Five Common Questions About Seasonal Allergies Answered

Apr 18, 2023 | Allergy, Your Health


If you find yourself sneezing and wheezing each spring, then you probably have seasonal allergies. And you’re not alone.  About one in four adults, and about one in five children have these allergies, according to the Centers for Disease Control and Prevention.

In this Q&A, Rachel Miller, MD, FAAAAI, System Chief of the Division of Clinical Immunology, answers five of the most frequently asked questions about seasonal allergies. Dr. Miller is also Dr. David and Dorothy Merksamer Professor of Medicine (Allergy and Immunology), and Environmental Medicine and Public Health at the Icahn School of Medicine at Mount Sinai, where her research focuses on the causes of asthma.

What are the symptoms of seasonal allergies?

Sometimes commonly known as hay fever, allergies can affect the nose and eyes and cause congestion and sneezing, eye itchiness, sore throat, and fatigue.  The symptoms can be triggered during certain seasons by pollens, such as those from trees during the spring and those from ragweed during the fall.  Symptoms may be unrelated to seasons if triggered by exposure to dust or animals that emit allergens year round. Some people with allergies develop allergic asthma, where the inflammation is focused in the lower airways.  This can manifest as shortness of breath or wheeze.

Who is prone to having environmental allergies?

Allergic rhinitis, whether seasonal or nonseasonal, occur in people who are genetically predisposed but also re-exposed to triggers in the environment.  The symptoms can be worsened by other factors such as stress, air pollution and smoking.

What is the best way to control environmental allergies?

There is no cure for allergies. But you can manage allergies with prevention and treatment. The best way to control allergic rhinitis is to first identify the triggers. They differ for different people.  This can be assessed by visiting an allergist who could perform skin or blood tests after taking a careful history.  If tree pollen, for example, is identified as a trigger, then wearing hats, sunglasses outdoors and removing shoes and showering upon return indoors, can minimize exposure.  If dust, then avoiding sweeping and instead mopping or vacuuming can minimize exposure. A second step is treating with medicines.  We have many medicines now to treat this.  These may be nose sprays, pills, or eye medications.  They are usually well tolerated.  If someone cannot tolerate the medicines or has persistent symptoms, then allergen immunotherapy either through injections, known as allergy shots, or medicine under the tongue, can be considered.

Have questions about kids and allergies? Click here for more information on pediatric allergy and immunology at Mount Sinai.

What kinds of medication can I take to lesson my symptoms?

Two of the main types of medications used to treat allergies are antihistamines and steroids. These medications are available over the counter in the form of pills, nasal sprays, eye drops, and by prescription. Here are some suggestions:

  • Look for products containing a nondrowsy antihistamine if you suffer from sneezing or a runny nose.
  • A steroid nasal spray can be used on its own or in conjunction with an antihistamine nasal spray to quickly clear the nasal passages. A saline rinse prior to using a nasal spray may help wash away pollen and ensure better penetration of the medication.
  • Itchy, watery eyes can be treated by trying artificial tears to wash away the offending pollen or antihistamine eye drops can be prescribed.

When should I consult a physician about my seasonal allergies?

Environmental allergies can occur at any time in life and vary in occurrence and severity. If your symptoms are not easily managed or well-understood, you can consult with an allergist/immunologist. Symptomatic treatment in combination with prescribed medications can successfully treat most situations.  An allergist/immunologist can conduct skin testing to see what specific substances you are allergic to.  If so, arrangements can be made for you to receive allergy injections that can help desensitize you to the offending allergens.  However, this takes time and does not afford immediate relief of symptoms.

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Food Intolerance or Food Allergy? How to Spot the Symptoms and Get Help

Updated on Mar 23, 2023 | Allergy, Gastroenterology, Your Health

Bloating, diarrhea, vomiting—these are just some of the unpleasant symptoms that food allergies and intolerances can trigger.

It’s normal to experience stomach issues from time to time. But if you find yourself experiencing them on a regular basis, you may have developed a food intolerance or a food allergy.

You can still enjoy a healthy, balanced diet. But if you think you have a food intolerance or allergy, you should not try to diagnose it yourself and should talk with a medical provider. Food allergies and intolerances can be difficult to identify, and trying to resolve them on your own may lead you to eliminate foods from your diet unnecessarily.

