Spring: Hello, allergies

Wheezing, sneezing, itchy eyes, nasal congestion, shortness of breath, hives… for many people, spring offers little relief. During this period of intense pollination, symptoms often worsen. Several seasonal allergies are typically involved, with allergic rhinitis, or hay fever, being among the most prevalent.

“Hay fever affects around 30 percent of the population, a rate comparable to that observed in Europe,” explains Professor Carla Irani, president of the Lebanese Society of Allergy and Immunology. “It affects the respiratory mucosa of the nose, sinuses and eyes, and is characterized by sneezing and itchiness in the mouth, ears and eyes,” she adds. “Seasonal allergens–particularly olive tree pollen and grass pollen, prevalent in Lebanon mainly in May and June, and again in September and October are the main triggers. Wall pellitory and dust mites, both of which persist throughout the year, as well as molds, particularly Aspergillus and Alternaria, can also contribute.”

Beyond these triggers, genetic predisposition also plays a role, interacting with environmental factors like pollution. “This is why allergies can appear at any age,” Professor Irani emphasizes.

“Once diagnosed through a skin prick test or a specific blood test, hay fever can be treated primarily with saline sprays to help clear inhaled allergens and pollutants, as well as second-generation antihistamines (intranasal corticosteroids), which do not cause drowsiness,” she points out. “In many cases, it can even be cured through immunotherapy, which targets the pollen responsible for the allergy and helps the immune system become more tolerant.”

Allergic asthma

Even when treated, allergic rhinitis can lead to chronic sinusitis, sometimes associated with nasal polyps, with a major complication: loss of smell. It can also cause allergic conjunctivitis, which carries its own risks. “In 40 percent of cases, it can progress to allergic asthma, a far more complex and inflammatory condition characterized by cough, shortness of breath, and wheezing,” Professor Irani reports. In Lebanon, an estimated 7 to 9 percent of the population is affected.

Respiratory allergies are complex. “Unlike food allergies–where avoiding the triggering leads to recovery–patients with allergic rhinitis or asthma remain exposed to the allergen,” the specialist notes. “Inflammation can persist even when the individual is not in that environment. For this reason, it is crucial to follow treatment carefully to prevent the allergy from developing into a year-round condition.”

Treatment for asthma typically involves inhaled corticosteroids and long-acting beta-agonists (maintenance inhalers). “Relying solely on short-acting beta-agonists (quick-relief inhalers) is not recommended, as they can mask underlying inflammation and worsen asthma over time,” Professor Irani warns. “Treatment may also include antileukotrienes, which reduce airway inflammation. In severe cases, biologic therapies, including monoclonal antibodies, have proven highly effective in preventing exacerbations, ER visits, and hospitalizations, while also improving patients’ quality of life.”

Starting treatment about ten days before the pollen season begins can help prevent severe episodes of allergic rhinitis or asthma. “This approach can help reduce the need for higher doses of medication if symptoms worsen,” Professor Irani explains. “Asthma, however, is more complex; in some cases, patients may need to continue a low-dose maintenance treatment even outside the pollen season.”

Cross-reactive allergies

In addition to respiratory conditions, spring allergies can also trigger less well-known reactions. Cross-reactive allergies, or oral allergy syndrome, are common during this season, particularly among people with food allergies–affecting around 3 percent of adults and 5 to 7 percent of children. Symptoms typically include itchiness in the throat and mouth, sometimes accompanied by swelling of the lips. “In these cases, the immune system reacts to the same proteins found in both pollen and certain fruits, such as peaches, plums, green almonds and other pitted fruits,” Professor Irani notes. Treatment is straightforward: avoiding the offending food.

Urticaria

Spring can also exacerbate urticaria, which affects nearly 20 percent of the global population, according to the World Health Organization. It occurs in two forms: acute and chronic. The symptoms are identical in both types: itchy, raised or skin-colored welts that appear suddenly, ranging from small spots to large patches.

“The persistence of the outbreaks enables us to make the distinction between the two forms,” Professor Irani clarifies. In the acute form, outbreaks typically last up to six weeks, while in the chronic form they can persist for several months.

Acute urticaria can be triggered by a food, a medication, a vaccine, or an insect bite. However, it often follows a mild viral infection of the upper respiratory tract or the digestive system. “Chronic spontaneous urticaria is more complex, as the immune system plays a central role in this form of the condition,” Professor Irani notes. “It can also be associated with other autoimmune diseases, such as thyroiditis, lupus, or certain rheumatic conditions. Stress may be an aggravating factor, but it is not a cause of the disease.”

Until recently, treatment relied primarily on cortisone, which can pose significant risks, especially in Lebanon, where self-medication is widespread. “Patients often take high doses without medical supervision, unaware of the potential dangers,” the specialist warns. “Beyond weight gain, long-term use without medical control can lead to serious complications, including diabetes, cataracts, and osteoporosis.”

According to the latest guidelines, urticaria treatment now includes antihistamines and anti-IgE, a new class of medication that has proven effective in patients.

In conclusion, studies show that people living in rural areas or on farms are less likely to develop allergies than those in industrialized environments, highlighting the influence of lifestyle and environment on immune development.