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What's in Toronto's Air in May
May in Toronto is beautiful. It's also brutal if you're pollen-sensitive. The city sits in a Great Lakes microclimate that produces a particularly aggressive spring allergy season, and by the first week of May, tree pollen counts routinely climb into the "high" and "very high" categories tracked by The Weather Network and Aerobiology Research Laboratories.
The main culprits this time of year are birch, oak, maple, and ash trees. Birch pollen is the dominant allergen in southern Ontario through mid-May, and it's especially potent because the proteins it contains cross-react with certain foods. That means if birch pollen makes you miserable, you might also notice tingling in your mouth after eating raw apples, cherries, or almonds. This is called oral allergy syndrome, and it's more common than most people realize.
By late May, grass pollen begins to overlap with tree pollen, creating a double exposure that can make the last two weeks of the month the worst of the entire spring season. If you've noticed your symptoms getting progressively worse each week, that overlap is likely why. Understanding what you're reacting to helps guide which treatments will work best, and that's where a conversation with your healthcare provider can make a real difference.
Recognizing Allergy Symptoms vs. Something Else
Seasonal allergies and upper respiratory infections share a frustrating number of symptoms. Both can cause a runny nose, congestion, sneezing, and fatigue. But there are reliable ways to tell them apart.
The Classic Allergy Pattern
Allergic rhinitis tends to produce clear, watery nasal discharge. You'll sneeze in rapid clusters rather than the occasional single sneeze of a cold. Itching is the hallmark. If your eyes, nose, throat, or the roof of your mouth itch, that's almost always an allergy rather than an infection. Symptoms also follow a predictable pattern. They're worse on dry, windy days when pollen counts spike and better on rainy days when pollen gets washed out of the air. If your "cold" has lasted more than ten days without improving, or keeps coming back every time you go outside, allergies are the more likely explanation.
When It Might Not Be Allergies
Fever and body aches point toward infection, not allergy. Thick, discoloured nasal discharge, especially if it's one-sided, suggests a sinus infection that may need treatment. Wheezing or significant chest tightness could indicate asthma being triggered by pollen exposure, which requires a different management approach than simple allergic rhinitis. If you have a history of asthma, spring pollen season can be a trigger for flares, and your provider may want to adjust your controller medications proactively. Care& members who deal with chronic conditions like asthma benefit from working with the same Nurse Practitioner who already knows their baseline and can spot changes early.
If you experience sudden swelling of your lips, tongue, or throat, difficulty breathing, hives spreading across your body, or dizziness and a rapid heartbeat after exposure to an allergen, this may be anaphylaxis. If you carry an epinephrine auto-injector (EpiPen), use it immediately and then call 911. Anaphylaxis is rare with pollen alone but can occur with related food allergens in people with oral allergy syndrome. Don't wait to see if it gets better on its own.
Over-the-Counter Allergy Medications Compared
You're standing in the allergy aisle at Shoppers Drug Mart, staring at a wall of boxes, and they all claim to be the best. Here's what the evidence actually supports for spring allergy relief in Toronto, broken down by medication type.
Second-Generation Antihistamines
Cetirizine (Reactine), loratadine (Claritin), and fexofenadine (Allegra) are the three most widely available options. All three are effective for sneezing, itching, and runny nose. Cetirizine tends to be the most potent of the three but is also the most likely to cause mild drowsiness. Fexofenadine is truly non-sedating, making it a better choice if you're working, driving, or studying. Loratadine sits in the middle. None of these should be confused with first-generation antihistamines like diphenhydramine (Benadryl), which causes significant drowsiness and isn't recommended for daily allergy management.
Nasal Corticosteroid Sprays
If you could only pick one allergy medication, this category wins. Fluticasone (Flonase) and mometasone (Nasonex, available OTC as generic) are considered the most effective single agents for allergic rhinitis. They reduce congestion, sneezing, itching, and runny nose. The catch is that they take several days to reach full effectiveness. If pollen season has already started and you're just beginning a nasal steroid, expect three to seven days before you notice meaningful improvement. For the best results, start using them a week or two before your symptoms typically begin each year.