Laura Manning, MPH, RDN, CDN

In this Q&A, Laura Manning, MPH, RDN, CDN, a registered dietitian at the Inflammatory Bowel Disease Center in The Mount Sinai Hospital, explains the differences between food intolerances and allergies, how to identify the symptoms, and how to seek help.

What are food allergies?

When someone has an immune response and produces an allergy antibody against a certain food, they have a food allergy. The most common food allergies are milk, eggs, fish, shellfish, tree nuts, peanuts, wheat, and soybeans, which are behind a majority of food allergies in the United States, according to the Food and Drug Administration. Allergic reactions typically occur within minutes, or up to two hours after ingestion.

What are the symptoms of food allergies?

An allergic reaction occurs every time you eat a food you are allergic to. Common symptoms include coughing, wheezing, itching, lip tingling, rashes, mouth swelling, hives, throwing up, and breathing difficulties. In severe cases, food allergies can cause people to go into shock and can be life threatening. You can experience changes in blood pressure and narrowing of your airways, which can cause difficulty breathing or vomiting.

What are food intolerances?

A food intolerance may happen when you lack enzymes responsible for digesting a certain food or food group. A common example is lactose intolerance, in which a person lacks a key enzyme for digesting lactose, a sugar found in milk. Other common examples of foods that may be poorly tolerated are beans, garlic, mushrooms, onions, and watermelon. These are foods that are high in FODMAPS, or fermentable carbohydrates, including lactose, fructose, fructans, galacto-oligosaccharides, and polyols.  These can rapidly ferment during digestion causing gas, bloating, diarrhea, and constipation when consumed in high amounts. Food intolerances typically develop in the gastrointestinal tract or the digestive system, and can sometimes be triggered by stomach infections. Certain gastrointestinal conditions, such as irritable bowel syndrome (IBS), can make someone more susceptible to FODMAP intolerances. Because FODMAPs are in a wide array of foods, it is important to seek help from a medical provider and trained dietitian to identify the foods causing the problem without completely eliminating them from a healthy diet.

What are the symptoms of food intolerances?

When you eat foods your body cannot digest, you will experience discomfort, including gas and bloating, and may also experience diarrhea, constipation, reflux, and gas.

What is the difference between food intolerances and food allergies?

Unlike food allergies, food intolerances do not involve the immune system, do not cause allergic reactions, and are not life threatening. People with food intolerances can usually have small amounts of these foods without a reaction, whereas those with allergies cannot. Those with food intolerances may even be able to acclimate themselves to these foods by eating small amounts over time, whereas those with food allergies cannot have even the smallest amount without a reaction. However, some food allergies may change or go away on their own with time, especially after adolescence. If you have a known food allergy, an allergist can help you safely retrial the foods you are allergic to.

How are food allergies diagnosed and treated?

A skin prick test, typically on the upper back or forearm, or blood test can identify food allergies. Because food allergies cannot be eliminated, you will need to avoid eating foods that trigger your allergies, including foods that have been manufactured in factories where those foods are also processed (a warning should be displayed on food labels). Working closely with a board certified allergist will help determine what your reactions are to certain foods and best treatments. You can schedule an appointment at the Elliot and Roslyn Jaffe Food Allergy Institute at the Icahn School of Medicine at Mount Sinai. You can also find qualified food allergists nationwide through The American College of Allergy, Asthma & Immunology.

How are food intolerances diagnosed and treated? Can I use a food sensitivity test?

Unlike food allergies, there are no official tests for food intolerances, which makes them more difficult to diagnose. While food sensitivity tests are available and popular, they are not FDA-approved, are unreliable, and frequently lead people to eliminate foods unnecessarily, which can lead to health issues. If you have an intolerance triggered by a FODMAP, going on a supervised food elimination diet, or low FODMAP diet, can help you identify the foods behind the intolerance. This diet involves eliminating high FODMAP foods and then slowly reintroducing them to identify the triggers. To avoid malnutrition, you should only go on this diet with guidance from a gastroenterologist and a trained registered dietitian. These experts will guide you through the process of identifying foods you are intolerant to and help you modify your diet in the healthiest way possible.

