Season of Allergy

Dr Rehana Kausar
Spring in Kashmir is perhaps the most beautiful season with daffodils, irises and tulips competing to bloom. However, it is also the season for allergies and flare up of asthma and eczema. Add to this the worsening weather woes and spring becomes the king of allergy seasons.

Also called hay fever, (although it isn’t caused by hay and there is no fever) it starts as sneezing and red eyes, runny, itchy nose and throat, sometimes itching in ears and fatigue.
You can differentiate it from a cold or flu because of absence of fever and once you are away from the allergen, the symptoms subside. If you’re experiencing nasal and eye symptoms without fever or significant body aches, it is likely an allergy. However, if you have a fever, chills, and more systemic symptoms, it may be the flu.
The causative factor is pollens from trees, flowers and most importantly from grass. With the advent of warm weather in March and April, trees and plants start to bloom and release pollen.
This leads to allergy in susceptible people and can cause flare ups of asthma. Other causes are molds and pet dander which may not be exclusive to spring but cause similar symptoms.
Allergies occur when our immune system which is supposed to react to pathogens like bacteria and viruses mistakes innocuous pollen as a threat and reacts to it with full gusto.
If anyone in your family is allergic chances are that you will also have an overzealous immune response to pollen. Pollen binds to the IgE antibodies sitting on the basophils and mast cells.
It is like flipping and a switch and the cells burst to release histamine, leukotrienes and other inflammation causing chemicals. The main culprit is histamine which binds to H1 receptors in your nose, throat and eyes causing blood vessels to leak.
Tissues get swollen and nerves get itchy. In spring, with pollen everywhere this reaction gets triggered over and over again.
Most common allergen in Kashmir are pollens from grasses (Bermuda grass and Ryegrass) and weeds, these are all pervasive and light weight which enter the nose and eyes casing itching and the other symptoms detailed above.
Other important pollens are from willow, pines, chinar, poplars and other trees. The pollen season starts in March and ends by June.
Poplar fluff is not by itself an allergen but carries pollen and fungi on it. Although a lot of trees have been chopped but research has shown that poplar fluff is not an important allergen and grass is the most common allergen in Kashmir.
Prevention:
Avoid the allergen: Stay indoors especially in the early morning and on windy days.
Use HEPA filters at home if you can afford it. Keep windows closed so that pollen does not enter the house.
Shower and change clothes after coming back from being outside.
Use a mask when you are outdoors. Minimize exposure to irritants like smoke, strong perfumes or chemicals which can worsen symptoms.
Medications: Since histamine is the most important player, we use anti-histaminics to block histamine from binding to the receptors. Over-the-counter medicines like Cetrizine, Loratidine can help during the pollen season.
Nasal steroids like fluticasone can be used as a spray but should be started before the season starts and continued till it is over.
Mast cell stabilizers like cromolyn sodium prevent the mast cells from bursting and releasing histamine.
Long term control is by using immunotherapy. In this form of treatment, you get tiny doses of pollen over months or years which trains your body to not respond to pollen as an allergen. It can take years to get the full effect and you need to meet an allergist for testing and treatment. The allergy specialist will first do a skin prick or a blood test to determine your triggers.
In addition, lifestyle changes like keeping yourself hydrated and use of cold compresses can help. In addition, do not keep wet laundry to dry outside where the pollens stick to it. Dry your clothes inside.
Use a wet mop in your house for cleaning instead of dry sweeping or vacuuming without a HEPA filter. Wash the mop immediately. In peak season, mop the house daily especially near entry ways, near windows and on furniture.
Carpets and allergies can be tricky combo. Carpets are like a sponge for allergens, they accumulate dust and pollen which comes in through the windows, on clothes or shoes. Unlike a hard floor, you cannot wet mop a carpet. Besides, carpets harbor dust mites which thrive in soft fibers. Their droppings are another allergen that can amplify the response to seasonal pollens. Wash your bedding weekly in hot water to remove pollens and dust mites.

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