Tree, Grass, and Other Pollen Allergy Symptoms and Treatments

Pollen allergies are common during times of year when grasses, weeds, flowers, and trees release pollen to reproduce. When your immune system mistakenly identifies pollen as a threat, it causes a range of symptoms, including a runny nose, a sore throat, itchy and watery eyes, and a dry cough. Many treatment options are available for pollen allergies. It is important to know your options and the seasonal pattern of your symptoms so you can minimize their impact on your daily life.

What are Pollen Allergies?

Pollen is released into the air when trees, grasses, weeds, and other plants reproduce. As pollen grains are released and carried in the wind, they come in contact with your eyes and nose and can be breathed into your lungs.

If you are sensitive to pollen, your immune system will overreact to it, mistaking it as a threat and increasing the production of immune cells, such as immunoglobulin E-producing white blood cells and mast cells, and chemicals, such as histamine and leukotrienes.

There is seasonal variation in pollen production. By knowing when pollen levels are high and correlating this to your symptoms, you can get an idea of what you are allergic to. However, many people have cross-reactivity, with symptoms extending across seasons and cross-reactivity between pollen and food. Thirty to 60% of food allergies are associated with pollen allergy.¹

Tree pollen is most common in the spring, peaking in April. Grass pollen peaks in the spring and summer, and weed pollen is most common in the late summer and fall. The timing varies by geography, and symptoms can vary by person.

Pollen Allergy Symptoms

Common pollen allergy symptoms include:

• Sneezing
• Runny nose
• Nasal congestion
• Itchy eyes
• Watery eyes
• Itchy throat
• Itchy ears
• Coughing
• Fatigue
• Postnasal drip
• Wheezing
• Shortness of breath

Diagnosing Pollen Allergies

Your doctor may recommend allergy testing to determine which environmental allergens you are most sensitive to.

Common allergy testing methods include:^2,3,4

• Skin prick tests: Skin prick tests involve pricking the skin and applying a small amount of the allergen to the nick. A red bump can indicate an allergic reaction.  
• Intradermal skin tests: An allergen is injected beneath the skin’s surface, and the areas are monitored for allergic reactions. Intradermal tests are more sensitive and are used when the results of a prick test are inconclusive.
• Blood tests: Enzyme-linked immunosorbent assay (ELISA) or radioallergosorbent test (RAST) measures the levels of immunoglobulin E (IgE). Increased IgE antibodies directed against a specific antigen can indicate an allergic reaction.
• Patch tests: Allergens are applied to an adhesive patch and left in place for 48 to 96 hours. The patch is removed, and the area is checked for signs of an allergic reaction. Patch tests identify allergens that cause contact dermatitis, a delayed allergic reaction.
• Provocation tests: This is a carefully controlled test conducted in an allergist’s office. It entails ingesting a small amount of an allergen and watching for any allergic responses.

Pollen Allergy Management

To reduce your exposure to pollen, consider making the following environmental changes, especially during seasons when your pollen allergies are at their worst.

• Minimize time outdoors, especially on windy days.
• Keep home and car windows closed.
• Use an air purifier indoors.
• Shower and change clothes after being outdoors to reduce the amount of pollen carried into your home.
• Sweep with a vacuum with a HEPA filter and dust regularly to reduce pollen in the home.
• Wear sunglasses and hats when outdoors to reduce pollen exposure.
• Track pollen reports and avoid high pollen days.
• Wear a mask outdoors when pollen counts are high.
• Avoid hanging laundry outside to dry.
• Start taking allergy medication two to three weeks before allergy symptoms are expected to start.
• Limit close contact with outdoor pets.

Pollen Allergy Medicine

Over-the-counter allergy medications treat runny nose, congestion, itchy eyes, watery eyes, itchy throat, fatigue, and skin rashes. Both single-ingredient and combination products are available. Finding an allergy medicine that effectively treats your symptoms with minimal side effects is important.

Antihistamines

Antihistamines block histamine, a chemical that is stored in mast cells, is released when you encounter an allergen you are sensitive to, and causes many symptoms associated with pollen allergies. Antihistamines treat nasal itching, sneezing, and a runny nose. They are less effective for relieving nasal congestion.

First-generation antihistamines, such as diphenhydramine (Benadryl) and chlorpheniramine, are sedating and are not typically used to treat allergies. First-generation antihistamine use can increase your risk for impaired work performance, motor vehicle accidents, and injuries. When taken at night, they can cause drowsiness that persists.⁵ Long-term use of first-generation antihistamines with strong anticholinergic properties is linked to dementia.⁶

Second-generation antihistamines are preferred because they are less sedating and longer lasting.

• Cetirizine (Zyrtec)
• Desloratadine (Clarinex)
• Fexofenadine (Allegra)
• Levocetirizine (Xyzal)
• Loratadine (Claritin, Alavert)

Cetirizine is thought to work fastest but is most likely to cause drowsiness. Fexofenadine is long-lasting and is least likely to cause drowsiness. Adding a second-generation antihistamine to a nasal corticosteroid is not thought to give any additional benefits.⁵

Antihistamines are also available in nasal spray form, such as azelastine (Astelin), and as eye drops. These products help reduce sneezing, itchiness, runny nose, and postnasal drip. Many people complain about the bitter aftertaste after using antihistamine nasal sprays. They can also cause changes in taste sensation, bloody nose, headaches, sedation, and nasal discomfort.

Examples of antihistamine eye drops include:

• Ketotifen
• Olopatadine
• Pheniramine and naphazoline

Decongestants

Histamine and other chemicals released in response to allergens cause swollen blood vessels in the nose and sinuses. Decongestants can narrow blood vessels and ease congestion.

