Seasonal allergies affect about one in four American adults, and if you’re among them, you know the routine: weeks of sneezing, congestion, itchy eyes, sinus pressure, and disrupted sleep. The immune system mistakes harmless pollen for a threat, triggering a cascade of histamine and inflammatory chemicals that can feel relentless.
The good news is that allergy science keeps advancing. The past year has brought meaningful updates, including a first-ever FDA approval for a serious sinus condition, along with clearer guidance on what works best and when to start treatment.
How Common are Seasonal Allergies, and are They Getting Worse?
Roughly 25.7% of American adults have been diagnosed with seasonal allergies, with the highest rates among those in their 40s, 50s, and early 60s (27.9% in the 45–64 age group), according to the American College of Allergy, Asthma and Immunology (ACAAI). All told, an estimated 106 million American adults and children live with allergies or asthma.
Many patients are surprised to develop new symptoms in midlife or to find that allergies they once managed easily are now significantly worse. Pollen seasons are starting earlier and lasting longer in many parts of the country, and the data backs that up.
Neeta Ogden, MD, director of the Allergy, Asthma and Sinus Center, and ACAAI spokesperson, explains why.
In the past we would see a decline in allergy symptoms in parallel with a less reactive immune system that comes with age. But with soaring pollen counts at levels we haven’t seen in prior decades, the immune insult is so extreme that it’s almost as if some reactivity is inevitable. This is leading to new onset allergy symptoms for the first time in your 50s or 60s, or continued allergy later in life even when we would have expected it to dissipate.
If your allergies seem new, or newly intense, you’re not imagining it.
What Works: The Foundation of Good Allergy Care
Nasal corticosteroid sprays remain the gold standard for allergic rhinitis, more effective than antihistamines alone for controlling congestion and postnasal drip. Several are available over the counter:
- Fluticasone (Flonase)
- Budesonide (Rhinocort)
- Triamcinolone (Nasacort)
These work best when used daily and consistently. It typically takes a few days to reach full effectiveness, and the doses in nasal sprays are low enough that they are not associated with the systemic effects of oral steroids.
Antihistamines—cetirizine (Zyrtec), loratadine (Claritin), fexofenadine (Allegra)—effectively relieve itching, sneezing, and runny nose, but are less effective for congestion on their own. Combining them with a nasal steroid often works better. Older antihistamines like diphenhydramine (Benadryl) cause significant sedation and are not appropriate for regular daytime use.
Combination nasal sprays that pair a steroid with a nasal antihistamine (such as Dymista or Ryaltris) show better results than either medication alone, so it may be worth considering if standard options aren’t effective.
The Timing Advantage: Why Earlier Is Better
One of the most consistently underutilized strategies is starting allergy medications one to two weeks before your typical symptom season. This matters more than many people realize, and the biology behind it is worth understanding.
“Once the allergic cascade starts and continues to receive input from the daily onslaught of seasonal triggers, it becomes that much harder to control or reverse,” says Dr. Ogden. “This is called allergic priming, a phenomenon where repeated, chronic exposure to an allergen like pollen causes the nasal mucosa to become hyper-responsive, leading to worse symptoms from lower levels of exposure later in the season.”
She continues: “Starting allergy medications one to two weeks before the season provides almost like a shield of armor against pollen. With earlier seasons we can’t predict when that first day of extreme pollen exposure will hit and with daily medicine on board, you can protect yourself against it.”
If you reliably develop symptoms every spring or fall at roughly the same time, discuss a pre-emptive start date with us. You can track local pollen counts at pollen.aaaai.org to time this precisely.
Immunotherapy: The Only Treatment That Changes the Underlying Response
Allergy shots (subcutaneous immunotherapy) remain the only therapy that can actually modify the underlying allergic response rather than just managing symptoms. The process involves regular injections of gradually increasing allergen doses over three to five years. Many patients achieve lasting relief that continues well after completing the course.
For patients in their 50s and 60s wondering whether immunotherapy is still worth pursuing, Dr. Ogden advises: “Immunotherapy remains a great option at those ages and may sometimes be better in older patients who may not do well taking medications like antihistamines. However, you have to proceed with caution in older patients who might have a more complicated medical history and make sure there are no contraindications.”
Practical considerations include the time commitment for regular injections and a small risk of anaphylaxis, which requires post-injection observation in the office. Sublingual immunotherapy (dissolving tablets placed under the tongue) is FDA-approved for certain pollen allergies as a needle-free alternative, but note that it is not approved for patients over 65.
Simple, Underrated and Very Effective: Saline Nasal Irrigation
Rinsing the nasal passages with a saline solution, using a Neti pot, squeeze bottle, or syringe, physically removes pollen, allergens, and irritants from the nose. It reduces postnasal drip and congestion, and it prepares the nasal lining so that medicated sprays absorb better. Used with sterile or distilled water once or twice daily, it has virtually no side effects and is widely recommended by allergy specialists.
