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April 26, 2023

‘Tis the Season for Sneezin’: Surviving Spring Allergies in North Carolina with Latonja Ivery, MD

Spring is in the air. If you’re among the many North Carolina residents who have seasonal allergies to pollen, this time of year can bring on a range of unpleasant symptoms, from runny, congested noses to watery, itchy eyes and sneezing.

Four of our beautiful cities – Raleigh, Greensboro, Winston-Salem and Charlotte – ranked among the nation’s “allergy capitals” in a March 2023 report by the Asthma and Allergy Foundation of America.

Allergy capitals are places where you’ll find lots of people with tissue boxes close at hand because of high levels of pollen due to our abundant trees, grasses and weeds. In the spring especially, warmer days cause plants to release pollen, which waft on the winds and coat outdoor surfaces in a fine, yellow dust.

Allergy Symptoms

When pollen levels spike, people who are sensitized to plant allergens, also known as “environmental” allergens, suffer with symptoms that include:

  • Runny, itchy nose (typically with a clear, thin discharge)
  • Nasal congestion/stuffiness
  • Post-nasal drip
  • Sneezing
  • Itchy, watery, puffy red eyes
  • Itchy ears or throat

While none of these symptoms on their own are serious, together, they can make people feel rather awful.

Allergies and Fatigue

Another common, but lesser known, symptom of allergies is exhaustion. Allergies can leave people feeling wiped out and fatigued. There are a few potential reasons for this.

Allergies result from the immune system revving up and overreacting to allergens in the environment, leading to inflammation in the nasal passages and elsewhere in the body. The inflammatory response is taxing for the body, which may lead you to feel more tired.

Allergies can also irritate nasal passages, making it more difficult to breathe. This means your body may be working a bit harder just to go about your normal activities. The nasal congestion can also interfere with your ability to get a good night’s sleep.

Is it a Sinus Infection or Allergies?

When patients come to see me with these symptoms, they often suspect they have a sinus infection, and they’re surprised to find out that allergies can bring on such misery.

Many of the symptoms of sinus infection and allergies overlap, so it can be hard to tell them apart, but there are some key differences.

A sinus infection, or sinusitis, is swelling in the cavities around your nasal passage, including in the cheeks and forehead. A sinus infection usually comes on the heels of a viral infection, such as a cold, although sinus infections can have other causes, including bacteria, fungi, and yes, allergies. But most often, it’s a viral infection that leads to swelling of the nasal passages, which makes it hard for mucus to drain from the sinuses.

Symptoms of a sinus infection include a stuffy or runny nose; a thick yellow or green nasal discharge; and pain, pressure or tenderness around the eyes, cheeks, nose or forehead. The symptoms of a sinus infection tend to escalate over a short period of time, and sometimes include a fever, fatigue, or chills. Although we sometimes treat sinus infections with antibiotics, in many cases sinus infections get better on their own.

Allergies, on the other hand, tend to be chronic. Allergies can periodically flare, such as when pollen counts are high in the spring. Pollen counts can spike at other times of the year, too, such as ragweed in the fall.

Year-Round Environmental Allergies

And if that’s not enough, some people deal with environmental allergies throughout the year.

Dust mites: tiny culprit, major allergen

A major cause of year-round allergy symptoms are dust mites, which are microscopic critters that live in mattresses, pillows, bedding, upholstered furniture and carpets. Dust mites feed on skin flakes, which accumulate in household dust.

To cut down on dust mites in your home, try taking these steps:

  • Encase your mattress and pillows in dustproof or allergen-blocking bed covers.
  • Wash all bedding weekly.
  • Vacuum frequently.
  • Replace wall-to-wall carpet with vinyl or tile floors if possible.
  • Dust mites also thrive in humidity, so reducing humidity in your home can help.
  • Reduce clutter where dust accumulates.
  • Use HVAC air filters to reduce the dust circulating in the air. (And don’t forget to change the filters about every three months!)

