How to Deal With Asthma and Fall Allergies

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In the fall, allergic rhinitis (hay fever) symptoms can worsen due to rising pollen from weeds. For some, that can also mean more asthma attacks. That's because some cases of asthma have the very same triggers as hay fever, many of which peak in fall months—ragweed most especially. This co-occurrence is called allergic asthma or allergy-induced asthma.

Dealing with allergic asthma during the fall can be difficult, but by preparing for the season with antihistamines and strict adherence to your asthma medications, you should be able to reduce the frequency and severity of seasonal asthma attacks.

Symptoms

Allergy-induced asthma is recognized by the presence of both asthma and allergy symptoms. Asthma symptoms associated with hay fever may involve:

  • 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

Hay Fever vs. Colds

Hay fever is often mistaken for the common cold given similarities in symptoms and seasonality. However, hay fever persists for as long as you are exposed to allergens, while colds usually last three to seven days. Moreover, nasal discharge from hay fever tends to be clear, while discharge from colds are more mucusy.

Causes

Studies have shown that hay fever is common in people with asthma, affecting around 80% of adults and children (compared to only 15% to 40% of the general population).

Still, it remains unclear if one predisposes a person to the other or if they develop independently (given that not everyone with allergic asthma is influenced by seasonal hay fever).

Regardless, an overactive immune response to otherwise harmless substances (allergens) is known to be at the heart of both conditions.

Exposure to allergens triggers the release of a protein called immunoglobulin E (IgE) whose role is to instigate inflammation to neutralize the perceived threat. IgE does this by instructing specialized white blood cells, called 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 recognized as asthma and the increased mucus secretion and nasal symptoms recognized as hay fever.

The allergens most commonly associated with fall allergy season are different from those of spring and summer. In fall, ragweed (genus Ambrosia) is by far the most common culprit, causing up to 30% of all pollen-related allergies. Other weeds can contribute to hay fever in the fall as well.

Depending on where you live in the United States, the peak season for ragweed can extend from late-August right up to the end of September.

From season to season, there are also variations as to when and how severe the various pollen seasons may be, with some overlapping with others.

Peak Seasons for Common Seasonal Allergens
Fall
  • Cockleweed (Lolium temulentum)
  • Pigweed (Chenopodium album)
  • Ragweed (genus Ambrosia)
Spring
  • Birch pollen (genus Betula)
  • Cedar pollen (genus Cedrus)
  • Oak pollen (genus Quercus)
Summer
  • Russian thistle (genus Salsola)
  • Sagebrush (Artemisia tridentata)
  • Timothy grass (Phleum pratense)
  • Outdoor molds like Aspergillus and Cladosporium

Diagnosis

If you have asthma and your symptoms worsen during the fall hay fever season, your doctor may refer you to an allergist to determine which pollens or molds you are allergic to.

The allergist will take into consideration the times of the year when your asthma symptoms worsen along with the types of pollens and molds common in your area.

Tests will then be conducted to determine your sensitivity to the suspected allergens. There are two tests allergists will commonly use:

  • Skin prick testing, which involves putting a small amount of a pollen or mold to see if an allergic reaction occurs
  • Specific IgE blood tests, which involve exposing a sample of blood to various allergens to see if any produce an IgE response

In addition, you may undergo pulmonary function tests (PFTs) to characterize the severity of your asthma symptoms. This typically involves spirometry testing to measure the amount of air you can forcefully expel from the lungs. Values before and after the use of an inhaled bronchodilator are compared.

Less commonly, segmental bronchoprovocation—in which you are exposed to small amounts of aerosolized allergens to see if asthma symptoms develop—may be used in people with mild allergic asthma.

Based on the findings, the allergist can make recommendations on which treatments are appropriate to prevent or control seasonal allergies as well as allergic asthma.

Treatment

The treatment of asthma during hay fever season typically involves two-pronged approach. On top of your short-acting (rescue) and long-acting asthma medications, your doctor 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 systemically (through the entire body).

Options include:

Some doctors will recommend that you start 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.

Taking daily antihistamines may help lessen the impact of hay fever but may do nothing to prevent asthma given that histamine is only one of the inflammatory compounds associated with allergic asthma.

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

Getting allergy shots is a more lasting approach to preventing the seasonal incidence of allergic asthma. A form of immunology, tiny amounts of an allergen are introduced 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 newer, short-term approach for the treatment of allergic rhinitis caused by ragweed, timothy grass, and other related grasses.

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

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 right through peak season.

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

While effective in treating pollen-related allergies, a 2015 review in the Cochrane Database of Systematic Reviews was unable to find any evidence that SLIT reduced the risk of asthma attacks.

Coping

While it is unlikely that drugs can entirely erase the risk of allergic asthma, the avoidance of seasonal asthma triggers will certainly help.

There are several ways to do this during the height of fall pollen 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. Be sure to dry them in a dryer rather than on an outdoor clothesline.
  • Limit contact with pets that have been outdoors. Regularly bathing pets also helps.
  • Avoid raking leaves. Raking stirs up pollen that you can readily inhale. If you can't leave this task to someone else, thoroughly water the leaves down before raking. Wear goggles and a face mask designed specifically for allergies, if possible. Strip off and place your clothing right 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. Newer air purifiers are equipped with a combination of HEPA filters and activated charcoal filters. Be sure that the unit can service the size of your room.
  • Bathe and shampoo before going to bed. This can remove any pollen clinging to your body, some of which might otherwise fall onto your pillow or sheets and be inhaled.

A Word From Verywell

If you find that your asthma symptoms are increasing during the fall or other certain times of the year and 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.

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