Ah-choo! Insights on Seasonal Allergies from a Big Red Expert

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With allergy season gearing up in much of the U.S., Cornellians tapped Dr. Aaron Pearlman of Weill Cornell Medicine for some insights. Pearlman is an associate professor of clinical otorhinolaryngology–head and neck surgery—a field whose practitioners are more commonly known in lay circles as ear, nose, and throat (ENT) specialists.

Not necessarily more common, but different allergens are present in different places. For example, you may not have the same type of trees in the Southwest as in the Northeast, so pollen allergies can manifest geographically. Of course, some allergens—like dust, mold, and animals—are everywhere, and those allergies are not seasonal.

Are allergy seasons getting longer, perhaps due to climate change?

I haven’t seen a study that says that to be true. But anecdotally, it can be February here in New York, and we start to see the crocuses come up. So if trees bloom a week earlier than is traditional, your allergy season is starting a week earlier. And if the weather stays warmer in the fall and the weeds are still around and blooming, your allergy season is going to persist.

Are there practical things one can do to prevent symptoms?

If you’re allergic to pollen, you can keep your windows closed, and if you’re running the air conditioning, the air is being filtered. But, understandably, people want to be outside when the weather is warm—so a lot of it is about trying to manage symptoms.

Can allergies come on at any time of life, as opposed to just in childhood?

Absolutely. We think your allergy profile can change approximately every seven years. People develop new allergies that they didn’t have as children, or sometimes a childhood allergy stops—“burns out” is a term I like to use—where you’re not as reactive to something you were allergic to.

But what can also occur is that patients who are quite allergic as children go on to develop more persistent diseases, like chronic rhinosinusitis or recurrent acute sinusitis.

We think your allergy profile can change approximately every seven years.

What are those, in lay terms?

Chronic rhinosinusitis is an inflammation of your sinuses, which are the air-filled spaces around your nose; it creates persistent symptoms of congestion, mucus, obstruction, and pressure. In recurrent acute sinusitis, patients may get frequent colds—and at the end of them, they get worse instead of better, with symptoms of congestive mucus or pain and pressure.

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These two conditions are different, but there is data showing that kids who had significant allergies may be more likely to develop them in adulthood.

Have there been any recent advances in allergy treatment?

There have been some innovations in drug management, such as medications for specific allergens, like grass. Immunotherapy—building up your body’s innate immunity to allergens, so you stop being so reactive to them—has been around for many years, but there are now different ways of delivering it beyond the traditional allergy shots.

There are novel methods such as sublingual therapy, where you put the allergen under your tongue; that can be a nice option, because the patient can do it at home. And immunotherapy is being incorporated into things you do every day; a colleague [William Reisacher ’90, professor of otolaryngology] has developed a system where it’s delivered in toothpaste.

Can seasonal allergies be life threatening?

That would be very rare. Your response to seasonal allergens doesn’t typically move into the realm of anaphylaxis, where your whole body swells and you get short of breath; it’s more food allergies that typically do that.

But what’s really hard is how uncomfortable allergies are—and your quality of daily life is extremely important. I’ll have patients come to me saying they can’t breathe, they can’t sleep; they’re so stuffy, they can’t concentrate. Even moderate allergies can really impact your life in a negative way.

Even moderate allergies can really impact your life in a negative way.

Can switching up over-the-counter antihistamines help?

It can. Even though they’re all similar, there are differences in formulation. With the newer ones, they’ve tweaked the molecules to maybe have fewer side effects, like sleepiness. Patients may find that one they’ve taken for years no longer helps as much, and another works better for them.

Lastly, is there a particular misconception about allergies you’d like to clear up?

Patients often will come to me and say, “I have really bad allergies; I’m stuffy all the time.” And we’ll test them and can’t find any obvious allergens; they have some other chronic inflammatory condition of the nose or sinuses.

The reason why this matters is because many patients will treat themselves with over-the-counter allergy medicines for years—but we can provide better treatment for them by figuring out what other condition they actually have. We’re inundated with TV ads implying that all nasal congestion is allergic—but that’s obviously not the case.

Illustration by Caitlin Cook / Cornell University; photo provided.

Published March 23, 2023

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