Examples of over-the-counter decongestants include:

• Pseudoephedrine
• Phenylephrine

Decongestant nasal sprays, such as oxymetazoline and phenylephrine, shrink swollen blood vessels in the nose and sinuses, but they can only be used for a short period because of their potential to cause rebound effects.

Decongestants are not safe for everyone, especially people with high blood pressure, diabetes, hyperthyroidism, closed-angle glaucoma, bladder neck obstruction, and heart conditions. Oral decongestants can cause insomnia, headache, nervousness, decreased appetite, pounding or fast heartbeat, high blood pressure, nausea, vomiting, and urinary retention.⁵

Corticosteroids

Intranasal corticosteroids are the first-line treatment for nasal and sinus allergy symptoms. They are used to prevent and treat allergic rhinitis. They are also moderately effective in treating eye itching, redness, and tearing.

Intranasal corticosteroids have an onset of action of 12 hours after dosage, but it may take seven days or more to reach their maximum effectiveness. Corticosteroid nasal sprays are typically started about two weeks before the expected allergy season.

Intranasal corticosteroids can cause nasal dryness, irritation, burning, and bleeding. More serious but rare side effects are also possible.⁵

Examples of intranasal steroids:

• Budesonide
• Ciclesonide
• Flunisolide
• Fluticasone
• Mometasone furoate
• Qnasi
• Triamcinolone

Steroid nasal sprays can cause nasal irritation, nosebleeds, headaches, sore throats, and an unpleasant aftertaste.

Combination medications

Combination medications are typically second-generation antihistamines and a decongestant. These medications have a “D’ in their name.

The problem with combination medications is that you may be taking more medication than you need, which increases side effects. Antihistamines typically work best when taken regularly throughout the allergy season. Decongestants can increase heart rate and blood pressure and, therefore, should not be taken more than a week at a time without talking with your doctor.  

Immunotherapy for Pollen Allergies

If your allergy symptoms persist or are not adequately treated with over-the-counter medications and making environmental changes, you may want to consider immunotherapy, commonly called allergy shots.

Immunotherapy involves injecting small but escalating doses of your allergen under the skin to teach your immune system to be less sensitive to the allergen. As your immune system becomes less reactive, you will notice a decrease in your allergy symptoms.

Subcutaneous immunotherapy

Small amounts of pollen extracts are injected under the skin in subcutaneous immunotherapy (SCIT) to gradually expose the immune system to increasing amounts of the allergen and desensitize it to pollen allergens. Once the build-up phase is complete, pollen extract is injected less frequently in the maintenance phase.

Sublingual immunotherapy

Sublingual immunotherapy (SLIT) involves placing a small amount of pollen extract under the tongue and holding them there. Long-term clinical trials show that SLIT provides long-term clinical benefits.⁷

According to the Asthma and Allergy Foundation of America, the Food and Drug Administration has approved SLIT for treating grass and ragweed allergies.

When to Seek Medical Help

Ready to talk with an online telemedicine doctor on the TelegraMD platform about your allergy symptoms? After reviewing your symptoms and medical history, your online doctor can provide an online diagnosis and transmit any necessary online prescriptions to your local pharmacy.

Telemedicine makes it possible to find a doctor on call when you need it. A 24-hour physician provides access to help whenever you need it to provide helpful and personalized advice about how to treat your pollen allergies. Telehealth can be more cost-effective than in-person doctor’s visits.

Disclaimer

While we strive to always provide accurate, current, and safe advice in all of our articles and guides, it’s important to stress that they are no substitute for medical advice from a doctor or healthcare provider. You should always consult a practicing professional who can diagnose your specific case. The content we’ve included in this guide is merely meant to be informational and does not constitute medical advice.

References

1. Poncet P, Sénéchal H, Charpin D. Update on pollen-food allergy syndrome. Expert Rev Clin Immunol. 2020 Jun;16(6):561-578. doi: 10.1080/1744666X.2020.1774366. PMID: 32691654.

2. Portnoy JM. Appropriate allergy testing and interpretation. Mo Med. 2011 Sep-Oct;108(5):339-43. PMID: 22073491; PMCID: PMC6188374.

3. Ansotegui IJ, Melioli G, Canonica GW, et al.. IgE allergy diagnostics and other relevant tests in allergy, a World Allergy Organization position paper. World Allergy Organization Journal. 2020;13(2):100080. doi:10.1016/j.waojou.2019.100080

4. Muthupalaniappen L, Jamil A. Prick, patch or blood test? A simple guide to allergy testing. Malays Fam Physician. 2021 May 31;16(2):19-26. doi: 10.51866/rv1141. PMID: 34386160; PMCID: PMC8346756.

5. OTC drugs for seasonal allergies. Med Lett Drugs Ther. 2019 Apr 22;61(1570):57-60. PMID: 31169808.

6. Richardson K, Fox C, Maidment I, Steel N, Loke YK, Arthur A, Myint PK, Grossi CM, Mattishent K, Bennett K, Campbell NL, Boustani M, Robinson L, Brayne C, Matthews FE, Savva GM. Anticholinergic drugs and risk of dementia: case-control study. BMJ. 2018 Apr 25;361:k1315. doi: 10.1136/bmj.k1315. Erratum in: BMJ. 2019 Oct 31;367:l6213. PMID: 29695481; PMCID: PMC5915701.

7. Penagos M, Durham SR. Long-term efficacy of the sublingual and subcutaneous routes in allergen immunotherapy. Allergy Asthma Proc. 2022 Jul 1;43(4):292-298. doi: 10.2500/aap.2022.43.220026. PMID: 35818157.