Seasonal Allergies in Pakistan: A Complete Survival Guide for Every Sufferer
Every spring, millions of people across Rawalpindi, Islamabad, and Pakistan wake up to sneezing, watering eyes, and a blocked nose that does not clear for weeks. A pulmonologist who treats pollen allergy patients every season explains what is really happening, which pollens are worst in Pakistan, and how to actually control your symptoms — not just endure them.
Every February, my clinic begins to fill. The pattern is predictable — patients arrive with itching, watering eyes, a nose that alternates between running freely and blocking completely, relentless sneezing, and a throat that tickles without relief. Some have been this way every spring for years. Some are experiencing it for the first time. All of them want the same thing: to understand what is happening and how to make it stop.
Seasonal allergies — driven primarily by airborne pollen — are one of the most common conditions I manage. Rawalpindi and Islamabad are not gentle cities for allergy sufferers. Mulberry trees, planted extensively across both cities for decades as street trees, release pollen that generates some of the highest airborne pollen concentrations recorded anywhere in the world during peak season. Added to this are acacia, chenopod weeds, and a succession of grass pollens that extend the allergy season from February well into August for the most sensitised patients.
Understanding your specific pollen triggers, knowing when your season peaks, managing your medication proactively rather than reactively, and knowing when symptoms cross the line from manageable to medically concerning — these are the tools that transform allergy season from an annual ordeal into a period of controlled, acceptable symptoms. This article provides all of them.
Pakistan's Pollen Calendar — Know Your Season
The single most practical piece of information for any seasonal allergy sufferer in Pakistan is knowing precisely when their specific triggers are in the air. Pollen calendars vary by geography — the seasons described below apply primarily to Rawalpindi, Islamabad, and the Punjab plains, with some variation for Karachi, KPK, and higher-altitude regions.
February — April: The Mulberry Season — Pakistan's Most Intense Allergy Period
Mulberry (Morus species) is the single most important allergenic tree in Rawalpindi and Islamabad. Planted extensively throughout both cities as ornamental and shade trees, mulberry releases enormous quantities of small, highly allergenic pollen grains during its brief but intense flowering season from mid-February through early April. Pollen counts during this period regularly reach levels classified as "very high" to "extreme" on international monitoring scales.
Mulberry pollen allergy produces the full spectrum of allergic rhinoconjunctivitis — severe nasal congestion and discharge, violent sneezing, intensely itchy and watering eyes, and palatal and pharyngeal itching. In sensitised asthmatic patients, mulberry season is consistently the period of worst asthma control — exacerbation rates in asthmatic patients spike dramatically in February and March in Rawalpindi, directly tracking the mulberry pollen count.
For mulberry-sensitised patients, this is the season to start medication proactively — two weeks before the expected pollen release — rather than waiting until symptoms are already severe. A nasal steroid spray started in early February, before pollen levels peak, provides substantially better control than one started mid-season when the nasal mucosa is already fully inflamed.
March — May: Acacia and Mixed Tree Pollens
Acacia trees — including Acacia arabica (kikar) and related species — are among the most common trees in Pakistan's urban and peri-urban environments. Their pollen season overlaps with the tail end of mulberry season and extends into May, meaning many patients experience a sustained period of tree pollen exposure from February through May with little respite. Acacia pollen causes rhinitis and conjunctivitis that is often attributed entirely to mulberry allergy — skin prick testing frequently reveals dual sensitisation to both.
April — June: Grass Pollens
Multiple grass species — including Cynodon dactylon (Bermuda grass, locally known as "doob"), Poa species, and various pasture grasses — release pollen from April through June. Grass pollen allergy is the most common seasonal allergy in temperate regions globally, and Pakistan's extensive grass coverage in parks, roadsides, and agricultural land makes it a significant contributor to the allergy burden. Bermuda grass pollen in particular is highly cross-reactive — patients sensitised to one grass are typically sensitised to most others, meaning the grass pollen season presents as a sustained multi-month exposure rather than a series of distinct seasonal peaks.
July — September: Weed Pollens
Chenopod weeds — including Chenopodium (lambs quarters) and Salsola (Russian thistle) species — are abundant in Pakistan's agricultural and waste ground areas and produce highly allergenic pollen during the summer and early autumn months. Chenopod sensitisation is particularly prevalent in patients from agricultural backgrounds and contributes to year-round or late-season symptoms in those who experience both spring tree pollen and summer weed pollen allergies.