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How Can I Tell the Difference Between Seasonal Allergies and COVID-19?

Updated on Jun 30, 2022 | Allergy, COVID-19, Your Health

Today, every sniffle, every cough, and every sneeze are a cause for concern. “Do I have COVID-19?” races through our minds. Madeleine R. Schaberg, MD, Director of Rhinology and Endoscopic Surgery, Mount Sinai Downtown, helps you tell the difference between allergies and COVID-19.

How do the symptoms of seasonal allergies differ from COVID-19?

The main symptoms of allergic rhinitis or seasonal allergies are itchy, watery eyes, runny nose, nasal congestion, and sneezing, while the symptoms of COVID-19 are fever, cough, body aches, sore throat, and shortness of breath. Many symptomatic patients with COVID-19 will have a fever which, in an adult, is a temperature above 99°F.

Other symptoms of seasonal allergies include post-nasal drip, facial pressure and sinus headaches, and mild fatigue. We generally do not see a significant amount of coughing with seasonal allergies, except in patients with significant post-nasal drip or allergy associated asthma. Sneezing is generally a prominent feature of seasonal allergies, but it has not been reported with COVID-19, although it may happen occasionally.

In general, the key differentiating factors between COVID-19 and allergies are fever and body aches (malaise). Typically, you do not see either symptom in allergy sufferers. While you may see some mild fatigue with allergies, the fatigue we are seeing with COVID-19 is more extreme.

Are there other symptoms that may indicate COVID-19?

Yes, in addition to cough and fever, many patients will experience a loss of smell (anosmia). We don’t typically see a loss of smell with seasonal allergies, unless patients have significant congestion of the nasal passages or have polyps blocking their nasal passages. The loss of smell that is associated with COVID-19 is thought to be due to direct damage to the olfactory nerve and specialized olfactory neuroepithelium.

It’s also worth noting that, for most people, COVID-19 is an acute illness. Patients will develop symptoms between 2 to 14 days after being exposed to the virus. Those symptoms will then last 10 to 14 days. Although symptoms may differ from person to person, they will appear in most people within the 14-day exposure window. This is true whether you have a moderate case or a severe case.

Allergies are more of a chronic issue. They will generally manifest as mild symptoms and last for the allergy season, which is typically from April to mid-June.  Compared to COVID-19, seasonal allergies, as well as allergies that occur perennially, have a much longer time course. In addition, patients will often be familiar with their typical seasonal allergy symptoms, as they often will be similar each spring.

What is the treatment for allergies?

For allergies, the first line of treatment is over-the-counter antihistamines. The main inflammatory mediator of seasonal allergies is histamine. This would include such medications as, cetirizine, loratadine, fexofenadine, and levocetirizine. There are also many over-the-counter steroid nasal sprays, which are extremely effective for allergy relief, such as budesonide, fluticasone, and triamcinolone.

If patients don’t get relief with over-the-counter medication, then an appointment with a rhinologist would be appropriate to explore possible prescription medication.

There are many prescription medications that can be extremely helpful.

I’m unsure if I am suffering from allergies or COVID-19. What should I do?

If you are experiencing mild symptoms that you are concerned may be COVID-19, there are a number of testing options available.

In-person testing is available at all Mount Sinai Urgent Care locations for walk-in or scheduled appointment.

You can also have your symptoms assessed virtually throughout Mount Sinai Urgent Care. Physicians are available for online consultations, video calls, and via text from your mobile device. Additionally, you can contact your Mount Sinai primary care physician or use Mount Sinai’s Express Online Consult Click4Care to receive virtual assessment of your symptoms.

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Will Using A Steroid-Based Nasal Spray Increase My COVID-19 Risk?

Updated on Jun 30, 2022 | Allergy, Cold and Flu, COVID-19, Ear Nose Throat, Health Hub, Your Health

The Centers for Disease Control and Prevention considers those who are actively being treated with high-dose corticosteroids to be immunocompromised. Most nasal sprays for allergies do not fall into this category. Consult your primary care physician regarding the specific medication you are taking.

Allergy sufferers are hyperaware of every cough, sneeze, and sniffle entering the height of this allergy season. Those with allergies are not only concerned with distinguishing their allergy symptoms from the novel coronavirus that causes COVID-19, but many are now worried that the medications they take to manage their symptoms might put them at increased risk.

