What is grass allergy

Grass allergy occurs when your have an allergic reaction after being exposed to pollen from grasses (as well as trees, plants and some weeds) at certain times of the year. Allergy to grasses is very common. Grass allergies can present in a variety of ways, including nasal symptoms (runny nose, stuffiness, sneezing), asthma, and eye symptoms (itchy, watery/red eyes). People can also have skin rashes (hives or skin welts) after exposure to grasses, but this is much less common.

Allergies are the result of a hyperreactive immune system. Your immune system serves to protect your body against infections and other conditions. Allergies are caused by an abnormal immune response to substances that are not harmful. For instance, if you have an allergy to grass pollen, your immune system identifies pollen as an invader or allergen and produces antibodies against grass pollen called Immunoglobulin E (IgE).

An allergy to grass pollen, like all allergies, is a case of mistaken identity. Your immune system sees grass pollen as potentially dangerous invaders, and wages war against them. Pollen, and other things that trigger allergies, are called allergens. In people with pollen allergies, the immune system responds to pollen by sending antibodies to trap it. Once an antibody has intercepted an antigen, it alerts cells in the linings of your nose, throat, and roof of your mouth to release chemicals called histamines. Histamines are responsible for the itching, sneezing, and swelling you experience.

Grass allergies are common because grass pollen spreads when blown by the wind, which is different from pollen that gets moved around by insects, so you are more likely to breathe it in and thus develop symptoms. In most regions of the United States, grass usually pollinates in the late spring season (April through early June).

There are two large classes of grasses: northern and southern. Common northern grasses include Timothy, Kentucky Blue, Johnson, Rye and Fescue. Common southern grasses include Bermuda and Bahia. Many regions of the United States have a predominance of one or more types of these grasses.

Common grass species that cause grass allergy include:

• Annual blue/winter grass
• Bahia grass
• Bermuda or couch grass
• Canary grass
• Cocksfoot or orchard grass
• Johnson grass
• Kentucky blue or June grass
• Ryegrass
• Timothy grass.

Other plants that commonly cause allergies include pellitory weed (also known as asthma weed), Paterson’s curse, ragweed and parthenium weed.

Grass pollen levels vary dramatically depending on weather conditions. They can soar on a dry, hot, or windy day and plummet after a rainstorm. If you have hay fever, you may want to check your local pollen count daily here (https://www.pollen.com/).

The American Academy of Allergy and Immunology recommends these strategies for people with pollen allergies:

• Keep windows closed and turn on the air conditioning, both at home and in your car.
• Protect your eyes from pollen by wearing glasses or sunglasses when you’re outdoors.
• Wash your hands often.
• Do whatever you can to reduce other common allergens. Vacuum often to reduce dust mites; use a dehumidifier to reduce mold; have someone else groom your pets.

Grass allergy is a very manageable condition, regardless of your age. There are many treatments currently available. Many over-the-counter products are also available, but it is recommended you see an allergist for guidance. With careful evaluation and follow up with your allergist, you can have a very high quality of life and enjoy all your activities.

When am I at risk of grass allergy?

You are more at risk of a grass allergy during the time of year when grasses are producing pollen. In most regions of the United States, grass usually pollinates in the late spring season (April through early June) and summer. But some grasses and weeds flower all year round.

There is more grass pollen in inland areas. It can be hard to avoid exposure to pollen and some pollen seasons can last for months.

It may help to monitor pollen counts regularly here (https://www.pollen.com/). During days of high pollen counts, staying indoors can be helpful. Closing windows can also decrease pollen exposure. Taking showers after coming home following outdoor exposure may decrease pollen exposure accumulated while outside.

How can I prevent grass pollen allergy?

