Allergist and immunologist Florence Ida Hsu often approaches her work like a detective would.
“I spend a lot of time asking patient questions regarding not just what their symptoms are but what led up to the symptoms, the nature of the symptoms, the severity, the timing, and their response to therapies,” said Hsu, assistant professor of clinical medicine and training program director for the Allergy & Immunology Fellowship at Yale School of Medicine.
For Hsu, these pieces of information offer clues in the quest for an answer — whether it ultimately leads her to diagnosing food or environmental allergies, or in some cases, a non-allergic cause.
This time of year, Hsu is especially busy helping patients navigate seasonal allergies. With spring approaching, that means sneezing, coughing, congestion, and itchy, watery eyes for a lot of people.
In an interview, Hsu explains what to expect this allergy season, why certain people suffer more than others, and what treatments are available.
The interview has been edited for length and clarity.
What should people expect this spring allergy season?
Florence Ida Hsu: I’m not sure how this spring will compare with previous seasons. We definitely had a colder winter than usual, but there’s also been plenty of precipitation. In general, warmer temperatures and precipitation do promote increased pollen generation. But there’s obviously variability season to season, so it’s honestly hard to predict.
What happens to the body for those with allergies during allergy season? How does pollen impact our health?
Hsu: Pollen by itself is innocuous, but our body sometimes views it as something that needs to be expelled. Some people develop antibodies called immunoglobulin E [IgE] against pollens if they are susceptible to developing allergies, after certain patterns of exposure. When someone has IgE to pollen and pollen comes into their airway, eyes, or nasal or ocular tissues, it triggers the release of histamine, which then causes symptoms.
Tips for managing seasonal allergies
• Leave car windows closed while driving and turn air settings to “recirculate.”
• Change your clothes after returning from the outdoors.
• Shower and wash your hair before going to bed at night.
• Wipe down your pets after going for a walk.
• Rinse your nose and eyes after allergen exposure.
What treatments are available for seasonal allergy sufferers?
Hsu: There are many, many treatments available. First, there are lots of over-the-counter therapies. So, you don’t necessarily have to see a medical provider for prescriptions. But if you do see us, for mild symptoms we will generally recommend starting with a daily oral antihistamine, specifically newer generation antihistamines that are less sedating and last longer. Such as loratadine, cetirizine, and fexofenadine. These medications can help symptoms for over 24 hours and are readily available over the counter.
For people who have localized symptoms to the eyes or nose, often treating the eyes or nose with topical therapies is going to be more effective. There are lots of allergy eye drops one can use, and we recommend using antihistamine eye drops, rather than “redness relief” vasoconstrictor eye drops. The problem with vasoconstricting eye drops is they don’t really treat the itching and swelling. For the nose, there are lots of nasal sprays. Certain nasal sprays are more effective for long-term management and safer. These include both antihistamine nasal sprays as well as nasal steroid sprays. The nasal steroid sprays are our go-to because they don’t just treat the symptom of the histamine release, but they actually control nasal inflammation from allergen exposure.
How much does the timing of seasonal allergy treatments matter? Should you start using them before your symptoms start?
Hsu: We recommend starting allergy medicines as soon as allergy season starts because as the season progresses, without treatment, symptoms can snowball, and congestion and inflammation get worse and worse. It’s difficult to dial it back, especially with the topical therapies. Imagine putting a nasal spray in a nose that’s completely congested and runny; the medicine doesn’t stay in very effectively if you’re blowing your nose immediately after you put it in. We generally recommend starting the nasal steroid sprays early in the season before symptoms get bad, and it also requires consistent use during the allergy season for best efficacy.
Can people also manage their allergies without medication? What non-pharmaceutical interventions do you recommend?
Hsu: There are many allergen avoidance measures one can implement. For example, keeping your windows closed and switching the air setting to “Recirculate” when driving in the car can decrease the amount of pollen-filled outdoor air drawn into the car and blowing into your face. But fresh air circulation is still periodically necessary to decrease humidity and CO2 levels. We do recommend limiting outdoor time if you’re particularly symptomatic, at least when it’s windy outside, or at times of day when pollen counts tend to be highest, around mid-day.
You can also wear eyeglasses or sunglasses to keep your eyes protected. Reusable contact lenses can be problematic as allergens stick to the lens surface and build up; daily disposable lenses or glasses are better options during allergy season. Some people wear masks when they’re outdoors so that they’re not breathing in as much pollen. If it’s unavoidable to be outdoors, we recommend changing your clothing when you come home, and taking a shower and washing your hair before going to bed so that you’re not bringing the pollen into bed with you. It’s also a good idea to wipe down your pets after they come in if you have to walk a dog, for example.
Another thing you can do is rinse the nose and the eyes after allergen exposure. You can use eye drops to rinse allergen out of the eyes, and you can similarly perform nasal saline rinses to rinse allergen as well as mucus out of the nose.
If you are not sure what airborne exposures are causing your runny nose and itchy eyes, it’s a good idea to schedule an appointment to see a board-certified allergist/immunologist as we can perform testing that will shed light on the cause of these symptoms.
