Why are my allergies getting worse?
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This is a CBC Podcast. Hi, I'm Dr. Brian Goldman. Welcome to The Dose. Well, it feels like seasonal allergies get worse every year. And I have to tell you, my itchy eyes this season feel itchier. And I've gone from two sneezes to five or more, which is apoplexy-inducing.

And I'm taking a lot more antihistamines. So this week we are asking, why are my allergies getting worse? Hi, Anne. Welcome back to The Dose. Hi, Brian. It's nice to be here. Nice to be talking to you, too. Are you a fellow sufferer? I am indeed. So I have empathy. You have empathy and I hope you have remedies, which is why we're talking to you. But before we begin, can you give us a hi, my name is, tell us what you do and where you do it.

Hi, I'm Dr. Anne Ellis, and I'm chair of the Division of Allergy and Immunology at Queen's University in Kingston, Ontario. So how bad has this year's allergy season been thus far? Honestly, Brian, we're just getting started. We've had a lot of starts and stops. We've had one or two nice warm days where you think, that's it, here it is, and yes, I'm sneezing. And then look at

that, it's minus two in the morning or cold enough that it shuts everything down or it's raining. This past weekend has finally brought, I think, I predict, once I look at my pollen counts a couple days from now, the official start to the tree pollen season in a real robust way, at least in Kingston, Ontario.

We're talking about this season's allergies, but we're also talking in more general terms. Are seasonal allergies actually getting worse? Generally speaking, there have been some couple of years in the past few years where

We've had a lot more pollen than we're used to seeing. It doesn't seem to be consistent. It's a bit annoying because it's harder to make better forecasts. But definitely last year's birch pollen season, and it looks like this year is going to be a doozy as well, has certainly been higher than we've seen in the past 10 years, for example.

So what makes it a doozy? How do you measure a doozy? So it's when you go from zero to 100 or more grains per cubic meter per meter in a couple of days, and it lasts. And we've had that now for two years in a row, where it's been very cold winters, and then very slow to consistently warm up in a way that really gives that right, nice signal to the trees that they should be doing something.

And when it gets warm late, and that's what leads to those really booming pollen seasons like we've had for the past few years. Are more people experiencing seasonal allergies now than say 10 or 20 years ago? If you go back to 20 years, absolutely.

We've seen a fairly impressive rise in allergies generally in Canada over the past 40 to 50 years. It plateaued about 10 years ago. So it's not that we have any more people suffering from allergies, probably they're just noticing it more because we have had a little bit more robust seasons and more of an

overlap in the spring. Like I said, we used to have a little bit more gradual lead into springtime pollen seasons. Now they start late and they start with a whopper and you get both tree and grass pollen at the same time. That's been very consistent over the past 10 years. So that could be why it seems like more people are suffering from allergies. We're not getting that separation between tree sufferers and grass sufferers. They're all getting it all at the same time.

And I gather that for people who are allergic to more than one type of pollen, these overlapping seasons are going to result in a much more prolonged season of allergic symptoms. Yeah.

Yeah, it ends up being overall a longer season and a bit of a double whammy, if you will, because you don't get a break in between the two types of pollens that can be triggering symptoms. It makes the springtime the hardest of all, I'd say, for allergy sufferers. Let's talk about some of the reasons. What does climate change have to do with seasonal allergies? Climate change has led to this shift in when we get spring and

and how we get spring. The fact that there is been a delay fairly consistently now in when we shift from winter to spring and spring to summer and that spring to summer shift has gotten much shorter as well, as you've probably noticed yourself.

And it just means that it changes how trees pollinate. It changes when the seasons start and stop and leads to things being different than they were 20 years ago, for sure. And does a longer growing season mean that we're going to have higher pollen counts? Absolutely. Not so much like you spread it out over the entire duration of the season. You get one or the other. Either it's short and intense or it's long and drawn out. So either way, it all leads to more symptoms.

