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Take steps now to prepare for cedar fever season this winter

Nicole Villalpando
Austin American-Statesman
High winds in winter can blow a lot of pollen from Ashe juniper around, causing people with cedar fever to feel terrible.

Cedar fever is coming. Believe it or not, now is the time to start taking steps to lessen the symptoms you might be feeling in December and January. 

Cedar fever is an allergy to a pollen. It's not really cedar-related and doesn’t typically come with a fever. It’s triggered when the male Ashe juniper trees get really excited to spread their pollen to the female Ashe juniper trees. They let the wind spread their pollen to all their female Ashe juniper friends far and wide. (How do you tell a male Ashe juniper from a female? The female has berries on the branches. The male will be coated with yellowish brown pollen.)

Anyone who has been exposed to this Ashe juniper pollen over time might start feeling its effects.

Tell the difference between Texas cedar fever and COVID symptoms

"There's definitely some overlap," said Dr. Haley Overstreet of Aspire Allergy & Sinus. She has treated patients who thought it was just their allergies, including cedar fever last season, and it turned out to be COVID-19. 

Both allergies and COVID-19 can have nasal congestion, runny nose, lack of smell and taste, and sore throat. Sneezing has been a challenge, Overstreet said, because initially everyone thought sneezing wouldn't be part of COVID-19, but she has tested patients with severe sneezing and they have been positive for COVID-19. 

What COVID-19 typically doesn't have is itchiness. Itchy eyes, itchy throat and itchy nose are more likely to be allergies than a virus.

Cedar fever will soon return to Central Texas when the male Ashe juniper trees become full with pollen and try to spread it to the female Ashe juniper trees.

Some symptoms that typically are not allergies but could be a virus include nausea and diarrhea. High fever also is not allergies, Overstreet said. 

Getting your allergies under control is important during times when a lot of virus is circulating in the community (be it COVID-19, common colds or RSV). 

Allergies can increase your risk for other illnesses, Dr. Gaurang Shah, emergency medical director at St. David’s Medical Center, said during the last cedar fever season. “Because you have more mucus, you’re more likely to catch and hold onto viral particles, which increases the risk of developing an infection,” he said.

Season starts at the end of December and typically hits Central Texas hard 

Typically, it kicks up at the end of December and lasts through January, possibly into February, but some years we've started to feel it in early or mid-December. 

There are other places across the country that have these Ashe juniper trees, but "the problem with Central Texas is our sheer volume," Overstreet said.

We have a lot of density of these trees, and these are trees that are extremely heavy pollinators, Overstreet said. "That's why it's so bad." 

It's hard to tell exactly what to expect this season 

We had a slightly wetter summer, a drier September, a slightly wetter October. When we have a wetter summer and fall, that gives the juniper time to get heavier with pollen.

"There's a variety of theories out there when it comes to cedar," Overstreet said. "We had a pretty mild summer. We may have larger pollen count, but you never know."

Get allergy tested to see if you are allergic to Ashe juniper or anything else. That can help you decide how to treat your allergies, including whether to start allergy shots or drops.

It will be a bad year if it is dry and windy during cedar fever season. We should all hope for a wet December and January once cedar fever season starts to dampen the pollen. Any winter precipitation would help knock down the pollen from the air. 

What makes cedar fever so difficult compared with other allergies is the amount of allergens in the air. Cedar pollen counts can be in the 10,000 to 12,000 range on a bad day. A bad oak day would be 800, meaning 800 pollen grains landing in a defined area compared with 12,000 pollen grains for cedar.

How long does it take to get cedar fever?

Start taking your allergy medications at least two weeks before the start of cedar fever, which usually is sometime in December.

Some people will never get it. Some people might get it the first year they move to Central Texas. Most people, though, need to go through a few seasons before they become allergic to the juniper pollen. It takes some exposure to produce the reaction.

Allergists typically don't see babies with cedar fever, but will see kids 18 months to 2 years with their first bad cedar fever season. It tends to be worse in kids that have eczema or asthma, Overstreet said.

"If you feel like it's impacting your life in any way, whether it be work, leisure or productivity, then it's worth getting treated," Overstreet said. Treatments start with testing to make sure cedar is the allergen that's bothering you.

Lessen your cedar fever symptoms with these tips 

Start taking your allergy medications now. Choose either a nasal spray like a Flonase or an antihistamine like a Claritin or Zyrtec. These can take about two weeks before they have the maximum effect. Once you start taking these medications, don't stop taking them until at least the end of January or after the daily pollen charts no longer list cedar or juniper.

Choose the medication that works for you. They can come with side effects such as being sedating or drying out the nose and mouth too much. Sometimes you might have to try a medication for a few weeks before you know if it is working, Overstreet said. Check with your doctor if you don't know what to try or are concerned about side effects or interactions with other medications.

Nancy Skinner receives her allergy shot from medical assistant Oralia Sustaita at the Central Texas Allergy & Asthma Center. Doing allergy shots for cedar fever usually is a three to five year process.

There are other treatments available from an allergy doctor. After getting tested to see what you're allergic to, you can start doing weekly allergy shots or taking daily allergy drops. Those treatments usually take three to five years before they are at their most effective and a patient can stop taking them. 

A new treatment is a series of three shots given a month apart that are injected into the lymph nodes between the stomach and the thigh. That series takes about two months to finish. It is possible to start the ExACT Immunoplasty treatments now and get some benefit for this season, but most likely, you would not feel the full effects until next season.

This treatment is typically not covered by insurance and costs about $2,500, which Overstreet said can be comparable for some patients who are getting regular allergy shots, depending on their insurance coverage for those shots. Out of pocket, allergy shots would be about $10,000 for the three-to-five-year course. Allergy drops cost about $50 a month and are typically not covered by insurance. That would be about $1,800 to $3,000 for three to five years. 

Other tips to help you through cedar fever season  

Using a neti pot each night to flush pollen from the nose can help during cedar fever season.

• Watch the allergy counts and plan outdoor activities for days when the pollen counts are lower. 

• Do a daily nasal rinse using distilled water in a neti pot or a squeeze bottle. This helps flush the pollen from the nose.

• Wear long sleeves, long pants and hats to keep pollen off the skin and out of the eyes when working or playing outside. Then remove those clothes and hat when you come inside and put on fresh clothes.

• Shower after an outdoor activity and at night. This helps keep pollen in your hair and on your skin off your pillow when you sleep. 

• Wear a mask outside. It's great for keeping out viruses as well as pollen. 

• Keep windows and doors closed during cedar fever season.

• Change air filters in your home if they haven't been changed recently.