There are actions you can take to reduce allergic reactions to grass pollen:

• Limit your outdoor activities when pollen counts are high. You can monitor pollen counts regularly here (https://www.pollen.com/). This will lessen the amount of pollen allergen you inhale and reduce your symptoms.
• Keep windows closed during pollen season and use central air conditioning with a CERTIFIED asthma & allergy friendly® filter attachment. This applies to your home and to any vehicle (car, bus, train, etc.).
• Start taking allergy medicine before pollen season begins. Most allergy medicines work best when taken this way. This allows the medicine to prevent your body from releasing histamine and other chemicals that cause your symptoms.
• Bathe and shampoo your hair daily before going to bed. This will remove pollen from your hair and skin and keep it off your bedding.
• Wash bedding in hot, soapy water once a week.
• Wear sunglasses and a hat. This will help keep pollen out of your eyes and off your hair.
• Limit close contact with pets that spend a lot of time outdoors.
• Change and wash clothes worn during outdoor activities.
• Dry your clothes in a clothes dryer, not on an outdoor line.

Grass allergy symptoms

Grass allergy from pollen can cause hay fever and thunderstorm asthma, with symptoms that include:

• runny nose
• sneezing
• blocked nose
• itchy, watery or red eyes
• throat irritation
• wheezing and chest tightness
• breathing difficulty
• headache
• cough.

If breathing becomes extremely difficult, seek immediate medical help.

Allergic rhinitis includes nasal symptoms (hay fever) consisting of sneezing, nasal drainage (runny nose), nasal congestion (stuffy nose) and itchy nose. Facial pressure can also occur. Asthma symptoms include cough, wheezing, chest congestion, chest tightness and shortness of breath.

Allergic conjunctivitis (eye allergy) includes eye symptoms of itchy, irritated, red and watery eyes. Rashes after exposure to grass usually are hives or welts. They are red, itchy and raised. Usually, actual contact with grass causes them. However, hives can also be caused by many other things, so it is important to talk with your allergist about your rash.

Grass allergy diagnosis

Diagnosis of grass allergy usually involves allergy testing. There are generally two types of allergy testing: skin prick testing and specific IgE testing (blood test). Allergy skin prick testing involves “pricking” grass extracts in a liquid form on the arms or back and waiting 10 to 15 minutes for an “itchy bump” to occur, indicating an allergy to grass. These tests should be ordered and performed by an allergist. A blood test involves a drawing blood and sending it to a laboratory to determine if you are specifically allergic to grass.

Skin Prick Test

In prick/scratch testing, a doctor places a small drop of the possible allergen on your skin. Then the nurse will lightly prick or scratch the spot with a needle through the drop. If you are allergic to the substance, you will develop redness, swelling and itching at the test site within 20 minutes. You may also see a wheal. A wheal is a raised, round area that looks like a hive. Usually, the larger the wheal, the more likely you are to be allergic to the allergen.

A positive Skin Prick Test to a particular pollen allergen does not necessarily mean that a person has an allergy. Health care providers must compare the skin test results with the time and place of a person’s symptoms to see if they match.

Specific IgE Blood Test

Blood tests are helpful when people have a skin condition or are taking medicines that interfere with skin testing. They may also be used in children who may not tolerate skin testing. Your doctor will take a blood sample and send it to a laboratory. The lab adds the allergen to your blood sample. Then they measure the amount of antibodies your blood produces to attack the allergens. This test is called Specific IgE (sIgE) Blood Testing. (This was previously and commonly referred to as RAST or ImmunoCAP testing.) As with skin testing, a positive blood test to an allergen does not necessarily mean that an allergen caused your symptoms.

Grass allergy treatment

You can also talk to your pharmacist or doctor about medications.

• Antihistamines (tablets or syrup) help stop sneezing, itchy eyes and other symptoms.
• Corticosteroid nasal sprays reduce inflammation.
• Decongestants (nasal sprays or tablets) unblock your nose but have side effects such as tremors, sleeping problems, anxiety and increased blood pressure.
• Salt water nasal sprays or rinses can reduce inflammation.