How long does allergy season typically last these days? If you're living in Ontario and you have tree, grass and ragweed, which are the common warm weather suffering, triggering things, tree pollen season starts usually now, 1st of May, goes through to mid to late June.

late may early june is when grass pollen starts and that goes through to mid to late july you have a bit of a reprieve in the middle of the summer before ragweed starts up almost like clockwork on august 15th and goes through to the first frost in the end of the fall those of you who are listening in the western provinces have the advantage of no ragweed but you have a longer tree season it started a long time ago compared to those folks in ontario and quebec for

for example. So pretty much from the minute it gets warm and not snowing to when the snow falls is when we see that pollens are causing problems for people with allergies. So if pollen allergies don't usually kick in until later in spring, why do some people start experiencing allergic symptoms around late March? That's typically from what we call snow mold. So when the snow melts but nothing's growing yet and you look at your lawn and you see those areas of dead brown grass,

That dead brown grass has been caused by snow mold that proliferated over the winter while it was covered in snow. And those spores get released as soon as there's no longer any snow on the ground to cover them up.

So that can certainly trigger symptoms for those people who are allergic to mold. And also in March, when we're having less actual snow or slush on the roads and you get all that dried salt and sand from the winter, that gets stirred up. It can certainly cause a lot of irritant type reactions that feel like allergies, but are really just direct irritation to your nose and eyes, etc. Roughly what percentage of patients will be allergic both to mold and

and to pollens? So we don't have great data on how many people are allergic to what specific things. We do know that 25 to probably 30% of Canadians suffer from allergic rhinitis or hay fever. And the majority of people who are allergic to one thing are at least allergic to one other thing, or we call them polysensitized. So 70 to 80% of people will be allergic to more than one thing if you were to skin test them.

What parts of Canada do we typically see the worst allergy seasons? Good old Quebec and Ontario, because we have nice, robust summers with lots of trees and lots of pollen. But importantly, also ragweed come late summer, early fall. We tend to get

the biggest hits in terms of seasonal allergies across the country, although the entire country is affected just in slightly different times and in slightly different ways. I mentioned climate change. Is that the only factor increasing the duration and severity of allergy season for the people who suffer from it?

I think there's also been some evidence showing that CO2 concentrations can make pollen more allergenic and also more robust, more likely to hang around, if you will. And plants will create more pollen under higher CO2 concentrations. So that's an important consideration. The

The other thing is the way in which we're planting trees now. We're planting more male trees that are the ones that create pollen as opposed to female trees, which are the ones that bear fruit. Because the ones that bear fruit make a bigger mess. So city planners like male trees better, which means they're planting more pollinating trees. So we're getting more allergen in the air because of some of those city planning decisions in Urdu.

urban areas. So that means the people who live in cities may have more severe allergic symptoms simply because of the trees that are being planted in the city. Yeah, they're not getting away from it just because there's less grass. Hi, everyone. I'm David Duchovny.

Join me on my podcast, Fail Better, where we use failure as a lens to reflect on the past and analyze the current moment. I speak with makers and performers like Rob Lowe, Rosie O'Donnell, and Kenya Barris, as well as thinkers like Kara Swisher and Nate Silver, to understand how both personal setbacks and larger forces impact our world. Listen to Fail Better wherever you get your podcasts.

We can't change the climate. We can, I guess, change the kinds of trees that we have in cities, but how do we help people cope with raging allergy symptoms? Well, we always say if you can avoid your allergen, that's optimal because if you don't come into contact, you won't have symptoms. However, when it comes to springtime allergies driven by pollen, it's hard to not go outdoors. There are some things you can do though. So keeping your window shut,

using air conditioning and filters on your furnace, for example, but also things like not hanging your clothes out to dry so they're not getting covered in pollen. That's something that we recommend. Again, washing your clothes right after you come in from outside, those sorts of things. But ultimately, people will turn to either their pharmacy or their physician to look for some of the therapies we have, which are safe and effective.

fortunately. So non-stimulating antihistamines, nasal critical steroid sprays, and we'll get into talking about immunotherapy, I'm sure, but at least we have lots of effective therapies that you can get either from your pharmacy or a prescription from your doctor.

