Spring brings warmer temperatures, sunshine and flowering buds; but for many people, it means bouts of spring allergies that are downright miserable.
Dr. Kenneth Johns joins us to discuss common spring allergies, what you should know and tips to alleviate symptoms.
Nip spring allergies in the bud with tips and expert information from allergist, Dr. Kenneth Johns
Selected Podcast
Preventing Spring Allergies
Featured Speaker:
Kenneth Johns, MD – Allergy and Immunology
Dr. Kenneth Johns specializes in allergy and immunology and practices at Allina Health Coon Rapids Clinic and Allina Health Maple Grove Clinic. His professional interests include child and adult asthma, seasonal allergies, hives and skin rashes. Transcription:
Preventing Spring Allergies
Melanie Cole (Host): Spring brings warmer temperature, sunshine, and flowering buds. But for many people, it can mean bouts of spring allergies that can be downright miserable. My guest today is Dr. Kenneth Johns. He specializes in allergy and immunology and practices at Allina Health Coon Rapids Clinic and Allina Health Maple Grove Clinic. Welcome to the show, Dr. Johns. Tell us about the spring allergies. What do you see most when spring comes around?
Dr. Kenneth Johns (Guest): Well, quite a few things show up in the spring. Some of those are allergies. Some of those are things that sort of sound like allergies, but as it turns out aren’t. In terms of allergens, we start to see some outdoor mold early in the spring. Those mold spores are not a real common allergen, but they can be a particularly difficult one to treat. A little later in the spring, when the trees pollinate, we have the tree pollen allergy. And that season is really very variable. Some years it’s early. Some years it’s late, depending on weather. Towards the end of spring, we start to see some grass pollen. Those would be the major allergens. Again, sometimes in the spring, we have problems. We have symptoms that are caused more by irritants, and sometimes we have problems that are more viral. Respiratory viruses can cause symptoms that really sound like allergy but aren’t.
Melanie: As you say, the respiratory viruses are going around at this time of the year. People have colds and things and runny noses. How do you know whether you have just a common cold or some kind of virus or whether it’s a seasonal allergy?
Dr. Johns: It can be really hard to tell them apart. In general, allergy symptoms are going to go on quite a bit longer. Your basic respiratory virus, you can have symptoms that go on for a week or 10 days, sometimes it will drag out to two weeks, whereas the allergy symptoms can go on for weeks or months. There is usually more itching with allergies than there is with respiratory infection. Otherwise, they can be hard to tell apart. We actually do tests for specific allergies. There are several different ways to do that. We do have the traditional skin test, where there are minute quantities of the pollen or the mold or what have you introduced underneath the skin, causing a welt if there’s a positive. And then we can do a blood test. There are various types of the blood test which have about the same accuracy, and sometimes we’ll do the blood test if we can’t do the skin test. But we have several different testing methods to diagnose a specific inhalant or allergy.
Melanie: Once you’ve diagnosed these as an allergy versus a virus or something else, then what is your first line of defense for treatment?
Dr. Johns: Well, we have basically three treatments for allergies: avoidance and then medications and then allergy shots or desensitization. I would say there really isn’t a first line. We have these options and we try to figure out what would be the best approach. Avoidance of springtime allergens is tough. Our springs in Minnesota are short enough as it is. I really discourage people from staying indoors. Beyond that, there’s not a whole lot you can do in terms of avoidance of those allergens. In terms of medication, we have lots of options. One by one, these options are gradually going over-the-counter, which makes things a lot easier. Sometimes we’re using antihistamine. Sometimes we’re using topical steroids in the nose. Sometimes we’re using different nose sprays. Sometimes we’re using eye drops and any combination thereof. We actually have quite a few options of very safe medications in different combinations for patients of any age, really. Then we have our traditional immunotherapy allergy shots. There are different types, but the consensus is that immunotherapy -- we call it subcutaneous, where you get an allergy shot weekly to begin with. Then they get spaced out as time goes by. This is a type of desensitization. We’re actually giving you very small amounts of that pollen, for example, that desensitizes you to the pollen when you inhale it or encounter it. These allergy shots, we’ve had them for about 100 years. I want to say allergy shots have been given for almost a century now, and they can be very effective for the right patient with the right allergy. The newest wrinkle in desensitization, as of this year, we have desensitization that’s a sublingual pill or drop. It’s something that’s been used successfully overseas for many, many years, and they’re just recently approved in the United States. We really don’t know how popular these are going to be. They’re only available for a few allergens, basically grass and ragweed. In terms of comparisons, we really don’t know how well they work compared to traditional allergy shots or medications. I’m going to say the jury is still out on the sublingual desensitization. There are options in some combination of those.
