Q&A: How to navigate simultaneous allergy, flu seasons
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Autumn brings relief from the summer’s heat and the lovely colors of the falling leaves. But it also brings patients with allergies and the flu back into doctors’ offices in droves.
Symptoms often overlap, and patients themselves may not be sure if they are suffering from ragweed in the air or that bug going around the office. But experienced practitioners can manage these cases and determine the right care for each patient.
Healio spoke with Stanley M. Fineman, MD, private practitioner with Atlanta Allergy and Asthma and former president of the American College of Allergy, Asthma & Immunology, about the challenges of navigating simultaneous allergy and influenza seasons.
Healio: As a practitioner, how do you address this overlap between allergy and influenza seasons?
Fineman: Allergies typically are associated with upper respiratory congestion, sneezing and itching, and they usually occur every year at the same time, which is when the pollen that you’re allergic to comes out. Respiratory infections, including the flu or COVID-19, typically have a fever. There usually are more body aches associated with these infections as well. You can get the same nasal congestion, but cough and fever are really the hallmarks of infections, whereas sneezing and itching indicate an allergy.
Healio: Are there any other factors that can help distinguish between allergies and infections like the flu?
Fineman: It’s important to get the patient’s history, because the history can tell in terms of onset of action and what the patient has been exposed to. A lot of times, the history can suggest whether it’s a viral respiratory illness, such as an infection, or an allergy-type of problem.
Also, patients who have allergies tend to have a family history of allergies. That’s No. 1. Secondly, they tend to have a temporal relationship with exposure to the allergen that causes a trigger. So, it tends to occur after each exposure. Let’s say that every fall, they get these symptoms, then that’s quite likely to be triggered by allergy.
The main thing is for the practitioner to realize that allergies don’t cause fever and they usually don’t cause body aches.
Healio: What kind of role does testing play in diagnosis?
Fineman: A skin test can help identify allergy triggers, but you don’t have to do that every time the patient comes in with these symptoms. Once you make the diagnosis that the patient has an allergy trigger, like a pollen trigger, then that usually is going to trigger symptoms each time they’re exposed to it. There also are tools such as antibody tests to check if there is a certain type of virus, and they can be helpful in identifying it.
Healio: Are there any specific times of year when practitioners have to be aware of what is coming their way?
Fineman: They need to be aware of when these allergens are a problem in their area. In Atlanta, where I practice, we know in the spring that we’re going to see tree and grass pollen. In the fall, we’re going to see ragweed pollen. We may see mold as well, sometimes through the summer. It’s probably helpful for practitioners to be aware of pollen counts in their area and make sure they know what’s in the air that might be causing their patients’ symptoms. Most major metropolitan areas have allergists or other people who report on pollen count. That should be available to practitioners in whatever area they’re in.
Healio: Asthma also peaks in the autumn, with high concentrations of flareups and hospitalizations. Is this something you are seeing in your practice as well?
Fineman: In Atlanta, we usually see it a little later, more like in October. But we do see some flares of respiratory illnesses in September. These flares are related to allergens and viruses alike.
Healio: Your practice’s website includes a meter that reports daily tree, grass and weed pollen counts as well as mold activity for Atlanta. How does this meter correlate with the patients you see?
Fineman: It doesn’t always correlate directly. But we are seeing a lot of patients who have allergy triggers through some of those pollens and also through mold, which is a big problem.
Healio: Because these allergies tend to be annual occurrences, how can doctors help patients prepare for them?
Fineman: It’s important for patients who have allergy-triggered symptoms to understand what causes them and have a treatment plan so they can start treatment before the pollen starts so they can get these symptoms under control earlier, so we usually recommend patients start their anti-allergy medications prior to the season starting.
Healio: Do biologics have a role in treating these allergies?
Fineman: Biologics are for specific illnesses, and they’re usually chronic-type medications for chronic illnesses. They have a specific role, but that’s a whole other area of therapy. For respiratory allergies, we usually start with nasal steroids and antihistamines. Quite frankly, when those don’t really work that well, allergy immunotherapy or allergy shots are really the best treatment for an allergy-type of condition.
Healio: Do flu shots play a role in your treatment?
Fineman: The flu shot is critical for patients who have respiratory allergies and illnesses, and I encourage our patients to get it every season. We do offer it in our office for our patients. We also recommend that they get up-to-date on their COVID-19 vaccines because we have very good and effective COVID-19 vaccines. Anything you can do to help prevent a respiratory illness is beneficial.
Healio: Do you have any other recommendations for patients or practitioners?
Fineman: If a patient or a practitioner thinks that the patient has allergies, then they should have an evaluation by an allergist that includes allergy testing. Then they can get a really good treatment plan and take care of their symptoms.