Ah, spring, the crocuses popping up to see if the pandemic is over. Lambs and calves gamboling in the fields.
Pollen coating your car and your lungs like Denver was rolled in baby powder.
More than 24 million Americans report hay fever each year, according to the CDC, and the sneezing and scratching of allergic rhinitis leads to 15 million doctor visits.
So we checked in with Dr. Pete Cvietusa, an allergist with Kaiser Permanente in Colorado, about the unofficial start of allergy season and what we’ve learned over the years. Cvietusa is board certified in allergy and immunology; he trained in pediatrics in Colorado, completed his allergy training at National Jewish and now cares for all ages of allergy patients.
What month do Coloradans start coming to you with allergy related questions or complaints?
I’d say typically it’s April, and the rest of spring. Fall is a big season, too. Things do kind of quiet down in the summer. It just depends on the person’s allergies, but you know the allergy season can start as early as late February with trees pollinating.
Many of us assume that global warming must be making allergies worse, is there proof of that?
There is some emerging evidence that the seasons are getting longer and starting earlier. It’s a little hard for us to appreciate that. I polled my group, and nobody could quite say
for certain that we were definitely seeing an earlier and earlier start to the allergy season. People complain every year that it’s the worst allergy season for them personally, so we’ve historically gotten that kind of communication from patients.
There are studies showing, in general, an expansion of allergy season and geography. As the planet warms, are there specific areas where doctors know it is now worse?
You know, I’m sure there are but I think the studies are looking at things more globally and not necessarily in a particular region. But from our vantage point here, I don’t know that there’s clearly a trend for a lengthening of the season. Clearly at a global level that’s happening and there’s evidence for that.
What are the most common environmental allergies in the Denver metro area that you deal with, and what starts happening in about March, April with your patients?
It’s more tree pollens in the spring, so cottonwood and your other tree pollens come out in April. Cottonwood trees are a big one, but cedar is also a real big one — the peak for that is usually April, and then continuing into June.
And would there be anything else in terms of grasses emerging, or flowers, in the springtime?
Grass pollen can be a pretty big deal and typically in Colorado has kind of a bi-modal peak, so it pops up in May, June, kind of quiets down in July, and it gets going again in August, September. In the fall, you’ll have more of the weeds. And then we have some molds that really thrive in our dry climate, and they can be found in the air pretty much year round, except when there’s enough snow on the ground to keep them out of the air.
Which leads me to a question that I hadn’t thought about: Masks. Should these mask habits that we’ve developed continue for people if they’re worried about allergies?
We saw a pretty big decrease in asthma visits during COVID, probably in part because people were just trying to stay away. But we do think that the masks help not only with COVID, but with other related infections and allergies. You probably have heard that the flu season was fairly nonexistent. I think it’s also helped a little bit with allergens, it’s not a complete protection, but it offers some partial protection, for sure.
What are the most common myths about seasonal or environmental allergies?
Some of the things that patients commonly come to me about are perfumes or strong odors or fire smoke or cigarette smoke. Not that those things don’t cause people to have symptoms that are very similar to allergies, or that make their allergy symptoms worse, because they do. They are pretty potent irritants, but they are that: irritants. The key thing there is that there’s not a test to validate that, whereas there is for pollens or animal dander or molds.
My analogy with patients is it’s kind of like wind on the flames. The wind doesn’t cause the fire to start but it sure makes it worse. Cold air is another irritant. It causes symptoms that are very similar to allergies but are not allergies. This is why there’s Kleenex at the front of the ski area lift line.
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Any other common myths?
We see an awful lot of people thinking that they have food allergies and relate this to a huge variety of different symptoms. But I would say in general, these nose and eye allergy symptoms that people are getting are not due to a food allergy. They’re going to be due to an airborne allergen. And food allergies present very, very differently, with very acute and consistent reactions: immediate hives, lip swelling and anaphylactic reactions.
What are your most common recommendations for people who have, let’s say, a mild allergy?
For a lot of people allergies are fairly episodic, they’re not so chronic. For that they can take over-the-counter antihistamines. Almost everything pharmacologically for the treatment of allergies has gone over the counter. For more chronic allergy symptoms, where they feel like they have a cold for prolonged periods of time, we generally recommend nasal steroids, and that can be a very effective treatment and perhaps is the most effective treatment. Although it has to be taken regularly, it’s not something that offers quick relief.
And what’s the generic for that? I believe Flonase is one of the brand names.
Flonase is one brand name, fluticasone is the generic. But there are other trade names and other generic steroids, and all of those can be purchased over the counter.
Are there different answers for people who have more debilitating allergies, lifelong.
There are people that pharmacology fails, and for those patients, we recommend allergy shots, which is a form of therapy that has been around for over 100 years and has lots of research and experience to show that it’s a safe and effective. But it’s very involved in terms of patient time and effort. It’s usually weekly shots for four to six months, and then it’s monthly thereafter. And so not everyone wants to go that route.
And before that you have to go through the series of tests that could also be time consuming.
Yes, the prerequisite is a very complete set of skin tests because we have to make sure that we put everything that a patient’s allergic to into their shot mix. It works the same whether you’re allergic to cats, dogs, mold or pollens. Some people, in part because of the way things are advertised, feel like there’s certain medications that work for certain allergies, but not for others, and that’s not been proven to be true.
So if I feel I have an allergy to a cat, I could take a Claritin-style drug for that in the same way that I would take it for tree pollen?
Exactly. It’s going to work the same regardless.
What else would you recommend for people to help themselves before it gets to the stage of seeing a doctor, to handle the upcoming spring season.
Sometimes we just stay indoors on a particularly bad pollen day. If it’s related to animal dander, then we certainly recommend trying to keep the pets out of the bedroom, to do as much dusting and vacuuming as they can to get rid of the indoor allergens. And in general, the more hard surfaces you have in a house, the less of an allergy issue that you have. Carpet is kind of a sponge in terms of soaking up all kinds of allergens.
We always ask in medical stories, how has the science and therefore the medicine changed in this field in recent years? Are treatments different?
I think one thing that’s making a little bit of an impact is sublingual therapy. It’s something that’s been done for quite a while in Europe, but it’s been slow to take hold here. In general the studies do show that allergy shots do work a bit better. But sublingual can be done at home and doesn’t require a visit to the doctor. Only a few products are FDA approved currently. So, grasses, and one weed and dust mites currently are the only products approved.
Tell us what “sublingual” treatment means?
So instead of desensitizing with shots, people are putting drops under the tongue that have the allergen, and as you might guess, they can experience some oral itching because of that as a side effect. Some may not like that and want to discontinue, but in general it is a therapy safe enough to do at home. There is a general requirement to give patients an epi pen in case they do have a bad reaction at home. But it’s typically done daily, usually a good month before the allergy season starts, and then during the allergy season. So, it is an option. It has its benefits and its downside, like I said, in general, shots are more comprehensive and tend to work a little bit better. It is a prescription item.
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