Posted On: April 13, 2026

Ask the Expert: Seasonal Allergies, Asthma, and What Actually Works — with Dr. Karen Kaufman

If you have been waking up with itchy eyes, a scratchy throat, and a head full of pressure, you are in good company. Northern Virginia is in the middle of one of its most intense allergy stretches of the year, and every spring I see patients walk into my office convinced they have caught a cold that will not quit. Many of them are surprised to learn that what they are dealing with is not viral at all.

Seasonal allergies are often dismissed as a minor inconvenience, but left untreated they disrupt sleep, drain energy, worsen asthma, and can quietly pull down your quality of life for months at a time. And if you are also living with asthma, it can make this condition worse, which is one of the reasons I take allergy-related symptoms as seriously as I do.

One of the most common conditions I see in my practice this time of year is seasonal allergies, and every year patients come in asking the same handful of questions. Is this a cold or is it an allergy? Will this make my asthma worse? When is it time to see a specialist?

To get you the most useful information, I am thrilled to introduce you to my friend and colleague, Dr. Karen Kaufman of Kaufman Allergy, Asthma and Immunology in Vienna.

Meet Dr. Karen Kaufman

When a patient of mine needs allergy or asthma care beyond what I can provide in primary care, Dr. Karen Kaufman is one of the first physicians I call. She is a double board-certified Allergist-Immunologist, a Fellow of the American Academy of Allergy, Asthma and Immunology, and has been repeatedly recognized by her peers as one of the Top Doctors in Northern Virginia and the greater Washington, DC area.

Her answers below are the ones I want every patient of mine to hear heading into this season.

What allergens are patients in Northern Virginia dealing with right now, and when does the season typically peak?

Tree pollen is the dominant culprit in our area, accounting for more than 90% of total annual pollen. If your eyes are watering and your nose won’t stop running, one of these trees is likely to blame. The tree pollen season typically runs from March through mid-June, with the worst of it in April and May. The grass pollen season will begin overlapping with tree pollen during May, so many patients are reacting to multiple triggers at once during that stretch. One trend worth noting is that climate change is extending our pollen seasons. The number of days of pollination has lengthened over the past few decades, and pollen levels are on the rise.

Can allergies change or worsen as we get older? Do hormonal shifts like perimenopause or menopause play a role?

Yes — allergies can absolutely change across your lifetime, and hormones are part of the story. While boys actually have higher allergy rates in childhood, women experience higher rates of allergic rhinitis from adolescence onward. Estrogen and progesterone can increase certain inflammatory cells in the nasal passages and cause nasal blood vessel engorgement, which may worsen congestion and allergy symptoms.

The perimenopause and menopause transition is an area of active research. Interestingly, a large recent study using the NIH’s All of Us Research Program found that after accounting for other factors, menopause was actually associated with a modest decrease in the odds of allergic rhinitis. So the relationship is more complex, and more individual, than we might expect. What’s clear is that hormonal fluctuations during the menstrual cycle, pregnancy, and the menopause transition can all influence nasal congestion and allergy symptoms.

What’s the difference between seasonal allergies and a cold? When should someone stop waiting for it to pass?

The two conditions share a lot of symptoms, but there are some reliable clues that distinguish them. Itching of the eyes, nose, or roof of the mouth is one of the most reliable signs of allergies. Colds rarely cause significant itching. Other symptoms include clear, watery runny nose, watery or red eyes, sneezing fits, sore throat, and seasonal or exposure-triggered patterns.

With a cold or viral infection, nasal discharge may thicken or change color, body aches and fever may occur, and are distinct from the symptoms of allergy. Viral symptoms typically resolve within two weeks, so if symptoms persist for longer despite adequate OTC treatment, if your sleep, work or quality of life are affected, you should see a specialist for further evaluation. Other symptoms that can suggest something distinct from viral infections or allergies but need attention may include one-sided nasal discharge, significant nosebleeds, loss of smell, or severe headache.

With so many OTC options available, what’s a good starting point — and what mistakes do people commonly make?

For mild or occasional symptoms, start with a second-generation oral antihistamine such as cetirizine (Zyrtec), loratadine (Claritin), levocetirizine (Xyzal) or fexofenadine (Allegra). These are less sedating than older antihistamines and work well for sneezing, itching, and runny nose. Nasal antihistamines like azelastine (Astepro) also help with similar symptoms.

For moderate to severe or persistent symptoms, including congestion and post-nasal drip, intranasal corticosteroids are the most effective option available over the counter, and fluticasone (Flonase), mometasone (Nasonex), triamcinolone (Nasacort), and budesonide all fall into this category. These sprays reduce inflammation in the nasal lining.

Common self-treatment mistakes to avoid:

• Using oxymetazoline nasal spray (Afrin) for more than 3–5 days — this causes rebound congestion that can be worse than the original symptoms
• Wrong spray technique — aim toward the outer wall of each nostril, away from the septum, to reduce nosebleed risk
• Stopping too soon — intranasal corticosteroids take at least 2 weeks to reach peak effect, though some benefit starts within days
• Using sprays only when symptomatic rather than consistently throughout the season
• Adding oral decongestants unnecessarily, which can raise blood pressure and disrupt sleep

Saline nasal rinses are inexpensive, safe, and can provide real additional relief when used alongside other treatments.

I have asthma. How are allergies and asthma connected, and what should I do differently during allergy season?

The connection is significant. Roughly 30–40% of people with allergic rhinitis have or will develop asthma, and most people with asthma also have rhinitis. This is because the upper airways (nose and sinuses) and lower airways (lungs) share the same inflammatory biology — what affects one often affects the other. Poorly controlled allergic rhinitis is directly linked to worse asthma control.