Steroid-based nasal sprays have come under particular scrutiny because the active ingredient—corticosteroids—can reduce the strength of the body’s immune system, which is concerning during a pandemic. Fortunately, nasal spray users need not worry. Anthony Del Signore, MD, PharmD, Director of Rhinology and Endoscopic Skull Base Surgery at Mount Sinai Downtown-Union Square, explains why allergy sufferers should keep using their medications.

Should I stop using my steroid-based nasal spray?

If patients are getting the relief that they usually receive from taking these medications, I typically say to continue using them. Often, symptoms of nasal drainage, nasal obstruction, or sinus infections will increase if you come off of the medications.

It is also important to remember that with topical intranasal sprays, as well as topical nasal rinses with steroids in them, the absorption of the steroid is quite low. And, there is conflicting evidence as to whether or not steroids taken this way will actually cause any decreased defense against the virus.

A lot of the data and recommendations that we’re getting is for systemic steroids, which are steroids taken by mouth or administered intravenously. That’s where we are seeing the decrease in the immune system.

As a result, I am staying away from prescribing oral steroids for the time being. But topical nasal sprays, as well as topical rinses, I’m okay with.

I take an allergy pill. Are there steroids in my medication?

We do not typically give oral steroids to patients complaining about the typical symptoms of seasonal allergies. Instead, we recommend nasal rinses/netipot, oral antihistamines, and intranasal antihistamines as well as intranasal steroids, with pretty good effect and results.

Oral steroids are usually reserved for more serious conditions like asthma, lupus, or severe systemic allergic reactions. And, if you have a more serious condition that requires the use of these oral steroids, you have to weigh the risks and the benefits. I would counsel these patients to practice social distancing, good hygiene, and taking other precautions. These preventative measures can often tip the scale so that the benefits outweigh the risk of the steroids.

What should patients do if they are concerned that their medications will decrease their ability to fight off COVID-19?

There’s a lot of information out there, and patients may be having a tough time finding the right answers. If patients have any questions during these tumultuous times, they should consider setting up an in-person or telemedicine appointment to talk with their health care provider. After getting a global view of the patient and seeing what other risk factors they have, proper recommendations can be made that may at least help to put fears at ease at a time that’s very uncertain for many.

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August Allergies Fall Into Autumn

Updated on Jun 30, 2022 | Allergy, Your Health

A cold spring and wet summer can produce a ragweed season that wreaks havoc for many New Yorkers, says Anthony Del Signore, MD, PharmD, Assistant Professor, Otolaryngology and Director of Rhinology and Endoscopic Skull Base Surgery at Mount Sinai Downtown-Union Square.

Ragweed grows best in wet conditions, producing enough pollen to affect allergy sufferers when the weather turns warm and dry. Typically, the ragweed season begins in August, peaks in September, and can last until November. As summer winds down, and global temperatures continue to increase, pollen counts rise. Warmer temperatures in the autumn, which often persist well into the winter, present a host of issues for allergy sufferers as these conditions contribute to a lengthier ragweed season. The ragweed pollen grain is fine and light, allowing for easy dissemination by wind. Given its low weight, pollen has been known to remain airborne for many days and travel hundreds of miles. Elevated pollen counts are most visible on warm, windy days, and daytime hours when plants are in full bloom. Cool, rainy, wet days can provide some respite with low pollen counts.

Ragweed Allergy Symptoms Not everyone is a sufferer, but approximately 20 percent of the population can be sensitive to ragweed pollen. Symptoms include:

  • Inflammation of the nasal cavity, nasal lining, and structures within the nose, leading to difficulty breathing, pressure, pain, and congestion
  • Nasal drip
  • Runny nose
  • Itchy, watery eyes 
  • Scratchy throat

Some people can also experience difficulty breathing, asthma exacerbation, sinus infection, and cough. Ragweed allergies can also cross-react and cause itching, burning, and swelling in the mouth with certain foods, including bananas, melons, beans, potatoes, celery, and cucumbers.

