allergies. If you have any food allergies, eliminate those food items from your diet. If you’re not sure, start with eliminating dairy first, then wheat and see how you feel.
• Add flavonoid-rich foods, like blueberries, blackberries, raspberries to your diet
• Drink lots of water to thin mucus
• Nasal irrigation may decrease local allergen concentrations in the nasal mucosa, as well as help with sneezing and congestion. One study found that doing nasal irrigation three times a day reduced allergy symptoms after about 3 to 6 weeks. To do nasal irrigation, you can use a neti pot, bulb syringe, or squeeze bottle to flush out nasal passages with salt water. Nasal irrigation should be reserved for children over the age of four.  

Supplements to help relieve allergy symptoms 

• Lactobacillus acidophilus. One small study suggests that L. acidophilus, a type of “friendly” bacteria, might help reduce allergic reaction to pollen. More research is needed but, for most people, adding this supplement may help.
• Quercetin. Quercetin is a flavonoid (plant pigment) that gives fruits and vegetables their color. In test tubes, it stops the production and release of histamine, which causes allergy symptoms such as a runny nose and watery eyes. However, there is not yet much evidence that quercetin would work the same way in humans. More studies are needed. Quercetin can potentially interfere with many medications, so speak with your physician before taking.
• Vitamin C (2,000 mg per day). Vitamin C has antihistamine properties and preliminary research suggests it might help reduce allergy symptoms. Other studies failed to show any effect.
• Fish oil 1000-2000 mg / day of EPA/DHA
• Butterbur (Petasites hybridus. 500 mg per day). Butterbur has been used traditionally to treat asthma and bronchitis and to reduce mucus. Several scientific studies suggest it can help with allergic rhinitis. One study of 125 people with hay fever found that an extract of butterbur was as effective as Zyrtec. Another study compared butterbur to Allegra with similar findings. However, both studies were small. So more research is needed. Researchers do not know whether taking butterbur longer than 12 to 16 weeks is safe. Butterbur can cause stomach upset, headache, and drowsiness. Pregnant and breastfeeding women, and young children should not take butterbur. If you take any prescription medications, ask your doctor before taking butterbur. Only use butterbur products from a reputable manufacturer under the guidance of your physician. Low-quality butterbur may contain potentially harmful toxins. Butterbur may interact with some medications that are processed by the liver. If you take any prescription medications, ask your doctor before taking butterbur.
• Stinging nettle (Urtica dioica, 600 mg per day for one week). Stinging nettle has been used traditionally for treating a variety of conditions, including allergic rhinitis. But studies so far are lacking. Only one small study suggested that stinging nettle might help relieve symptoms of allergic rhinitis. Pregnant women and young children should not take stinging nettle. Talk to your doctor before taking stinging nettle if you have diabetes or if you take blood pressure medication, blood thinners, diuretics, water pills, lithium, or other medications processed by the kidneys.

If your summer allergy symptoms persist, please schedule an appointment to discuss with your doctor.