Pollen Allergy
Pollen allergy, also known as "hay fever" is one of the most common triggers of seasonal allergies. Experts usually refer to pollen allergy as “seasonal allergic rhinitis.”
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What are Symptoms of Pollen Allergies?
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People with pollen allergies only have symptoms when the pollens they are allergic to are in the air. Symptoms include:
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Runny nose (also known as rhinorrhea – this is typically a clear, thin nasal discharge)
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Stuffy nose (due to blockage or nasal congestion – one of the most common and troublesome symptoms)
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Sneezing
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Itchy nose, eyes, ears, and mouth
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Red and watery eyes
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Swelling around the eyes
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Brain fog
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Sinus headache
If you have asthma and pollen makes your asthma worse, you may have allergic asthma. It is the most common type of asthma.
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Allergies
Symptom causing allergens are introduced to the immune system slowly from low to higher doses to adapt and acclimate the immune system to the offending allergen. This is called immunotherapy. SLIT therapy stands for sublingual immunotherapy.
What are some Types of Allergies?
What are some Types of Pollen?
Typically produced by species of trees, grass and weeds.
The most common allergens are listed below.
Tree
Alder, Ash, Aspen, Beech, Birch, Box elder, Cedar, Cottonwood, Elm, Hickory, Juniper, Maple, Mulberry, Oak, Olive, Pecan, Poplar, Walnut, Willow.​
Grass
Bahia, Bermuda, Fescue, Johnson, Kentucky blue, Timothy.
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Weed
Ragweed, Burning bush, Cocklebur, Lamb’s-quarters, Mugwort, Pigweed, Russian thistle, Sagebrush, Tumbleweed​.
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Mould
Types of fungi caused by excessive water and humidity. They’re typically found in poorly ventilated areas like bathrooms and basements.
Pet dander
Flecks of dead skin shed by pets with fur or feathers like dogs, cats and birds. Dander floats in the air of your home and is the main source of pet allergies.
Dust mites
Tiny, microscopic bugs that live in your home. They can collect on humid, dust-prone furnishings like pillows, mattresses, carpets and stuffed toys.
Seasonality of Pollen Allergies
Mould, Pet dander, Dust mites
Weed
Tree
Grass
January
February
March
April
May
June
July
August
September
October
November
December
For more information: https://www.kleenex.com/en-ca/tips-advice/allergies/pollen-calendar
Oral Allergy Syndrome
Pollen Food Allergy Syndrome (PFAS), also known as oral allergy syndrome (OAS), is a condition where individuals experience allergic reactions to certain raw fruits, vegetables, and nuts. The symptoms are usually limited to the mouth and throat and may include itching or swelling of the lips, tongue, and throat. In some cases, it can cause mild systemic reactions. OAS is often triggered by proteins in certain fruits, vegetables, and nuts that are structurally similar to proteins found in pollen.
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Pollens and their food cross-reactivity counterparts additions to the document to the right:​
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Grass pollen: celery, melon
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Ragweed pollen: melons, sunflower seeds.
Resources: FOOD ALLERGY CANADA
"OAS is primarily associated with IgE-mediated allergic reactions rather than IgA or IgG"
Panallergens
Panallergens play a significant role in IgE and IgG cross-reactions, particularly between pollens and seemingly unrelated plant-based food allergens. These cross-reactions occur due to shared structural components in various allergens. Notably, panallergens are implicated in reactions involving both immunoglobulin E (IgE) and immunoglobulin G (IgG). Examples of well-known panallergens include seed storage proteins, profilins, lipid transfer proteins (LTPs), and cross-reactive carbohydrate determinants (CCDs). These components are found in diverse plant sources and can lead to allergic responses in individuals sensitized to them.
Cross-reactions extend beyond plant-based allergens and may involve other sources such as latex, mammal milks, or invertebrates. The shared allergenic components in these substances can trigger immune responses in individuals with sensitivities, leading to allergic reactions. Understanding the presence and potential cross-reactivity of panallergens is crucial for accurate diagnosis and effective management of allergies associated with diverse sources.
