Diseases & Conditions

Get a Jump on Fall Allergies

By on 09/11/2017

Fall is here, and with it, fall allergies.

The proof? For some of us, it’s the onset of fall ragweed allergies. If you suffer with it, you know the symptoms: runny nose and congestion, itchy eyes and throat, postnasal drip, maybe an annoying cough, reflexive throat clearing and other upper respiratory miseries.

fall allergies

Gary Kuan-Hsiang Huang, MD, PhD

“When I was looking at the pollen monitoring stations, the season has actually already begun, starting about late August,” agrees Einstein Healthcare Network allergy specialist Gary Kuan-Hsiang Huang, MD, PhD, who practices at Einstein Medical Center Philadelphia. Dr. Huang says he is already starting to see patients with the characteristic complaints associated with ragweed allergy.

Ragweed can be a prolific pollen producer, with a single plant generating more than a billion grains of pollen in its lifetime—and you might have to endure ragweed allergy for longer than in the past due to global climate change, says Dr. Huang. According to one theory gaining credence in the allergy community, Dr. Huang explains, carbon dioxide has been rising, and that has been correlated to a better growth of ragweed. “The plants have gotten bigger, taller, and now produce more pollens than before. They also blossom for a longer period, as they come out a bit earlier every year.”

Waiting for the First Frost

Close-up of ragweed, ambrosia plant (artemisiifolia)

When will it end? Typically, with the first frost.

“Luckily, the frost is our friend to condense the pollen—except we don’t know when the ending time is,” says Dr. Huang. “It’s hard to know because we don’t know when winter starts. Last winter was very warm, and the first frost came late.”

Although ragweed allergies are typically most significant in the fall, he says, people can have symptoms throughout the year if they are allergic to other environmental triggers.

Of all the people suffering seasonal allergies, he adds, “ragweed allergy plays a significant role in more than half of that proportion, with pollen and symptom volumes peaking around mid-September.”

Ragweed sensitization is the third most common allergy sensitization, affecting around 26.2 percent of the U.S. population, trending just behind dust mites (27.5 percent) and perennial rye grass (26.9 percent) allergies.

Aside from the common seasonal allergy symptoms, ragweed and other weeds such as mugwort can complicate further to sinusitis, reduced sense of smell, snoring and bad breath. In some cases, patients report a unique syndrome—oral-allergy syndrome—in which certain fruits and vegetables can cause a pricking or burning sensation in the mouth that is often associated with lip and tongue swellings. “For the ragweed,” says Dr. Huang, “patients tend to complain of reactions to the different melons, cucumbers and banana.”

For most of us, ragweed allergies can be an annoyance, but for many, the symptoms can be more significant. In addition to confusing hay fever for strep throat and sinusitis, ragweed allergies can exacerbate the symptoms of serious respiratory disorders like asthma.

Prevention is the Best Medicine

“Asthma can get harder to control, and there is a good body of evidence to suggest that a very inflamed nasal and throat mucosa (the mucous membranes) makes the airway more irritable, and makes existing asthma even harder to control,” says Dr. Huang, who has been on staff at Einstein since 2011. “A lot of these people think they have bronchitis. They can become feverish and have symptoms more like pharyngitis (a throat inflammation). It can be mistaken for infection. They don’t respond to antibiotics. Or they think they’ve had a cold that just lingers and won’t go away, for weeks and months.”

Prevention is generally the best course of action. Starting over-the-counter medication two weeks before the season begins is often recommended. “Keeping that nasal and throat mucosa calm before the season becomes advanced is quite important,” says Dr. Huang, “because then you are ahead of the game. We usually advocate for treatment ahead of time after our allergy tests help patients to recognize the triggers.”

For people with severe environmental allergy, immunotherapy—or “allergy shots”—may be indicated. Those typically need to be given up to three months before the allergy season begins.

There’s no need to suffer through ragweed season if you did not plan ahead. Allergists can provide medications and other interventions that will ease your symptoms.

“In an urgent context, very often a nasal steroid is a go-to,” says Dr. Huang, “and we would recommend an increased dose under our supervision. Antihistamines very often help. There are other oral medications and nasal applications that may augment the combination of oral antihistamine and nasal steroids. We hope to give you more specific and effective advice that over-the-counter medication may not offer.”

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