How to Find Allergy Symptom Relief

It may be tempting to try to muscle through pollen season without seeking help from a medical professional, but patients should see a primary care provider if their allergies are making them feel lousy. There’s a lot we can do to help you get relief.


These over-the-counter medications block the body’s histamine response, which causes swelling and inflammation. Over-the-counter medications such as cetirizine (Zyrtec), loratadine (Claritin), and fexofenadine (Allegra) are relatively non-sedating and can all help tamp down symptoms.

If you find you’ve been taking one for a while and it’s not working as well as it once did, switching to another may help.

Some patients also find they can take the medications for a few weeks leading up to pollen season and when their particular allergens are at their peak, and then they no longer need them. Others, such as people with very bad dust mite allergies, may need antihistamines year-round to keep symptoms at bay.

H2 Blockers

Classic antihistamines block H1 receptors. H2 blockers such as cimetidine (Tagament) or famotidine (Pepcid) are another type of antihistamine that are better known for use in treating gastroesophageal reflux disease (GERD). But H2 blockers can also be used to treat anaphylaxis, a severe form of an allergic reaction. H2 blockers can be used to treat people with itchiness due to chronic hives.

Corticosteroid nasal sprays: Nasal corticosteroid sprays include fluticasone (Flonase), triamcinolone (Nasacort), or budesonide (Rhinocort Aqua). These can be bought over the counter to reduce nasal inflammation, runny nose, and sneezing. Unlike steroids that are taken orally, nasal steroids don’t have any major side effects and can be taken safely for long periods of time.

Allergy Shots

While the other treatments deal with the symptoms of allergies, allergy shots – or allergen immunotherapy – change the way the immune system reacts to allergens. Allergen immunotherapy is a form of long-term treatment that decreases allergic symptoms for people with rhinitis (nasal congestion), allergic asthma, conjunctivitis (eye allergy) and stinging insect allergy (such as allergies to bees, wasps and hornets). In most people, allergy shots lead to lasting relief of allergy symptoms even after treatment has stopped. While very effective, allergy shots are a commitment.

The two phases of allergy shots:

Build Up Phase

During the build-up phase, patients receive a just-under-the-skin injection containing a very small amount of their allergen or allergens. Injections are given one to two times a week for several months, and the amount of the allergen is gradually increased over time.

Maintenance Phase

Eventually, the patient reaches a top dose of their allergen, which is then maintained in shots given every two weeks to once a month, for three to five years. Allergy shots can be used for trees, grass, weeds, mold, dust mites, animal dander and insect venom.

Allergies and Asthma

Another reason to get seasonal allergies under control: it’s very common for people with asthma to also have seasonal allergies, sometimes called hay fever, and hay fever is linked to asthma exacerbations.

Postnasal drip can trigger coughing, which can irritate the airways and lead to wheezing. Also, those same allergens causing inflammation in the nasal passages can trigger inflammation in an asthmatic’s hypersensitive airways. It’s important to make sure both asthma and allergies are under control.

Testing for Environmental Allergies

If treatments such as antihistamines and nasal sprays are doing the trick to control symptoms, it may not be necessary to test for the specific allergens causing reactions. But to find out precisely which allergens are causing reactions, or if you want to consider receiving allergy shots, we can do allergy testing. There are two types of allergy testing:

Skin testing places a small droplet containing the allergen just under the skin and then measure the skin reaction. Results take about 20 minutes.

Blood tests are another option. Blood tests detect IgE antibodies that circulate in the blood. Blood tests can measure total IgE levels, or IgE antibodies to a particular allergen.

Once the testing is done, we can implement a plan to help you feel better! Remember, you don’t have to just put up with all that sniffling, sneezing and stuffiness. We can help you get relief and improve your quality of life – even if you’re living in one of our lush, green allergy capitals.

Get Allergy Relief Today

If you want to stop suffering during the allergy season, visit Avance Care today. With same-day and next-day appointments, you can start your journey to overcoming allergies now!

Click below to learn more about Dr. Ivery and the North Wake Forest team.

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