What You Need To Know In Your Battle Against Allergies - UVA Today

Q. Any specific suggestions for children, who, during school recesses, are often subjected to a lot of pollen?

A. We’ve come a long way from taking exclusively Benadryl, as needed, for seasonal allergies. There are nasal sprays and oral antihistamines approved down to 6 months of age that are non- or low-sedating and can definitely control symptoms, and not slow them down for their school activities.

Our goal of allergy treatment for patients of all ages is to always find a personalized management plan that teaches them to live life to their fullest without allergies standing in the way.

Q. Is there a way to know if what somebody is experiencing in terms of sneezing, coughing and a runny nose is, in fact, allergies and not COVID-19? Any telltale signs?

A. Unfortunately, the overlap of symptoms and ability to distinguish a sneeze and cough due to allergies versus COVID-19 is tough. Fever is certainly a hallmark of COVID-19, but it is not commonly seen in seasonal allergies. However, some patients who are severely allergic to mountain cedar trees sometimes sense low grade fevers and what is called “cedar fever” due to the storm of allergic mediators released with heavy pollen exposure, particularly in southwest Texas. Loss of smell is seen in a subset of COVID-19 patients, sometimes seen in patients with severe nasal polyp disease, and much less commonly in pure allergic rhinitis.

Q. If somebody has lived with allergies long enough, is it possible that eventually they just get used to them and their body learns how to fight them off better?

A. We do see patients who become less severe or “lose” their allergies with time. This probably happens more commonly with allergens that are present all year long such as pet dander. The mechanism underlying the natural loss of allergic sensitization is not well studied. It is much more beneficial to more intentionally desensitize patients using allergy shots and tablets, where we have the greatest evidence for tolerance induction through the development of protective immune responses to allergen exposure.

Q. One of your specialties is allergen immunotherapy (a treatment for environmental allergies that involves exposing people to larger and larger amounts of allergen in an attempt to change the immune system’s response). Have there been any advancements in this area over the last 10 years, and are there any promising advancements on the horizon?

A. I had the opportunity to participate in the development of our last comprehensive national practice parameters for allergen immunotherapy and sublingual immunotherapy, devoted to help standardize the practice using evidenced-based medicine principles to ensure treatment with the most effective doses, and safe administration that minimizes risks to patients.

I also had the great fortune to serve as an FDA advisory committee chair that contributed to the approval of new sublingual tablets to grass, ragweed and dust mites. This is a new treat-yourself-at-home option, compared to allergy shots performed in a doctor’s office for patients with their symptoms dominated by these allergens. Tablets for additional allergens are in development, and in some cases already approved overseas.

Finally, just last week I moderated an allergen immunotherapy discussion by national thought leaders in Washington, D.C., who are seeking ways to improve patient and provider awareness. We also touched on the tremendous access gap for the underserved who aren’t often afforded the opportunity to receive specialized diagnostic and treatment care. I am convinced that the future is bright for bringing new treatment options to patients and providing cures that go far beyond symptomatic treatment.