Treatment for Ragweed Allergies

Treatment for ragweed allergies often begins with prevention and avoidance. Frequent household cleaning, changing linens, and washing bedding and clothes can minimize daily exposures. Nasal saline washes are extremely important to decrease pollen levels within the nasal cavity. Medications become an important part of surviving the season. Over-the-counter medications are often the first line of defense. Antihistamines, decongestants, and nasal steroid sprays are the most popular options. Staying ahead of the pollen levels is extremely important, so pre-treatment with antihistamines and nasal sprays may help. For those with persistent symptoms, prescription-strength oral medications and nasal sprays may be needed to control symptoms and provide relief. For those with an allergy verified through skin or blood testing, allergy shots or drops can be used to slowly help patients become immune to yearly symptoms.

When Allergy Sufferers Should See a Physician

Allergy sufferers should seek the care of a physician if symptoms persist for more than three months or the sufferer experiences; 

  • Worsening nasal obstruction
  • Nasal bleeding
  • Sinus infections
  • Watery nose 
  • An increase in asthma An allergist and ENT (ear, nose and throat) doctor can help provide relief.

Allergists can arrange for a testing of allergens, with either blood tests or skin-prick testing; provide advice on avoidance; and administer allergy shots. ENT doctors can help with persistent nasal obstruction, congestion that is not improving, or worsening symptoms by providing oral and nasal medications. More importantly, an ENT can help rule out structural abnormalities within the nasal cavity that may exacerbate symptoms.

Commonly seen issues include;

  • Nasal polyps that block the nasal airway
  • A deviated septum causing airway obstruction
  • Inferior turbinate hypertrophy, which can decrease the amount of space available for air to pass through in the nose.

Allergy sufferers should be clear to ask their doctor the following important questions:

  • What medications are best to control my symptoms?
  • Are there structural issues within my nose that may be leading to more symptoms than usual? 
  • Is the source of my nasal drip allergies or should I be concerned about something more?

During allergy season, sufferers should track pollen counts in their geographic area. Pollen.com, both a website and mobile app, tracks pollen counts year-round. In addition, it can alert sufferers as to which seasonal allergens are most important in certain geographic areas. For information regarding allergy symptoms and treatments, American Academy of Allergy Asthma and Immunology is an excellent resource.

Anthony Del Signore, MD, PharmD

Anthony Del Signore, MD, PharmD

Assistant Professor, Otolaryngology and Director of Rhinology and Endoscopic Skull Base Surgery at Mount Sinai Downtown-Union Square

Dr. Del Signore’s specific clinical interests include endoscopic minimally invasive management of chronic sinusitis, paranasal sinus and skull base tumors, cerebrospinal fluid leaks (CSF), and allergic disease. His current research is focused on health outcomes following skull base surgery and the implementation of sinus treatment protocols and surgical intervention.

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Is My Nasal Congestion Allergies?

May 24, 2017 | Allergy, Ask the Doc

Sometimes it’s hard to know if nasal congestion and sneezing are from an allergy or a cold. Many people have seasonal allergies or pet allergies, so they’re familiar with these symptoms and they usually know what’s causing them. In other cases, when people haven’t had severe allergies in the past, we usually start to consider allergies as a cause of congestion when the symptoms have lasted for over a week and haven’t responded to other types of treatment. If that’s the case, I’d ask the patient about things they may be exposed to, like a new pet in the house, for example. Or think about what might be flowering in that particular season that they might be reacting to, and recommend that they take an antihistamine on a trial basis to see if that helps their symptoms. If they’re still not getting better, and the symptoms have been lasting longer than a week, I’d recommend they see a doctor. Mount Sinai has urgent care centers in Manhattan and Brooklyn that are open every day, 365 days a year with extended hours, and you don’t need an appointment. So, just walk in and we’ll be happy to see you.

Judah Fierstein, MD is a board-certified emergency medicine physician at Mount Sinai Doctors, seeing patients in the Upper West Side, Brooklyn Heights, Dumbo, and Inwood. Trained in New York City, he is certified by the American Board of Emergency Medicine. He was awarded his medical degree from the Icahn School of Medicine at Mount Sinai, where he also completed his residency in Emergency Medicine. He is the Medical Director of Mount Sinai Doctors Urgent Care. Dr. Fierstein is fluent in Spanish.

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