Year-Round: Indoor Allergens
House dust mite, cockroach, cat, dog, and mould allergens cause perennial rhinitis that may be present throughout the year — sometimes worsening in winter when homes are sealed and indoor allergen concentrations rise. Many patients have both seasonal pollen allergy and year-round indoor allergen sensitisation, experiencing a "double peak" — worsening symptoms during pollen season on top of baseline year-round symptoms.
Why Allergy Symptoms Are Worse Some Years Than Others
Patients frequently ask why their symptoms seem more severe in some years than others, even without any change in their treatment. Several factors influence the severity of any given allergy season.
Weather patterns have an enormous influence on pollen production, release, and dispersal. Warm winters followed by sudden warm spells in early spring trigger synchronised, intense pollen release from trees that have been accumulating energy reserves through winter. Dry, windy days during pollen season carry pollen furthest and generate the highest airborne concentrations — conversely, rain washes pollen from the air and provides temporary relief. Urban heat island effects in Rawalpindi and Islamabad — where the city centre is several degrees warmer than surrounding rural areas — can extend the local pollen season beyond what rural pollen monitoring data would predict.
Climate change is lengthening pollen seasons and increasing pollen concentrations globally. Data from multiple monitoring stations shows that pollen seasons in South Asia are starting earlier and lasting longer than they did twenty years ago — a trend that directly worsens the experience of allergy sufferers and increases the proportion of the population crossing the sensitisation threshold each year.
Personal sensitisation also evolves over time. A patient who previously reacted only to mulberry may develop additional sensitisation to grass or weed pollens after years of high-level exposure — a phenomenon called "spreading sensitisation" that explains why allergy symptoms seem to worsen and extend later into the season as patients get older.
Recognising the Symptoms — And When They Cross a Line
Repeated sneezing (often in long bursts on waking), profuse clear watery discharge, nasal congestion that alternates sides, and intense itching inside the nose and at the back of the throat. These are the hallmark symptoms of allergic rhinitis — present during the pollen season and absent or minimal outside it.
Intense itching, redness, and watering of the eyes — allergic conjunctivitis — affects the majority of pollen allergy patients and is often more socially disabling than nasal symptoms. Rubbing the eyes releases more histamine and worsens the itch in a self-perpetuating cycle. Antihistamine eye drops provide more targeted relief than oral antihistamines alone for this component.
Worsening breathlessness, wheeze, or chest tightness during pollen season in a patient with known or suspected asthma indicates pollen-triggered lower airway disease. This is the symptom that demands the most urgent attention — asthma exacerbations during pollen season can be severe and rapid. Any asthmatic patient experiencing deteriorating control during pollen season should contact their pulmonologist proactively rather than waiting for a crisis.
Nasal congestion forcing mouth breathing during sleep disrupts sleep quality profoundly — producing the characteristic exhaustion and cognitive impairment of allergy season that patients describe as "seasonal brain fog." This fatigue is physiological, not imagined, and responds directly to effective allergy treatment that restores nasal breathing during sleep.
Eustachian tube dysfunction from nasal congestion causes a blocked, full sensation in the ears and sometimes reduced hearing during allergy season. This is particularly problematic in children, in whom recurrent Eustachian tube dysfunction during multiple allergy seasons can cause chronic otitis media with effusion (glue ear) and hearing impairment that affects language development and academic performance.
Mucus draining from the congested nose into the throat triggers a persistent, irritating cough and the need for constant throat clearing. This post-nasal drip cough can persist for weeks after the pollen season ends as the nasal mucosa slowly returns to its normal state — and is one of the most common causes of subacute cough (three to eight weeks duration) in Pakistani adults.
The most important message I give allergy patients every January — before the season begins — is this: do not wait until you are suffering to start your medication. Nasal steroid sprays work by reducing baseline inflammation, not by blocking acute reactions. They take days to reach their full effect. Starting two weeks before your season begins means you enter the peak pollen period with your nasal mucosa already protected, not already inflamed. This one change — from reactive to proactive treatment — transforms the allergy season for most patients.
