Oregon is known as the “Grass Seed Capital of the World.” With nearly 1,500 farms in the state, Oregon is a major world producer. But pollen — including from grass — in the Willamette Valley leads to Oregonians suffering from allergies during the summer. We dig into the details of this year’s allergy season with Shyam Joshi, an assistant professor of medicine and head of allergy and clinical immunology in the OHSU School of Medicine.
The following transcript was created by a computer and edited by a volunteer:
Dave Miller: We turn now to seasonal allergies. It’s a phrase that, for a lot of people, may not seem adequate for the scale of the problem these days. For one thing, grass pollen season is starting earlier and can be lasting longer than it used to. Then when you add in pollens from trees and weeds, some people might have so-called “seasonal allergies” from February through Halloween. Shyam Joshi is an associate professor of medicine and pediatrics at OHSU, where he is the director of the Allergy and Immunology Clinic. He joins us now. Welcome to the show.
Shyam Joshi: Thank you so much for having me. Looking forward to our discussion.
Miller: I want to start with a voicemail from a listener just to get us kicked off. This is Rita in Salem.
Rita [voicemail]: I’m having the worst allergies of my life. I have never had more than a sneeze or two and this year is kicking my butt. I have tried all the major allergy medicines. Nothing is giving me any relief. The itchy eyes, the runny nose, the constant sneezing – it’s just too much. I hope we get some relief soon and that everybody out there suffering finds some relief. Maybe it could rain. Would that help? Anyway, I look forward to hearing what other people have to say and maybe there’s something out there that could help me by listening to the rest of you.
Miller: All right. So, before we get to possible solutions or help, let’s talk about the problem. How does this year compare to recent years in terms of pollen levels?
Joshi: We’ve seen pollen levels probably on par with the last few years. Not necessarily a lot more. Not necessarily a lot less. But if you look at the trend over the past few decades, we are definitely seeing longer pollen seasons and much higher pollen counts than we did 20 or 30 years ago.
Miller: What are the reasons for that?
Joshi: Climate change. I think that that’s what it comes down to. What we’re seeing is warmer weather throughout the summer and warmer weather earlier in the year. And so the pollen season is starting earlier. Also, when you have higher levels of CO2 in the environment, it actually triggers these plants to produce higher amounts of pollen. So, not only are we seeing a longer season, we’re just seeing a lot more pollen in the air which is leading to more people becoming allergic, and more people developing more severe allergies than what they’ve experienced in the past.
Miller: Candy Roberts wrote on Facebook:
“I moved to Corvallis in 1990 and had never heard about the grass seed farms. I’m very allergic to most types of grass and they were still burning the fields annually back then. I would alternate two types of allergy meds, and carry Kleenex and eye drops everywhere with me. I moved to Boston a few years ago and it’s so strange to take a single Allegra now and then instead of timing my allergy meds all spring and summer.”
She added, “I still miss Oregon though.”
Can you put the Willamette Valley, Western Oregon in the national context in terms of allergens?
Joshi: Absolutely. So I’ve practiced allergy in the Northeast as well as the South. Grass season here is very unique. It is impressive how much pollen is produced in such a short period of time during peak grass season. There are other parts of the country that have other allergens that are equally as bad, such as ragweed especially in the Midwest, or cedar allergies down in the South. The grass season here is really one of a kind and pretty problematic for people that are new to the area.
Miller: Rita mentioned rain in her voicemail. We get almost none of it in the summer. How big a difference would rain make?
Joshi: Weather plays a huge role in allergies. Rain causes a lot of the pollen that’s circulating in the air to fall to the ground. And so you don’t see it as much in the air. The problem with rain though, too, is if you have a pretty wet spring, it also produces a lot more allergenic plants later on. And we saw that last year when we had a little bit wetter spring. Allergy season started a little bit later, but it also lasted a little bit longer. And we saw some really incredibly high pollen counts last year. So it can provide temporary relief, but long-term can also be problematic.
Miller: How big a toll do seasonal allergies take population-wide?
Joshi: Yeah, it’s a great question. So when we think of how medical conditions affect people’s lives, affect the health care costs, allergy is not something we often think about. But environmental allergies is up there in the top 10 [of] the most costly medical conditions across the U.S., just because of how many people have allergies in the country. Upwards of up to 40% of people have environmental allergies.
