Spring Fever: PollenNation

Spring time brings beautiful flowers, lush green grass, and gentle warm breezes. In Mississippi, it can also bring snow, floods, and mosquitoes all in the same week. Jackson, Mississippi is one of the nation’s worst places for allergy sufferers. It routinely ranks in the top 3, often times at the #1 spot. I have asked a friend and colleague, Dr. Chelle Pope Wilhelm, to discuss surviving allergy season in Jackson.

Many people attribute their sinus congestion, cough, runny nose, and sore throat to the rapidly changing weather. While that may play into it somewhat, it has more to do with allergens than the barometer.

What is an allergy?

An allergy is an inappropriate immune response to normal exposures that we encounter every day.  Essentially, allergies occur when a person’s immune system mistakenly identifies common exposures, such as pollen and animals, as harmful.  This immune reaction causes allergic inflammation in susceptible people, and this inflammation causes the allergy symptoms.

What causes us to have allergies?

Essentially, there is no one answer to this question.  Many people encounter the same exposures every day and never develop any allergy response.  One theory (the hygiene hypothesis) is that children are not exposed to the same degree of infectious agents, such as bacteria, in today’s world, and this is affecting how the immune system develops.  Some scientists are studying how the bacteria in our guts affect the development of allergic disease.  While no one really knows why some people develop allergies and others do not, the biggest factor in determining this is genetic history.  Atopy (allergy) tends to run in families.  When a parent or a sibling is affected by allergies, a person’s risk is increased that they too will develop allergies.  

What are the symptoms of seasonal allergies?

The most common symptoms of seasonal allergies are typical hay fever symptoms, including runny nose, nasal congestion or stuffiness, nasal itching, and drainage down the throat.  People also tend to have eye symptoms (allergic conjunctivitis), including burning, itching, and watering of the eyes.  Many people will also develop a common allergic rash called eczema.  Of course, the most concerning symptoms are those associated with asthma, including shortness of breath, cough, wheezing, and chest tightness.  Not all patients with allergies develop asthma, but they do have a higher risk compared to those without allergies.

What are the most common causes of allergies?

The most common causes of allergies are pollens, including tree pollen, grass pollen, and weed pollens.  Outdoor allergens like these have particular seasons when they are more prevalent.  For instance, tree pollen typically is prevalent in the spring season, while grass starts to become a problem in summer.  Weed pollens are typically found in the fall season.  Other common allergens are dust mites and animal dander (typically cats and dogs).  These allergens are present year-round and are typically indoor sensitivities.

At what point should I seek help from a physician?

There are numerous over the counter options to help treat the symptoms of allergies.  Typically, over the counter antihistamines are first line treatments.  However, if these medications are not effective at eliminating your symptoms, you should see your physician.  Your physician can help guide other treatments to hopefully get you some relief. There are some prescription medications that may help.  Allergies can cause a lot of problems outside of just a stuffy nose.  Allergies can affect your sleep and, in turn, affect your day to day activities.  It is always best to seek care from your physician sooner rather than later if typical over the counter antihistamines are not effective.  Most importantly, if you are having any symptoms of asthma, including chest tightness, cough, shortness of breath, or wheezing, you need to be seen by your physician.

At what point should I consider asking for a referral to an allergist?

If your physician has trouble controlling your daily symptoms with standard therapy, typically 1-2 allergy medications, he or she will typically suggest that you see an allergist to discuss other treatment options.  One benefit of seeing an allergist early is that you can identify your triggers and learn tips and tricks on how to adjust and minimize your daily exposures.  Anytime you have asthma symptoms that are not controlled with standard treatments provided by your primary care physician, you should consider seeing an allergist.  An allergist can help determine common triggers of asthma and work with your primary care physician to help manage your asthma with other types of therapy when needed.  

How do you get tested for allergies?

You first need to be seen by an allergist to have a thorough history taken that can guide the next steps.  Typically, people will be tested for allergies by skin prick testing.  This is where the allergist will use a small plastic device to scratch the skin with the different environmental allergies in your local area.  This test is done in the allergist’s office and the results are available to discuss with the doctor during that visit.  The other option for allergy testing is to obtain lab work to look for allergies.  This is typically done if there is another health reason that prevents skin testing from being done safely.  These results are usually available a few days later.

What happens if you do have allergies?

If you are found to be allergic on testing, certain avoidance measures can be recommended depending on your triggers.  A treatment plan that is tailored to you and your seasonal symptoms can be discussed and planned.  Allergen immunotherapy is also available and very effective.  Allergen immunotherapy is what most people know as “allergy shots,” and these are tailored to each person’s individual triggers.  We also have sublingual immunotherapy available for some select allergies.  Sublingual immunotherapy is a tablet that is placed under the tongue daily for treatment of allergies.  

I used to never have allergies when I was little, now I seem to be allergic to everything. What happened to me?

It is a common misconception that allergies and asthma are childhood illnesses only.  Allergies and asthma are not simply childhood illnesses.  These illnesses can affect any age group.  Yes, many people develop the issues in childhood and carry these through life.  Others have trouble in their childhood years and then get a break from symptoms for a few years, only to go on to have recurrence of symptoms later in life in their 30s or 40s.  However, many people have never had any issues with allergies or asthma at all until the symptoms hit in adulthood.  It is common to see people of all ages develop symptoms without any childhood history.  We even see it develop in the retirement years.  Unfortunately, this misconception may delay some people from seeking care because they do not believe having these issues at their age is possible.  Allergies are possible at any age.

Dr. Wilhelm received her bachelor of science degree in Microbiology from Mississippi State University in Starkville, Mississippi, in 2003.  She received her medical degree from the University of Mississippi Medical Center in Jackson in 2007.  She completed her residency in Internal Medicine at the University of Mississippi Medical Center in Jackson in 2010, where she was chief resident in the Department of Internal Medicine from 2010-2011.  She completed a fellowship in Pulmonary Medicine at the University of Mississippi Medical Center in 2013, followed by a fellowship in Asthma and Allergy at the University of Mississippi Medical Center in 2015.  She was an assistant professor at the University of Mississippi Medical Center from 2015 until joining Mississippi Asthma and Allergy Clinic in July 2017. 

Dr. Wilhelm is certified by the American Board of Internal Medicine, the sub-board of Pulmonary Medicine, and the American Board of Allergy and Immunology. 

A native Mississippian, Dr. Wilhelm is active with the American Lung Association.  She is married with one daughter.

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