No one is born with allergies. Whether people develop them, like most medical problems, depends on the combination of genetics and environment, nature and nurture. Certain people are born with a tendency – the genetic component – to develop allergies. At some point they become exposed to allergens like tree pollen, cat dander or peanuts – the environmental component. If a person’s genetic tendency is strong and the exposure has the right amount, timing and route of administration, then a clinical allergy may develop.
The genetic side of this formula is set in stone. You can’t pick your parents. The exposure side, however, is variable. Tennessee has more tree pollen than Phoenix. Humid areas (Mississippi) have more dust mites than arid climates (Colorado). Urban areas (Baltimore) have more cockroaches and cat dander than rural areas (Beaver Dam, KY). So you would think that the prevalence of allergies would be higher in areas with greater environmental allergy loads. But, you’d be wrong.
A recent study looked at the prevalence of positive allergy tests in all areas of the U.S. and found that the numbers were pretty much the same wherever you live. A whopping 44.6%(!) of U.S. adults are sensitive to at least one allergen. In kids ages 1-5, that number is 36%. Interestingly, the rates didn’t vary from region to region, though they were a little higher in urban areas, 50%, vs. rural areas, 40%. Rates of sensitization to individual allergens did differ. For example, the South had more dust mite allergy and the West had more pollen allergy, but the overall rates remained constant.
So what does this all mean? It suggests that the genetic component of allergies is much more important than the environment. If your body has an allergic tendency, it’s going to find an allergen to react to no matter where you live or what you try to avoid. You can avoid specific allergens, but you can’t avoid all of them, and you can’t run from your genetics.
Pollen allergies are largely responsible for the classic hay fever symptoms of sneezing, itchy, watery eyes, and runny nose. Allergists generally divide pollens into three types: tree pollen, grass pollen, and weed pollen. Each type has a discrete season during which it is the primary pollen. The rule of thumb for temperate climates, like we have here in Nashville, is tree pollen in the spring, grass pollen in the summer and weed pollen in the fall. So, if you’re mowing your lawn in April and you have a bad flare, it’s not the grass, but the tree pollen that’s responsible.
So what can you do about pollen allergies? Like most inhalant allergies, the three options are avoidance, medications, and immunotherapy. Avoidance can be tough for outdoor allergies, since it can take very little time to get a massive exposure and no one wants to be locked indoors for months on end. Pollen counts tend to be the highest in the early morning, so avoiding prolonged exposure during those hours may help. Also, rinsing off after being outdoors will help remove pollen grains that may be lingering in the hair or on the skin. If you must mow during your peak pollen season, a mask can be helpful.
Medication-wise, the starting point for most people is a simple antihistamine. Over-the-counter options have improved significantly with the addition of loratadine and cetirizine to the market. Antihistamines work best for symptoms of sneezing, itchy, watery eyes and runny nose. They are not very helpful for nasal congestion or drainage.
If these simple options don’t work, then it’s time to see a board-certified allergist. We actually have the tools to make you less allergic to your specific allergens. We call it Immunotherapy. We can teach your immune system to ignore your triggers, which will shut off your allergies at the source and give you systemic relief, fewer symptoms and fewer complications while using fewer or no medications. It’s the most natural way to change the trajectory of your immune system.
Dr. John Overholt is a board-certified allergist and asthma specialist at the Allergy, Asthma and Sinus Center. Call 1-866-231-0701 to make an appointment at any of their 11 Middle Tennessee locations.