It's possible to make a decision to stay indoors on days when there is high pollen count. Am I right? Yes, it is a possibility. Yeah. How do you do that? Where do you where do you get that kind of information? So in terms of looking to find out, is it a high pollen day? So your clues just from looking out your window are, is it sunny and is it windy? Those are the best indicators that there's probably lots of pollen in the air.

Otherwise, you could, in theory, turn to the Weather Network or other channels like that. Unfortunately, they are no longer using data on pollen counts from Aerobiology, which is a company that actually counts the pollen at major centers all across the country. They have turned to AI to base the pollen counts on historical pollen counts.

which may or may not be accurate for the day in which you're living in. So things to look for are, is it raining? Is it not windy? Those are likely your best days to go outside because there's less likely to have high pollen in the air when the rain is holding it down where it belongs and it's not windy, which is not blowing it around.

Is there value in using face masks if you are going to go out on a day with a high pollen count? And if so, what kind of face mask? Yeah, so this is an interesting finding that came out during the pandemic, actually, and people were wearing masks outside for the first time ever. We did realize that if you were wearing those medical grade masks, like we asked you to wear when you came into the hospital, for example, they did block the inhalation of pollen and other sort of particles, which makes sense. But it really did help rejuvenate

reduce the amount of pollen that you breathe in. So that is a reasonable way to minimize your pollen exposure on an outdoor day. All right, let's talk about medications. Let's talk about antihistamines because they're ubiquitous. They're easy to obtain. Which ones do you recommend?

You definitely want to look for ones that say non-sedating antihistamines. Once a day is a good clue that it's a non-sedating antihistamine. The older sedating antihistamines like Benadryl that people are familiar with, unfortunately, we have realized for many years and increasingly we're able to get that message through to the public that these are really not safe antihistamines to use. And they're not all

all that effective. The side effects, the data profile is an issue with those older antihistamines. They don't work as well for allergic rhinitis anyway. They wear off fast. So it's much better to use the non-stating antihistamines like cetarazine, does loratadine, loratadine, fexofendine. But essentially, ask your pharmacist for which ones of these are second generation or non-stating antihistamines. Those are the safe and effective options you want to choose from.

And are these all over the counter or are there prescribed non-sedating antihistamines as well? Yeah, we have.

Three different non-sedating anti-histamines that can be prescribed by your physician, Rupal or Rupatadine, Blextin or Belastine. And there's a high dose of Reactin or Cetirizine that can be covered by a drum plan if you're fortunate enough to have one. You mentioned corticosteroid nasal sprays. What can you tell us about those? Just to first and foremost, make sure that people are aware that those nasal sprays are not designed to work instantly. They are meant to be used on a regular basis throughout the season to provide your maximal benefits.

They are safe. They are steroids, but they're low-dose steroids that don't get past the nose. So it's not like some of the side effects you may have heard of from steroids generally, but they are very effective in reducing nasal congestion in particular, which you may not find antihistamines do the trick for you to do.

And when used properly, they're very safe. And especially if you use, you can use them throughout the entire season without difficulty. And I have patients who have year-round allergies who use these nasal sprays all year round without any issues. So the key is to just make sure that you're, one, pointing that device towards your ear when you're spraying that into your nose. Don't put it up and down or worse, don't put it to the middle of your nose. Because then, one, the medication isn't getting where it needs to go. Two, you're more likely to have side effects like nosebleeds, nasal dryness and headaches.

So when you put the pointer in, angle it towards your ear and then spray down to get the delivery of the nasal steroid spray that's in it.

Are there any risks in using antihistamines or nasal sprays on a long-term continuous basis? If you're using those second generation newer antihistamines, like I mentioned, or the nasal steroid sprays as you're using them as prescribed, there are no significant risks to long-term use. That's not the case of those older sedating antihistamines, though, that have been described to have some fairly impressive side effects and long-term consequences if used regularly on a long-term basis.