Melanie: If avoidance is impossible because you want people getting outside and such, are there things that they can do inside when they are? Do air filters work? Do dehumidifiers work? Does changing their pillowcase or using these anti-allergic pillows/ Any of these kinds of things you read about, do any of those work?
Dr. Johns: Air cleaners and air filters are a real popular approach, but the data, the studies really aren’t there to show that they actually make patients feel better. It isn’t a real common recommendation. The best that you can say is if you’re indoors and the doors and windows are shut and the air conditioners are running, that’s probably as good as it can get. A specific filter or HEPA system or what have you, like I said, we really don’t have good evidence that those are terribly helpful. The other avoidance measures that you are referring to really have to do with the dust mite allergy, which is more of a perennial, year-round allergy. If people are allergic to dust mites, there are things that can be done to reduce their exposure, but they really wouldn’t be helpful for the spring pollen allergy or mold allergy.
Melanie: Can you develop these kinds of spring allergies as you age, or do you get them as a child and keep them all through your life?
Dr. Johns: There are different patterns. There are some kids that seem to get them very young. But the most common pattern would be that late teens, early 20s who, over a course of years develop seasonal allergies, seasonal allergic rhinitis. They may sort of peak in the 20s and plateau in the 30s and 40s and then sort of gradually fade away. There definitely is a natural history for the main group of people with seasonal allergic rhinitis. Adult onset, someone in their 30s, 40s, 50s who just sort of develops pollen allergies, that’s not real common. That wouldn’t be a real common pattern. I think that it probably does occasionally happen. But more commonly, other things, other conditions that have some similar symptoms of allergies, those can show up as an adult. For example, people that are having more difficulty tolerating irritants like smoker dust, that’s something that can really show up in any age and will sort of fool you because it can sound like seasonal allergies but isn’t, and certainly has different treatment.
Melanie: In just the last minute, Dr. Johns, can you please give the listeners your best advice on how to reduce spring allergies, as it’s coming right around the corner?
Dr. Johns: Well, as they say, I think it would be cruel and unusual to stay indoors, so I think you should stay outdoors and enjoy the weather while you can. Medication-wise, it’s reasonable to start with over-the-counter antihistamine or nose sprays, specifically topical nasal steroid sprays, which are now over-the-counter. If those fail, it’s probably time to talk to somebody like me. We have some options for you.
Melanie: Thank you so much. It’s great information to try and nip those spring allergies in the bud. You’re listening to the WELLcast with Allina Health. For more information, you can go to allinahealth.org. That’s allinahealth.org. This is Melanie Cole. Thanks so much for listening.
Preventing Spring Allergies
Melanie Cole (Host): Spring brings warmer temperature, sunshine, and flowering buds. But for many people, it can mean bouts of spring allergies that can be downright miserable. My guest today is Dr. Kenneth Johns. He specializes in allergy and immunology and practices at Allina Health Coon Rapids Clinic and Allina Health Maple Grove Clinic. Welcome to the show, Dr. Johns. Tell us about the spring allergies. What do you see most when spring comes around?
Dr. Kenneth Johns (Guest): Well, quite a few things show up in the spring. Some of those are allergies. Some of those are things that sort of sound like allergies, but as it turns out aren’t. In terms of allergens, we start to see some outdoor mold early in the spring. Those mold spores are not a real common allergen, but they can be a particularly difficult one to treat. A little later in the spring, when the trees pollinate, we have the tree pollen allergy. And that season is really very variable. Some years it’s early. Some years it’s late, depending on weather. Towards the end of spring, we start to see some grass pollen. Those would be the major allergens. Again, sometimes in the spring, we have problems. We have symptoms that are caused more by irritants, and sometimes we have problems that are more viral. Respiratory viruses can cause symptoms that really sound like allergy but aren’t.
Melanie: As you say, the respiratory viruses are going around at this time of the year. People have colds and things and runny noses. How do you know whether you have just a common cold or some kind of virus or whether it’s a seasonal allergy?
Dr. Johns: It can be really hard to tell them apart. In general, allergy symptoms are going to go on quite a bit longer. Your basic respiratory virus, you can have symptoms that go on for a week or 10 days, sometimes it will drag out to two weeks, whereas the allergy symptoms can go on for weeks or months. There is usually more itching with allergies than there is with respiratory infection. Otherwise, they can be hard to tell apart. We actually do tests for specific allergies. There are several different ways to do that. We do have the traditional skin test, where there are minute quantities of the pollen or the mold or what have you introduced underneath the skin, causing a welt if there’s a positive. And then we can do a blood test. There are various types of the blood test which have about the same accuracy, and sometimes we’ll do the blood test if we can’t do the skin test. But we have several different testing methods to diagnose a specific inhalant or allergy.
