When Your Seasonal Allergy Symptoms Aren't Allergies

April showers bring May flowers—and for many people, congestion, sneezing, and itchy, watery eyes. But sometimes those seasonal allergy symptoms, even in the spring, don’t stem from plant and tree pollen but rather from dust mites and pet dander.

And at least a third of people who believe they have allergies actually have a condition known as nonallergic rhinitis, a reaction that can be triggered by an infection, a sensitivity to chemicals or drugs, or changes in weather patterns.

Effective treatment starts with identifying the cause. But that doesn’t always mean allergy tests, especially the ones now offered by some pharmacies or those you can buy to test yourself.

Identifying the Cause of Your Seasonal Allergy Symptoms

If you suspect that your symptoms are caused by an allergy, you can often get confirmation—and relief—by taking the simple steps described below. But if you’re uncertain or the measures don’t help, talk with a doctor.

A physical exam and a few questions about your symptoms, environmental and occupational exposure, hobbies, overall health, and other factors should help narrow it down.

If necessary, an allergy skin test, which involves pricking the skin with a tiny amount of the suspected allergens, can confirm a diagnosis. A little redness shows that you have an allergy; no reaction suggests nonallergic rhinitis.

Be wary of any allergy test that’s not prompted by worrisome symptoms, a doctor’s exam, and your medical history.

The free tests offered in pharmacies or home tests that you can buy often check for common allergens, including cat dander, cedar, dust mites, egg, and grass. But such tests are often misleading and can cause you to make unnecessary lifestyle changes.

The American Academy of Allergy, Asthma Immunology is so concerned about the potential overuse of those tests that it recently included them in Consumer Reports’ Choosing Wisely campaign, which highlights unnecessary and sometimes harmful medical care.

Coping With Allergies

If you do have an allergy, the following recommendations often help.

Avoid allergens. For outdoor allergies, check pollen and mold spore levels with the National Allergy Bureau. When counts are high, stay indoors with the windows shut and the air conditioning on.

For indoor allergies, use an air conditioner or dehumidifier, remove carpeting from bedrooms, wash rugs, curtains, and bedding often, and vacuum regularly.

To control dust mites, encase your mattress, box spring, and pillows in allergenproof covers. Keep pets out of your bedroom. Fix leaks and ventilate rooms, and clean up mold promptly.

Use the right drug. The best first choice is often a generic version of an over-the-counter antihistamine, such as cetirizine, fexofenadine, or loratadine.  All cost less than their brand-name counterparts (Zyrtec, Allegra, and Claritin, respectively). 

Prescription and over-the-counter steroid nasal sprays, such as fluticasone (Flonase, Flonase Allergy Relief, and generic) and triamcinolone (Nasacort, Nasacort Allergy 24HR, and generic), are also very effective, though you should stop using them if they cause irritation or nosebleeds.

For Nonallergic Rhinitis

Start by trying to avoid known triggers. If a drug is the culprit, ask your doctor about trying an alternative.

If you can’t avoid the trigger, consider using prescription or OTC steroid nasal sprays for treating serious allergies beforehand, or a spray that contains the prescription nasal antihistamine azelastine (Astelin, Astepro, and generic). Steroid sprays also work well for persistent symptoms.

Check Your Seasonal Allergy Symptoms

To see whether you have an allergy or something else, start by keeping track of your seasonal allergy symptoms, when you experience them, and what triggers them. Then see below to determine whether you’re likely to have an allergy or nonallergic rhinitis.

Allergies

• Symptoms: Congestion, itchy and watery eyes, clear nasal discharge, sneezing, and scratchy or ticklish throat.
• When: Outdoor allergies usually start in February or March and end in October. Indoor allergies often last year-round, though they can come and go.
• Triggers: Pollen from trees, grass, and weeds; indoor and outdoor mold; pet dander; dust mites; flakes of dried skin; and cockroach feces, saliva, or body parts.

Nonallergic rhinitis

• Symptoms: Congestion, runny nose, and sneezing, but without the itchy eyes or sore throat.
• When: Often lasts year-round, though periodically.
• Triggers: Respiratory infections, changes in weather and temperature, cold or dry air, food (especially spicy items), alcohol, strong odors or fumes, tobacco smoke, perfume, air pollution, and certain medications, notably aspirin, ibuprofen (Advil and generic), naproxen (Aleve and generic), certain blood pressure drugs, and erectile dysfunction drugs, such as sildenafil (Viagra), tadalafil (Cialis), and the enlarged prostate drug tamsulosin (Flomax and generic). 

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