Tree Pollen Allergy

How to Diagnose and Manage the Symptoms of Common Tree Pollen Allergies

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tree allergy

Spring is usually very welcome after a harsh winter, but for a lot of people, the spring season also means stuffy noses, sneezing, itchy eyes, headaches, and tiredness. Many times this is due to a tree pollen allergy.

What Is It?

Tree pollen is most prevalent in the springtime and those allergic to trees have symptoms that can really get in the way of enjoying the pleasant weather. So which trees might cause the problem?

Pollen from wind-pollinating trees is most likely the culprit of spring allergies. Fruit trees are insect pollinated and not usually implicated to cause allergies. This is partly because insects are not able to carry the volume of pollen needed to cause an allergy. Also, pine trees including the evergreen Christmas tree, are not usual culprits of tree pollen allergy due to the inherent nature of pine. If your allergies act up around this tree, it's more likely the mold and allergens on the tree causing your symptoms rather than the pine allergen itself.

Trees That May Cause an Allergic Reaction

Depending on where you live, these trees listed can be potential allergens:

  • Hickory
  • Birch
  • Oak
  • Elm
  • Ash
  • Beech
  • Cottonwood
  • Sycamore
  • Maple

Pollination of trees usually occurs shortly after their leaves grow, but can also occur before and during leaf development. When trees are full of leaves, which is generally in late spring, pollination has usually ended. However, some elm trees can pollinate in the fall and some juniper species pollinate in both fall and winter.

But there is good news. The time period during which tree pollination occurs is short, so patients that are tree allergic report experiencing brief periods of symptoms compared to other allergens.

Cedar Fever

This phenomenon applies most often to people residing in central Texas. Cedar trees are prevalent in this area and pollinate in the winter months, usually between November and January. Cedar trees are the most allergenic tree in central Texas. Though the name suggests a fever, those allergic to the pollen will have typical allergy symptoms.


Symptoms of tree pollen allergy are similar to those of other seasonal allergies. Symptoms include nasal congestion, runny nose, post nasal drip, sneezing, itchy and watery eyes. You may also experience headaches and tiredness.

Allergies can trigger asthma attacks and cause more coughing or wheezing. You may find that you need to use your inhaler more often during your allergic season. Seasonal and perennial allergies can also cause contact urticaria, which means that after touching an allergen and then touching your body, you may develop hives at that location.


Your allergist/immunologist can help in diagnosing which trees you are allergic to. This is done with a skin test which includes small pricks with various tree extracts. The skin test can be applied on the back or the forearm. After administration, there is a 20-minute wait, and if you are feeling itchy and develop a reaction similar to a mosquito bite, then you may be considered to have a positive test.

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Take the following steps to manage the symptoms of your tree pollen allergy.

  • Get ahead of the game. If you have a tree allergy, start medications a few weeks prior to the season starting. This will help mediate your symptoms even before your season starts. Hopefully, you will notice a decrease in your seasonal symptoms.
  • Allergy immunotherapy, also known as allergy shots, deliver a small amount of your allergen to allow your immune system to become tolerant. Allergy shots can cure your allergies or make them much more comfortable with little medication. This treatment usually requires a 3-5 year commitment.
  • SLIT, short for sublingual immunotherapy, is not available for trees yet, but this is a promising oral medication that will cure allergies with no injection. Currently, this treatment option is helpful for grass, ragweed and dust mite allergies. SLIT is a treatment in which drops of medication are placed under your tongue. Talk your allergist to see if you are a candidate for this type of treatment.
  • Studies show that an intranasal steroid is more effective than over-the-counter antihistamines like cetirizine, fexofenadine, levocetirizine, and loratadine. The nasal spray can also help your eye symptoms. Be cautious if you have any eye problems including increased ocular pressure or glaucoma.
  • The use of antihistamine eye drops is a more direct approach to handle your itchy and watery eyes.

Do not take your antihistamines for a few days before seeing your allergist so he/she can perform a skin test. The antihistamine prevents a good histamine response on your test which makes it difficult to interpret.

Relation to Food Allergy

Tree pollen can resemble proteins that are constituents of several pitted fruits. For example, if you are found to be allergic to the birch tree, that allergen strongly cross-reacts with apple, peach, plum, celery, cherry, apricots, kiwi, hazelnuts, almonds, carrots and some other fruits and nuts.

Symptoms of this type of allergy, known as oral food allergy, can include itchy mouth, itchy throat, and itchy lips. The symptoms are usually localized to the mouth area and do not progress to other body parts.

However, studies show these reactions are very unlikely to progress to a more severe allergic reaction including anaphylaxis. If you can eat fruit peeled or cooked, then you can most likely continue to enjoy the fruit.

It will be up to your allergist if you will need an epi-pen for oral food allergy syndrome. Removing the skin or heating the food distorts the allergen so the immune system no longer recognizes the food. This means you should not have any symptoms.

How to Avoid Tree Pollen

There are a few ways to decrease your exposure to tree pollen. Decreasing exposure can help in minimizing your symptoms.

  • Limit outdoor activity in the early morning hours, especially from 5 a.m. to 10 a.m.
  • Drive with the windows closed to prevent exposure to pollen
  • Sleep with the windows shut to limit pollen entering the home
  • Avoid hanging laundry outside to dry
  • After being outdoors, take a quick shower and change your clothes so pollen isn’t on your body for too long
  • Avoid being outdoors if its windy or if pollen counts are high. Keep in mind that the high pollen counts may not be specific to you. Check with your allergist to see what pollen type you need to watch out for!
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