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Get ready for a bad allergy season

As a long, cold winter finally gives way to spring, those with seasonal allergies should prepare for the worst: An onslaught of seasonal allergens that could cause severe bouts of sneezing, stuffed sinuses, runny nose, and watery eyes could be on the way.

For the nearly 18 million American adults and nearly 7 million children who suffer from hay fever brought on by seasonal allergies to tree, grass, or weed pollens and other airborne allergens, symptoms could be particularly bad this year. The reason? Trees are blooming about a month behind schedule in New England and elsewhere, and the release of those pollens will likely coincide with seasons for other allergens, creating a shorter but more intense peak season that is still to come.

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“We’re getting intermittent high pollen counts, but not remotely what’s usual for this time of year,” said Dr. Christopher Randolph, an allergist and station head of the pollen counting center at Waterbury Hospital in Connecticut, the nearest station to Boston that conducts official pollen counts.

Randolph monitors daily tree, grass, and weed pollen counts — the measurement of the number of grains of pollen in a cubic meter of air — from a Waterbury lab that collects samples on grease-covered rods rotated through the air and using a device with a vacuum pump that sucks in air and traps pollen on sticky tape.

The overall warming trend over the past few decades has typically led to longer, more intense, pollen seasons, Randolph said. But the brutally cold winter and cooler than average spring this year has led to an unusual delay in trees blossoming.

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Because of that delay “we’re very much expecting to see an overlapping of trees, grasses and weeds,” said Susan Kosisky, chief microbiologist of the Allergen Extract Laboratory at the Walter Reed Army Medical Center in Washington, D.C. That means allergy sufferers might have more severe symptoms — and possibly a higher risk of life-threatening asthma attacks — if pollen counts suddenly soar all at once.

The season could go one of two ways: If the weather remains cool, pollen counts could stay low through the season, providing a break for allergy sufferers.

‘Monthly allergy shots can be formulated to contain several extracts that a person is allergic to.’

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But if the weather suddenly shifts from cold to warm followed by sustained sunny, humid days, pollen counts could quickly rise to record-breaking peaks. While rain washes pollen out of the air, sunny days often mean peak levels of pollen as the small, light grains spread through the air.

Compounding the issue, tree pollens could be reaching their peaks just as grass pollen begins to take hold in late May, blurring what are usually two distinct pollen seasons in the New England area.

At this point, Randolph said, “it’s hard to predict what will happen this year.”

But once the allergy season hits, those who suffer will undoubtedly be looking for relief, especially if they experience asthma attacks from allergy flare-ups. A February study published in the journal Asthma found that asthma-related emergency room visits and hospitalizations in New York rose when spring tree pollen counts were above average, and other research suggests such visits rise by 10 to 15 percent on peak pollen days.

Some allergy sufferers could eventually benefit from three new preventive treatments for grass and ragweed pollen allergies approved in April by the US Food and Drug Administration. Two of the new treatments to prevent grass pollen allergies — Oralair and Grastek — were approved in April, too late to be helpful this season because they need to be taken 12 weeks before the grass pollen season gets underway. Another tablet to treat short ragweed pollen allergies — called Ragwitek — will hit pharmacy shelves by May, according to the manufacturer Merck, just in the nick of time for patients to begin taking it 12 weeks before the ragweed season in the fall.

Allergists still aren’t certain, though, how many patients will actually benefit from the tablet treatments. Dr. Aidan Long, an allergist at Massachusetts General Hospital, said the tablets are likely the “leading edge” of a new trend in allergy treatments because of their convenience. Patients can take the tablets at home each day rather than going to an allergist’s office for regular shots. But Long said tablets may have limited use because only a minority of patients are allergic to grass pollen.

“Monthly allergy shots can be formulated to contain several extracts that a person is allergic to,” he explained. Those with multiple allergies could find that shots still work best, especially if they’re allergic to dust mites and tree pollens. The tablets can also cause some discomfort in the mouth like itchiness or soreness in the lips, tongue, or throat that usually resolves after a few weeks but could be irritating enough for patients to stop taking them.

Karen Hsu Blatman, an allergist at Brigham and Women’s Hospital, agreed that the tablets are an “exciting new option” that could prove useful for those with a limited number of seasonal allergies, especially shot-averse children who need to endure weekly or monthly shots for three to five years.

“Kids are probably the best population for these tablets because they tend to have specific seasonal allergies rather than multiple things they’re allergic too,” Blatman added.

In Europe, allergy sufferers are often given liquid drops to place under their tongue to treat a wide range of respiratory allergies from dust mites to various tree pollens.

While the liquid drops aren’t FDA approved, allergists here are increasingly making them in compounding pharmacies and offering them to patients. “These drops are the primary mode of treatment in England and Italy,” said Dr. Philip Hemmers, an allergist in private practice in Fairfield, Conn., who uses them for some of his patients. “Most studies suggest that allergy shots work better, but some patients prefer the convenience of the drops.”

For those who self-treat their symptoms, over-the-counter antihistamines can help dry up nasal passages; using a corticosteroid nasal spray three to four weeks before allergies normally kick in can dampen the body’s immune response to allergens. “People often think these sprays aren’t working, but you have to give them time,” Hsu Blatman said. “They offer a delayed gratification for symptom prevention.”

Nasal sprays are usually available by prescription, but Nasacort Allergy 24HR was the first to go over-the-counter last year.

Allergists also recommend using common sense measures to keep allergy symptoms in check.

“We tell people to keep their windows closed when pollen counts are high,” said Randolph. “Any pollen that drifts in can remain in the house and cause pollen reactions, even in the middle of winter.”

Wearing a face mask outdoors can help keep pollen out of the nose and mouth, he added, though it’s best to stay indoors as much as possible, especially between 9 a.m. and noon when pollen counts are at their highest.

When is it safe for tree pollen allergy sufferers to head back outside? Pollen counts are likely to remain high until June, Randolph said.

Deborah Kotz can be reached at dkotz@
globe.com
. Follow her on Twitter @debkotz2.
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