Amanda Wilde (Host): When spring fever turns to hay fever, seasonal allergies can be just miserable. In this episode, Allergy and Immunology Specialist, Dr. Margo Stevenson shares methods and strategies for how to feel better during the peak of seasonal allergies.

This is Healthy Takeout, a podcast from Harrington HealthCare System. I'm Amanda Wilde. Dr. Stevenson, great to have you here. Thank you for your time.

Margo Stevenson, DO: Thanks so much for having me today.

Host: Can you explain what seasonal allergies are and how they differ from other types of allergies?

Margo Stevenson, DO: Sure. So when we think about seasonal allergies, it's when the body's immune system is recognizing and overreacts to something in the environment. Typically that causes no problems in most people. And a good way to kind of divide that up is looking at seasonal allergies. And those are ones that occur in the spring, summer, and early fall, usually related to pollens from trees, grass, and weeds, versus all year allergens, and that we also call perennial allergens. And those can be things like dust mites, or cat and dog hair, cockroaches, and mold.

Host: You mentioned some common triggers for seasonal allergies. Do they vary by region?

Margo Stevenson, DO: Yeah, absolutely. So right now, as we're talking, it's March in New England, and this is the big time where the tree pollen starts coming out. So this week, for example, we had juniper pollen come out and in other parts of the country, like the South, those pollens come out sooner.

Host: Well, if our immune system is responding or over responding to this pollen in the air, what symptoms should we watch out for?

Margo Stevenson, DO: So that would be most commonly runny nose, also itchy eyes, lots of sneezing, kind of a feeling of nasal blockage or congestion. And then a tricky one that people don't think about sometimes is actually fatigue or tiredness and that's because when your nose is all blocked up it makes it hard to sleep well at night.

Host: So it's always related. And with that in mind, how do we distinguish between seasonal allergies and other respiratory conditions like the common cold or COVID-19?

Margo Stevenson, DO: When you look at seasonal allergies, they tend to occur at the same time every year. So it takes a few years when you're young to get sensitized. And then after that, you notice, for example, if you're allergic to ragweed, every August, you seem to have itchy eyes and a runny nose. So looking at the seasonality of it. And then typically, even though it's called hay fever, seasonal allergies don't usually present with a fever. And so that's one thing you can use to differentiate it from COVID-19 or a common cold.

Host: Now, I want to talk about what you do in terms of treatment. But first, are seasonal allergies curable or preventable, or is treatment primarily focused on managing symptoms?

Margo Stevenson, DO: So when we think of mild allergies, for example, somebody just has some minor nasal congestion and sneezing, we can treat those. Sort of mask the symptoms using over the counter medications such as oral antihistamines. But when somebody has moderate to severe seasonal allergies, causing them to miss school, miss work, just they can't tolerate the medication, we do have something that's called allergy injections or allergy shots that we can use to help patients.

Host: So tell me more, as an Allergy and Immunology Specialist, how you treat patients who come in to see you.

Margo Stevenson, DO: The first thing that we do is we do allergy testing because the more information we have about what you're allergic to, the easier it is to treat. And so a patient would come into my office and the first thing we do is skin testing on the back with some sharp toothpicks, looking at over 40 allergens.

And we look at all the ones we had mentioned before. We look at different trees, grass, weeds, mold, different fuzzy animals like cats, dogs, and rabbits. And we see if the pricks on the back kind of look like little bug bites. And that tells us what allergens that that patient has. And from there we can develop a plan.

So it is important to say, you know, I have all year allergens such as dust plus seasonal allergies. And I've failed a lot of over the counter medications. And at that point, we would consider allergy shots.

Host: So yeah, what do these treatment plans tend to include, medications, shots? What about lifestyle changes to combat seasonal allergies.

Margo Stevenson, DO: One of the first steps you can do, for a lifestyle change would be avoidance of allergens, which is really tricky to do. And so for a tree pollen, that's keeping our windows shut in the spring. If you're outside, you know, children with like play clothes or adults with gardening clothes, you want to change your clothes and shoes when you come inside and take a shower, wash your hands.

