Itchy, sneezy, miserable. Austin braces for arrival of an unwanted guest: cedar fever

In Central Texas, cedar fever season is right around the corner. Are you ready for it?

This pollen allergy typically hits the Austin area in December and lasts through January, sometimes into February. For cedar fever sufferers, that means itchy eyes, runny noses, scratchy throats and generally feeling terrible.

What causes cedar fever?

Cedar fever is an allergy to a pollen. It isn't really cedar-related and doesn’t typically come with a fever. It’s triggered when the male Ashe juniper trees get excited to spread their pollen to the female Ashe juniper trees. They let the wind spread their pollen to all their female Ashe juniper friends far and wide. (How do you tell a male Ashe juniper from a female? The female has berries on the branches. The male will be coated with yellowish brown pollen.)

Anyone who has been exposed to this Ashe juniper pollen over time might start feeling its effects.

What makes cedar fever so difficult compared with other allergies is the number of allergens in the air. Cedar pollen counts can be in the 10,000 to 12,000 range on a bad day. A bad oak day would be 800, meaning 800 pollen grains landing in a defined area compared with 12,000 pollen grains for cedar. Last year, Austin saw some days with 20,000-plus cedar counts.

Who gets cedar fever?

Some people will never get cedar fever. Others might get it the first year they move to Central Texas. Most people, though, need to go through a few seasons before they become allergic to the juniper pollen. It takes some exposure to produce the reaction.

Allergists typically don't see babies with cedar fever but will see kids 18 months to 2 years with their first bad cedar fever season. It tends to be worse in kids who have eczema or asthma, said Dr. Haley Overstreet of Aspire Allergy & Sinus.

"If you feel like it's impacting your life in any way, whether it be work, leisure or productivity, then it's worth getting treated," Overstreet said.

Treatments start with testing to make sure cedar is the allergen that's bothering you.

There are treatments beyond the over-the-counter medications, but those take some planning. Allergy shots need to be started six months before the season begins, and drops need to be started three months before.

What can we expect this year?

This winter is expected to be drier than normal, which could be bad news for cedar fever sufferers. Rain is needed to help wash away the pollen and prevent it from flying everywhere.

Dry, windy days are the worst. We will see plumes of yellow juniper pollen floating through the air and landing on cars, sidewalks and people.

How can you tell cedar fever from COVID-19, flu or RSV?

This cedar fever season, Austinites also will be dealing with respiratory viruses such as respiratory syncytial virus, flu and possibly COVID-19.

Flu arrived in late September. RSV also hit at that time. That double dose has filled children's hospitals around the country, including in Austin, where at times there have been no available beds.

Respiratory syncytial virus and other respiratory viruses have these symptoms: runny nose, coughing, sneezing, fever, wheezing and decreased appetite.

Flu has these symptoms: fever or chills, cough, sore throat, runny or congested nose, muscle or body aches, headache, fatigue and sometimes vomiting or diarrhea.

COVID-19 symptoms are typically fever or chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting, and diarrhea.

What these viruses don't have is itchiness, though some people with COVID-19's omicron variant did experience some scratchy throats. Unlike viruses, allergies typically do not produce a fever unless a sinus infection develops.

People with allergies typically have itchy or watery eyes, puffy eyes, itchy throat, sneezing, runny nose or congestion, and a sinus headache. Allergies can also worsen asthma symptoms.

"There's definitely some overlap," Overstreet said.

She has treated patients who thought it was just their allergies, including cedar fever last season, and it turned out to be COVID-19.

If you're not sure what you have, take a COVID-19 test if you have one at home. If you think it might be flu, see your doctor to get it confirmed. Both COVID-19 and flu have antiviral medications that when given early can lessen symptoms.

If you are having trouble breathing, which could be a sign of these viruses, seek medical care from an emergency room.

How can you avoid the allergy/virus double whammy?

In addition to getting flu shots and COVID-19 boosters, getting your allergies under control can help prevent viruses.

Allergies can increase your risk for other illnesses, said Dr. Gaurang Shah, emergency medical director at St. David’s Medical Center.

“Because you have more mucus, you’re more likely to catch and hold on to viral particles, which increases the risk of developing an infection,” he said.

How can you ease cedar fever symptoms?

Start taking allergy medications, if you haven't already. Choose either a nasal spray, such as Flonase, or an antihistamine, such as Claritin or Zyrtec. These can take about two weeks before they have the maximum effect. Once you start taking these medications, don't stop until at least the end of January or after the daily pollen charts no longer list cedar or juniper.

Choose the medication that works for you. They can come with side effects such as being sedating or drying out the nose and mouth too much. Sometimes you might have to try a medication for a few weeks before you know whether it is working, Overstreet said. Check with your doctor if you don't know what to try or are concerned about side effects or interactions with other medications.

Plan around the pollen. Watch the allergy counts and plan outdoor activities for days when the pollen counts are lower.

Rinse and repeat. Do a daily nasal rinse using distilled water in a neti pot or a squeeze bottle. This helps flush the pollen from the nose.

Dress the part. Wear long sleeves, long pants and hats to keep pollen off the skin and out of the eyes when working or playing outside. Then remove those clothes and hat when you come inside and put on fresh clothes.

Shower after an outdoor activity and at night. This helps keep the pollen in your hair and on your skin off your pillow when you sleep.

Wear a mask outside. It's great for keeping out viruses as well as pollen.

Keep pollen outside. Keep windows and doors closed during cedar fever season.

Change air filters in your home if they haven't been changed recently.

This article originally appeared on Austin American-Statesman: Austin, here's how to get ready for arrival of cedar fever season