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Seed Storage Proteins: Seed storage proteins are proteins primarily found in seeds, nuts, and kernels of plants. These proteins serve as a source of nutrition for the developing plant embryo. Unlike some allergens that may be denatured by heat or stomach acid, seed storage proteins are stable under these conditions. This stability makes both raw and cooked foods containing these proteins potential allergens. In some cases, genetic modification of plants may introduce novel proteins that could lead to cross-reactions. For instance, there have been instances where genes from Brazil nuts were found to be similar to those in genetically modified soy, potentially causing allergic reactions in individuals sensitive to Brazil nuts.
Profilins: Profilins are proteins found in the cytoplasm of plant cells, and they play a role in the sensitization of individuals to pollens. Unlike some allergens, profilins are denatured by heat, meaning that clinically significant reactions typically occur with raw foods. In Canada, there is evidence of clinically relevant cross-reactions with foods listed under birch, ragweed, and timothy pollens. Sensitization to profilins can lead to allergic reactions in individuals exposed to these specific pollens and related foods, particularly when consumed in their raw form.
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Lipid Transfer Proteins (LTPs): Lipid transfer proteins are allergenic proteins resistant to heat, stomach acid, and proteolytic enzymes, making both raw and cooked foods potential allergens. They are considered major allergens in the rosaceae family of foods, which includes fruits like apples, apricots, and peaches. LTPs are often found in the peel or skin of these fruits. Due to their stability, LTPs can cause allergic reactions even after cooking. Allergic responses to LTPs may manifest as oral allergy syndrome or more severe systemic reactions.
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Cross-Reactive Carbohydrate Determinants (CCDs): Cross-reactive carbohydrate determinants (CCDs) are carbohydrate structures found on glycoproteins in various plants. These structures are not unique to specific allergens and can be shared among different plant sources. IgE antibodies may recognize these common carbohydrate structures, leading to cross-reactivity between seemingly unrelated allergens. CCDs are not heat-labile, so cooking does not eliminate the potential for cross-reactions. While CCDs themselves may not always cause clinically significant allergic responses, they can interfere with the accurate diagnosis of specific allergies, as tests may detect IgE antibodies targeting CCDs rather than allergen-specific proteins.
Labs we use for testing IGE: Aller Detect or USBiotek or LifeLabs.
Cost: Highly variable.
Sublingual Immunotherapy for Allergies Treatment
Allergy desensitization therapy is best initiated 6-12 weeks BEFORE the allergy season.
January/ February is a good time to get started.
What is SLIT and who can benefit?
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Sublingual immunotherapy (SLIT) involves placing a diluted allergen under your tongue for one to two minutes and then swallowing it.
SLIT is a great alternative to costly injections. No need to wait to see an immunologist. Great for individuals with extreme sensitivities and children. The World Health Organization has endorsed SLIT as an alternative to injection therapy (allergy shots).
What are some precautions or contraindications?
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It is not recommended for pregnant women to start taking allergy drops. However, if a woman is already taking sublingual immunotherapy drops and becomes pregnant, she can continue SLIT at a stable dose throughout pregnancy.
Do not use sublingual immunotherapy if you have open sores, cuts or ulcers in your mouth, or if you are undergoing dental procedures that cause bleeding (oral surgery, tooth extraction, etc.), because the allergen in the medication could enter your bloodstream too quickly and cause a reaction.
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How does treatment work?
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The idea is to slowly acclimate the immune system to the offending allergen over time.
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Treatment includes 1 or 2 or 3 max of the following allergens. If choosing 3 at the same time, they must be of the same class.
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Dust mite mix
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Tree mix - 10
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Tree mix - 2
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Ragweed mix
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Weed mix - 6
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Grass mix - 5
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Mould mix - 4
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Dog mix
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Cat mix
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1 mL of the diluted allergen(s) will be placed under the tongue daily for 6 weeks.
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Week 1: Most diluted vial 6x dilution
Week 2: Diluted vial 5x dilution
Week 3: Diluted vial 4x dilution
Week 4: Diluted vial 3x dilution
Week 5: Diluted vial 2x dilution
Week 6: Most potent diluted vial 1x dilution
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Instructions: Patient would use a needle and syringe and extract 1 mL of solution from the vial every morning 30 minutes before food and place under the tongue. Leaving the needle inside the vial for the week and only attaching and detaching the syringe.