Antihistamine Eye Drops
Itchy, watery, red eyes are often the most bothersome allergy symptom, and oral antihistamines don't always resolve them completely. Ketotifen eye drops (Zaditor) are available over the counter and work within minutes. They can be used alongside an oral antihistamine and nasal spray without significant drug interaction concerns.
"The most common mistake allergy sufferers make isn't choosing the wrong medication. It's starting the right one too late."
If you're pregnant, breastfeeding, or planning a pregnancy, check with your provider before starting any new medication. Some antihistamines and nasal sprays have better safety profiles than others during pregnancy, and your Nurse Practitioner can help you choose the safest effective option. For children, pediatric dosing differs from adult dosing, and not all OTC products are approved for every age group. Your provider can give you age-appropriate guidance, and pediatric care at Care& covers these conversations in detail.
When OTC Isn't Enough: Prescription-Strength Options
About 20 percent of seasonal allergy sufferers don't get adequate relief from over-the-counter treatments alone. If you've been taking an antihistamine daily, using a nasal corticosteroid spray correctly, and still struggling through May, prescription options exist that your NP can evaluate you for.
Prescription Nasal Sprays
Azelastine is a prescription antihistamine nasal spray that works differently from oral antihistamines and can be particularly effective when combined with a nasal steroid. Combination sprays that contain both an antihistamine and a corticosteroid in one device offer a convenient step-up option. Ipratropium nasal spray targets the runny nose specifically and can be helpful if that's your dominant symptom even when everything else is controlled.
Montelukast and Other Add-On Therapies
Montelukast (Singulair) is a leukotriene receptor antagonist that's sometimes prescribed as an add-on for allergic rhinitis, especially in patients who also have asthma. It's important to know that Health Canada has issued an advisory regarding potential neuropsychiatric side effects associated with montelukast, including mood changes, sleep disturbances, and in rare cases, suicidal thoughts. Your NP will discuss these risks with you and help determine whether the benefits outweigh the risks in your specific situation.
If you take other medications regularly, your provider can help you choose allergy treatments that won't cause interactions. This is especially true if you're on blood pressure medications, antidepressants, or other daily prescriptions. Having a dedicated Nurse Practitioner who knows your full medication list makes these decisions much safer and more straightforward.
Care& members have access to on-premise lab work at both Toronto locations. If your NP suspects your symptoms aren't straightforward allergies, blood work can be drawn during the same visit. No separate lab trip needed. Results appear in your Care& app (app.careand.ca) as soon as they're ready.
Allergy Immunotherapy
For people with severe, recurrent spring allergies that don't respond well to medications, allergy immunotherapy (allergy shots or sublingual tablets) can provide long-term relief by gradually desensitizing your immune system to specific pollens. This typically requires a referral to an allergist, and your Nurse Practitioner can coordinate that referral for you. Immunotherapy is a longer commitment, usually three to five years, but it's the only treatment that actually changes your immune response rather than just managing symptoms.
Concerned about your symptoms? Your NP can help.
Meet Our NPsNon-Medication Strategies That Actually Help
Medications are the backbone of allergy management, but pairing them with smart lifestyle adjustments can significantly reduce your overall pollen exposure and symptom burden. These strategies won't replace your antihistamine, but they can mean the difference between a tolerable May and a miserable one.
Timing matters. Pollen counts in Toronto are typically highest in the early morning, between 5 a.m. and 10 a.m., and on dry, windy afternoons. If you run or cycle outdoors, shifting your workout to late afternoon or early evening can reduce your exposure. After spending time outside, shower and change clothes before settling into your home for the evening. Pollen clings to hair, skin, and fabric. If you have a dog that loves Trinity Bellwoods or Riverdale Park, give them a quick wipe-down when they come inside too.
