Seasonal Allergies

Seasonal Allergies

Austin can be a tough city for those who suffer from allergies.  Each season has distinct allergens that can wreak havoc on your immune system.  Here is a brief overview of the most prevalent allergens for the upcoming Spring season as well as the other seasons. Also, learn about various treatment options and ways to ultimately prevent allergy symptoms.


Oak pollen is most prevalent in the spring with other tree species including Ash, Elm, Pecan, and Cottonwood also producing copious pollen.


Grass predominates in the summertime so lawn cutting and the occasional breeze disperses its pollen widely. If there are plenty of showers, mold can also spike during this season.


Ragweed is the main culprit during the cooler fall months. If the weather is particularly mild the allergen count can be similar to spring levels.


Ashe juniper or mountain cedar trees produces its pollen during the winter months. In fact, on cool, sunny days light “clouds” of pollen can be seen hovering in the Austin air. Cedar allergies are notable for the intense generalized reaction it can produce. “Cedar Fever” feels like the flu with fatigue, bodyaches, and chills.

Symptoms & Treatment

Allergens (pollens, weeds, chemical exposures, etc) sometimes stimulate the immune system to react. Symptoms can range from a simply annoying sneeze to distressing shortness of breath. Typical symptoms are mild such as post-nasal drip, watery/itchy eyes, and a scratchy throat. However, depending on both your sensitivity and the environmental count of the pollen, potentially troublesome issues like a persistent cough or even wheezing can develop.  Allergic substances range from environmental exposures to chemical pollutants. Even tobacco exposure can contribute to nasal congestion.

The foundation of allergy treatment is a combination of exposure reduction (i.e. leave the environment) and antihistamines such as zyrtec and allegra. For more persistent symptoms the addition of a nasal steroid such as Flonase may be needed. For those with moderate to severe symptoms, visiting a healthcare facility will be required. A prescription for allergy eye drops or even a steroid injection with a breathing treatment may be needed.



Ultimately, the only effective way to rid yourself of allergies is to either eliminate it from your environment or lessen your immune response. Allergy shots or drops (immunotherapy) may be needed to build up the body’s immunity to the allergen and lessen your response over time.


ExpressMD offers testing both for inhalant allergens as well as food allergens.

How is allergy testing performed?

For inhalant allergies, the most common method of testing we perform is known as skin prick testing. Allergen extracts are introduced through very tiny and superficial pricks in the skin, with minimal discomfort. The level of reactivity is then directly measured by the size of the skin welt that occurs at each test site. Most commonly, this is performed on the patient’s back. Our skin prick panel tests for 70 common environmental allergens including grasses, trees, weeds, molds and fungus, dust, and animal dander. Certain medications need to be avoided prior to skin testing. You should receive a list of medications to avoid when you schedule testing.

Certain patients, especially those with poorly controlled asthma, those who have had a previous severe reaction to skin testing, and those who are unable to discontinue any of the mediations listed, may undergo allergy testing via a blood test. This is an indirect test in that it measures antibodies in the blood rather than a direct reaction to the allergen, but it is a useful alternative to skin testing in these patients.

Food allergy testing is conducted via a blood test. We have various panels available to test for both IgE-mediated food allergies as well as IgG-mediated food sensitivities.

What are the benefits of allergy testing?

Testing for inhalant allergies helps guide treatment in several ways.

For many patients it simply helps determine to what degree allergies may be playing a role in their symptoms. A remarkably negative allergy test in the face of significant symptoms can still be useful in that it directs additional testing and treatments toward other potential causes of these symptoms.

Information about what substances are triggering a patient’s allergy symptoms can help the patient anticipate situations and seasons that may be especially bothersome. Efforts can be made to avoid these allergens, and medication can be started prior to times of high exposure as a prophylactic measure.

Finally, the results of allergy testing guide individualized immunotherapy, which can desensitize a patient to the allergens and effectively cure the allergies.


