How to Deal With Asthma and Fall Allergies

If pollen is a trigger for your asthma, then the fall is likely to be a challenging season for you, especially if you also have allergic rhinitis (hay fever). If this is the case, you're in good company: Around 80% of adults and children who have asthma also have hay fever, as compared to 15% to 40% of the general population.

With pollen from ragweed and other allergens on the rise, you may be at an increased risk of asthma attacks in the autumn. You can mitigate this risk by preparing for the season by taking antihistamines and being especially strict about adhering to your asthma management strategies.

Symptoms

If you have allergic asthma and allergic rhinitis that are triggered by ragweed or other autumn allergens, you may experience a mix of symptoms of both conditions when you're exposed, among them:

• Shortness of breath (dyspnea)
• Wheezing
• Coughing
• Chest tightness
• Fatigue
• Sneezing
• Nasal stuffiness
• Runny nose
• Headache
• Sinus pain
• Itchy, watery, red eyes (allergic conjunctivitis)
• Swollen, blue-colored skin under the eyes ("allergic shiners")
• Itchy mouth or throat

Causes

Both asthma and hay fever result from an immune response to otherwise harmless substances (allergens). Exposure to allergens triggers the release of a protein called immunoglobulin E (IgE) that attempts to neutralize the perceived threat by causing inflammation. It does this by instructing specialized white blood cells, mast cells and basophils, to release inflammatory compounds into the bloodstream, including histamine, leukotrienes, and interleukins.

These chemicals cause the bronchial spasms and narrowing of airways that characterize asthma as well as the increase in mucus secretion and nasal symptoms recognized as hay fever.

Depending on where you live in the United States, the peak season for ragweed can extend from late August to the end of September. During this time, ragweed (genus Ambrosia) is the most common allergen, responsible for up to 30% of all pollen-related allergies. There are other allergens that trigger asthma and hay fever in the fall, as well as allergens that cause these conditions during other parts of the year.

Diagnosis

If you have asthma and your symptoms worsen during the fall hay fever season, your healthcare provider may refer you to an allergist to determine which pollens or molds you are allergic to. They will start by taking into consideration the times of year when your asthma symptoms worsen along with the types of pollens and molds common in your area.

Then it's likely the practitioner will determine your sensitivity to the suspected allergens using one of two common tests:

• Skin prick testing, which involves putting a small amount of a pollen or mold just under the skin to see if an allergic reaction occurs
• Specific IgE blood tests, in which a sample of blood is exposed to various allergens to see if any produce an IgE response

In addition, the allergist may perform pulmonary function tests (PFTs) to evaluate how severe your asthma is. This typically involves spirometry testing to compare the amount of air you can forcefully expel from your lungs before and after you use inhaled bronchodilator.

In rare cases, allergists choose to do a segmental bronchoprovocation, in which a patient is exposed to small amounts of aerosolized allergens to see if asthma symptoms develop.

Treatment

Managing asthma during hay fever season typically requires a two-pronged approach. In addition to whichever short-acting (rescue) and long-acting asthma medications you regularly use, your healthcare provider may recommend treatments to help prevent or control allergy symptoms.

Antihistamines

Antihistamines work by blocking the actions of histamine that incite an allergic response. Oral antihistamines aim to control or relieve allergy symptoms systemically (through the entire body).

Options include:

• Over-the-counter (OTC), non-drowsy drugs like Allegra (fexofenadine), Claritin (loratadine), or Zyrtec (cetirizine)
• Older-generation OTC antihistamines like Benadryl (diphenhydramine), which may be used if allergies are interfering with sleep
• Prescription antihistamines like carbinoxamine or hydroxyzine

Some healthcare providers recommend starting a daily dose of oral antihistamines two to four weeks before the beginning of pollen season—a practice known as preseason prophylaxis—to reduce the frequency and severity of hay fever symptoms. With respect to ragweed, that could mean starting as early as the first or second week of August.

Antihistamine eye drops and nasal sprays work in the same way as oral antihistamines and can be useful in helping relieve local symptoms, but they do not treat allergies systemically.

Allergy Shots

Clinically known as subcutaneous immunotherapy (SCIT), allergy shot treatment is a potentially more long-term approach to preventing seasonal allergic asthma. It works by introducing tiny amounts of an allergen into the body to gradually desensitize you to it.

Immunotherapy is conducted in two phases:

• The build-up phase takes between three and six months, during which time you are given allergy shots every one to three days in gradually increasing doses.
• The maintenance phase is the period during which you are given monthly shots to ensure the sustained avoidance of allergic reactions.

Although allergy shots can effectively cure allergies in many people, not everyone achieves the same response.

Sublingual Immunotherapy

Sublingual immunotherapy (SLIT) is a short-term approach to treating allergic rhinitis caused by ragweed, timothy grass, and other related grasses.

SLIT involves either pills or drops containing tiny amounts of allergens that are taken sublingually (under the tongue). Used daily, the therapy is started 12 weeks before the onset of pollen season and continued through peak season.

Oralair and Grastek are approved for the treatment of grass pollen allergy, while Ragwitek is approved for the treatment of ragweed pollen allergy.

Studies investigating the use of SLIT medications have shown they can reduce the incidence and severity of ragweed or timothy grass allergies by 28% to 40%.

Coping

Besides medication and immunotherapy, steering clear of known allergy triggers will obviously help to prevent symptoms of both hay fever and asthma. Some ways to do this during allergy season:

• Monitor pollen and mold counts in your area. Local weather forecasts regularly do this. You can also check the National Allergy Bureau for live updates.
• Wash clothes you have worn outdoors. Dry them in a dryer rather than on an outdoor clothesline.
• Limit contact with pets that have been outdoors. Regularly bathing pets also helps.
• Delegate leaf raking. Raking stirs up pollen that you can easily inhale. If you must do the raking yourself, thoroughly water down the leaves first and wear goggles and a face mask designed for allergies, if possible. Strip off and place your clothing in the washer as soon as you enter the house, and shower immediately.
• Stay indoors when counts are high. If you are prone to severe asthma attacks, consider wearing a face mask when outdoors. Masks rated N95, which filter out 95% of particles smaller than 0.3 microns, are especially useful.
• Keep your windows closed. If it is especially hot outside, use an air conditioner rather than letting in fresh air through open windows or doors.
• Get an air purifier. Choose one with a combination HEPA filter and activated charcoal filter. Be sure the unit is the right size for the room you'll be using it in.
• Bathe and shampoo before going to bed. This can remove any pollen clinging to your body, some of which might otherwise transfer onto your pillow or sheets and be inhaled.

A Word From Verywell

If your asthma symptoms increase during the fall or other certain times of the year and you don't know why, keep an asthma diary detailing everything you do or eat, places you go to, and symptoms you experience during the day. Doing so may reveal patterns that can help you pinpoint your specific allergy triggers.