Pollen allergy

1) Disease Description (Causes and Symptoms)

• Definition summary: Pollen allergy (hay fever) is a disease in which plant pollen floating in the air enters the respiratory tract and causes an IgE-mediated hypersensitivity reaction (Type I hypersensitivity).
• Causes: Seasonal pollen from trees such as cedar (including cypress/arborvitae species), alder, and birch, as well as ragweed and other weeds, are the main causes. Some flowers (chrysanthemums, daisies, etc.) may cause contact dermatitis through skin contact. It is closely associated with the season (spring, early summer, etc.) and weather conditions (worsening on warm, dry mornings and after thunderstorms or wind).
• Pathophysiology (brief): When specific IgE produced after previous exposure is bound to mast cells and basophils, re-exposure causes IgE cross-linking and the release of inflammatory mediators such as histamine and leukotrienes, resulting in vasodilation, increased secretion, and bronchoconstriction.
• Main symptoms: Sneezing, clear runny nose, nasal congestion (allergic rhinitis), itchy and bloodshot eyes (allergic conjunctivitis), eye discharge, cough, wheezing, and shortness of breath (bronchial asthma), and skin redness, itching, and hives. Fatigue, reduced concentration, and decreased sense of smell may also occur, and symptoms are usually worse in the morning.

2) Treatment Methods

• Avoidance (environmental management)
  • Avoid going outdoors during seasons and times with high pollen levels (mornings and windy days), wear a mask and protective eyewear, shower and change clothes when returning home, keep indoor windows closed (ventilate briefly), avoid drying laundry outdoors, and use HEPA filters and vacuum cleaners, etc.
• Medication (standard)
  • Allergic rhinitis: Topical (intranasal) steroids (most effective as the first-line treatment), oral second-generation antihistamines (less sedating), decongestants (short-term), and saline nasal irrigation.
  • Conjunctivitis: Antihistamine, vasoconstrictor, or mast cell stabilizer eye drops.
  • Asthma-related symptoms: Inhaled beta-2 agonists (short-acting), inhaled steroids (maintenance), and, if necessary, short-term oral steroids.
  • Other: Leukotriene receptor antagonists (for selected patients) and short-term oral steroids in severe cases.
• Immunotherapy (disease-modifying treatment)
  • Subcutaneous immunotherapy (SCIT) or sublingual immunotherapy (SLIT). Long-term treatment (over several years) may reduce sensitivity and improve symptoms.
  • Considerations: Effectiveness varies depending on the patient and allergen. The treatment period and cost are substantial. Adverse effects, including anaphylaxis, may occur. It is limited or applied cautiously in cases such as severe uncontrolled asthma, certain cardiovascular diseases, and early pregnancy (individual assessment of restrictions is required).
• Surgical treatment
  • If accompanying structural abnormalities of the nose (deviated nasal septum, enlarged inferior turbinates, etc.) worsen symptoms, corrective structural surgery may be considered as an adjunctive treatment (it does not eliminate the allergy itself).
• Precautions (points to note during treatment and risk of complications)
  • Immunotherapy carries a risk of anaphylaxis → Appropriate monitoring and emergency response at a medical institution are necessary.
  • Patients with asthma may experience worsening respiratory symptoms → Regular use of controllers such as inhalers and immediate medical attention if symptoms worsen are necessary.
  • First-generation antihistamines may cause drowsiness → Use caution when driving or operating machinery.
  • If left untreated for a long time, it may progress to asthma or interfere with daily life, sleep, studies, and work.

3) Checklist Before an Outpatient Visit (Items to Prepare, Information to Provide to the Doctor, and Preparation for Medical History Questions)

• Items/materials to prepare
  • List of currently used medications (including OTC medications), whether inhalers or nasal sprays are being used, and their dosage and effectiveness
  • Copies of previous allergy test results (skin prick test, specific IgE), if available
  • Symptom diary: When symptoms began, seasons and times when they worsen, and triggering situations (exercise, specific places, thunderstorms, wind, etc.)
  • If you have a history of asthma, recent PEF (peak expiratory flow) records or frequency of inhaler use
  • Photos of symptoms (bloodshot eyes, skin rash, etc.) or videos (when coughing or wheezing occurs)
  • Pregnancy plans or current pregnancy status, and major underlying conditions (such as heart disease)
• Key information to tell the doctor first during the outpatient visit
  • Symptom patterns (timing, frequency, aggravating factors), effectiveness and adverse effects of previous treatments, living environment (occupation, residence, pets), and previous experience with immunotherapy.

Example questions for patients to check for themselves before the visit (in a form they can provide to the doctor)

• "When did the symptoms start, and during which season or time of day are they worse?"
• "What medications have you tried, and were they effective? Did you experience any side effects?"

4) Examples of General Questions to Ask the Doctor

• What are the expected effects and possible side effects of this medication (for example, an intranasal steroid or antihistamine)?
• Is immunotherapy suitable for me? What is the expected treatment duration, when should effects begin, and what is the approximate success rate?
• If I have asthma symptoms (or shortness of breath), what signs indicate that I should come to the hospital urgently?
• Are there any medications that are safe to take during pregnancy or breastfeeding? If I am planning a pregnancy, what treatment recommendations apply?
• What are the most effective avoidance (prevention) methods in daily life?

5) Examples of Disease-Specific Questions (1–2 tailored to the condition)

• I would like to consider immunotherapy (subcutaneous or sublingual). In my case (considering my age, underlying conditions, and whether I have asthma), which method is recommended, and what are the expected duration, cost, and adverse effects?
• Rhinitis caused by seasonal pollen frequently leads to asthma exacerbations. What medications or management strategies (for example, criteria for using preventive inhalers or restrictions on exercise) do you recommend to prevent asthma exacerbations?

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If needed, we can also provide information on the main seasonal pollen (trees, weeds, and grasses) in your current area of residence, or a symptom diary template (a simple table) that you can use when receiving medical care.