When it's our all year allergens like dust mites, so dust mites, they live in our mattress and pillow. We want to cover our mattress and pillow with waterproof covers that kind of locks in the dust mites.

Host: So this in a way it doesn't cure the allergy, but prevent it from acting up.

Margo Stevenson, DO: Yeah, they can certainly decrease it. So when we talk about those interventions and medications, like the oral antihistamines or nasal sprays; those are decreasing or masking the symptoms. Whereas when we do the allergy shots or the allergen immunotherapy, that's more, changing your immune system over a long period of time. It takes three to five years to become less allergic.

Host: So do you have to make a commitment to that therapy for that period of time?

Margo Stevenson, DO: Yes. And so what it is, is you come in, it's a weekly injection to what you're allergic to in small doses over time, specifically around 23 to 30 weeks for weekly, and then it goes monthly after that for 3 to 5 years.

Host: And what have you seen in terms of success with this method and how do you know what's working?

Margo Stevenson, DO: So overall patients will have around an 80 percent decrease in symptoms. So that would be like decrease in nasal congestion and sneezing. Overall using less medications, which is one of the goals. So say before they used to use nasal sprays and oral allergy pills, they're using less, they're missing less days of work or school.

And then a lot of patients that have allergies also have other allergic conditions like asthma. So I'd be looking for their asthma to also be better controlled while they're on allergy shots.

Host: Does that mean everyone can benefit from these allergy shots?

Margo Stevenson, DO: So there is no age limitation on the allergy shots. Typically the youngest patients I have are age four or five, all the way up into the nineties. And I've seen a benefit in all ages from allergy injections.

Host: We've touched on children just a little bit during our interview, and I'm wondering if seasonal allergies impact children differently than adults. Are there any unique considerations for managing allergies for kids?

Margo Stevenson, DO: The little guys, they have to live through a couple seasons. So we typically don't see the seasonal allergies in them until around age two, three, four, or five, and they don't like to blow their nose. So they tend to do kind of a repetitive choking and snorting.

So they present definitely less nasal blowing, less sneezing, and more of a snorting. So it's hard to tell that they have allergies. And in general, kids complain less than adults do. So a lot of children with allergies go unnoticed.

Host: That kind of leads to my next question, which is, what is the most common misconception you run into about seasonal allergies?

Margo Stevenson, DO: I think that they're limited to seasonal. So a lot of people that have seasonal allergies also have the all year allergens, like the dust and the cat and the mold, in addition to something else that we call non-allergic triggers. And that would be smoke, and perfumes, change in temperature, change in humidity.

So a lot of times it's not always as simple as somebody's just allergic to ragweed. It's kind of mixed into this picture of seasonal, all year, and non-allergic.

Host: So, a bunch of overlapping things that you sort of have to sort out with your doctor?

Margo Stevenson, DO: Testing really helps with that.

Host: Can you share some practical tips for managing our environment in regards to seasonal allergies, I mean, you did mention some things earlier inside the home. Also, when we're outdoors, are there ways to keep symptoms in check?

Margo Stevenson, DO: One thing to do would be wear sunglasses. That actually does keep some of the pollen out of your eyes. And then exercising, you want to exercise before sunrise and after sunset because the pollen comes out in the early morning and the evening.

Host: That's great. Dr. Stevenson, thank you so much for sharing some really helpful information and strategies on how to deal with seasonal allergies.

Margo Stevenson, DO: No problem. Thanks so much for having me.

Host: That was Allergy and Immunology Specialist, Dr. Margo Stevenson. For more information, visit harringtonhospital.org/allergy or call 774-452-7200. If you found this podcast to be helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you.

I'm Amanda Wilde. We'll talk again next time on Healthy Takeout, a podcast from Harrington HealthCare System.