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What are some conventional treatments often prescribed by medical doctors?
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Typical medications prescribed in the conventional model for allergies
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Nasal corticosteroid sprays to reduce inflammation (swelling) in the nose and block allergic reactions. Nasacort®, FLONASE®, and RHINOCORT®
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Antihistamines come in pill, liquid, or nasal spray form. They can relieve sneezing and itching in the nose and eyes. They also reduce a runny nose and, to a lesser extent, nasal stuffiness. Look for a long-acting, non-drowsy antihistamine. ZYRTEC®, Claritin®, Allegra®, CLARINEX®
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Decongestants are available as pills, liquids, nasal sprays, or drops. They help shrink the lining of the nasal passages and relieve nasal stuffiness. They generally are only used for a short time. SUDAFED®, Vicks Sinex™, Afrin®. Check with your doctor before using decongestants if you have high blood pressure, glaucoma, thyroid disease, or trouble urinating. They may cause issues if you have any of these conditions and they may interact with other prescription medicines.
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Leukotriene receptor antagonists (or modifiers) block the action of important chemical messengers (other than histamine) that are involved in allergic reactions. SINGULAIR®, Zyflo CR®, ACCOLATE®
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Cromolyn sodium is a nasal spray that blocks the release of chemicals that cause allergy symptoms, including histamine and leukotrienes. This medicine has few side effects, but you must take it four times a day. NasalCrom®
Resources
Using CERTIFIED asthma & allergy friendly® products in your home can help you have a healthier indoor environment, as well as reduce allergens.
Find out more here.
References
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1- https://aafa.org/allergies/types-of-allergies/pollen-allergy/
2- https://asthma.ca/get-help/allergies-and-asthma/
3- https://acaai.org/allergies/allergic-conditions/food/pollen-food-allergy-syndrome/
5- PreMedline Identifier: 18727478
Preventive effects of sublingual immunotherapy in childhood: an open randomized controlled study.
Ann Allergy Asthma Immunol. 2008; 101(2):206-11 (ISSN: 1081-1206)
Marogna M ; Tomassetti D ; Bernasconi A ; Colombo F ; Massolo A ; Businco AD ; Canonica GW ; Passalacqua G ; Tripodi S
Pneumology Unit, Cuasso al Monte, Macchi Hospital Foundation, Varese, Italy.
BACKGROUND: Sublingual immunotherapy (SLIT) has been proved to be effective in allergic rhinitis and asthma, but there are few data on its preventive effects, especially in children.
OBJECTIVE: To evaluate the clinical and preventive effects of SLIT in children by assessing onset of persistent asthma and new sensitizations, clinical symptoms, and bronchial hyperreactivity.
METHODS: A total of 216 children with allergic rhinitis, with or without intermittent asthma, were evaluated and then randomized to receive drugs alone or drugs plus SLIT openly for 3 years. The clinical score was assessed yearly during allergen exposure. Pulmonary function testing, methacholine challenge, and skin prick testing were performed at the beginning and end of the study.
RESULTS: One hundred forty-four children received SLIT and 72 received drugs only. Dropouts were 9.7% in the SLIT group and 8.3% in the controls. New sensitizations appeared in 34.8% of controls and in 3.1% of SLIT patients (odds ratio, 16.85; 95% confidence interval, 5.73-49.13). Mild persistent asthma was less frequent in SLIT patients (odds ratio, 0.04; 95% confidence interval, 0.01-0.17). There was a significant decrease in clinical scores in the SLIT group vs the control group since the first year. The number of children with a positive methacholine challenge result decreased significantly after 3 years only in the SLIT group. Adherence was 80% or higher in 73.8% of patients. Only 1 patient reported systemic itching.
CONCLUSIONS: In everyday clinical practice, SLIT reduced the onset of new sensitizations and mild persistent asthma and decreased bronchial hyperreactivity in children with respiratory allergy.
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