And then you take into all the indirect costs associated with environmental allergies. It can trigger asthma. It obviously makes people absolutely miserable. But really, it causes work absenteeism. People aren’t able to go to work. They’re not as efficient at work. It causes kids to miss school, then parents can’t go to work. It really does take a toll. And I think a lot of people, unfortunately, brush it aside and just say “It’s allergies.” But it does cause a significant disruption in people’s quality of life.
Miller: Just to take a step back here, what is an environmental allergy? What’s happening in the body?
Joshi: It’s an abnormal response of your immune system to identify something that should be innocent – like pollen or dander – that shouldn’t really activate the immune system. But all of a sudden, it does activate the immune system. And how the immune system responds to that is by those symptoms that you experience: sneezing, itchy nose, itchy, watery eyes, runny nose, congestion. It’s not supposed to happen, but something is causing the immune system to identify these substances as bad.
Miller: Is there any connection between these kinds of environmental allergies and things like dietary or bee sting allergies that can lead to anaphylactic shock?
Joshi: Not that we know of right now. There’s a lot of interest in that and seeing how diet specifically affects your risk of developing allergies. And there might be something there, especially with the microbiome, but we’re still in the early stages of really understanding that connection. And it’s hard to make any specific recommendations at this time.
Miller: Let’s listen to another voicemail from one of our listeners.
Kenny [voicemail]: Hi. My name is Kenny. I live in Portland, Oregon. The allergies are bad and I get them really bad every year. This year I think has been particularly brutal. What I do is a neti pot, religiously, every night before bed. I use Flonase right before bed to keep my nose from totally clogging up. Whatever I can find on sale at Costco for dry eyes. I get eye drops, allergy medication, Allegra. I go for the big stuff, go to my provider and get Sudafed, get 30 mg of that at least. Yeah, that’s what I do to try to get through it. And a lot of these things are pretty temporary, but I manage.
Miller: So Kenny there seems to have an “everything but the kitchen sink” approach to this. But it doesn’t seem like it’s working as well as he’d like. As he says, a lot of this is just temporary. He mentioned the neti pot first there, something other folks wrote about or left us voicemails about. Can you describe what that is and how it might help people with allergies?
Joshi: Yeah. A neti pot is a way to push saline or salt water solution through the nasal cavity and kind of clean out the nasal cavity. So it’s particularly helpful in people who are spending time outdoors in an environment that they’re allergic to. So grass pollen for instance. And then when you come in and you do the neti pot, it rinses all that pollen out of the nasal cavity and reduces the risk of developing symptoms because of that pollen. So yeah, absolutely, neti pots are great in terms of soothing the nasal cavity and removing allergens. And some of the other things he mentioned as well can be helpful in masking the symptoms that people experience.
Miller: Jen Proctor Andrews on Facebook wrote:”Having to give my son allergy medicine regularly is not fun. But if we don’t, it leads to other illnesses, chronic coughs, for instance. Grass is a waste of water and doesn’t support a healthy ecosystem.”
Ryan Hooper wrote: “I’m 76 and I feel fine. I’ve been taking a 24-hour allergy pill for 20 years. Claritin and Allegra work great for me.”
Are these drugs ones that people can take daily for decades with no serious side effects?
Joshi: Many of the medications that we use for allergies are very safe to use, short-term and long-term. There aren’t a lot of studies looking at 20 or 30 years down the road. But in general, we do feel like these medications are safe.
Miller: This, I think, goes back to the level of grass seed farming and grass pollen in particular that we have in the Northwest – I’ve heard folks say that they didn’t have allergies before they moved to the Northwest. Is that something that you encounter as a doctor?
Joshi: Sometimes. What we tell patients is that nobody is born with allergies. Allergies have to develop at some point in your life. A lot of the time it’s in childhood. But we’re seeing patients develop allergies in their twenties, thirties, forties, fifties or even sixties at this point. And when you do move to a new environment and you get exposed to new types of allergens – different things in the environment – it can take two or three years to develop new allergies to that area as well.
