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When fall arrives, Susie Saunders Brusa knows she will start to feel achy, tired and less inclined to engage in her favorite exercise, hiking along the undeveloped ranchland near her Monterey County, Calif., home.

“I have year-round allergies, but the fall symptoms are the worst,” Brusa said. “When they first start, I feel like I’m getting the flu.”

Allergies occur when the body’s immune system overreacts to a foreign substance. Spring may be the season most people associate with outdoor allergies, but for Brusa and millions of others, autumn is just as much a source of misery.

In 2021, about 26 percent of adults and 19 percent of children — some 81 million Americans — were diagnosed with <a href="https://www.aafa.org/rhinitis-nasal-allergy-hayfever/" target=_blank>seasonal allergic rhinitis, </a>often called hay fever, according to the <a href="https://aafa.org/?gclid=CjwKCAjwyY6pBhA9EiwAMzmfwf05MkA6lQq-gaGwTVsaq0hY_WLLsI_gqU1XYK5uh9LZFyG7sV5LvRoCGUAQAvD_BwE" target=_blank>Asthma and Allergy Foundation of America</a>.

Ragweed pollen is the most common pollen allergen in the fall, according to the foundation, particularly in eastern states and the Midwest.

Other common allergens include sagebrush in the West and Lamb’s quarters or English plantain nationwide, as well as such outdoor mold allergens as <i>Alternaria</i> and <i>Cladosporium</i>, found in decaying leaves and plants, said <a href="https://providers.ucsd.edu/details/22367/allergy-immunology" target=_blank>Marc Riedl</a>, professor of medicine and clinical service chief of allergy and immunology at the University of California at San Diego and practicing allergist/immunologist at UC San Diego Health.

“For many people, these seasonal outdoor allergen exposures occur on top of chronic indoor allergen exposure to things like dust mites and animal dander,” Riedl said. “So for these people who may have some low-level chronic allergy symptoms, this seasonal spike in outdoor allergens can push their symptoms to an intolerable level and generate miserable fall allergies.”

In many parts of the country, mold counts start escalating in July and continue to rise through autumn, while weed pollen starts at the end of July and ends with the first hard freeze, said Jill A. Poole, division chief of allergy and immunology and professor of medicine at the University of Nebraska Medical Center.

For people allergic to both, “the fall is particularly rough, since people are usually outside enjoying fall walks, football games and more,” Poole said.

Add to that list gardening and raking leaves — two common fall activities that increase exposure and aggravate symptoms.

“I must shower immediately after working in the garden, which is not always convenient,” Brusa said.

Typical fall allergy symptoms include stuffy nose, scratchy sore throat, watery and itchy eyes, fatigue, and headache, among others.

“When I was younger I would lose my voice twice a year — once in the spring and once in the fall,” said Kathryn Spinelli of Holland, Mich. “That still happens sometimes. Though now, I tend to just have a rough voice, and not lose it entirely. My college French teacher used to say that I only had a proper accent when my allergies were in full swing.”

When indoor and outdoor allergies converge

Moreover, elevated weed pollens and mold often occur at the same time common respiratory viruses emerge, “making fall a particularly difficult season for patients with asthma, allergies and other respiratory diseases,” said <a href="https://childrensnational.org/visit/find-a-provider/william-sheehan" target=_blank>William Sheehan</a>, associate professor of pediatrics at George Washington University’s School of Medicine and Health Sciences and attending physician in the division of allergy and immunology in the Severe Asthma Program at Children’s National Hospital. “For children and adolescents, emergency room visits and hospitalizations for asthma and respiratory conditions typically peak in October.”

As people move indoors during the colder months, allergic patients are exposed to indoor environmental allergens. “In urban environments, mouse and cockroach allergens can be problematic for allergic patients,” Sheehan said. “Not only are patients spending more time inside, but windows are usually closed resulting in less ventilation and air exchange.”

Pets can also track pollen indoors, Poole added.

Researchers also say climate change is making allergies worse.

There is <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0205677" target=_blank>evidence,</a> for example, that ragweed is sprouting in locations it never did before, and proliferating in places where it did. Warmer temperatures have brought earlier springs, late-ending falls, shorter and milder winters, and large amounts of moisture. All of this promotes mold and nourishes the trees and plants that produce pollen.

“The fall pollination season for ragweed begins earlier and lasts longer as compared to years past,” Sheehan said. “The first frost at the end of the fall season has been arriving later in recent years as compared to previous decades. … Certain trees, grasses and weeds that were previously only found in more southern areas are now also able to grow in more northern locations.”

The trend is not confined to rural areas, he added. “Urban areas may be particularly susceptible to these environmental changes,” he said. “Ragweed plants in urban environments grow faster, flower earlier and produce more pollen.”

All of this means that allergy sufferers like Spinelli can hardly wait for the cold.

“I hate winter, but I welcome the first hard frost or two,” she said. “Because that’s the end of allergies for me.”

Here’s some advice from the experts about how to cope with fall allergies:

If you have allergy-like symptoms and have never been tested for specific allergies, get the tests. If you know what you are allergic to, you will know what to avoid.

You may have had your fill of masks, but wearing one can help, especially when doing outdoor yard work or gardening. Any mask will help, but N95 masks are “even more effective, catching particles only 0.04 micrometers in size,” <a href="https://www.uclahealth.org/news/seasonal-allergies-wear-your-face-mask-for-relief#:~:text=Medical%20masks%2C%20such%20as%20N95,eye%20allergies%20(allergic%20conjunctivitis)." target=_blank>according to UCLA Health</a>.

On days with high pollen counts, stay indoors as much as possible with windows closed and air conditioners or air purifiers on. Resist the urge to open the windows, which allows allergens inside.

If you spend time outdoors, wash your face or shower, and change your clothes when you come inside. Shower before bed. “The worst thing that patients can do is to be outside in the evening and then come right inside and immediately go to bed without washing,” Sheehan said. “This carries all the pollens with them onto their sheets and pillows for then all-night exposure.”

Saline nasal sprays or sinus rinses can be helpful in removing allergens from the upper airway, particularly if used after a day of outdoor exposure.

Patients with long-term, severe symptoms should consider immunotherapy in the form of injections or oral medication.

Over-the-counter, non-sedating, long-acting antihistamines, such as Claritin and Zyrtec, may help, but avoid short-acting sedating antihistamines, such as Benadryl, Poole said, “as they make you drowsy, and I worry about impairments in the person.”

Nasal steroid sprays — most are now sold over-the-counter — can ease nasal and sinus swelling and congestion.

Be wary of decongestant nasal sprays that can be “addicting” to the nose if used for more than three days. Also, avoid oral decongestants such as Sudafed, which potentially can increase blood pressure, Poole said.

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Marlene Cimons is a Washington-based freelance writer who specializes in health, science and the environment. She was a Washington reporter for the Los Angeles Times covering public health, biomedical research policy, and food and drug regulation.

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Fall allergies are common. These tips can make them less miserable. 

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