Such as? Antihistamines like diphenhydramine, which is what's in Benadryl, has been associated with dementia when used long-term. And certainly we know if the elderly use those first-generation sedating antihistamines can cause delirium and cognitive difficulties.

So again, when we have these safer, newer options, particularly when things like RuPaul and Blexton are available by prescription, we have so many better, safer, effective ways to treat allergies than those older sedating antihistamines. If you take one of those non-sedating antihistamines every day for, say, 5 or 10 or 15 years, will that have any effect on your immune system and your ability to respond to allergies?

Certainly, medications like an antihistamine don't lose their effectiveness just because you use them day in and day out for years and years on end. Sometimes patients have reported to me that they feel like it's not working anymore. Chances are good that means you need to move on to something beyond an antihistamine. But certainly, it's safe to take an antihistamine on a daily basis all the way through the year if you need to.

When I was a child, I had a seasonal cough every September and I ended up having allergy shots as a kid. How effective are they?

Old school allergy shots, very effective. The downside is, of course, as you know, Brian, they require an injection and they require weekly visits to the doctor's office. But for the treatment of environmental allergies of any kind, very effective. Basically, we retrain your immune system to ignore the things you're allergic to rather than continuing to have allergic reactions to them.

So the way in which we used to do this for everyone was a series of weekly injections or buildup over the course of six months, followed by monthly injections thereafter for usually a typical course of five years to produce a long lasting change in your immune system. Now,

Now, however, we have sublingual immunotherapy tablets. So these are tablets that just dissolve under your tongue and are also specific to the things you're allergic to. So for you, Brian, I would guess if it was every fall, it was probably ragweed that was getting you. So you would take a tablet now starting in April every day through to the first frost, and then you'd stop and start that back up again the following spring. And that would very much improve your need for medications and symptoms you would experience during ragweed season.

in that September month. That's interesting. So are you finding that more patients are opting for tablets under the tongue instead of needles these days?

It's really improving access to immunotherapy and that disease modifying option because the tablets are much more palatable than weekly trips to the doctor's office for an injection. And it's really opened up the ability to really get definitive relief for allergy symptoms. So I definitely am prescribing much more immunotherapy in total.

But particularly, I'd say at least half of my practice has switched to tablets as opposed to injections. And are they approved for patients of all ages? Yes, that's the exciting thing. Just last week, the final one fell into place so that all the tablets we have in Canada that are available to treat birch, grass, ragweed and house dust mite are now approved for ages five and up. So accessible to essentially all ages. And how expensive are they?

The answer will depend on which province you're in and what kind of drug plan you have. The price per tablet, all in out of pocket cost, is approximately $5 a day. However, the company who makes this product does have a fairly generous patient support program if you need to have some of that covered. And also some of them are covered by some provincial formularies. So ask your specialist about all the various options to help get those covered.

But clearly, five bucks a tablet for half a year could be quite pricey for a lot of Canadians. There's no doubt that it could be for some Canadians. So again, always worth having a conversation about the various options that are there to try to help offset those costs.

And if you have an employee drug plan, then there's a good chance it's going to be covered? Yes, that's correct. What can you tell us about Zolair and its potential use in treating seasonal allergies? Zolair, the generic name is omalizumab, is a monoclonal antibody, which is what we call

refer to as a biologic therapy that targets IgE, which is an allergy antibody, if you will. So IgE is the antibody in our immune system that's responsible for all the allergic reactions that we experience. Zoller's been on the market for, believe it or not, 25 years now as a treatment for allergic asthma, been

been very effective in reducing exacerbations or reducing asthma attacks in patients who suffer from allergic asthma. But it also helps for regular routine allergies, not only allergic rhinitis, it's quote unquote not indicated for that, but definitely my patients who have allergic asthma and allergic rhinitis have noticed a huge improvement in their hay fever symptoms while they're on Zolair.