— Dr. Nabila Zaheer, Pulmonologist
Who Gets Seasonal Allergies and Why?
Risk Factors for Seasonal Allergic Disease in Pakistan
- Family history of atopy — allergic rhinitis, asthma, and eczema cluster in families. If one parent has seasonal allergies, their child has a 30 to 40 percent chance of developing an atopic condition. If both parents are atopic, the risk rises to 60 to 80 percent. The tendency toward allergic sensitisation is largely inherited, though which specific allergens trigger symptoms depends on environmental exposure.
- Living in Rawalpindi or Islamabad — the exceptionally high mulberry tree density in both cities creates pollen concentrations that sensitise a disproportionately high proportion of the urban population compared to rural or coastal areas. The urban heat island effect also extends and intensifies the local pollen season.
- Early childhood respiratory infections — paradoxically, a clean indoor environment with limited microbial exposure in early childhood (the "hygiene hypothesis") increases atopic sensitisation risk by depriving the developing immune system of the microbial challenges it needs to calibrate its allergic response appropriately.
- Air pollution exposure — diesel exhaust particles and other urban air pollutants enhance the allergenic potency of pollen grains by binding to their surface and act as immune adjuvants that potentiate allergic sensitisation. Urban residents exposed to high pollution are more likely to develop allergic disease and to have more severe symptoms than rural residents with equivalent pollen exposure.
- Previous asthma or eczema — the atopic march — the tendency for atopic conditions to progress from eczema in infancy to allergic rhinitis in childhood and asthma in adolescence — means that a patient with any one atopic condition is at elevated risk of developing additional sensitisations over time.
- First-time presentation in adulthood — new adult-onset seasonal allergies are more common than many patients expect. Relocation to a new city (particularly to Rawalpindi or Islamabad with its high mulberry burden), increased stress, or simply cumulative exposure crossing the sensitisation threshold can trigger first-time allergy symptoms in adults in their thirties, forties, and beyond.
Treatment: Managing Every Component Effectively
Effective seasonal allergy management requires treating all affected systems — not just suppressing the most prominent symptom. A patient who treats nasal symptoms but ignores eye symptoms, or vice versa, achieves only partial relief. The following framework covers every component.
Intranasal corticosteroid sprays — fluticasone furoate (Avamys), mometasone (Nasonex), or budesonide (Rhinocort) — are the most effective treatment for seasonal allergic rhinitis and the first-line recommendation for moderate-to-severe symptoms. They reduce nasal inflammation, congestion, discharge, sneezing, and post-nasal drip. They must be used consistently every day — not just on symptomatic days — and they take several days to reach full effect. For mulberry-sensitised patients in Rawalpindi, starting nasal steroid spray in early February — before pollen counts peak — provides the best possible baseline protection. Correct technique is critical: tilt the head slightly forward, aim the nozzle toward the outer wall of the nostril (not the nasal septum), and breathe in gently while spraying.
Second-generation antihistamines — cetirizine, loratadine, fexofenadine, or bilastine — are effective for sneezing, nasal itch, and eye symptoms. They work within one to two hours of the first dose and are taken once daily. They are significantly less effective than nasal steroids for nasal congestion — which is why they complement rather than replace nasal sprays. Second-generation antihistamines are preferred over first-generation ones (chlorphenamine, promethazine) because they do not cause significant sedation — an important practical point for students, drivers, and working adults during exam and work periods that coincide with peak pollen season.
Oral antihistamines provide only partial relief of allergic conjunctivitis. Antihistamine eye drops — olopatadine, ketotifen, or azelastine — deliver active medication directly to the conjunctival surface where the allergic reaction is occurring, providing faster and more complete relief of itching, redness, and watering. They are used twice daily during pollen season and can be combined with oral antihistamines for comprehensive coverage. Mast cell stabiliser drops — sodium cromoglycate — used four times daily as a preventive measure, reduce the reactivity of conjunctival mast cells and are particularly useful when started at the beginning of the season before symptoms peak.
