John Weiler, MD, Professor Emeritus
Division of Allergy and Pulmonary
University of Iowa Hospitals and Clinics
Creation Date: May 2000
Last Revision Date: May 2000
Peer Review Status: Internally Peer Reviewed
Why is it so bad this time of year with the allergies?
It is springtime. It is the time when spring pollens make their
appearance in many parts of the country. In the spring, we see tree pollens, and
after the tree pollens begin to decrease, we see grass pollens. In wet weather,
such as we are having in the Midwest at the present time, we see an increase in
mold count. So, there is a seasonal increase in symptoms in people with allergies
to these substances. We will also see an increase in the fall, at which time we
will see increases in ragweed and other weed pollens.
What can the pollen count tell an allergy sufferer, and what do the
Pollen counts provide an indication of the amount of pollen in the
air, in the environment around the pollen counter. Unless the pollen counter is
in your yard, you can only use the pollen count to indicate the pollen that is in your area. Typically, the counters are on the top of a one-story building or
perhaps six or seven feet above the ground. We attempt, with a pollen counter, to obtain an average for that area. However, if you spend your entire day in your office, go to your car that is parked in a closed parking ramp, drive home with your air conditioning on and windows closed, and park in your closed garage,
those pollen counts will have little relevance to you. On the other hand, if you
are a farmer, and spend your entire day in the field, those pollen counts may be
very relevant. In that circumstance for a farmer, a low pollen count may cause
considerable symptoms, in contrast to the office worker for whom a high pollen
count may have little clinical relevance.
What are most people allergic to?
As I indicated, people may have allergies to a variety of pollens and
molds. They also may be allergic to pet dander and other animal dander; also,
dust mites and insects such as cockroaches. There are two kinds of presentation
of allergy symptoms. The symptoms may occur with a seasonal increase, and this is
called seasonal allergic rhinitis. On the other hand, substances present during
the entire year may cause perennial allergic rhinitis.
For multiple, year-round allergies, which prescriptions are better: pills
Patients with hay fever (allergic rhinitis) tend to present with
three kinds of symptoms: itching, runny nose, and congestion. For itching, the
best medications are probably antihistamines. Antihistamines are either available
over-the-counter or by prescription. All of the current non-sedating
antihistamines, the so-called second-generation antihistamines, are only
available by prescription. For runny nose, the best medication may be an inhaled
nasal steroid, although antihistamines are also given. Moreover, there are other
drugs, ipratropium bromide (Atrovent) nasal spray, which can be used to treat
runny nose. Finally, for congestion, the best drug is probably a nasal steroid.
As you see, it is best when a patient with allergic rhinitis consults his/her
physician to discuss the best course of therapy. Some of these drugs are
available over-the-counter but others require a prescription. So a visit to your
physician may be extremely helpful so that your physician can individualize the
therapy that you will receive.
Is it possible for someone to obtain additional allergies throughout
their life after being tested for allergies?
Yes. Typically, we find that most people develop their allergies by
the time they reach early adulthood. Skin tests performed at the age of 21 or 22
will often demonstrate the same responses as would be seen if we re-skin tested
them at age 50. However, occasionally we see someone develop new reactivity as an
What are molds, and how are they different from pollen?
Molds grow in various areas of the country in warm, damp
environments. They produce spores that are spread by the air. This occurs most
commonly in the spring and warmer months and again in the fall. Mold may be
present all year in a warm, damp environment such as a basement so local
increases in molds may be very important for some people depending upon their
house and other exposures. Plants produce pollens when they pollinate. Many
plants spread their pollen by the air. One rule of thumb is that the plants with
bright flowers tend to pollinate by insects whereas plants that are much more
plain use the air to spread their pollen. Insects pollinate roses, but ragweed is
pollinated through the air.
At what age do most people develop allergies?
Many people will develop their allergies by the time they reach young
While traveling in Australia I experienced for the first time in my life
an asthma attack. That was last year in April when I was 59 years old. A week ago
while visiting Washington, DC, I caught a cold and after a couple of days had
another asthma attack. In both cases my symptoms were relieved by the use of an
inhalant prescribed for asthmatics. I am rather alarmed by this development. I
have had "hay fever" all my life but never asthma. Should I see a specialist? I
live in Iowa City.
Yes, you should see a physician.
How long can you take over-the-counter allergy medications safely?
In general, it is safe to take over-the-counter allergy medications
as long as you read and heed the label warnings. Most of these medications are
safe, however, some should only be taken for a short time. For example, people
will take over-the-counter antihistamines off and on for years. As long as they
understand that these over-the-counter antihistamines may cause drowsiness and
impair performance and heed these warnings, then it is safe to use medications
over an extended period of time. Over-the-counter decongestant nasal sprays, on
the other hand, should not be taken for more than a few days. If these drugs are
taken for more than two to three days people may develop "rebound" from these
drugs. Rebound means that after a short while, these drugs actually cause
symptoms more than they relieve them. Another over-the-counter medication is
cromolyn sodium and in general, it is safe to take this drug over a prolonged
period. Oral decongestants may be a problem for people with hypertension.