Treating your nasal symptoms aggressively isn’t just about comfort, it actually improves asthma outcomes. Important management considerations include ensuring that nasal symptoms are well-controlled, and asthma symptoms are being closely monitored. Patients who have asthma should be tested to determine which specific allergens are contributors, and discuss specific treatment options with a specialist to include appropriate environmental controls, monitored lung function, optimized medication regimens, and allergen immunotherapy.

Are there lifestyle or household changes that actually make a difference in reducing allergen exposure?

Environmental control is genuinely first-line therapy — not just a nice supplement to medication. Here are the measures with the strongest evidence behind them.

For outdoor allergens such as pollen, it’s important to take shoes off at the door after spending time outdoors. Washing hands and face, along with saline to rinse out the inside of the nose is helpful. Taking a shower after spending time outdoors, and changing clothing are all helpful ways to address pollen. For those with pets at home, more frequent bathing of pets that go outdoors is helpful to reduce the pollen being brought inside on their coats.

For indoor allergens like dust mites, washing the bed linens weekly in hot water helps, along with encasing the pillows and mattresses, and keeping the humidity in the bedroom under 45%. For pet allergies, frequent bathing of the pet and the use of HEPA air and vacuum cleaners might help to some degree, but it’s important to keep in mind that there are treatment options such as immunotherapy which help to reduce the symptoms of environmental allergy (including pets) and improve our quality of life while living with our furry family members.

When is it time to consider allergy testing or immunotherapy? Who is a good candidate?

Allergy testing is always a good idea any time symptoms suggest allergy, but it becomes particularly important when symptoms are not well controlled or when quality of life is affected. Testing is also valuable when the diagnosis is uncertain. And that matters more than people realize: only about 75% of patients with classic allergy symptoms actually have allergic rhinitis. One in four turns out to have non-allergic rhinitis, a different diagnosis that requires a different treatment approach. Knowing the correct diagnosis means getting the right treatment.

Testing determines the specific allergen profile that is relevant and helps us provide a customized treatment plan for each patient. This includes the specifics of environmental controls, the most appropriate medications used at the appropriate time of year for symptom control, and to discuss immunotherapy as an excellent treatment option. For patients with recurrent sinus infections, testing matters even more. The appropriate management of allergies also helps reduce the frequency of sinus infections.

One pattern we see often is that patients who have year-round allergen exposure have simply adapted to feeling unwell. Their baseline has shifted so gradually that they often don’t recognize how significantly their symptoms are affecting them, until we treat their allergies. Time and again, patients tell us they had no idea how good they could feel. That statement resonates so deeply.

Allergen immunotherapy is worth considering for anyone with environmental allergies who is tired of managing symptoms, wants to rely on fewer medications, or is simply ready to feel well again. Beyond the typical nasal symptoms, one of the most common quality-of-life complaints we hear is fatigue and poor sleep quality, and immunotherapy addresses those too. The best candidates are patients who want more than symptom control; they want their lives back.

What makes immunotherapy different from every other allergy treatment is that it actually changes the underlying immune response. It’s the only disease-modifying option available, meaning that with consistent treatment over time, patients don’t just feel better in the moment, they get better, and stay better long term. That’s a meaningful distinction.

As we engage in shared decision making with our patients, we walk through all available options, including risks and benefits, so that patients can choose the best path to relief.

If you could give one piece of advice for managing seasonal allergies, what would it be?

Get a proper diagnosis from a board-certified Allergist Immunologist. An evaluation with allergy testing is the fastest path to effective treatment and real symptom relief. I say this often: no one chooses to have allergies, but we all have a choice in what we do about them.

Think about what that could mean — breathing easily, sleeping soundly, and spending time outdoors without dreading it. That’s not out of reach. It’s available to everyone, and we’re here to help make it happen.

When to Talk to Your Doctor About Seasonal Allergies

If allergy season has become a months-long problem rather than a few bad weeks, it is worth a conversation. The signs that you have moved beyond “manage it at home” territory include:

• Symptoms that persist longer than two weeks despite consistent over-the-counter treatment
• Sleep, energy, or daily function noticeably affected
• Asthma that feels harder to control during allergy season
• Recurrent sinus infections
• Uncertainty about whether what you are experiencing is allergies, a lingering virus, or something else entirely

For my patients who fit this picture, I often refer to Dr. Kaufman’s team. Having a specialist I trust to send patients to — someone who will treat them as a whole person, not a chart — is one of the things I value most about how we practice here. That kind of care coordination is what concierge medicine is built for, and it is one of the reasons I believe in this model of care.

Final Thoughts

Seasonal allergies are not a minor inconvenience to push through until summer. They affect your sleep, your energy, your asthma control, and your day-to-day life — and they are treatable. If this year feels harder than last, or if you are tired of guessing what will work, start with a proper diagnosis. My team and I are here to help you figure out the right next step, whether that is a small adjustment to your current routine or a referral to a specialist like Dr. Kaufman.

Sources and References

• Asthma and Allergy Foundation of America (AAFA). Allergy Capitals Report. aafa.org
• Centers for Disease Control and Prevention. Most Recent National Asthma Data. cdc.gov
• American Academy of Allergy, Asthma & Immunology (AAAAI). Pollen and mold count and seasonal allergies. aaaai.org
• Settipane RA, Kaliner MA. Nonallergic Rhinitis. American Journal of Rhinology & Allergy.
• NIH All of Us Research Program — published analyses on allergic rhinitis and menopause association.