Twice-daily nasal saline rinsing physically removes pollen, dust, and allergens from the nasal passages and reduces the inflammatory mediator load in the nasal mucosa. It is completely safe, inexpensive, and supported by good clinical evidence as an adjunct to pharmacological treatment. Used consistently, it reduces symptom scores and decreases the amount of medication needed. Use isotonic saline for regular maintenance; hypertonic saline for more congested days where additional mucolytic benefit is needed. Rinse after returning home from outdoor exposure to remove pollen deposited during outdoor activities.
For asthmatic patients, pollen season requires proactive step-up of asthma management — not waiting until exacerbations occur. Ensuring the inhaled corticosteroid preventer is being used consistently and correctly, reviewing the asthma action plan, and discussing with your pulmonologist whether a temporary increase in maintenance therapy during peak season is appropriate are all important preparatory steps. A written seasonal action plan — specifying what to do if peak flow falls, when to start oral steroids, and when to seek emergency care — should be in place before pollen season begins, not drafted during an acute deterioration.
Allergen immunotherapy — administered as subcutaneous injections or sublingual drops/tablets over three to five years — is the only treatment that modifies the underlying allergic sensitisation rather than suppressing its symptoms. For patients with moderate-to-severe seasonal allergic rhinitis — particularly mulberry or grass pollen allergy — immunotherapy reduces symptoms by 30 to 40 percent, decreases medication requirements, prevents the development of new sensitisations, and substantially reduces the risk of progressing from rhinitis to asthma. It represents the most significant long-term management option available to severe seasonal allergy sufferers and should be discussed at a pulmonology or allergy consultation. Its effects are sustained for years after the treatment course is completed.
Practical Daily Strategies During Pollen Season
Beyond medication, a set of practical daily habits significantly reduce pollen exposure and improve symptom control during peak season — without requiring any expense or medical prescription.
- Check the pollen count before outdoor activities — pollen count apps and websites provide daily estimates for Rawalpindi and Islamabad. On "very high" or "extreme" days, limit outdoor exposure as much as possible — particularly in the morning when pollen counts are highest (typically between 5am and 10am as temperatures rise and air turbulence increases).
- Keep windows closed during peak pollen hours — open windows in the early morning or during windy conditions allow pollen to accumulate inside the home. Keep windows closed during peak pollen hours and use air conditioning with a clean filter if available. Open windows in the evening after 6pm when pollen counts typically fall.
- Shower and change clothes after outdoor exposure — pollen settles on hair, skin, and clothing during outdoor activity. Showering when returning home removes pollen before it is transferred to furniture, bedding, and pillows. This is particularly important in the evening before sleep — removing pollen from hair and skin before bed significantly reduces nocturnal exposure.
- Wear wraparound sunglasses outdoors — large-frame or wraparound sunglasses create a partial physical barrier that reduces the amount of pollen reaching the eyes, meaningfully reducing eye symptom severity on high-pollen days.
- Do not dry laundry outdoors during pollen season — clothes and bedding dried outside accumulate pollen that is then transferred directly to skin during sleep. Indoor drying, or using a clothes dryer, eliminates this exposure route.
- Use a HEPA air purifier in the bedroom — a HEPA filter in the bedroom captures pollen, dust mite allergen, and mould spores, reducing the allergen load in the most important environment — where eight hours of sleep are spent. Even on high outdoor pollen days, a well-functioning HEPA purifier maintains significantly lower indoor pollen concentrations than outdoor levels.
- Avoid mowing grass or being near freshly cut grass — mowing releases large quantities of grass pollen and leaf fragments containing allergens. Either avoid mowing entirely during grass pollen season, wear an N95 mask if unavoidable, or arrange for someone else to do it on your behalf.
Every year I see patients in late February who have been suffering for two weeks and have just started their nasal spray. I ask: did you know your season was coming? They always say yes. Did you start your spray in advance? They almost always say no. The pharmacological evidence is clear — prevention is dramatically more effective than rescue. For allergy patients in Rawalpindi, February is when preparation happens. January is when preparation should have happened.
— Dr. Nabila Zaheer, Pulmonologist
When to See a Specialist — Not Just a Pharmacist
Many seasonal allergy sufferers manage their symptoms with over-the-counter antihistamines and never seek medical assessment. For mild, well-controlled symptoms, this is often appropriate. But several situations warrant a specialist consultation rather than self-management.