Do allergies cause headaches?
What's the difference between hay fever and allergies?
Technically, hay fever is called allergic rhinitis. Most people, when
they speak of allergies, are referring to this condition. However, technically
"allergies" implies more than just hay fever or allergic rhinitis. People may
also have asthma that is triggered by "allergies."
I have been diagnosed with asthma. I sometimes experience tightness in
the chest; however, when I use my peak flow meter, the numbers are still average
for me. What might be going on?
I suggest that you visit with your physician to discuss these
I do not understand what caused my two asthma attacks, or how a cold can
cause asthma. What are the causes of late-onset (60 years old!) asthma?
In many people with asthma, a viral infection will cause an
exacerbation (increase in symptoms). Many researchers are studying mechanisms of
asthma. Research that is currently being conducted is very exciting. We have, in
the last 10 years, learned a considerable amount about the basic mechanisms that
underlie asthma. Nevertheless, we still do not know precisely why some people
develop asthma and others do not.
I have been taking Nasonex for many months but in the last week I've been
getting mild headaches that last most of the day. If this could be the result of
allergens, which ones are the most likely culprits?
If these headaches are concerning to you, you should visit with your
In other words, in future, any time I catch a cold or have an allergic
reaction to airborne substances, I may also have an asthma attack?
Yes. We now have reason to believe that both asthma and hay fever are
becoming increasingly more common in the population. In undeveloped and
underdeveloped nations, these disorders are far less common than they are in
developed nations. In developed nations many more people are concerned about
these problems and are presenting to their physicians for treatment. Clearly,
mortality rates from asthma are increasing steadily. These statistics are very
concerning to us as physicians. We will have to wait to see if the new
medications available to us are able to have an effect on these alarming trends.
We certainly hope that these new medications are able to decrease the mortality
rate for asthma.
It is also useful to share with you the concern that many of us have over how our
patients take these drugs. We know that these new drugs are effective because
there have been many clinical trials to show their effectiveness. However, we
also know that many patients who are prescribed medications are not fully
compliant in taking them. We have learned that one major cause in these new
medications not being effective is that patients are not taking them as directed.
We can offer one piece of advice to patients. Patients should try to take their
medications as prescribed and to communicate fully with their physicians when
they are not able to do so. This is extremely important so that these drugs can
be administered properly.
Are inhaled nasal steroids more effective on arising or at bedtime or
when (assuming that my prescription calls for once-a-day use only)?
Most people take their once-a-day inhaled nasal steroids in the
morning. Most of the clinical trials have been done with patients taking the
drugs in the morning. Often, people select the most convenient time and that
usually is in the morning. These once-a-day medications have clearly been able to
increase compliance; patients are able to take a once-a-day medication and not
miss doses whereas drugs that must be taken more than once a day are much more
difficult for patients.
What is bronchial asthma?
Bronchial asthma is another term for asthma. Asthma is a condition
whereby the airways (the tubes that bring air into and out of the lungs) are
obstructed. This obstruction is reversible. That means that the airways are
blocked sometimes but generally not all of the time. This reversibility is the
hallmark of asthma, along with inflammation of the airways. To make the
diagnosis, we typically look at spirometry, which is a measure of the ability to
exhale air. We look for people to be able to reverse their obstruction by about
Is it possible to have an asthma attack once a year?
Asthma attacks can occur at variable intervals. Some people will have
an attack only a year or even less frequently. Other people will have almost
constant attacks. There are a wide variety of asthma triggers.
Can you develop asthma in your mid 20s?
I noticed during a recent hot spell when we had the house totally open
that my nasal steroids were more effective in spite of copious pollen (here in
Iowa City). Does this suggest that the more potent allergens for me are most
likely to be the indoor ones? We have three cats, and we dust and vacuum only
once a week.
Cat dander is a very potent allergy. It may be very difficult to
treat people with allergies to cats. I always recommend that people who have cats
do their best to keep the cats out of the house. Cats should never come in the
bedroom. Even with the best of medication, it is often extremely difficult to
control symptoms in someone with cat allergies. It is important to restate that
the best treatment, better than any medication, is avoidance. Vacuuming can be
important, but animal dander is difficult to remove. Dander will be found in
upholstered furniture, carpeting, drapes, and even clothes. Children with cat
allergy may have flares of symptoms in their school because of cat dander that
has been brought in on clothing.
We are now in the middle of the spring allergy season. It is perhaps
a good time for people with allergies who have not seen their physician recently
to discuss with their physician the new treatments that are available to control
these symptoms. These are exciting times, and there are many new drugs available
to treat their allergies.