Keep windows closed during peak pollen days, even when the weather is gorgeous. Use your air conditioner's recirculate function. If you don't have central air, a portable HEPA air purifier in your bedroom can reduce overnight pollen exposure, improving sleep quality. Nasal saline irrigation with a squeeze bottle or neti pot physically flushes pollen out of your nasal passages and can be done two to three times daily during peak season. Use distilled or previously boiled water, never tap water, to avoid rare but serious infections.
Care& members can request prescription refills with one click through the Care& app. If you already know which allergy medication works for you and just need a refill before pollen season hits, you can save yourself an unnecessary trip. Learn more about how the membership works.
When to See Your Nurse Practitioner
Most seasonal allergies can be managed with OTC medications and the strategies above. But there are clear situations where professional assessment is the right move. If you've been using an antihistamine and nasal steroid consistently for two weeks without meaningful improvement, it's time to talk to your provider. If your symptoms are interfering with sleep, work productivity, or your ability to exercise, that's a quality-of-life issue worth addressing. If you're developing recurrent sinus infections during allergy season, or if you have worsening asthma symptoms, your NP can evaluate whether your current treatment plan needs to change.
If you have an OHIP-covered family doctor, they can certainly help with allergy management. The challenge many Torontonians face is getting a timely appointment during peak allergy season, when spring symptoms are competing with every other reason people visit their family doctor. And if you're among the estimated 2.2 million Ontarians without a family doctor at all, you may not have a regular provider to turn to.
Care& Family Health offers a family practice alternative built around the kind of access and continuity that makes allergy management more effective. The membership model, at $450 plus HST per year, includes unlimited visits with the same Nurse Practitioner who knows your history. That means your NP remembers which medications you've already tried, knows about your asthma or other conditions, and can adjust your plan without starting from scratch every spring. You can learn more about membership pricing to see if it fits your needs. Care& isn't covered by OHIP, but for many people, the value of timely access and unrushed appointments makes it worthwhile.
Frequently Asked Questions
When is pollen count highest in Toronto?
Tree pollen peaks between late April and late May, with birch and oak being the dominant species. Grass pollen begins rising in late May and peaks in June and early July. The highest counts on any given day tend to occur between 5 a.m. and 10 a.m. You can check daily pollen forecasts through The Weather Network or the Aerobiology Research Laboratories website.
Can I take two different allergy medications at the same time?
Yes, combining different types of allergy medications is generally safe and often more effective than a single medication alone. For example, pairing an oral antihistamine (like cetirizine) with a nasal corticosteroid spray (like fluticasone) and antihistamine eye drops targets different symptoms through different mechanisms. However, you should not take two oral antihistamines at the same time. If you're unsure about combinations, ask your healthcare provider.
Why do my allergies seem worse every year?
You're not imagining it. Climate data shows that warmer temperatures are extending pollen seasons and increasing pollen production across southern Ontario. Carbon dioxide also stimulates pollen-producing plants to create more pollen per plant. Your immune system may also become more sensitized over time with repeated exposure, leading to stronger reactions to the same amount of pollen.
Do decongestant nasal sprays like Otrivin help with allergies?
Topical decongestant sprays (oxymetazoline/Otrivin, xylometazoline/Dristan) provide fast congestion relief, but they should not be used for more than three consecutive days. Using them longer can cause rebound congestion, a condition called rhinitis medicamentosa, that makes your congestion worse than it was before you started. Nasal corticosteroid sprays are a much safer long-term option for allergy-related congestion.
I don't have a family doctor in Toronto. Can I get allergy treatment through Care&?
Yes. Care& Family Health is a Nurse Practitioner-led family practice with two Toronto locations in Yorkville and Lawrence Park. NPs can assess your allergy symptoms, prescribe medications, order blood work if needed, and refer you to an allergist for immunotherapy. The membership model (not covered by OHIP) gives you a dedicated NP who knows your history, so you won't have to re-explain your situation every spring. You can also use the pay-per-visit option at $100 per visit if you prefer not to commit to a membership.
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