Are your allergy symptoms flaring up lately? If you are one of many Nashvillians with runny, stuffy nose this time of year, it is likely you are either allergic, or you aren't! Or maybe both of those! What?

We evaluate many patients with nasal symptoms that flare significantly this time of year. Until we get several good frosts, all of the plants that have been producing pollen since late spring are still active. These include grasses (northern turf grasses like Kentucky bluegrass and fescue, and southern grasses like Bermuda, bahia, and johnson) and weeds, including plantains (see earlier post for pictures!), lamb's quarter, pigweed, kochia, and many others.

However, a spike in nasal/sinus symptoms in fall, when related to pollen allergy, is usually due to ragweed. Ragweeds (Ambrosia genus) are highly allergenic plants native to the Americas. They are among the most common plants to be allergic to (depending on the study, among those with allergic rhinitis, up to 80% may be sensitized to ragweed), and also contribute significantly to asthma symptoms. In our area, we have abundant short ragweed and giant ragweed. Ragweeds are short day plants, meaning that they wait for the days to shorten again before they start to flower, and so they begin flowering in much of the US beginning around the middle of August. If you have fall allergies ragweed may well be an important allergen for you. We can complete skin testing and get you an answer in about a half hour. If you are allergic, this opens additional options including allergy shots and ragweed sublingual immunotherapy (for which there is a FDA approved product, Ragwitek).

Many patients who flare this time of year have negative skin testing to common aeroallergens, known as vasomotor or non-allergic rhinitis. These patients have much the same nasal/sinus symptoms, but are reacting to the changing weather and air quality patterns that occur rapidly in the fall, rather than to pollen in the air. This is another situation where skin testing is very helpful, because it can tell you that you may be able to stop medicines, including Singulair and oral antihistamines, that are unlikely to benefit you if you don't have allergic triggers for your nasal symptoms.

Finally, some patients have allergy by skin testing, but clearly also have non-allergic triggers (for example their fall flare isn't explained by what they are allergic to, or by history they also react around non-allergic triggers like perfumes/strong scents). These "mixed rhinitis" patients can benefit greatly from a combination of therapies targeting both allergic and non-allergic triggers.

If you aren't feeling well this fall, let us review your history and find our what is driving your symptoms, to help get you on the right treatments to feel your best!