Melanie: Once you’ve diagnosed these as an allergy versus a virus or something else, then what is your first line of defense for treatment?
Dr. Johns: Well, we have basically three treatments for allergies: avoidance and then medications and then allergy shots or desensitization. I would say there really isn’t a first line. We have these options and we try to figure out what would be the best approach. Avoidance of springtime allergens is tough. Our springs in Minnesota are short enough as it is. I really discourage people from staying indoors. Beyond that, there’s not a whole lot you can do in terms of avoidance of those allergens. In terms of medication, we have lots of options. One by one, these options are gradually going over-the-counter, which makes things a lot easier. Sometimes we’re using antihistamine. Sometimes we’re using topical steroids in the nose. Sometimes we’re using different nose sprays. Sometimes we’re using eye drops and any combination thereof. We actually have quite a few options of very safe medications in different combinations for patients of any age, really. Then we have our traditional immunotherapy allergy shots. There are different types, but the consensus is that immunotherapy -- we call it subcutaneous, where you get an allergy shot weekly to begin with. Then they get spaced out as time goes by. This is a type of desensitization. We’re actually giving you very small amounts of that pollen, for example, that desensitizes you to the pollen when you inhale it or encounter it. These allergy shots, we’ve had them for about 100 years. I want to say allergy shots have been given for almost a century now, and they can be very effective for the right patient with the right allergy. The newest wrinkle in desensitization, as of this year, we have desensitization that’s a sublingual pill or drop. It’s something that’s been used successfully overseas for many, many years, and they’re just recently approved in the United States. We really don’t know how popular these are going to be. They’re only available for a few allergens, basically grass and ragweed. In terms of comparisons, we really don’t know how well they work compared to traditional allergy shots or medications. I’m going to say the jury is still out on the sublingual desensitization. There are options in some combination of those.
Melanie: If avoidance is impossible because you want people getting outside and such, are there things that they can do inside when they are? Do air filters work? Do dehumidifiers work? Does changing their pillowcase or using these anti-allergic pillows/ Any of these kinds of things you read about, do any of those work?
Dr. Johns: Air cleaners and air filters are a real popular approach, but the data, the studies really aren’t there to show that they actually make patients feel better. It isn’t a real common recommendation. The best that you can say is if you’re indoors and the doors and windows are shut and the air conditioners are running, that’s probably as good as it can get. A specific filter or HEPA system or what have you, like I said, we really don’t have good evidence that those are terribly helpful. The other avoidance measures that you are referring to really have to do with the dust mite allergy, which is more of a perennial, year-round allergy. If people are allergic to dust mites, there are things that can be done to reduce their exposure, but they really wouldn’t be helpful for the spring pollen allergy or mold allergy.
Melanie: Can you develop these kinds of spring allergies as you age, or do you get them as a child and keep them all through your life?
Dr. Johns: There are different patterns. There are some kids that seem to get them very young. But the most common pattern would be that late teens, early 20s who, over a course of years develop seasonal allergies, seasonal allergic rhinitis. They may sort of peak in the 20s and plateau in the 30s and 40s and then sort of gradually fade away. There definitely is a natural history for the main group of people with seasonal allergic rhinitis. Adult onset, someone in their 30s, 40s, 50s who just sort of develops pollen allergies, that’s not real common. That wouldn’t be a real common pattern. I think that it probably does occasionally happen. But more commonly, other things, other conditions that have some similar symptoms of allergies, those can show up as an adult. For example, people that are having more difficulty tolerating irritants like smoker dust, that’s something that can really show up in any age and will sort of fool you because it can sound like seasonal allergies but isn’t, and certainly has different treatment.
Melanie: In just the last minute, Dr. Johns, can you please give the listeners your best advice on how to reduce spring allergies, as it’s coming right around the corner?
Dr. Johns: Well, as they say, I think it would be cruel and unusual to stay indoors, so I think you should stay outdoors and enjoy the weather while you can. Medication-wise, it’s reasonable to start with over-the-counter antihistamine or nose sprays, specifically topical nasal steroid sprays, which are now over-the-counter. If those fail, it’s probably time to talk to somebody like me. We have some options for you.
Melanie: Thank you so much. It’s great information to try and nip those spring allergies in the bud. You’re listening to the WELLcast with Allina Health. For more information, you can go to allinahealth.org. That’s allinahealth.org. This is Melanie Cole. Thanks so much for listening.