Spring Is Here: Tree Pollen Allergy Refresher

April 15, 2011

Tree pollen allergy is the main cause of symptoms for early and mid spring allergy sufferers.  Some people are allergic to pollen from a single tree genus such as Oak (genus: Quercus) or Birch (genus: Betula).  Others have problems with pollen from many different types of trees.  In most cases tree pollen from one genus does not cross react with pollen from other genera of trees. Therefore, those people who are sensitive to one or two types of trees will have a shorter period of symptoms compared with those who are sensitive to seven or eight different types of trees.  In other words, some people with tree pollen allergy will have bad symptoms for one or two weeks in April or May and others will have symptoms from early March through early June.

Medications to relieve symptoms (reprinted from 4/7/10 post):

Despite the fact that there are many good medications to control and treat seasonal pollen allergy, people continue to suffer unnecessarily.  Here are some helpful hints:

1. If non sedating over-the-counter antihistamines are not controlling your symptoms, see your allergist.  There are a variety of prescription medications including oral antihistamines, oral leukotriene antagonists, nasal steroid sprays, nasal antihistamine sprays and an assortment of eye drops that can be used.

2. Use combinations of medications.  If one medication is not working, most people stop that medication and try another one.  Often a combination of medications is what is needed.  Usually this is done by combining together medications that act in different ways or at different sites.  This should be done with the help of your allergist.

3.  Learn exactly which pollens you are allergic to and start your medications before those pollen counts get too high and before you have symptoms.  If you know you are allergic to a specific pollen, you can anticipate when the counts of that pollen will be high.  Trees, grasses and weeds pollinate on a fairly regular schedule each year.  That schedule varies by geographic region.  It is more difficult to reverse symptoms that are already in full force as opposed to preventing severe symptoms in the first place.

Environmental Control Measures (reprinted from 3/25/10 post):

Although you can’t avoid tree pollen, there are some things you can do to reduce exposure.  Here are some tips:

1.  Sleep with the windows closed and the air conditioner on with the vent closed to the outside.  Although it is great to feel and smell the spring air, if you sleep with the windows open, the pollen levels in your bedroom will be higher than they need to be and you will have more symptoms.

2. When riding in a car, keep the windows closed and put the air conditioner on with the vent closed to the outside.  If you don’t need the air conditioner, still keep the vents closed to the outside.  You want to minimize the amount of outdoor air and pollen you are bringing into the car.   When riding in a car, you are exposing yourself to significantly more pollen than when you are sitting on a park bench or hanging out on your front porch.  This is because the volume of air you are exposed to is higher and that volume increases as you increase your speed.

3. Pollen counts tend to be higher in the morning than in the afternoon.  If you like outdoor sports activities, do them in the afternoon instead of the morning.  In fact, people with severe tree pollen allergy might want to consider only engaging in sporting activities indoors during the peak of the pollen season.    As is the case with riding in a car, running, jogging and cycling result in particularly high pollen exposure.

4. When you come home at the end of the day, hop in the shower, rinse your hair and change your clothes.   Pollen will settle on your clothes and hair and it is helpful to try to reduce the amount of pollen you are bringing into your home, and especially into your bed.

5. Do not leave clothing outside for any length of time and especially do not attempt to dry clothing outside during the pollen season if you are allergic.

Tree Pollen Allergy and Foods (reprinted from 4/9/10 post):

Certain fruits, vegetables and nuts contain allergens that cross react with tree pollen, specifically the pollen of birch and alder.  These foods include the following:

Nuts: Almond, Hazelnut

Fruit: Apple, Apricot, Cherry, Kiwi, Nectarine, Peach, Pear, Persimmon, Plum, Orange

Vegetables: Carrot, Celery, Fennel, Potato

Although most people with tree pollen allergy can eat these foods without any problem, up to 1/3 of people who are allergic to tree pollen will develop symptoms of what is called the Oral Allergy Syndrome.  The most common of these symptoms is itchiness of the mouth and throat.  A small minority of people who have symptoms of the Oral Allergy Syndrome will have more widespread symptoms seen in other forms of food allergy and it is sometimes difficult to differentiate those who will have just the oral and perioral symptoms from those who have more general allergy symptoms.   Most people with the Oral Allergy Syndrome are only allergic to a few of the foods listed above and not all of them.  In my experience the most common foods to cause symptoms are apples, carrots, cherries and peaches.   Having said that, I do have patients who react to all of the foods.

It is very important to point out that the tree pollen cross reacting allergens in these fruits and vegetables are generally not the major allergens of the foods, but are minor allergens that tend to be heat labile.  That means that these minor allergens lose their effect as allergens with exposure to heat and usually people with this form of food allergy can eat the food in a cooked form without any problem.  So raw apples are a problem, but apple pie, apple sauce and apple juice are usually OK.  It is not unusual for me to see a patient in my office who thinks they are allergic to the skin of the apple or to a pesticide sprayed on the apple because they know they are fine with cooked apple.   Invariably these are people with tree pollen allergy and they are experiencing the Oral Allergy Syndrome.  Also, these allergens tend to be acid labile which means that they lose their effect as allergens when they are exposed to stomach acid.  That is one reason why the symptoms are usually confined to the mouth.

There is some evidence that the common nasal and eye allergy symptoms that people with tree pollen allergy have, may get worse with exposure to these foods in people with the Oral Allergy Syndrome.  I usually recommend that people who have oral itchiness with exposure to one or more of these foods avoid those foods completely in the raw form, especially during the pollen season as it can make their other pollen allergy symptoms worse.

It is important to speak to your allergist about this form of food allergy in order to determine if you need to avoid the foods completely or only in the raw form.  Remember a small percentage of people with this form of food allergy can have more widespread symptoms of an allergic reaction or anaphylaxis with exposure.

Note: The content of this blog is for informational purposes only and is not meant as specific medical advice for a specific person.   If you have a medical problem, please contact your doctor.

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