So a lot of patients come and say, “Hey, should I just move to the desert? And I’ll be OK?” And my answer is no. You move to the desert and two or three years from now, you’re gonna be allergic to stuff that’s in the desert. You can’t really run away from it unfortunately.
Miller: If allergies, broadly, are the body’s overreaction to things that are not truly harmful, but the reaction can be either frustrating or much worse, once a kind of overreaction happens, can our bodies then overreact to other allergens that didn’t cause us problems before?
Joshi: Yes, they can. There’s probably not as clear a direct correlation as most people would hope that we have. But there’s really one unique phenomenon that I would like to spend a minute on and it’s called pollen-food allergy syndrome. So when patients are allergic to specific pollens, the most common one being birch tree pollen, that can also have cross reactivity with a lot of different foods, especially with pitted fruits – cherries, plums, peaches, some nuts, carrots, celery.
When patients who are very highly allergic to birch pollen eat some of these foods, they can actually get a local allergic reaction in the mouth. The body thinks they’re eating a handful of birch pollen because the proteins in the foods are so similar to the birch pollen. And it’s usually not something that causes a serious side effect, but it can be really annoying to have an itchy mouth every time you want to eat a fruit.
Miller: Let’s listen to one more voicemail. This is Sam in Portland.
Sam [voicemail]: I’ve suffered from grass pollen allergies my entire life and it kicked up to 11 when I moved to Eugene in 2006. I’ve tried everything from homeopathic remedies, over-the-counter medication, and … what is it again? Oh, yeah, local honey. All the above. The thing that really helped me out the most, that kind of took the edge away, was acupuncture. Acupuncture paired with a little bit of over-the-counter medicine cut down my grass pollen sensitivity, especially my itchy, watery eyes and stopped-up nose by like 90%. It really was fascinating.
Miller: Is acupuncture something you recommend for your patients?
Joshi: Yeah. Great question. Acupuncture is something that’s not been well studied, unfortunately. But I have seen patients improve in their allergic disease, whether that’s environmental allergies or asthma with acupuncture. Is it foolproof? Absolutely not. I’ve seen as many patients that haven’t seen any benefit with acupuncture. But it is a definite alternative option for patients who have tried the stuff that has been studied and are looking for other ways for symptom relief.
One thing I do want to add to this is one thing that we haven’t talked about throughout the segment is allergy shots. That’s one treatment option that is much more effective than any of these over-the-counter medications that are available. And the goal of allergy shots is actually to potentially cure you of allergies. What it does is to change the immune system. It alters the immune system over time and actually reduces your sensitization to these pollens. So when your body gets exposed to these pollens, after you finished allergy shots, your body doesn’t react the same way it used to. The immune system doesn’t get activated the same way as it used to and can essentially remove the allergies as an issue at all.
Miller: And I’m glad you went there. I wanted to talk about this before we are done. Are these shots, in general, specific to each allergen, each class of allergen?
Joshi: It’s personalized to each person and each type of allergen. So it’s really based off of a patient’s history, as well as their testing results, on what things they’re specifically allergic to. Then the physician or the provider would create an allergy mix for the patient, that’s based off these results, and administer that over time. So it’s not really a one-size-fits-all, like all these other medications that are over-the-counter. It’s very specific from person to person.
Miller: Just to go back to what you were saying earlier, that this is not just an inconvenience, this is an enormous population-wide cost. And it can take a big toll on individuals. Nevertheless, do you find that even a lot of patients you talk to just seem to be OK with muscling through?
Joshi: Yeah. And I think that’s what’s really unique about this condition. A lot of people have seasonality. So they’re miserable for two to three months out of the year. And then as soon as that season is done, a few months later, they forget how miserable they were. And so they don’t seek out medical care. They don’t seek out seeing an allergist. They don’t plan for the next season because it’s kind of out of sight, out of mind. And then when the next season hits again, it’s like, “Oh man, it’s, it’s pretty bad.” So I think it’s just the unique nature of this condition. A lot of people have seasonality to their symptoms that people just brush off, unfortunately.
Miller: Shyam Joshi, thanks very much.
Joshi: Absolutely. Thank you for having me.
Miller: Shyam Joshi is an associate professor of medicine and pediatrics at OHSU, where he is the Allergy and Immunology Clinic director.
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