Environmental Allergies

Dr Anna Wolfson of the Allergy and Clinical Immunology Unit discusses environmental allergies, skin testing and allergy shots.

Overview

Ten to 30 percent of adults, and up to 40 percent of children, are affected by environmental allergies, more commonly known as allergic rhinitis or hay fever. Environmental allergies develop when the body’s immune system recognizes and overreacts to pollens, dust, animal dander or mold; things that typically don’t cause a reaction in most people. Symptoms of environmental allergies include itching, sneezing, watery eyes, nasal congestion, runny nose and postnasal drip. In severe cases, allergic rhinitis may be associated with asthma and sinusitis.

Some patients only experience symptoms during certain seasons, but for many patients, environmental allergies can occur year-round without or without seasonal changes.

• Seasonal Allergies: Symptoms of seasonal allergic rhinitis can occur in spring, summer and early fall. They are usually caused by allergic sensitivity to airborne mold spores or to pollens from trees in the spring, grass in the summer, and weeds in the fall
• Perennial Allergies: People with perennial allergic rhinitis experience symptoms year-round. It is generally caused by dust mites, animal hair or dander, cockroaches or mold

Comprehensive, Multidisciplinary Care for Environmental Allergies

Patients with seasonal or year-round environmental allergies will benefit from consultation with an allergy physician, as environmental allergies can be contributing to the symptoms. Your allergy physician’s expertise includes not only the diagnosis and treatment of environmental allergies but also the management and prevention of:

• Asthma
• Sinusitis or recurrent sinus infections
• Skin diseases such as eczema (atopic dermatitis)

Our highly trained physicians will ask you questions to better understand your history, consider skin testing and are dedicated to managing and mitigating the impact of your environmental allergy symptoms on your well-being and quality of life.

State-of-the-Art Care in Boston & Waltham

A full range of allergy-related services is available at Mass General's downtown Boston campus serving primarily adult patients, and at Mass General Brigham Healthcare Center (Waltham), serving both adult and pediatric patients. Services include:

• Expert evaluation and diagnosis by allergy specialists
• Comprehensive allergy evaluation and testing onsite
• Patient-specific allergen immunotherapy (allergy shots) supervised by experienced clinicians
• A staff physician and fellow on call 24/7 for patients with urgent conditions

What to Expect

At your first appointment, you can expect a thorough history and evaluation by one of our allergy specialists. To diagnose your environmental allergies, we conduct a thorough review of your medical history, including recent changes in symptoms, and exposures in your home, workplace and elsewhere. In addition to a physical examination, we may also perform:

• Environmental allergy skin testing to determine which allergens may be triggering your symptoms
• Blood tests when skin testing is not appropriate
• Breathing tests to evaluate asthma symptoms
• Imaging if needed to evaluate for sinus disease

After diagnosing your environmental allergies, we tailor a treatment plan to manage your symptoms. We cover your plan in detail with you, explaining how to avoid or minimize exposure to factors that trigger your symptoms. We also may prescribe clinically proven medications, such as antihistamines and/or nasal sprays.

When allergen immunotherapy (allergy shots) is recommended, we prepare customized extracts meticulously at the Mass General hospital pharmacy. Allergy immunotherapy begins with shots administered weekly at the office of your choice (Boston or Waltham), building up to a monthly maintenance dose in most cases.

All injections are administered by experienced clinical practitioners. After an injection, you are required to stay at our office for 30 minutes for routine observation to ensure your safety. We monitor your treatment closely and adjust it as needed.

Patients may self-schedule appointments for allergy immunotherapy administration online via Patient Gateway, or by speaking to the front desk staff or by telephone. Patients may not have more than four injections scheduled at any given time. If any additional appointments are scheduled outside of the allotted four, they will be canceled to allow room for other patients to receive their injections.

Another option that may be appropriate for select patients is allergy sublingual immunotherapy, also called SLIT. Allergy sublingual immunotherapy is a pill that you take under your tongue as opposed to a shot. However, it is FDA approved for the treatment of allergic symptoms due to a very few specific allergens, and we can discuss this option for you, as well.

Read about options for SLIT

About This Program

Expertise in Treating Regional Conditions

Our program is among the few in Boston with the resources to manage care for patients with allergies across the spectrum, from mild to severe. Our specialists are particularly skilled at diagnosing and treating allergic conditions associated with New England's unique climate, geography, plants, animals and other factors that trigger symptoms.

We treat the complete range of allergens and irritants that affect the nose and nasal system (rhinitis) and eyes (conjunctivitis), including those categorized as:

• Seasonal allergens: Pollens from plants and trees trigger symptoms when they become airborne, usually during spring, summer and fall
• Perennial allergens: These allergens occur throughout the year and include dust mites, mold, pet dander and cockroaches
• Environmental irritants: Substances such as chemical odors, perfumes, cigarette smoke and pollution can irritate without the presence of a specific allergy. Generally, no testing is available for this type of irritant reaction and the diagnosis is made based on the history

Our expertise extends to treating conditions that occur frequently but may be less well known to the public, such as:

• Non-allergic rhinitis: For many patients, symptoms of rhinitis are not caused by allergies, but rather by irritants or physical triggers. This problem can occur when patients inhale substances (e.g. air pollution, perfumes, smoke, cold/dry air) or ingest spicy foods, causing nasal blood vessels to dilate
• Oral allergy syndrome: Many patients with seasonal allergies experience itching or swelling in the mouth or throat when eating certain fresh fruits and vegetables. These reactions are triggered by allergens in the fruits and vegetables that are similar to pollen allergens

When patients have allergies in combination with chronic sinusitis, we treat them in collaboration with our ear, nose and throat colleagues at the nearby Massachusetts Eye and Ear.

Advancing the Treatment of Allergies

The rich history of treating allergies at Mass General dates back to the founding of the Allergy Unit in 1919. In the 1960s, our researchers conducted the first controlled studies in which ragweed pollen extract was injected repeatedly to relieve ragweed symptoms. This breakthrough effort and others at Mass General have transformed how clinicians treat allergies to this day.

Today, an impressive range of allergy-related studies takes place at Mass General. Scientists in the Center for Immunology and Inflammatory Diseases conduct basic research in the mechanisms of immune-mediated inflammatory diseases. Our specialists often collaborate with the center's researchers when a patient's condition proves exceptionally difficult to diagnose. Additionally, patients can take part in clinical trials of chronic sinusitis, nasal polyps and asthma through the Allergy Clinical Research Unit.