First Drug Approved for Fungal Sinus Disease
Allergic fungal rhinosinusitis (AFRS) is a chronic sinus condition caused by an allergic immune reaction to naturally occurring fungi. It produces thick, sticky mucus that can fill and expand the sinuses and erode surrounding bone. The same type 2 inflammatory pathway implicated in eczema, asthma, and nasal polyps are involved, and it has a high recurrence rate even after surgery.
However, in a promising development this February, the FDA gave a green light to the first drug ever approved for this condition. Dupilumab (Dupixent) is a biologic that works by blocking specific inflammatory signals (IL-4 receptor alpha) rather than broadly suppressing the immune system. It is already approved for eczema, asthma, nasal polyps, COPD, and chronic hives. In Phase III trials, patients receiving dupilumab showed 50% improvement in clogged sinuses (opacification) after one year, and significant reductions in polyp size, congestion, and bone erosion.
“This is an exciting approval and shows the continued diversity of applications for dupilumab, especially in the setting of rhinosinusitis,” says Dr. Ogden. “For those patients it offers very significant relief for a serious condition with a 92% reduction in need for further sinus surgery or systemic corticosteroids compared to placebo, and an 81% reduction in nasal congestion. It’s pretty groundbreaking and life-changing for patients managing what can be a debilitating disease.”
If You Have Both Allergies and Asthma
Allergies and asthma frequently overlap. High pollen counts can worsen asthma symptoms and increase flare risk. Drugs such as Singulair can help manage both conditions simultaneously, though they carry a small risk of mood-related side effects in some patients.
A Word About Online Allergy Information
Be aware that although social media is filled with posts purporting new cures, it’s often inaccurate. In fact a 2026 study published in the Journal of Allergy and Clinical Immunology found that the most engaging content was often the least informed. Natural remedy claims were the most common theme, followed by promotion of IgG food panel testing, and fears about allergy medications.
A persistent example: although not supported by evidence, many believe that eating local honey can desensitize you to local pollens. The reality is that most wind-borne pollens causing hay fever are not the same pollens bees carry into hives, and the amount in honey is far too low to produce a therapeutic immune response.
Acting on misinformation can delay effective treatment, so please check with our office before spending time and money on unproven approaches.
When to See an Allergist
We can manage many straightforward seasonal allergies at our office, but will refer you to an allergist if:
- Your symptoms are not adequately controlled despite standard medications
- You want to identify your specific allergens through skin or blood testing
- You’re considering immunotherapy to reduce long-term medication dependence
- You have recurrent sinus infections, nasal polyps, or symptoms suggestive of fungal sinus disease
- You experience symptoms year-round
- You have coexisting asthma
Seasonal allergies are common, but prolonged suffering doesn’t have to be. With the right timing, evidence-based treatment, targeted new therapies for severe disease, and careful evaluation of your options, most patients can achieve meaningful relief. If you have questions about anything described here, please don’t hesitate to bring them to your next visit.
Our goal: to help you breathe easier, literally.
Allergy-Proofing Your Home
Reducing indoor allergen exposure can meaningfully improve symptom control alongside medication.
Bedding & Bedroom
- Encase mattresses and pillows in allergen-barrier covers
- Wash bedding weekly in hot water (at least 130°F) or dry on high heat
- Minimize rugs, heavy curtains, and hard-to-clean decor that collect dust
Air Quality
- Keep windows closed during high-pollen days; use air conditioning
- Replace HVAC filters regularly; HEPA filters trap the finest particles
- Vacuum weekly with a HEPA-filter vacuum (standard vacuums can disperse fine particles back into the air)
Pollen Control
- Shower before bed to rinse pollen from hair and skin
- Change clothes after spending time outdoors on high-pollen days
- Wear sunglasses outside to reduce eye exposure
Mold & Moisture
- Keep indoor humidity below 50%; use a dehumidifier if needed
- Check under sinks and around appliances regularly for moisture or leaks
Pets
- Keep pets out of bedrooms if dander is a trigger
- Bathe dogs weekly to reduce dander (bathing cats is generally less helpful for reducing human symptoms)
A Quick Guide to Alternative Methods
Saline Nasal Irrigation
Evidence: Strong. Widely recommended as an adjunct to standard treatment. Physically removes allergens and improves medication absorption.
Acupuncture
Evidence: Modest. Some randomized trials suggest small symptom improvement but it is not a substitute for evidence-based treatment.
Butterbur
Evidence: Preliminary. Some antihistamine-like effects in small studies, but raw butterbur contains compounds toxic to the liver. Only PA-free certified products should be considered.
Quercetin and Other Supplements
Evidence: Insufficient. Lab studies are promising, but human clinical trial evidence remains limited and inconsistent.
Probiotics
Evidence: Emerging. Certain strains may modestly reduce symptoms by influencing gut-immune interactions. An active area of research, but not yet standard practice.
Dietary Changes
Anti-inflammatory diets (fruits, vegetables, omega-3 fatty acids) support overall immune health, but medical treatment may still be needed.
Note: Always consult with us before starting supplements or alternative therapies. “Natural” does not automatically mean safe, and some supplements interact with prescription medications.