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Month: February 2023

Allergies to Tree Pollen

This year so far it has been much warmer than usual for Winter. Typically in the Washington, DC Northern Virginia, and Maryland metropolitan area, trees begin to pollinate in March. Over the last few years however, tree pollination began in February. This year, we have seen tree pollen in the air in January and February! For many individuals, tree pollen is the cause for terrible hay fever (i.e., allergic rhinitis) symptoms. In addition to hay fever, tree pollen can and does exacerbate asthma symptoms in those who are allergic to trees and also have asthma. Some of the first trees to pollinate in this area include cedar, maple, elm, alder, birch, and poplar.  Later in the Spring season, the principal tree that causes difficulties for people with tree pollen allergies is the oak tree.  Other trees that pollinate during this later time frame include walnut, hickory, and pine.

Interestingly, it is not the flowering trees that generally cause allergy symptoms. Most people think that in the Washington, DC area that the cherry blossoms are a major cause of allergies. In fact, cherry blossoms rarely cause allergies but they tend to bloom when other trees that cause allergies in the area pollinate. People either suffer from tree pollen allergies or see others suffer from tree pollen allergies and associate the blooming of the cherry trees with allergies. It is the “ugly” non-flowering trees that tend to cause allergy symptoms. Why, you may ask? Flowering trees (e.g., dogwood trees, cherry trees, redbud trees, magnolia trees) are pretty for a reason. The pollen from flowering trees is relatively heavy. Since the pollen is heavy, it needs the help of bees to help cross-pollinate. The abdomen of the bees land on the pollen of a flower after being attracted to the flower. The bees then land on another flower and the pollen from their abdomen cross-pollinates the other flowers. Non-flowering trees (e.g., maple trees, oak trees, birch trees, hickory trees), on the other hand, have much lighter pollen which is easily wind dispersed. They cross-pollinate by releasing their pollen into the air and having it blow to other trees. It is the result of this wind dispersal that leads to people becoming allergic to tree pollen. Individuals inhale the tree pollen and they may become sensitized to the pollen which manifests itself by the classic allergy or asthma symptoms.

What are the allergy symptoms for tree pollen allergies? The classic symptoms may include runny nose, nasal congestion, post-nasal drip, itchy nose, itchy throat, itchy roof of mouth, sneezing, sinus congestion, sinus headaches, itchy eyes, watery eyes, puffy eyes, dark circles under the eyes, and/or redness of the eyes. Other less common symptoms may include fatigue, sore throat, snoring, hoarseness, itchy skin, coughing, and/or feeling like you are in a “fog.” Tree pollen can also trigger asthma or even cause asthma symptoms in those who have never had asthma or asthma symptoms. The classic symptoms of asthma may include chest tightness, wheezing, coughing, and/or shortness of breath.

The diagnosis of tree pollen allergies begins with a comprehensive history and physical examination by a board certified allergist. Allergy testing by skin testing or blood testing is often performed in order to determine if the allergies are caused by tree pollens or other allergens such as molds, grasses, weeds, and/or dust mites. In addition to finding out what the patient is allergic to, the degree of the allergy can be ascertained by the severity of the reaction on skin testing or the degree of positivity on the blood tests.

The management of tree pollen allergies begins with avoidance or prevention, if at all possible. Individuals are encouraged to monitor the pollen counts which can be tracked on the top right of our homepage by clicking Today’s Pollen Count.  In one’s car, it is advisable to keep one’s windows and sunroof closed and to turn on the air conditioner and change the air filters regularly (about once a month).  Use the re-circulate feature in the car so that the air is not coming into the vehicle from the outside.  Choose an automobile that has a filter in its air conditioning unit, if possible.  Stay indoors wherever possible when the pollen count is high (i.e., generally on dry warmer days).  It is important to realize that rain washes away pollen from the air causing pollen counts to be lower on wet cooler days.  Since pollen is released in the early mornings, try to avoid exercising during this time. If a person goes outdoors, shower, wash one’s hair, and change one’s clothing before returning home in order to lessen one’s pollen exposure.  Avoid drying clothes outdoors when the pollen count is elevated.  Avoid yard work and mowing lawns, if possible.  If one needs to do yard work, wear a filtration face mask in order to reduce exposure to the tree pollen.  Avoid contact lenses which may trap pollen in one’s eyes.  Wash one’s pets regularly and avoid close contact with a pet that goes outside during the pollen season since pets carry tree pollen on their coats.

The treatment of tree pollen allergies varies depending on how severe the patient’s symptoms are and if and how the trees affect and alter the desired lifestyle of the individual. Some people do not mind staying indoors in the Spring where others want to participate in outdoor activities such as golfing, jogging, baseball, etc. Oral antihistamines [Clarinex (desloratadine), Allegra (fexofenadine), Zyrtec (cetirizine), Claritin (loratadine), Xyzal (levocetirizine)] and nasal corticosteroids [Flonase (fluticasone), Nasonex (mometasone), Nasacort AQ (triamcinolone), Rhinocort Aqua (budesonide)] are usually the first medications prescribed in individuals that have tree pollen allergies. Oral decongestants [Sudafed (pseudoephedrine)] may be useful in certain patients with nasal congestion assuming there is no contraindication for using them such as hypertension. Other medications may be used and some of these may include oral leukotriene antagonists [i.e., Singulair (monteleukast)], nasal antihistamines [i.e., Patanase (olopatadine), Astelin (azalastine)], nasal anticholinergics [i.e., Atrovent (ipratropium bromide)], and various eye drops. For the treatment of asthma induced by tree pollen, inhaled corticosteroids, leukotriene antagonists, long acting beta 2 agonists, and/or short acting beta 2 agonists are utilized.

