With cooling temperatures and students returning to school come those dreaded fall allergies.

But the triggers for fall allergies are different than in spring, the season known for runny noses and watery eyes.

In and around the Columbus area, fall allergies begin to emerge in mid-August, said Dr. Summit Shah, an allergist at Premier Allergy & Asthma. Spring allergies are especially severe due to grass and tree pollen, while fall allergies due to weed pollen are increasingly mild.

"We're in the valley, and we do have a lot of trees," he said. "Also, as we become more industrialized, we're removing a lot of ragweed tree plants. So I do feel like our falls are getting a little bit milder than our spring symptoms."

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Ragweed especially is a big trigger in this region during this time of year, as well as molds that are not seen as much in the spring, Shah said.

"We're seeing patients suffering from not only ragweed, but Russian thistle, pigweed ... goldenrod, lots of different types of mold, and then also with the temperature dropping, it's a really bad trigger for asthmatics," Shah said.

But seasonal allergy severity also depends on the individual, said Dr. Chris Brooks, an assistant professor and allergy and immunology physician at Ohio State University's Wexner Medical Center. Some people have year-round allergies to such things as dust mites, cat and dog hair, and indoor molds. Others may have more severe symptoms during the spring, summer or fall.

"Symptoms are determined by how each individual person reacts to the allergen," said Brooks, who practices at the Wexner Center's Eye and Ear Institute near Grandview Heights. "An individual might have bad allergies in the fall but not that bad of allergies in the spring and vice versa. So that's why it's really helpful to figure out what specific thing you're allergic to."

Doctors recommend comprehensive allergy testing to better understand and address symptoms, which can include sneezing; coughing or wheezing; runny nose and watery eyes; congestion; itchy eyes, nose, throat or skin; drainage; and fatigue.

"If you have mild to moderate symptoms, you can usually get away with just an over-the-counter medication," Shah said. "But if you're having persistent symptoms in the fall, like many of the patients that we see do experience, we recommend allergy testing."

An allergist can administer skin allergy testing, which is done by placing a small amount of allergy-causing substances on the skin all at once and checking for allergic reactions. The skin test does not involve needles. Instead, the provider will use a small plastic device that applies allergens with a small scratch or prick.

Allergists also offer spirometry and blood tests to diagnose symptoms.

Treatments can also vary. There are several options for severe symptoms, including prescription medications, allergy shots and immunotherapy, which can eliminate an individual's allergies altogether. Shah said 30% to 40% of Premier's patients undergo immunotherapy treatment.

"Once we find out what you're allergic to, we can actually make your body 'unallergic' to that by giving you small doses," Shah said." You can actually get small increments of the actual thing that you're allergic to over time and over the course of a couple of months."

Treatment consists of getting injections and can be done in one or several appointments over six months up to a year.

Immunotherapy can be an option for people who do not like taking medications or the side effects that come from them, Brooks said. The Wexner Medical Center also offers sublingual immunotherapy, which is administered orally and can be completed at home.

As seasonal allergies appear, there are also things you can do to reduce your symptoms at home. Brooks recommends taking showers after exposure to outdoor allergies and decreasing exposure to the outdoors.

"Not that we want people if they just are inside all the time, but if you are able to spend more time inside, that can be helpful, especially with the windows closed," Brooks said.

He also suggests oral and nasal antihistamine medications and nasal irrigation devices.

"They can either use different devices to basically wash out their nose and their sinuses with things like distilled water or boiled water that has been cooled to room temperature," he said. "And that can clean out different pollens and debris."

Shah also suggests using nasal sprays and allergy medications before symptoms start.

"It's always good to get kind of ahead of the game," he said.