If you are prone to thunderstorm asthma, you may need to take asthma medication as a precaution in spring, the first time that you notice ‘wheezy’ breathing or coughing.

Some people benefit from immunotherapy treatment, which exposes you to small doses of allergens to help stop your allergic reaction. It takes a while to work, and needs to be undertaken with the help of an allergy specialist.

Preventing grass allergy

There are many things you can do to reduce the chance that you experience grass allergy symptoms. Where possible, try to:

• stay indoors until after midday, particularly in the pollen season and on windy days
• avoid going out before or during thunderstorms, particularly when pollen counts are high; see also information on thunderstorm asthma
• wear sunglasses to protect your eyes
• don’t mow the lawn, and stay inside while it’s being mown
• check your garden for plants that might bring on allergic reactions, and consider planting a low-allergy garden
• keep your windows closed at home and in the car
• if you use air conditioning in the car, put it on recirculate rather than fresh air
• try to have holidays by the beach, where the sea breeze keeps pollen down, or avoid holidays in pollen season
• shower when you get home and run water over your eyes.

Saline nasal sprays and rinses

Nasal saline sprays are available over-the-counter and involve spraying saline, or salt water, in your nostrils. Nasal saline rinses involve filling a bottle with water, putting a modified salt packet in the bottle, mixing it and rinsing out your nose. Although easy to use, the rinsing process may seem unusual at first and may take a little getting used to. Saline sinus rinses can bring relief to patients with chronic sinus or rhinitis problems without the use of medication.

It is important to make sure the water you use is purified in some way. You can use bottled water or distilled water. When you do the rinse, usually the salt water goes in one nostril and out the other. Nasal saline therapies can moisten dry nasal passages and can help with nasal symptoms due to grass allergies.

Saline Rinse Recipe

Ingredients

1. Pickling or canning salt-containing no iodide, anti-caking agents or preservatives (these can be irritating to the nasal lining)
2. Baking soda
3. 8 ounces (1 cup) of lukewarm distilled or boiled water

In a clean container, mix 3 teaspoons of iodide-free salt with 1 teaspoon of baking soda and store in a small airtight container. Add 1 teaspoon of the mixture to 8 ounces (1 cup) of lukewarm distilled or boiled water.

Use less dry ingredients to make a weaker solution if burning or stinging is experienced. For children, use a half-teaspoon with 4 ounces of water.

Using a soft rubber ear bulb syringe, infant nasal bulb or a commercial nasal saline rinse product from your drug store, use the rinse by following these steps:

1. Draw up saline into the bulb. Tilt your head downward over a sink (or in the shower) and rotate to the left. Squeeze approximately 4 ounces of solution gently into the right (top) nostril. Breathe normally through your mouth. In a few seconds the solution should come out through your left nostril. Rotate your head and repeat the process on the left side.
2. Adjust your head position as needed so the solution does not go down the back of your throat or into your ears.
3. Blow your nose very gently to prevent the solution from going into your ear and causing discomfort.
4. After using the rinse, you may continue using your prescribed nasal medications as normal. You may notice that they work better.

Do not use sinus rinses if your nasal passageway is severely blocked. As with any medical product, be sure to speak to your doctor about using sinus rinses and stop using if you experience pain, nosebleeds or other problems.

Grass allergy medicine

Nasal steroid sprays

Nasal steroid sprays are anti-inflammatory medications that are sprayed in the nostrils. The steroids used to treat allergies are different than other types of steroids, such as testosterone and estrogen. Even though some nasal steroid sprays are available over-the-counter, it would be advisable to see an allergist first. Prescription corticosteroid nasal sprays such as mometasone furoate (Nasonex) and fluticasone propionate (Flonase) may be a little more effective. They control symptoms by reducing inflammation. When used properly and in conjunction with an allergy physician, steroids are safe. Steroids have some potential side effects including irritating the nose, headaches and causing nasal bleeds. Using nasal saline a few minutes prior to the nasal steroid sprays can potentially prevent this nasal irritation and can also further help your nasal symptoms. It is recommended that you bring all nasal sprays you are using (they come in various forms) to your allergist.