Sublingual Immunotherapy (SLIT)

  • A very safe treatment that uses the patient’s own immune system to achieve results. The immune system is introduced to the allergen in small and increasing doses until natural immunity is developed.
  • Currently considered off-label by the FDA, but uses the same safe and FDA-approved extracts used in traditional subcutaneous immunotherapy (allergy shots).
  • Allergy symptoms may potentially begin to subside as early as 1-3 months following the beginning of treatment. Most patients notice an improvement within 6-12 months. The full treatment course is 4 years and the resulting relief can last many years, if not a lifetime.
  • Drops are placed under the tongue and can be taken at home
  • Drops are administered on a daily basis
  • Is a travel friendly treatment option
  • Estimated cost is $4,500 spread out over 4 years. Your health insurance may pay for part of these costs.
  • Healthcare Savings Accounts (HSA or Flex Spending) can be used to pay for expenses not covered by insurance.
  • Side effects are mild and include stomach aches, irritation under the tongue, or an increase in allergy symptoms
  • Most patient do not experience side effects


  • A safe, FDA approved treatment that uses the patient’s own immune system to achieve results. The immune system is introduced to the allergen in small and increasing doses until natural immunity is developed.
  • Allergy symptoms may subside as early as 3-6 months following the start of treatment. Full recovery take approximately 3-4 years and can last many years, if not a lifetime
  • Shots are administered in office by a highly trained Allergist. Patient is monitored for 30min following treatment to establish that there is no reaction.
  • In the first several courses of treatment, injections are administered 1-2 times a week, then gradually tapered depending on the patient’s particular response and needs.
  • Estimated cost including office visits, testing, and 4 years of therapy shots is $6800-$8400
  • Shots must be administered at the office
  • Side effects are usually mild, but can be moderate or severe in some patients, even leading to discontinuation of therapy.

Does my health insurance cover SLIT?

Insurance does typically cover all or some portion of allergy testing.

However, most insurance plans do not pay for allergy drops at this time.  Call your insurance company to discuss your benefits.   Even though the drops are paid for out-of-pocket, there is still substantial cost savings with allergy drops compared to allergy shots.   Because fewer office visits are required with allergy drops, you can expect significant cost savings on insurance co-pays, missed work and costs for travel time for clinic visits.

What are the potential side effects from SLIT?

Thankfully, side-effects from allergy drops are rare.   Most of our patients report no side effects at all.  However, sometimes the following mild reactions occur:

  • Mild increase in allergy symptoms
  • Stomach ache
  • Irritation under the tongue

These symptoms usually go away within thirty minutes after the drops are taken.  All side-effects usually completely resolve within 1 week of starting the drops.  If side effects seem more severe or last longer than 2 weeks, please contact our office right away.  In the unlikely event that you have a severe reaction, call 911 or go to the nearest hospital emergency room right away.

What are the benefits of SLIT, and when will I start to notice improvement?

Often, symptoms decrease within a few weeks after starting allergy drops.  However, it may take up to one year before you begin to notice improvement.   Our goal is at least an 80% reduction in symptoms.  Some patients experience 100% allergy relief, but most still experience some allergy symptoms that are less intense than before treatment.

You can take your allergy drops in the privacy of your home.  Compared to allergy shots, you do not have to worry about travel expenses or the cost of missed work/school/childcare due to frequent office visit requirements.  Once stable on your drops, you can sign up for auto-refill to receive your drops every 3 months by mail.   Once the 3-4 year treatment course is completed, you can expect long-term, even life-long reduction of your allergy symptoms.

How is SLIT Provided?

Your personal prescription for immunotherapy is prepared based on your unique allergy test results.  Allergen extracts are prepared in our office by mixing them with a glycerin-saline solution.  Drops are placed under the tongue daily.  The concentration of allergen extracts is gradually increased every 3-4 weeks with a new bottle until you reach your maintenance dose.  The drops contain no phenol or other toxins.

Can I take allergy medications while I’m taking SLIT drops?

Yes!  Allergy medications do not interfere with allergy drops.  In fact, allergy medications are often used in the early stages of allergy drops.  However, your need for allergy medications should decrease during the course of your treatment.

Can children use SLIT?

Yes!   Allergy drops are safe and effective for children.  They will appreciate not needing a shot, too!

How do I know if I am a candidate for SLIT therapy?

Allergy testing (skin prick testing and/or blood tests) is the first step to determine what you’re allergic to.  Since both types of immunotherapy are effective, the decision between SLIT (drops) and SCIT (shots) often comes down to a question of safety, cost, and convenience.   Our staff and providers are happy to counsel you to decide what is right for you and your family.