When I was growing up, I didn’t have allergies. My little sister did, and they looked miserable. Now I cough and sneeze every spring. You can imagine that right now during the COVID19 pandemic, being a lung and ICU and doctor with a non-stop chronic dry cough from the month of March to June is a little problematic. In addition to wearing a mask during my entire shift, I frequently put on an eye shield, not so much for the additional droplet protection, but to keep me from even trying to touch and rub my eyes all the time. I hope I’m not causing my colleagues at work, or worse, my patients, to be worried that my cough might be a harbinger of a lethal pandemic virus.
How did this happen to me though? I recently have been spending more time outdoors with my kids. It is hard to not notice the green coat of pollen on almost every surface. I found myself staring at this pollen-coated puddle on a walk the other day.
I do not remember this growing up here in Oregon. I graduated high school in 1998. I remember around this time always feeling really bad for my sneezing coughing little sister, but the things that made her sneeze always seemed invisible. Now I see pollen clouds being blown across the landscape. Multiple places along the sidewalk where a prior pollen-filled puddle has dried up there is now a literal pollen stain on the path. This is wild. Am I just feeling that there’s more pollen because I now have allergies and notice it? Or is there actually more pollen? It turns out that science has told us that there is absolutely more pollen, and the culprit is climate change. Climate change is leading to longer pollen seasons and more intense pollen. There’s actually a great deal of disturbing research on how pollen is changing, from becoming both less nutritious for our pollinators, as well as more allergenic, and plants are producing greater amounts of it. This interacts in all sorts of concerning ways with increasing carbon dioxide in the atmosphere. I’m always trying to learn more about this and will continue to explore it in future posts, but there’s too much to cover at once about all the different ways that climate change is affecting our respiratory health. Today I’m focusing on the pollen season. The US Department of Agriculture has a massive economic interest in this, as all of us rely on pollen and pollinators for our food. So changes to pollen are a big deal. One scientist there has been studying this for quite a while- Lewis Ziska, PhD a research plant physiologist at the USDA. I have really loved looking at his studies while learning more about this topic. They are very practical and look at real world data and scenarios.
One study he and his group did looked at why allergies have been increasing in the United States over the last 30 years. They note that this is a very important question to answer since we spend around 21 billion dollars a year on allergies in the United States. They focused on the Ambrosia species, also known as ragweed, since it is a very common cause of allergies. Around 10% of the US population is sensitive to ragweed, and they noted that around 27% of allergic individuals had ragweed sensitivity according to two other large studies.
I did not know this, but the National Allergy Bureau has 8 different locations in the United States between Austin, Texas and Fargo, North Dakota and has been recording the pollen records in these sites. Combining this with a software program from Texas A&M looking at the closest weather stations, the researchers were able to look at pollen counts and temperature trends. They also looked at a couple Canadian locations with similar information. They examined multiple factors, including seasonal precipitation, and found that it was the delay in the cold start of fall and the decrease in days with frost that correlated most significantly with increasing pollen.
We now have up to 27 more days of pollen season in North America thanks to climate change.
That is a lot more sneezing and a lot more health care expenditures related to allergies. I take care of people with severe asthma, and many of them can have exacerbations (or severe worsening of their disease) related to allergies and pollen. There is obviously the severe economic costs of asthma when someone ends up in the hospital, needs the ICU, is on a ventilator etcetera. We not only pay for their hospital stay, but there is also the significant economic cost of the misery related to asthma. When a kid has to stay home sick from school and a parent has to stay home, either their employer pays for a sick day or, if that parent doesn’t have sick days, then the family economy is hurt because of missed work. All of our economy drags more because that family is spending that much less on food, clothing, activities, etc since they missed those wages. Furthermore the doctor visits, the inhalers, other medications, etc add up to a lot of money. A three inhaler regimen can be over $10,000 a year. Asthma biologic drugs can run $300,000 per year, and their need is increasing with increasing severe allergic asthma. Somebody is paying that money, even if an individual family isn’t paying that full amount because of their health insurance, the rest of us are paying either in elevated health care premiums, or in Medicare and Medicaid expenditures. Here in Oregon, we taxpayers pay for most of the asthma care because patients on Oregon Medicaid have more than twice the prevalence of asthma (around 23%) compared to those with some other form of insurance (around 9%). They are also more likely to be hospitalized. Most asthmatics in the US also eventually end up on Medicare, also funded by all of us.
There is no such thing as free unhealthy air. We all pay for it. Pollen season and intensity is increasing as the climate warms. This brings misery, wasted lives, wasted talent, and wasted money. Another reason not to light those fossil fuels on fire- not only are they bad to breathe into our lungs, they warm the planet and lead to excess pollen, which is also bad to breathe for many of us.
Twitchy Airway Club Members– knowing your particular problem pollen season can be helpful. Ragweed is a common offender for many, but if you know there is a seasonality to times that you are worse, talk to your doctor about whether a season-specific medication plan might be right for you. If you’re not sure what your triggers are, time to fill out a trigger diary!
- Follow pollen counts in your area (eg here)- you may be able to figure out how to adjust your medications and habits accordingly
- Keep windows closed during pollen season, ideally you have an air filtration system in your home, but that is not an option for many
- Take shoes off coming in
- Consider taking a shower at the end of the day so you can sleep pollen-free
- Plants tend to release pollen in the morning, so consider evening workouts
References this page:
Ziska et al. Recent warming by latitude associated with increased length of ragweed pollen season in central North America. Proc Natl Acad Sci. March 8, 2011 108 (10) 4248-4251.
Oregon Health Authority- “Asthma Among Oregon Health Plan Members”