See a pulmonologist or allergy specialist if: your symptoms are not adequately controlled despite regular use of a nasal steroid spray and antihistamine; you develop chest symptoms — breathlessness, wheeze, or chest tightness — during pollen season; your symptoms are affecting your sleep, work, school, or quality of life significantly; you are interested in allergy testing to identify your specific sensitisations; you want to discuss allergen immunotherapy as a long-term solution; you have had to use oral steroids to control allergy symptoms; or your symptoms are present year-round rather than purely seasonal, suggesting additional indoor allergen sensitisation requiring assessment.
Frequently Asked Questions
Can seasonal allergies develop for the first time in adulthood?
Yes — absolutely. While allergic sensitisation often begins in childhood, new sensitisations can develop at any age. Adults who move to Rawalpindi or Islamabad from a city without mulberry trees frequently develop mulberry pollen allergy within one to three seasons of arrival — their immune system encounters the pollen for the first time at high concentrations and develops sensitisation. Stress, hormonal changes, and cumulative allergen exposure crossing a sensitisation threshold can all trigger first-time allergies in adults in their thirties, forties, or even later. Adult-onset seasonal allergy is far more common than most patients expect.
Is it safe to use a nasal steroid spray every day for months?
Yes — modern intranasal corticosteroid sprays are safe for daily long-term use throughout the pollen season and beyond. The dose of steroid absorbed into the systemic circulation from a nasal spray is minimal — far less than from oral steroids or even high-dose inhaled corticosteroids for asthma. Long-term daily use does not cause nasal thinning, dependence, or significant systemic steroid effects at standard prescribed doses. The most common local side effect is nasal dryness or minor nosebleeds, which are reduced by correct technique (spraying toward the outer wall of the nostril, not the septum) and use of saline moisturising spray alongside.
My child sneezes constantly during mulberry season. At what age can they start allergy medication?
Second-generation antihistamines in liquid formulations are available and safe from age two upwards — cetirizine from age two, loratadine from age two with appropriate dosing. Intranasal corticosteroid sprays are safe and effective from age two with appropriate paediatric formulations. Children with moderate-to-severe seasonal allergic rhinitis benefit significantly from treatment and should not simply be expected to suffer through the season. Allergy skin prick testing is also possible in young children and provides specific information about which pollens are driving symptoms, guiding both treatment and long-term management including immunotherapy consideration. Please do not assume children must simply endure their allergy symptoms — effective, safe treatment exists at all ages.
Do anti-allergy injections (immunotherapy) work for mulberry pollen allergy specifically?
Yes — allergen immunotherapy for mulberry pollen (Morus alba) is available and has been used for several decades in Pakistan, particularly in Rawalpindi and Islamabad where mulberry allergy prevalence is high. Both subcutaneous injections and sublingual drops containing mulberry pollen extract are available. The treatment requires commitment — three to five years of regular administration — but produces sustained symptom reduction that continues for years after the treatment course ends. For patients with severe seasonal symptoms despite optimal medication, or those who want to move beyond symptom suppression to actual immune modification, immunotherapy is the most meaningful long-term intervention available. Discuss it at your next pulmonology or allergy consultation.
My allergy symptoms seem to be getting worse every year. Is that normal?
Unfortunately, yes — and there are several reasons for it. First, sensitisation can "spread" over years of exposure, meaning a patient who initially reacted only to mulberry may develop additional sensitivity to grass and weed pollens over time, effectively extending their allergy season. Second, climate change is increasing pollen production, extending seasons, and starting them earlier than historical patterns — systematically worsening pollen exposure year on year. Third, untreated allergic inflammation progressively lowers the threshold for allergic reactions, making the same pollen count produce worse symptoms over successive seasons. The most effective way to interrupt this worsening trajectory is appropriate treatment — particularly allergen immunotherapy — combined with environmental controls to reduce overall allergen exposure. Worsening symptoms are a signal to seek specialist assessment, not to accept progressive deterioration.
Allergy Season Does Not Have to Be Something You Just Survive.
If seasonal allergies are affecting your sleep, your work, your children's school performance, or your asthma control — a specialist assessment with allergy testing, optimised medication, and a personalised management plan can transform your experience of pollen season. Book a consultation with Dr. Nabila Zaheer at PulmoCare today — before next season begins.
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