Autumn and spring bring blooming and renewal — but also plenty of tissues. Behind the runny nose, itching and sneezing that many people experience lies an unexpected reaction of the body itself: an allergy. Why does it flare up, and how can it be distinguished from an ordinary winter illness?
“Allergy, broadly speaking, is an abnormal reaction of the immune system to something it is exposed to and should ignore. It’s a kind of malfunction,” explains Professor Yossi Rosman, head of the Allergy and Clinical Immunology Unit at Meir Medical Center. “Instead of recognizing that there is no danger, the system responds — and in an exaggerated way.
“This can be a food allergy, such as peanuts or sesame, certain medications, bee venom or things we routinely inhale, known as airborne allergens: dust, pollen from grass, flowers, trees and weeds, animal dander and more. The immune system responds locally, which can present as persistent watery runny nose, sneezing or itching. In people with asthma, it can cause bronchial constriction and shortness of breath.
“In spring and fall, which are flowering seasons, we inhale pollen present in the air — in Israel, common sources include cypress, oak, olive, pecan, poplar and grasses. In people with allergies, the immune system identifies these pollens, which are not present year-round, and reacts with a range of symptoms.”
Some suffer year-round
According to Rosman, allergens fall into several categories. “There are perennial allergens, such as house dust mites, which are a type of parasite. People allergic to them suffer throughout the year. There are seasonal allergens, like plant and grass pollen. Some people are allergic to both dust mites and pollen — they suffer all year, but much more in spring. Someone allergic to pecan pollen, for example, will suffer once a year, mainly during May.”
How can allergy symptoms be distinguished from a seasonal virus?
“Allergies have characteristic symptoms: mainly watery runny nose, frequent sneezing and itching of the eyes, ears or palate. Sometimes a trigger can be identified with tests — drops of allergens are placed on the skin, the area is lightly scratched and the reaction is observed. It is not always possible to tell whether an episode is caused by allergy, a virus or bacteria.
“Sometimes the trigger is obvious. Someone allergic to cat dander who enters a home with a cat will start sneezing and have a runny nose, and it will subside after leaving. With a virus, the nasal discharge is thicker, there is nasal congestion and it may be accompanied by fever and headaches. With allergies, there are no headaches, the discharge is watery and the nose is usually completely open.”
Who is prone to allergies?
“This is mainly a disease of younger people. If a 60-year-old comes in and says they developed a runny nose in the past year, the chances that it is allergic are low. Allergic rhinitis or asthma usually begins around ages 5 to 7, peaks in the 20s and 30s and tends to lessen with age.
“People with a family history of allergies are at higher risk, often due to genetic predisposition. There is a whole group of atopic and allergic diseases — food allergies, allergic asthma, allergic rhinitis, atopic dermatitis — that tend to occur together. If someone in the family has one of these, siblings or children are at increased risk.
“When it comes to severe disease, people with asthma are at risk of significant worsening. For example, allergic asthma triggered by olive pollen in spring can lead to more severe asthma attacks, sometimes requiring hospitalization and, in rare cases, posing a life-threatening risk.”
In some cases, it can be cured
“In medicine, we would like to prevent disease — if someone is allergic to something, they should avoid it,” Rosman says. “In asthma and allergic rhinitis, prevention is almost impossible, and avoidance is relevant mainly to things inside the home.”
How is it treated and what is new?
“Today, antihistamine treatments are available — pills or sprays — that are effective for symptoms such as runny nose, itching and sneezing. They work for several hours and provide rapid relief. They don’t solve the problem, but they offer good symptom control and are suitable for occasional sufferers.
“For people with daily symptoms, there are preventive daily treatments with a cumulative effect, usually steroid-based nasal sprays. These are safe, have no significant side effects and are intended for those who suffer daily for a couple of months a year.
“For asthma patients, inhalers containing anti-inflammatory steroids and bronchodilators are available. These can be used as needed in mild cases or as regular preventive treatment in more severe cases.
“There is also immunotherapy, which can cure allergic rhinitis and allergic asthma. This involves exposing the body to the allergen in small doses, usually by injection, gradually increasing the dose until the immune system learns to ignore it. This is a very effective curative treatment, but it is a long process, requiring weekly injections for several months and then monthly injections for several years.
Prof. Yossi RosmanPhoto: Meir Medical Center spokeswoman from Clalit Group“These vaccines are intended for people who suffer severely, do not respond well to medications and want root-level treatment. There is also immunotherapy in tablet or sublingual form instead of injections, which in Israel is currently available only for dust mite allergy. Worldwide, there are also curative treatments for pollen allergies.
“At the forefront of innovation for allergic asthma are advanced biological therapies designed for severe cases. They do not cure the disease and are intended for patients whose asthma does not respond to inhalers.”
How can symptoms be eased during an attack?
“Pay attention to timing. If symptoms recur at the same time each year, it’s probably not a virus. I also recommend seeing an allergy specialist for diagnosis. Today, there is no need to suffer — effective treatments are available.
“Preventive treatment with steroid nasal sprays can be life-changing. Many people are wary of steroids, but these sprays act locally and have minimal side effects. Use them for one season. The key is consistency; otherwise, symptoms return.
“If you know you are prone to allergic attacks, you can start using the spray in advance. It is not addictive. Ultimately, this is a condition that significantly affects quality of life.”