The board certified allergists at Black & Kletz Allergy have 3 offices in the Washington, DC, Northern Virginia, and Maryland metropolitan area and treat both children and adults with tree pollen allergies. We have offices in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. Black & Kletz Allergy offers on-site parking at each of their 3 office locations and the Washington, DC and McLean, VA offices are also Metro accessible. There is a free shuttle that runs between our McLean, VA office and the Spring Hill metro station on the silver line. To make an appointment, please call our office or you can click Request an Appointment and we will respond within 24 hours on the next business day. Black & Kletz Allergy has been serving the asthma and allergy needs of the Washington, DC metro area community for more than 5 decades and we strive to offer the highest quality allergy and asthma care in a compassionate and specialized environment.

Respiratory Syncytial Virus (RSV)

Nearly all children get infected with respiratory syncytial virus (RSV), a highly contagious virus, by their second birthday. RSV has a seasonal predilection, usually from December to March every year. In most instances, it causes mild “cold-like” symptoms and resolves without complications in approximately 1-2 weeks.

Although most cases get better and resolve on their own, respiratory syncytial virus can sometimes lead to severe illness requiring visits to the emergency room. In some cases, hospitalization may be required. The incidence of severe illness due to RSV is especially high during the Winters in the U.S. Surging RSV infections in conjunction with the rise in flu and COVID-19 infections has been termed the “tripledemic.”

RSV is especially severe in very young children and adults over 65 years of age. Predisposing factors to severe RSV infections may also include underlying chronic lung and/or heart conditions as well as having a compromised immune system.

Respiratory syncytial virus is the most common cause of bronchiolitis (i.e., inflammation of the small airways in the lungs) in children younger than 1 year of age. RSV causes approximately 60,000 hospitalizations among children under the age of 5 annually. RSV infection is estimated to cause approximately 15,000 annual deaths in the U.S. in adults over the age of 65. Respiratory syncytial virus is the leading cause of lower respiratory tract infection in children and is a common cause of wheezing in infants and young children. Studies suggest that a severe RSV infection early in childhood is linked to development of asthma later in life.

The infection of respiratory syncytial virus spreads from person to person primarily by contact with respiratory secretions and to a lesser extent by aerosol and droplets. RSV can survive for many hours on hard surfaces such as tables and door handles and lives on soft surfaces such as tissues and hands for shorter amounts of time.

The symptoms of respiratory syncytial virus usually begin 2 to 3 days after contact with the virus. The initial symptoms usually include nasal congestion and runny nose with clear mucus secretions, an itchy throat and a dry cough. Children can also experience mild fevers, poor appetite, and reduced physical activity.

For babies, thick mucus can clog up the nose and small air passages in the lungs, making it difficult for them to breathe. Narrowed bronchial tubes may also cause wheezing in addition to a severe cough. Respiratory distress requires hospitalization where supplemental oxygen and inhaled medications can be administered.

Older adults, especially those with asthma, chronic obstructive pulmonary disease (COPD), heart diseases, and/or diabetes mellitus can develop pneumonia from an RSV infection. The virus can also aggravate their underlying lung conditions requiring emergency treatment.

The diagnosis of RSV is suspected by clinical presentation and can be confirmed by laboratory tests using a nasal mucus swab. Imaging of the lungs may also be needed in order to evaluate the severity of the condition.

The treatment of respiratory syncytial virus is only supportive care in most instances as there is no specific medication available. For young children, nasal saline with gentle suctioning and a cool-mist humidifier may help with their breathing.

In severe cases, intravenous (IV) fluids may need to be given in order to treat dehydration. Oxygen supplementation may be needed to relieve any breathing difficulty.

A medication known as Synagis (palivizumab) is sometimes prescribed in order to minimize or prevent serious RSV disease among high-risk infants and children less than 2 years of age. This drug does not improve symptoms for children already suffering from RSV, nor does it prevent infection with RSV.

People infected with RSV are usually contagious for 3 to 8 days and may become contagious 1 to 2 days before they begin showing signs of the illness.

One of the most effective ways to prevent an RSV infection is to practice good hand hygiene. Frequent hand washing, covering sneezes and coughs, and avoiding direct contact with unclean surfaces are very helpful in minimizing the spread of respiratory syncytial virus.

Effective vaccines and therapeutics to prevent and treat RSV infections are in active development. The research into developing an RSV vaccine began in the 1960’s and this year (2023) RSV vaccines should be on the market. The pharmaceutical companies Pfizer, GSK, and Moderna have been working on such a vaccine and are all close to the final product. Pfizer and GSK announced promising Phase III results in 2022 and they are now both awaiting regulatory approval for the vaccine.

The board certified allergists at Black & Kletz Allergy see both adult and pediatric patients and have over 5 decades of experience in the field of allergy, asthma, and immunology. Black & Kletz Allergy has 3 convenient locations with on-site parking located in Washington, DC, McLean, VA (Tysons Corner, VA), and Manassas, VA. The Washington, DC and McLean, VA offices are Metro accessible and we offer a free shuttle that runs between the McLean, VA office and the Spring Hill metro station on the silver line. To schedule an appointment, please call any of our offices or you may click Request an Appointment and we will respond within 24 hours by the next business day. We have been servicing the greater Washington, DC metropolitan area for over 50 years and we look forward to providing you with the highest state-of-the-art allergy care in a friendly and relaxed environment.