Nasal Antihistamines

Nasal antihistamines are nasal sprays that have antihistamines. Antihistamines are different from steroids, and usually work quite quickly to bring relief of symptoms. Nasal sprays containing cromolyn sodium can prevent mast cells from releasing histamines. Some people note a bitter taste with nasal antihistamines. As with any medications, they have other potential side effects so one must discuss them with an allergist prior to use.

Oral antihistamines

Oral antihistamines are pills that can help with allergy symptoms. Over-the-counter antihistamines like cetirizine (Zyrtec), fexofenadine (Allegra), and loratadine (Alavert, Claritin) relieve symptoms by blocking histamines. They can help the nasal drainage and sneezing symptoms. However, they usually do not help nasal congestion, as nasal steroid sprays can. It is better to use the newer non-sedating antihistamines, as these are better tolerated. But drugstore remedies often don’t do the job for people with severe allergies. There are potential side effects, including increased sleepiness or sedation during the day, increased dryness and difficulty urinating. Recently, there has been a potential association between older adult patients and dementia (decreasing memory) with these agents.

Oral Steroids and Steroid Injections

Systemic steroids (steroid pills or injections) are used at times if allergy symptoms are very severe. Steroid pills and steroid injections (shots) are much stronger than topical steroids and can therefore cause more side effects (including weight gain, high blood pressure and bone problems). If used, they should only be used cautiously under the guidance of your allergist.

Grass allergy immunotherapy

Allergy immunotherapy is a treatment that aims to correct or “cure” this abnormal immune response. It involves regular administration of the allergenic substance by injecting it subcutaneously into the arm, which is also known as ‘shots’ or subcutaneous immunotherapy or as a solution or tablet underneath the tongue. Sublingual immunotherapy is the medical term for delivering the allergic substance underneath the tongue. In the United States, the only FDA-approved forms of sublingual immunotherapy are allergy tablets.

The allergy tablets work by “teaching” your immune system that grass pollen isn’t a threat. They do this by delivering harmless doses of pollen to the tissues lining your mouth. From there the allergens pass into your bloodstream. You take the first tablet in a doctor’s office in case tablet triggers a serious allergic reaction. If there are no alarming side effects, you can then take the medication at home.

The FDA has approved two tablets for grass-pollen allergy. Grastek contains an extract of Timothy grass pollen. It is meant to be taken every day, year-round. Oralair contains a mixture of pollens from Kentucky blue grass, orchard grass, perennial rye, sweet vernal, and Timothy grass. Grastek should be taken daily for about six months, beginning four months before allergy season gets underway. People who take either tablet are also given an automatic epinephrine injector (EpiPen) to use if they have a life-threatening allergic reaction.

Both forms of allergy immunotherapy—the shots and the tablets—are prescribed by allergist / immunologists. An allergist / immunologist, often referred to as an allergist, has specialized training and experience to determine which allergens are causing your symptoms and can discuss if allergy immunotherapy is right for you.

Allergen Immunotherapy (Allergy Injections or Allergy Shots)

Allergy shots (giving injections of small doses of what you are allergic to under the skin in the arms to desensitize your immune system to grass pollen effects) are currently approved for the treatment of asthma, hay fever and eye allergies due to grass pollen. Allergy shots, the original immunotherapy, have been used to treat allergies for more than a century. Allergy shots are not the same as steroid shots or steroid injections. Allergy shots should be performed in the office under the supervision of an allergist as there is the potential of allergic reactions to them.

Allergy injections not only relieve symptoms but can also prevent new allergies from developing. As an added bonus, children who get the full course of allergy shots are less likely to develop asthma.

