Environmental allergies occur when the immune system reacts to substances in the environment, known as allergens. Common symptoms include sneezing, runny or stuffy nose, itchy or watery eyes, coughing, wheezing, skin rashes, sore throat, and fatigue. These symptoms can range from mild to severe and can significantly affect daily life.

Allergens that commonly trigger environmental allergies include pollen from trees, grasses, and weeds, as well as mold spores, dust mites, and animal dander. Therefor contrary to popular opinion there isn't a single "allergy season". There are allergy seasons all year round. It just depends on what a person is allergic to. When a person with allergies comes into contact with these allergens, their immune system mistakenly identifies them as harmful invaders and releases chemicals like histamine to combat them. This immune response leads to the typical allergy symptoms.

Genetics play a significant role in the development of environmental allergies, as they often run in families. Additionally, environmental factors such as pollution and exposure to allergens from an early age can increase the risk of developing allergies.
Avoiding allergens, using allergy medications, and undergoing allergy shots (immunotherapy) are common approaches to managing environmental allergies. Allergies can also develop at any age. Most people think allergies are something one develops as a child but allergies can develop at any age. In fact the majority of adults who have allergies did not develop their first symptoms until they reached adulthood.

Allergies are a complex immune response which varies from one person to the next and even from one season to another. As such there is no one treatment or approach that works best for everyone but there are some general recommendations that will help most people.

Initial treatment for allergies usually involves either an antihistamine or a nasal steroid spray or both. These medications are available over the counter without a prescription. There are several things to keep in mind when using these drugs.

• Allergies are a type of inflammation. While an acute attack may respond in hours once treatment begins, symptoms that have been present for a while will often require continuous and prolonged treatment in order to obtain  and sustain a reduction in symptoms
• Prevention is better than treating symptoms which have already developed. For patients who have had symptoms every year at a certain time it is desirable to start treatment several weeks before their season starts. Allergy symptoms are easier to prevent and require less medication than when they are treated after symptoms have developed. Similarly an allergy attack will respond more rapidly and more completely if treated while symptoms are mild than if those symptoms are allowed to become severe
• Consistency is important. Results will be better is medication is used daily throughout the patients allergy season rather than using it only on days when symptoms are most severe

Treatment options for allergies include:  
Over the counter -OtcPrescription required - Rx

1. Antihistamines: These medications block the action of histamine, reducing allergy symptoms like sneezing, itching, and runny nose. 
   • Examples: Claritin (loratadine)_Otc, Allegra (fexofenadine)_Otc, Zyrtec (desloratadine)_Otc
2. Decongestants: Decongestants help relieve nasal congestion by shrinking swollen nasal tissues, making it easier to breathe. 
   • Examples: Sudafed (pseudoephedrine)_Otc Note - Any antihistamine that ends with a -D, like Claritin-D also has pseudoephedrine in it along with the antihistamine
3. Nasal corticosteroids: These nasal sprays reduce inflammation in the nasal passages, alleviating symptoms like nasal congestion, sneezing, and runny nose.
   • Examples: Nasacort (tiramcinalone)_Otc, Flonase (fluticasone) _Otc, Nasonex (mometasone)_Rx - Note: Some of these are over the counter, Some require a prescription. The ones that require a prescription are no more effective that the ones that are over the counter
4. Allergy shots (Immunotherapy): Immunotherapy involves regular injections of allergens to desensitize the immune system, reducing allergic reactions over time.
5. Sublingual immunotherapy (SLIT): Similar to allergy shots, SLIT involves placing allergen extracts under the tongue to desensitize the immune system. It's an alternative for those who prefer not to receive injections.
6. Other Allergy medications: Other medications like 
   • leukotriene modifiers - Singulair (montelukast) R_x
   • mast cell stabilizers - Nasalcrom nasal spray _Otc
   • nasal anticholinergics - Astepro (azelastine) nasal spray _Otc
7. Avoidance: Avoiding allergens whenever possible can help reduce allergy symptoms. This may include keeping windows closed during high pollen seasons, using air purifiers, and regularly cleaning to reduce dust mites and mold.
8. Corticosteroids: Steroids are sometimes necessary for severe attacks but these medications can have significant side effects and should not be used frequently or for prolonged periods except when absolutely necessary
9. Natural remedies: Some people find relief from allergies using natural remedies like saline nasal rinses, herbal supplements, and acupuncture. However, the effectiveness of these methods may not be well documented, and it's essential to consult with a healthcare professional before trying them.

Individuals with severe allergies or those who don't respond well to standard treatments may need to consult with an allergist for specialized care and treatment options. There are some newer medications that can be extremely effective but due to their expense, these are generally reserved for patients who have moderate to severe symptoms that have failed to respond to the standard therapies listed above.

Several biologics have been developed or are under investigation for the treatment of allergies. These usually require consultation with an allergist. Some notable new medications include:

1. Omalizumab (Xolair): Originally approved for treating allergic asthma, omalizumab has also been approved for chronic idiopathic urticaria (hives). It works by targeting immunoglobulin E (IgE), a key player in allergic reactions.
2. Dupilumab (Dupixent): Approved for the treatment of moderate to severe atopic dermatitis (eczema) and moderate to severe asthma with an eosinophilic phenotype, dupilumab targets interleukin-4 (IL-4) and interleukin-13 (IL-13), which play crucial roles in allergic inflammation.
3. Mepolizumab (Nucala): Initially approved for severe eosinophilic asthma, mepolizumab has shown promise in treating eosinophilic esophagitis, a condition related to allergies. It targets interleukin-5 (IL-5), which regulates the production and survival of eosinophils, a type of white blood cell involved in allergic reactions.
4. Reslizumab (Cinqair): Similar to mepolizumab, reslizumab targets IL-5 and is approved for severe eosinophilic asthma.
5. Benralizumab (Fasenra): Another IL-5 antagonist, benralizumab is approved for severe eosinophilic asthma. It works by binding to the IL-5 receptor on eosinophils, leading to their depletion.