Cedar Fever Symptoms, Causes & Treatment

What is Cedar Fever?

Inflammation of the mucus membrane of the nose and adjoining sinuses caused by the immunologic reaction to Mountain Cedar (Juniper Ashii) pollen is called Cedar Fever.

Despite the name, fever typically does not accompany the symptoms of seasonal allergic rhinitis induced by Mountain Cedar.

Junipers have male and female plants. Male plants turn reddish brown during pollination season and their pollen can be seen as a cloud or smoke around the tree.

When does Cedar Fever occur?

Mountain Cedar pollinates from November to March, but the highest pollen counts are seen throughout December, January and February. Thus, during the winter months when most of the country is free of pollen, Central Texas experiences the highest counts of Mountain Cedar pollen. The pollen counts of Mountain Cedar can reach tens of thousands of grains per cubic meter of air.

Where are Cedar trees found?

Mountain Cedar trees grow naturally and are the most allergenic tree in Central Texas. They are also found in New Mexico, northern Mexico, Arkansas, and Oklahoma.

Symptoms of Cedar Fever

Common symptoms include sneezing, nasal itching, runny nose, nasal blockage, cough, headache, ear itching and/or blockage, and a tendency to develop ear or sinus infections.

It is not unusual to experience symptoms such as itching, runny or swollen eyes or asthma symptoms such as shortness of breath, wheezing, or cough in association with allergic rhinitis.

A flare up of eczema (dry, inflamed patches of skin) can occur during the allergy season for a small percentage of patients.

Diagnosis of Cedar Fever

Diagnosis of Cedar Fever is initiated by taking a thorough history. A detailed physical examination is performed. This followed by allergy testing concludes the diagnosis.

Allergy testing

Most allergists perform skin tests to diagnose allergies. Skin tests are usually performed on the back in adults and on the arms in young children. The appointments usually take 1.5 to 2 hours and results are known at the end of the visit.

Blood tests can also be performed to diagnose allergies in special circumstances.

Treatments of Cedar Fever

Treatments vary depending upon the severity of the disorder. Such treatments can broadly be classified as follows:

Non Medicinal:
Nose washes: For patients with milder symptoms nasal washes can be used alone. For patients with more severe symptoms, they can be used in conjunction with other medications. Nasal saline spray can be used if nasal washes are hard to perform.

Medicinal:
Nasal steroids: These are nasal anti-inflammatory medications. They are very effective in controlling symptoms of allergic rhinitis. Nasal cromolyn sodium is a milder anti-inflammatory that is available over the counter and can help some patients.

Leukotriene antagonists: These are Oral anti-inflammatory medications. They are milder and can be used in selected patients.

Oral steroids: Oral steroids are reserved for patients with severe symptoms of allergic rhinitis. They are used for a short duration due to possible side effects.

Oral antihistamines: Histamines cause a number of symptoms in allergic rhinitis. Oral antihistamines block the effect of histamine. These antihistamines may be sedating and short acting or they may be non-sedating and long acting.

Antihistamine nasal sprays: These have the advantage of working topically and help with a number of symptoms of allergic rhinitis.

Oral decongestants: Nasal blockage can be treated with oral decongestants, which can be short acting or long acting. They can be used alone or in combination with antihistamines. Oral decongestants can raise heart rate and blood pressure and should therefore be used with caution.

Decongestant nasal sprays: These are topical decongestants and are not recommended for long term use because of rebound effects.

Nasal anti-cholinergic sprays: These help reduce nasal drainage and are used for symptomatic relief for nasal drainage.

Immunotherapy (Allergy Shots or Allergy Injections):
Immunotherapy slowly desensitizes patients to what they are allergic to and improves symptoms of allergic rhinitis. Small and incremental doses of allergens are injected subcutaneously during the build-up phase. Once the maintenance dose is reached, injections are continued for 3-5 years. Immunotherapy also helps allergy-induced asthma.