If you decide to get allergy shots, you’ll need to pencil in a number of trips to the doctor’s office on your calendar. As is the case for the tablets, allergy shots require skin or blood tests to determine what substances you’re allergic to. Then a lab will create injectable solutions containing low doses of those allergens. At the beginning, you’ll have one or two injections a week, each time with a slightly higher concentration of allergens. Once an effective dose is reached—usually after three to six months—you’ll need monthly shots for three to five years.

This schedule is a deterrent for many people. According to the American Academy of Allergy and Immunology, only a third of people who could benefit from allergy shots have them, and three-fourths of people who start having shots drop out before they finish treatment. A new procedure, which involves injecting allergens directly into the lymph nodes is being tested in clinical trials. If successful, the treatment would require only three or four shots a year.

Sublingual Immunotherapy

Sublingual immunotherapy has the same concept as allergy shots, but instead of shots, it involves placing a dissolving tablet, containing grass pollen, under the tongue on a daily basis. Generally, allergic reactions can occur to sublingual immunotherapy, but they are more rare than reactions to allergy shots. After initial doses in the allergist’s office, sublingual immunotherapy can be used at home, under the guidance of the allergist. Sublingual immunotherapy is currently approved for grass allergy treatment in the United States and Canada.

How do allergy tablets work?

Allergy immunotherapy, whether it’s the shots or the tablets, works much like a vaccine. Your body responds to the added amounts of a particular allergen given, eventually developing a resistance and immune tolerance to it. Allergy tablets can lead to decreased, minimal or no allergy symptoms with symptom relief for years after treatment is completed.

Allergy tablets administer the allergen in a tablet form under the tongue, generally on a daily basis. They are currently available in the United States for dust mite, grass pollen and/or short ragweed pollen induced allergies.

In clinical studies, during treatment for one ragweed or grass pollen season, patients who received allergy tablets experienced significant improvement in their allergy symptoms, required less allergy medications and in general reported a better quality of life in the first treatment season. These improvements were even better in the second and third treatment year. During dust mite tablet studies, patients demonstrated improvement during the first treatment year.

If you aren’t responding to allergy immunotherapy, it may be because you have other allergies in addition to dust mites, grass and ragweed. Other reasons could be that there are high levels of the allergen in your environment or major exposures to non-allergic triggers like tobacco smoke are present.

What is the length of treatment?

The grass and ragweed tablets are typically started four months before the start of the featured pollen season and continued throughout the season. Dust mite tablets may be started any time during the year and are taken year-round. Tablets are similar to allergy shots in terms of the effectiveness of controlling allergy symptoms, and both have been shown to provide long term improvement even after the treatment has ended.

The first dose is taken at the healthcare provider’s office, where the patient is to be observed for at least 30 minutes for potential adverse reactions. Future dosages can be administered at home, making the dosage schedule more convenient than allergy shots.

Who can Be treated with allergy tablets?

Grass allergy tablets are currently approved for ages 10 through 65. Ragweed and dust mite tablets are currently approved for ages 18 to 65.

Allergy immunotherapy is not started on patients who are pregnant but can be continued on patients who become pregnant while receiving it. In some patients with other medical conditions or who take certain common medications, allergy tablets may be more risky. It is important to mention other medications you take to your allergist.

What are the possible side effects?

Allergy tablets have a more favorable safety profile than allergy shots, which is why it does not need to be given in a medical setting after the first dose. However, the FDA-approved product information for the four tablets available in the United States includes a warning about the possibility of severe allergic reactions, including anaphylaxis, from the tablets.

That is why the preferred location for receiving your first dose is your prescribing allergist’s office. Initial treatments may also be given at another facility where the physician and staff are trained to recognize and treat reactions or have received instructions by your prescribing allergist.

The primary side effects of allergy tablets are local reactions such as itching or burning of the mouth or lips and less commonly, gastrointestinal symptoms. These reactions usually stop after a few days or a week. An epinephrine autoinjector should also be prescribed to patients receiving allergy tablets in the event that a severe allergic reaction should occur at home.