In the United States, it's also indicated for food allergy, which doesn't have that indication for it in Canada. But often people will ask me about that medication in the context of their food allergies. And so we have a bit of a discussion about that.

things that we can and can't expect from something like Zolair for allergies generally. But I certainly can tell you it's very helpful for patients with allergic asthma, and it does help allergic rhinitis. If you happen to have both, then it's easier to get access to a medication that's designed for asthma off the bat. Let's put it that way.

And you'd end up taking one injection prior to the allergy season? Oh, unfortunately, no, it doesn't work in that way. Zolair is a once a month injection, then you would take it year round. There is one study that was done giving it pre-seasonally for the so-called September spike of asthma in children. But unfortunately, it doesn't have that indication in Canada. So it would be hard to prescribe it that way.

I would gather that this would be a considerably more expensive medication than the tablets that you place under your tongue. That's correct. Yeah, it depends on the dose of Zolair is dependent upon your level of IgE in your blood and your weight, but ranges from $15,000 to $37,000 a year, depending on what your dose is. So definitely the tablets are a less expensive way to go if you're looking at something where you'd be paying out of pocket.

Boy, you know, for a topic that has been around for a long time, it seems as if there's a lot of exciting developments in the treatment of seasonal allergies. Let's hope that your research can go a long way to reducing the suffering of people like me with seasonal allergies. And Dr. Anne Ellis, I want to thank you for coming back on The Dose to talk about this broadly popular topic, especially nowadays. Pleasure as always. Thank you, Brian.

Dr. Anne Ellis is chair of the Division of Allergy and Immunology at Queen's University's Department of Medicine. Here's a dose of smart advice. Seasonal allergies are getting worse in Canada and around the world. That means longer allergy seasons and more severe symptoms. One reason is that climate change has led to warmer temperatures and longer growing seasons. These extend the time that pollen is in the air.

warmer temperatures throughout the year lead to an earlier start to allergy season. In addition, increased atmospheric carbon dioxide associated with climate change leads plants to produce more pollen as well as pollen that is more potent. We used to have distinct allergy seasons brought on by, for instance, pollens produced by trees, grass, and ragweed. Now, these distinct seasons tend to overlap, making it seem as if it's all one lengthy period of symptomatic misery.

Urban planning is another factor. City planners have long recommended planting pollen-producing trees rather than messier fruit-bearing trees, further contributing to higher pollen levels. The symptoms of seasonal allergy haven't changed, although they may be more severe. They include nasal congestion and post-nasal drip, sneezing, itchy eyes, nose and throat, fatigue, cough and wheezing.

allergies are affecting more people than ever. So much so that the World Health Organization has recognized seasonal allergies as a global health issue.

To minimize symptoms, stay indoors when symptoms are severe, such as when it's windy and rainy. Reduce your exposure to pollen by closing windows at home and in the car. If you must go outside on heavy pollen days, wear a hospital mask. Effective treatments include prescription and non-prescription antihistamines, nasal corticosteroids, and decongestants.

Allergy shots are a form of immune therapy in which you are given injections of pollen extract beginning with a small dose and gradually increasing over three to five years. The shots condition your immune system to make antibodies that block the production of other antibodies that trigger allergies. Immune therapy can also be taken in tablet form that is placed under the tongue once each day beginning before the pollen season and continuing until the season is concluded.

Omelizumab or Zolaire has shown promise in treating seasonal allergies, particularly seasonal allergic rhinitis or hay fever.

The downsides are that the medication is expensive and must be taken continuously to reduce allergy symptoms. If you have topics you'd like discussed or questions answered, our email address is thedoseatcbc.ca. If you liked this episode, please give us a rating and review wherever you get your podcasts. This edition of The Dose was produced by Samir Chhabra, our senior producer is Colleen Ross. The Dose wants you to be better informed about your health. If you're looking for medical advice, see your healthcare provider. I'm Dr. Brian Goldman. Until your next dose.

For more CBC Podcasts, go to cbc.ca slash podcasts.