Spring Allergy Treatment: How to Breathe Easy in Pollen Season

Türkiye's pollen calendar is broad: February-March (birch, pine, cedar pollens), April-May (olive, plane tree pollens — especially intense in Mediterranean and Aegean), June-July (grasses, cereals), August-October (ragweed and other weeds). Depending on which pollen sensitises you, allergic season can be short or year-long.

Pollen levels are highest early morning (06:00-09:00) and late afternoon (16:00-19:00). Driven by atmospheric dispersion dynamics. Rainy days transiently lower pollen but the sunny day after re-concentrates it. Windy dry days are worst.

Regional differences: Istanbul (birch, pine, grasses), Ankara (no olive but heavy grasses), Izmir/Aegean (olive pollens very high), Black Sea (forest plants — different profile). Türkiye's State Meteorological Service provides daily measurements from pollen stations.

Practical advice: after identification (allergy test results), know your pollen profile and take targeted measures (spray + antihistamine) during its peak. Outside peak, spray alone may suffice. We expand on the clinical framework in our general ENT services.

Distinguishing spring allergy from a cold matters because the treatments differ completely. Hallmark difference: allergy persists (throughout the season) and does not cause fever; a cold lasts 7-10 days and may include low-grade fever.

Allergy symptoms: repeated sneezing fits (peaks on waking), watery nasal discharge (clear and copious), bilateral nasal obstruction, nasal itching (most characteristic — the "allergic salute" hand gesture), eye itching + watering, postnasal drip, fatigue (systemic effect of chronic inflammation).

Cold symptoms: 1-2 days of sore throat, then 2-7 days of nasal discharge (initially clear, later thickening), fever <38°C, muscle/joint pain, malaise. Fully resolves in 7-10 days.

Mixed cases happen: allergic people also get colds; their overlap creates a complex picture. ENT evaluation is warranted in this case.

The gold standard for allergy diagnosis is the prick test. 12-20 allergen extracts are placed on the forearm and pricked into the skin; reactions (redness + wheal) are read at 15-20 minutes. Sensitisations are precisely identified.

Alternative: blood test (specific IgE) — antibody levels to 12-20 allergens are measured separately. Results in 2-3 days. Blood testing is often preferred in children (skin pricking can be uncomfortable).

Interpretation: a positive result indicates sensitisation only — it must match clinical symptoms. Some people are lab-positive without symptoms; no treatment needed there. Symptoms aligning with pollen season confirms diagnosis.

Timing: ideally OUTSIDE an allergy flare — antihistamines used during attacks confound the test. If you take antihistamines, pause 7 days before testing.

Step 1 — avoidance: practical tips. Avoid being outside during peak pollen times (06:00-09:00 and 16:00-19:00). Keep windows closed; use AC and air purifier. Shower and change clothes on returning home (hair and clothing carry pollen). Don't hang laundry outside — it traps pollen. A pollen-filter mask (FFP2 or N95) helps outdoors but is not full protection.

Step 2 — antihistamine: first-generation drugs (chlorpheniramine, hydroxyzine) sedate; not recommended. Second-generation (loratadine, cetirizine, fexofenadine, desloratadine) — 1 tablet daily, non-sedating, effective. Over-the-counter. Effect begins in 1-2 hours, relief felt after first dose. Better outcome when started 1-2 weeks before pollen season.

Step 3 — intranasal corticosteroid spray: the most effective medical therapy for spring allergy. Mometasone, fluticasone, budesonide, triamcinolone — 1-2 puffs per nostril daily. No side effects (very low systemic effect). Full effect after 4 weeks of regular use. Start 2 weeks before the pollen season for optimal results.

Correct spray technique: tilt head slightly forward, aim away from septum (when spraying right nostril, target the left ear direction). Do not blow nose for 10-15 minutes after spray. This lets the medication be effective. More detail: sinusitis page.

Immunotherapy (allergy shots or drops) is the root cause treatment — not just suppressing symptoms but retraining the immune system to stop reacting. A 3-5 year programme, but on completion the allergy largely resolves.

Two forms: 1) Subcutaneous immunotherapy (allergy shots, SCIT) — injection in the arm, weekly for the first 3-6 months, then monthly; 3-5 years. 2) Sublingual immunotherapy (SLIT) — drops or tablet under the tongue, daily; 3-5 years. SLIT is newer, more convenient and has fewer side effects.

Suitable for: patients with clinically symptomatic, lab-confirmed allergy, partial response to medical therapy. Most effective for pollen allergies (birch, grass). Strong indication if asthma coexists.

Advantages: retrains immune system, removes drug dependence, reduces asthma development risk by 50% (especially important in children), dramatically improves quality of life.

Drawbacks: long-term (3-5 years), regular follow-up, rare allergic reaction risk early on (anaphylaxis <0.1%), yearly cost (cheaper than medical therapy long-term). Decision made by ENT or allergy specialist.

Nutrition: an anti-inflammatory diet (omega-3 fatty acids, antioxidant-rich fruits, leafy greens) reduces allergic inflammation. Dairy can increase mucosal stickiness in some patients — restriction during the season helps.

Saline rinses: isotonic or hypertonic nasal sprays 2-3 times daily wash pollens stuck to nasal mucosa, reduce symptoms. Cheap, no side effects.

Vitamin D: low vitamin D levels worsen allergic flares. Aim for serum >30 ng/mL; supplement 1,000-2,000 IU/day if low.

Acupuncture: some studies show 20-30% symptom reduction in spring allergy. Evidence level moderate — useful as adjunct, not standalone.

Probiotics: gut flora is known to modulate immunity. Certain strains (Lactobacillus rhamnosus, Bifidobacterium lactis) reduce allergic flares. 3-6 month courses are advised.

Mild spring allergy can be managed with over-the-counter antihistamines. The following situations call for ENT or allergy specialist evaluation:

1) Symptoms not improving with OTC treatment within 2 weeks. 2) Breathing difficulty alongside symptoms (possible asthma). 3) Recurrent sinusitis (3+ episodes per year). 4) Polyp suspicion (loss of smell). 5) Disturbed sleep quality (sleep apnoea risk rises). 6) Considering immunotherapy (specialist needed). 7) Paediatric cases — paediatrician or paediatric allergy specialist.

In Türkiye allergy specialists (adult allergy + immunology) or ENT surgeons (allergic rhinitis + surgical need) offer the service. Immunotherapy can be managed by either. Paediatric cases need a paediatric allergy specialist. Related reading: our Istanbul ENT services.