Cedar Fever: Analyzing the Impact of This Tree Allergy

When most people think of allergies, they envision spring and summer months as the primary adversaries. However, in Oklahoma, winter brings its own formidable challenge – cedar fever.

Unlike its seasonal counterparts, cedar fever strikes during the colder months, causing persistent symptoms on those sensitive to the pervasive pollen of Ashe juniper trees, commonly known as mountain cedar. In this blog, we speak to Sarah Henderson, PA-C, a physician assistant at the INTEGRIS Health Hennessey Medical Clinic, to learn more. We look at why cedar fever can be so overwhelming and how visiting an allergist can offer support in diagnosing and treating this allergy.

“Winter brings a surge of respiratory illnesses, including influenza, RSV and COVID-19, along with seasonal allergies like cedar fever,” Henderson says. “Because their symptoms overlap—fever, congestion and fatigue—it’s essential to see your health care provider for an accurate diagnosis and appropriate treatment.” 

What is cedar fever?

What to know: Cedar fever, a common allergy associated with mountain cedar pollen, affects many people in Oklahoma, Texas and other regions. Symptoms of cedar fever include nasal congestion, itchiness, sneezing and sometimes a slight increase in body temperature due to inflammation.

Cedar fever is an allergic reaction triggered by pollen from mountain cedar trees, also known as juniper trees.

• A complex response occurs due to the immune system recognizing the pollen as a foreign invader.
• As an attempt to eliminate the perceived threat, the immune system overreacts and releases mast cells that then distribute histamines into the blood.
• Symptoms are similar to common allergy symptoms such as sneezing and nasal congestion, but it can also cause itchy and watery eyes, sore throat and fatigue.
• The intensity of symptoms distinguishes it from other seasonal allergies.

Why does it affect Oklahoma so much?

Why it matters: Cedar fever is notably prominent in Oklahoma during the winter months due to the prevalence of Ashe juniper trees, which are abundant in western and central regions of the state. These trees release pollen from December to February, coinciding with the winter season. The geographical location and climate of Oklahoma, characterized by its open plains and strong winter winds, make the allergy season worse. 

Despite the name, mountain cedar trees aren’t actual cedar trees; they are members of the juniper family called Juniperus ashei. 

• The term "mountain cedar" was coined by early settlers who, upon encountering juniper trees, were reminded of European cedar trees due to their fragrant, rot-resistant wood.
• Juniper trees are found in parts of Texas and Oklahoma – in Oklahoma, the Arbuckle Mountains and the Wichita Mountains have a high concentration of juniper trees.
• The trees thrive in environments characterized by rocky hills, open plains and areas with well-drained soil. 

Unlike most other trees, juniper trees pollinate in the winter.

• The cedar fever season typically lasts from December to February (peaking in mid-January), although symptoms may start as early as November and last until March.

The pollen is incredibly concentrated during the winter months and can travel hundreds of miles. 

• The small, light pollen granules produced by male trees can be carried long distances by strong winds from the west, southwest and south.
• Oftentimes, visible yellow and orange clouds of pollen can be seen around the trees.
• Pollen from red cedar trees, which are prominent in central and western Oklahoma, is also highly concentrated from December to March, which can exacerbate existing allergies from Ashe junipers.

Dry winter conditions allow the pollen to stay airborne and spread across the region.

• In Oklahoma specifically, stronger winter winds are more common due to a combination of a more southward jet stream and a flat, open terrain that allows wind to whip through.
• Plus, the release of pollen is typically most abundant right after a cold front.

Why is it called cedar fever?

At a glance: Cedar fever rarely results in an actual fever. Historically, the term "fever" may have been used to describe the allergy's intense, flu-like symptoms, including fatigue and body aches.

The “fever” associated with the allergic reaction is due to inflammation causing a slight increase in body temperature – not a true fever. 

• Historically, the term may have been used colloquially to describe the intense experience of the allergy season.
• It’s also easily confused with the cold or flu because cedar fever can produce flu-like symptoms and also occurs during the same winter months.
• Over time, the condition became widely recognized as "cedar fever" due to misleading symptoms and the impact it had on people.

Treating cedar fever

Key points: Managing cedar fever involves medications, lifestyle adjustments and preventive measures to alleviate symptoms and minimize exposure to pollen. 

Over-the-counter medications include antihistamines, decongestants and nasal sprays to produce symptomatic relief.

• Antihistamines (loratadine, cetirizine, levocetirizine and fexofenadine) block the action of histamines to reduce sneezing, itching and runny nose. Azelastine is a nasal antihistamine that is also available over the counter.
• Decongestants (pseudoephedrine or phenylephrine) narrow blood vessels in the nasal passages to reduce swelling and congestion, allowing air to flow more freely through the nose.
• Steroid nasal sprays (fluticasone or triamcinolone) reduce inflammation and swelling in the nasal passages to treat congestion, sneezing and itching.
• Patients who have heart disease or high blood pressure should consult their health care provider before taking any over-the-counter medication. 

Prescription medications include more potent versions of OTC allergy medications, leukotriene modifiers and allergy shots.

• Desloratadine is a prescription antihistamine that can be prescribed by a health care provider.
• Leukotriene modifiers (montelukast) work by blocking the action of leukotrienes to reduce inflammation, decrease nasal congestion and sneezing.
• Allergy shots gradually desensitize the immune system in a two-part phase – a build-up phase that involves injections once or twice a week for several months and a maintenance phase that includes lower-dose injections every four to six weeks for months or even years.

Lifestyle changes and other preventative measures can also help reduce exposure to juniper tree pollen.

• Keep windows closed during peak pollen times to prevent pollen from entering the home.
• High-efficiency particulate air (HEPA) filters can help trap pollen and other allergens indoors.
• Limit outdoor activities when pollen counts are high, particularly in the morning and on windy days.
• Shower and change clothes after spending time outdoors to remove pollen from your body and clothing.

Next steps: For more information on allergy services, contact your INTEGRIS Health physician or visit INTEGRIS Health Allergy and Immunology.

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