When the wind picks up and the air is dry in winter, the juniper pollen blows around, giving us an early dose of cedar fever.
Typically cedar fever shows up around Christmas and peaks in January. This year, we're expected to have a more robust season because fall rains caused juniper trees to thrive. We should all hope for rains this winter to drench the juniper pollen and limit its ability to blow around.
"It's the dry, windy days that really are troublesome," says Dr. Chad Whited, an ear, nose and throat doctor with Austin ENT and St. David's Medical Center.
Whited suggests patients talk to their allergists or primary care doctors for some guidance on how to treat an allergen, but the best and first line of treatment is avoidance, he says.
That's easier to do if you're allergic to dogs or a food, but with pollen allergies, unless you're willing to move somewhere like Denver, he says, "there's no avoidance."
You can limit your exposure, though, by keeping your windows rolled up, avoiding outdoor activities, taking a shower before going to bed to wash off the pollen and changing sheets and pillows regularly.
You also can wash out your nose using a neti pot or similar device. Make sure you use distilled or filtered water to avoid introducing something else, such as an amoeba, into the nose.
Neti pots are homeopathic treatments that work; Whited says what doesn't work is eating local honey or eating juniper berries. Juniper berries will make you sick, and honey is related to flower pollen, not juniper pollen.
Also try to avoid bringing more allergens into the house, including mold. Whited recommends picking real Christmas trees to which you are not allergic. If you're using an artificial tree or other decorations, those can be covered with mold. Rinse them off, shake them out and leave them outside to dry before bringing them into the house.
When it comes to medications, Whited likes to start with a nasal steroid such as Flonase. Spray it in your nose to coat it, but avoid sniffing it in. You want it to stay in the nose and not get washed down the throat, he says.
All nasal steroids are basically the same except for their carrier ingredient, he says; if you've tried one and had a bad reaction, try another one first before dismissing the entire class of medication.
Nasal steroids don't work right away. You need to start them before allergy season symptoms hit, and you have to use them daily.
If those don't work, the next step is over-the-counter antihistamines such as Claritin, Zyrtec and Allegra. They are basically the same except Zyrtec works faster, usually in about an hour verses one to three hours, and it can cause more drowsiness, but not as much as Benadryl, which some people use as a sleep aid, though that's not encouraged.
If one doesn't work, try a different antihistamine, but if it's working, stick with it. Some people have been told to switch out antihistamines so the body doesn't get used to that particular one, but that's not necessary, Whited says.
These antihistamines last about 24 hours, and you should take them in the morning for the most impact.
If you have severe eye symptoms, try over-the-counter steroid eye drops to help.
If none of the over-the-counter stuff is working, the next step is seeing a doctor, such as an ENT, pulmonologist or allergist. That doctor will explore allergy testing to see what your allergies are and what level of allergic reaction you have. You are likely to be prescribed allergy shots or drops. "They are both equally effective," Whited says.
The advantage of drops is that you can do them at home or when you travel; disadvantages include having to take them every day instead of once a week and they are not always covered by insurance.
Shots and drops take three to six months to start reducing sensitivity to an allergen, but often you have a benefit that lasts a few years. It's not a complete fix, though. You will have to restart the shots or drops.
Some people cannot use shots or drops such as people with heart conditions or certain levels of reaction to the allergen.
What if you need help now and can't wait three to six months for shots or drops to work? Doctors can prescribe short-term steroid therapy. You have to weigh the benefits with the side effects, which can include mood swings, increased appetite, weight gain and elevated blood sugar.
Allergies can feel like having the flu or a severe cold, complete with body aches, but they typically don't cause a fever. Also allergies typically will respond to antihistamines, and they come with clear nasal discharge.
If you have a fever or yellow, green or another color of stuff coming out of your nose, it could be an infection. Then you really want to see a doctor.