“I think the problem is that some people have a couple of weeks when they are miserable, and then the rest of the year they are fine, so they think they’ll just grin and bear it… But there is a better way. You can take steps to minimize those weeks of misery.” Yale Medicine pediatric allergist Stephanie Leeds, MD
“People are sneezing and coughing, and not getting tested for COVID-19 because they assume it’s allergies. And they are probably correct.” Yale Medicine allergist Florence Ida Hsu, MD
Pollen and other breathing allergies in the time of COVID are strange and often misleading bedfellows. Symptoms can overlap. Both have forceful respiratory aspects. Many of us have spent long periods of time indoors, many in sealed rooms with air conditioning and air filters. When we ventured outside, most of us wore masks. Fewer cars on the road generated less air pollution. Allergies in 2020 were hardly a primary concern. Welcome to 2021. COVID has not gone away, although a very large pool of Americans have now been vaccinated or generated an immune resistance by surviving an infection. Allergies really never left.
In the overall scheme of things – most certainly accelerated by climate change – the pollen count has continued to rise, year by year. Kathy Katella, writing for the May 18th edition of Yale Medicine, explains: “[Last] year was an unusual interruption of what experts say has been a rising pollen count trend… ‘This year I’m hearing a lot of patients say their symptoms are very severe,’ says Stephanie Leeds, MD, a Yale Medicine pediatric allergist… ‘The tree pollen has been particularly intense,’ says Florence Ida Hsu, MD, a Yale Medicine allergist who has seen patients with lots of nasal congestion, sneezing, coughing, and red, itchy eyes—and in the most serious cases, allergic symptoms that have led to asthma flares.
“A combination of at least two things could be contributing to these miserable symptoms. One small part is that more people are going outside without masks (which can also protect against pollen), now that the Centers for Disease Control and Prevention (CDC) has relaxed mask guidelines. The other—and bigger—reason is that many are facing an onslaught of pollen.
“‘With climate change, the general trend has been that we’re getting higher levels of pollen and longer pollen seasons, whether that’s due to warmer temperatures or increased carbon dioxide emissions; it’s probably multifactorial,’ says Dr. Leeds. A study published in February in the journal Proceedings of the National Academy of Sciences (PNAS) backs this up: It reported a lengthening of the pollen season by 20 days and a 21% increase in pollen concentrations between 1990 and 2018…
“Pollen is an airborne substance that comes from grass, flowering plants, trees, and weeds. In the past 12 months, 19.2 million adults and 5.2 million children under 18 were diagnosed with hay fever, the name given to allergic rhinitis caused by pollen. When someone has hay fever, their immune system identifies pollen as a threat and releases signals that lead to congestion, itchy eyes, runny nose, and sneezing, as well as problems like sinus pressure and allergic conjunctivitis (itchy, watery, and red eyes).
“The amount of pollen in the air depends on the season and the geographic area in which you live. The study reported in PNAS found the most pronounced effects in Texas and the Midwestern United States. However, the Northeast can have a significant spring allergy season as well, Dr. Leeds says. Tree allergies are especially common in New England—particularly due to birch and oak. Pollen allergies can also cause a cross-reaction with certain foods in some people; symptoms include an itchy or tingling mouth and throat after eating raw fruits and vegetables, seeds, and nuts.” Windy days can accelerate the impact of airborne irritants. Particles can lodge in your hair, to be dispersed later when you bring them inside. Children are often more severely impacted when they take their play outside for longer periods, usually without wearing masks. Some outgrow those allergies, but some don’t.
Yet with COVID lingering, there is one more confusing variable when addressing allergies. “The CDC has a Venn diagram that shows symptoms the two conditions have in common. These include congestion, cough, difficulty breathing, fatigue, runny nose, sore throat, and shortness of breath. But comparing the most common symptoms reveals clear differences. Seasonal allergies usually cause itchy or watery eyes and sneezing, while COVID-19 is characterized by fever and chills, muscle and body aches, new loss of taste and smell, nausea and vomiting, and diarrhea.
“‘Because of COVID-19, people are afraid of you when you’re sniffling,’ says Dr. Hsu. ‘But it goes both ways—a lot of people are sniffling and sneezing and coughing, and they are not getting tested for COVID-19, because they assume it’s allergies. And they are probably correct.’…Often the distinction is clear—people with allergies itch more, and they don’t have the fatigue, malaise, and fever that comes with COVID-19. But anyone who is concerned should call their doctor, she says.” Yale Medicine. Allergy shots can be an effective treatment, but that takes planning and time. Non-medicine-related treatments can mirror CDC COVID guidelines, but, hey, we’ve just had too many of those restrictions.
Yale Medicine has a list of practical suggestions: “Medications aren’t the only way to help solve the problem. If you are having seasonal allergy symptoms, the CDC and Yale Medicine doctors offer the following non-medical strategies to help both adults and children:
Stay in the house if you can, particularly on windy days. Keep the windows closed (in the car, too). Run the air conditioner, which should have a clean filter on it.
Wear a face mask when you go outside to prevent you from inhaling larger particles of pollen (note that smaller particles can still get through). Wash the mask after each use because it may have pollen on it.
Wear a hat and sunglasses to avoid getting pollen in your hair and to protect your eyes.
Avoid outdoor activities such as mowing lawns or raking leaves, as they stir up pollen.
If you spend time outdoors, brush off any pollen once you go back inside. “If you are pollen-sensitive, it’s a good idea to take a bath, wash your hair, and change your clothes, especially if you’re going to bed,” says Dr. Hsu. “Try to minimize the amount of pollen that goes from your head to your pillow, because you will be breathing it in all night.”
During the COVID-19 pandemic, the CDC suggested ways to create a cleaner air space at home that can also be helpful in protecting against outdoor air irritants. A portable air cleaner/purifier can help; it works best when run continuously with the doors and windows closed.
If your home has a forced air system, consult a qualified heating, ventilation, and air conditioning (HVAC) professional about filters (HEPA or MERV-13 or higher) and settings (“Recirculate” and “On” rather than “Auto”) that can be used to reduce indoor air irritants.
“Check the daily pollen count (the number of grains of pollen in a cubic meter of air based on a sample taken in a 24-hour period) before you decide to spend time outdoors. The measure is reported as low, moderate, high, or very high. You can sign up with the National Allergy Bureau for notifications with information for your area.” There is clearly hope, but given the escalation in pollen every season, for many, increasingly severe seasonal allergies just might be a way of life for a very long time.
I’m Peter Dekom, and for a few of my readers, I hope today’s blog just might make dealing with seasonal allergies a little bit easier.
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