Symptoms and Treatment of Grass Allergy

Does breathing in the fresh air of a beautiful spring day trigger itchy eyes and a runny nose? Or do you experience an itchy rash by simply sitting on a grassy hill?

If so, you may be experiencing a grass allergy. This type of allergy is common and can occur from breathing in grass pollen or, in some people, by direct skin exposure to grass.

Interestingly, grass allergy can also be associated with pollen food allergy syndrome, resulting in allergies to tomatoes, potatoes, and peanuts. Usually, symptoms of pollen food allergy syndrome are mild, but in rare cases, symptoms are severe and warrant epinephrine carriage.

Symptoms

Grass pollen is most present in the air during the late spring or early summer months, and it's known to cause a variety of different allergic symptoms, such as:

• Allergic rhinitis (sneezing, runny and stuffy nose, nasal congestion)
• Allergic conjunctivitis (itchy, watery and/or red eyes)
• Asthma (a cough, wheezing, chest tightness, trouble breathing)

One reason why grass allergy is so common is that its pollen is scattered by the wind and not carried around by insects, so there are simply more opportunities for exposure.

Less commonly, direct contact with grass may result in allergic reactions, such as itching, urticaria (also called hives), and eczema (also called atopic dermatitis). 

Diagnosis

If you think you might have a grass allergy, speak to your healthcare provider and get tested. There are two major classes of grass: northern and southern grasses. Northern grasses are common in colder climates and include timothy, rye, orchard, sweet vernal, red top, and bluegrasses. Southern grasses are present in warmer climates; Bermuda grass is the major grass in this category.

If you have a grass allergy, you are more likely to be allergic to most types of grasses, if not all grasses, since grass pollens all have very similar proteins that cause allergies. Still, to be certain, an allergy test can determine which strains you are allergic to.

Association With Food Allergies

Allergies to grass can predispose a person to oral allergy syndrome (OAS), which is caused by cross-reactivity between proteins in fresh fruits and vegetables and grass pollen.

Grass pollen allergy is associated with OAS to tomatoes, potatoes, melons, and oranges. The proteins in the fruits and vegetables that cause OAS can be easily broken down by cooking or processing the offending foods. That's why symptoms don’t usually occur with cooked or processed foods like tomato sauce.

If you eat a fresh tomato, however, you may experience itching, burning, or stinging in your mouth, throat, and tongue. The symptoms generally last only a few seconds or minutes, since the proteins that cause the symptoms are broken down quickly by saliva. However, while anaphylaxis from OAS is rare, it can occur.

Treatment

If you have a confirmed grass allergy, there are ways to decrease your exposure and lessen your symptoms.

Reduce exposure: For one, you can try to reduce your grass exposure by staying inside and closing your windows during days of high grass pollen count. It's also wise to shower after being outside to remove any residual pollen on your skin. 

Over-the-counter solutions: There are over-the-counter (OTC) remedies, such as nasal saline sprays or rinses, that may ease your symptoms. These sprays can hydrate the inside of your nose, reducing congestion. In addition, the nasal steroid spray Flonase (fluticasone propionate) is also OTC and can reduce inflammation in your nose. You can talk with your healthcare provider about using it, though, if you prefer, since it may cause some side effects.

If you are exposed to grass and have an allergic reaction, you can take OTC antihistamines to relieve your symptoms. Oral antihistamines can treat itching and hives caused by direct grass exposure. They are especially effective when combined with bathing or changing clothes after significant grass exposure, such as after a soccer game.

Prescription medication: Severe allergies may require prescription medication. You can also try immunotherapy—the introduction of small amounts of an allergen into your system—which, in time, may lessen your reaction to grass.

Immunotherapy: Immunotherapy can be administered as allergy shots (called subcutaneous immunotherapy) or sublingually, in which a tablet containing grass pollen is held underneath the tongue. Subcutaneous immunotherapy may be more effective, but sublingual immunotherapy is probably more convenient and comfortable. In addition, whole-body or systemic reactions to the dissolvable tablets occur more rarely with the tablets compared to the shots.

There are currently two FDA-approved sublingual (under-the-tongue) tablets for treating allergic rhinitis (with or without allergic conjunctivitis) in children and adults from a grass pollen allergy:

• Oralair (a 5-grass pollen extract sublingual tablet)
• Grastek (a Timothy grass pollen sublingual tablet)

A Word From Verywell

If symptoms from your grass allergies are significant, see an allergist so you can devise a treatment plan that works best for you. A grass allergy is common, but the good news is that you can live well with it by making small behavioral modifications and using OTC or prescription medications as needed. If these do not work, immunotherapy may be worth considering.