Allergy to grasses is very common. Grass allergies can present in a variety of ways, including nasal symptoms (runny nose, stuffiness, sneezing), asthma, and eye symptoms (itchy, watery/red eyes). People can also have skin rashes (hives or skin welts) after exposure to grasses, but this is much less common. Grass allergies are prevalent because grass pollen scatters in the wind, which is different from pollen that gets moved around by insects, so you are more likely to breathe it in and thus develop symptoms. In most regions of the United States, grass usually pollinates in the late spring season (April through early June).
There are two large classes of grasses: northern and southern. Common northern grasses include Timothy, Kentucky Blue, Johnson, Rye and Fescue. Common southern grasses include Bermuda and Bahia. Many regions of the United States have a predominance of one or more types of these grasses.
Grass Allergy Symptoms & Diagnosis
Allergic rhinitis includes nasal symptoms (hay fever) consisting of sneezing, nasal drainage (runny nose), nasal congestion (stuffy nose) and itchy nose. Facial pressure can also occur. Asthma symptoms include cough, wheezing, chest congestion, chest tightness and shortness of breath.
Allergic conjunctivitis (eye allergy) includes eye symptoms of itchy, irritated, red and watery eyes. Rashes after exposure to grass usually are hives or welts. They are red, itchy and raised. Usually, actual contact with grass causes them. However, hives can also be caused by many other things, so it is important to talk with your allergist about your rash.
Diagnosis of grass allergy usually involves allergy testing. There are generally two types of allergy testing: skin prick testing and specific IgE testing (blood test). Allergy skin prick testing involves “pricking” grass extracts in a liquid form on the arms or back and waiting 10 to 15 minutes for an “itchy bump” to occur, indicating an allergy to grass. These tests should be ordered and performed by an allergist. A blood test involves a drawing blood and sending it to a laboratory to determine if you are specifically allergic to grass.
Grass Allergy Treatment & Management
The major goal of treatment is an improvement in your quality of life. You should be able to participate in your school, work, social and family activities. In addition, sleep should be restful and undisturbed.
Avoidance of Grass Pollen
It may help to monitor pollen counts regularly. During days of high pollen counts, staying indoors can be helpful. Closing windows can also decrease pollen exposure. Taking showers after coming home following outdoor exposure may decrease pollen exposure accumulated while outside.
Saline Nasal Sprays and Rinses
Nasal saline sprays are available over-the-counter and involve spraying saline, or salt water, in your nostrils. Nasal saline rinses involve filling a bottle with water, putting a modified salt packet in the bottle, mixing it and rinsing out your nose.
It is important to make sure the water you use is purified in some way. You can use bottled water or distilled water. When you do the rinse, usually the salt water goes in one nostril and out the other. Nasal saline therapies can moisten dry nasal passages and can help with nasal symptoms due to grass allergies.
Nasal Steroid Sprays
Nasal steroid sprays are anti-inflammatory medications that are sprayed in the nostrils. The steroids used to treat allergies are different than other types of steroids, such as testosterone and estrogen. Even though some nasal steroid sprays are available over-the-counter, it would be advisable to see an allergist first. When used properly and in conjunction with an allergy physician, steroids are safe. Steroids have some potential side effects including irritating the nose, headaches and causing nasal bleeds. Using nasal saline a few minutes prior to the nasal steroid sprays can potentially prevent this nasal irritation and can also further help your nasal symptoms. It is recommended that you bring all nasal sprays you are using (they come in various forms) to your allergist.
Nasal antihistamines are nasal sprays that have antihistamines. Antihistamines are different from steroids, and usually work quite quickly to bring relief of symptoms. Some people note a bitter taste with nasal antihistamines. As with any medications, they have other potential side effects so one must discuss them with an allergist prior to use.
Oral antihistamines are pills that can help with allergy symptoms. They can help the nasal drainage and sneezing symptoms. However, they usually do not help nasal congestion, as nasal steroid sprays can. It is better to use the newer non-sedating antihistamines, as these are better tolerated. There are potential side effects, including increased sleepiness or sedation during the day, increased dryness and difficulty urinating. Recently, there has been a potential association between older adult patients and dementia (decreasing memory) with these agents.
Systemic Steroids: Oral Steroids and Steroid Injections
Systemic steroids (steroid pills or injections) are used at times if allergy symptoms are very severe. Steroid pills and steroid injections (shots) are much stronger than topical steroids and can therefore cause more side effects (including weight gain, high blood pressure and bone problems). If used, they should only be used cautiously under the guidance of your allergist.
Allergen Immunotherapy (Allergy Injections or Allergy Shots)
Allergy shots (giving injections of small doses of what you are allergic to under the skin in the arms to desensitize your immune system to grass pollen effects) are currently approved for the treatment of asthma, hay fever and eye allergies due to grass pollen. Allergy shots are not the same as steroid shots or steroid injections. Allergy shots should be performed in the office under the supervision of an allergist as there is the potential of allergic reactions to them.
Sublingual immunotherapy has the same concept as allergy shots, but instead of shots, it involves placing a dissolving tablet, containing grass pollen, under the tongue on a daily basis. Generally, allergic reactions can occur to sublingual immunotherapy, but they are more rare than reactions to allergy shots. After initial doses in the allergist’s office, sublingual immunotherapy can be used at home, under the guidance of the allergist. Sublingual immunotherapy is currently approved for grass allergy treatment in the United States and Canada.
Grass allergy is a very manageable condition, regardless of your age. There are many treatments currently available. Many over-the-counter products are also available, but it is recommended to see an allergist for guidance. With careful evaluation and follow up with your allergist, you can have a very high quality of life and enjoy all your activities.
Find out more about hay fever here.
This article has been reviewed by Thanai Pongdee, MD, FAAAAI