The Twelve Days of Allergies

By Christopher Vickery, MD, FAAOA

Why We Sneeze at Christmas, Even Though the Pollen Counts Are Low

Many people are surprised to find their allergy symptoms flaring in December, even though outdoor pollen counts are low. The holidays bring a number of indoor and environmental triggers that can cause significant symptoms despite the absence of seasonal pollen. Here is a humorous Yuletide take on why patients may be suffering at this time of year.

A Partridge in a Pear Tree

Live Christmas trees, wreaths, and garlands can introduce mold spores, dust, and residual pollen, wreaking havoc in susceptible individuals. Even artificial trees may harbor dust mites. Contact dermatitis can also be exacerbated by plant resins or sap—or simply by mechanical irritation from prickly evergreens.

Two Dust Mites Miting

Dust and dust mites abound this time of year as homes are closed up for winter. Ornaments and decorations retrieved from attics and closets stir up additional dust, all of which can contribute to symptoms in dust-sensitive patients.

Three Mold Spores Sporulating

Wet leaves, rainy weather, damp basements, and fresh greenery can all contribute to elevated mold spore exposure, leading to nasal symptoms and lower airway irritation during the winter months.

Four Calling Birds (and Other Pets)

Pets remain antigenic throughout the year—including birds, dogs, and cats. All furry or feathery pets produce dander, which serves as a persistent source of allergen regardless of season.

Five Golden Rings

Gift-giving often brings jewelry. Nickel is a common metal allergen and can produce an itchy rash at sites of skin contact—the gift that keeps on giving.

Six Geese a-Laying

Eggs, milk, and nuts are used abundantly in holiday baking. Remember that holiday guests may have food allergies, and take appropriate precautions.

Seven Swans a-Swimming

With all that swimming, we want to keep our homes warm and cozy. Turning up the thermostat results in warm, dry indoor air, which can irritate nasal membranes. Low humidity may worsen congestion and dryness, sometimes alleviated by the judicious use of a humidifier.

Eight Maids a-Milking

Hard-working hands pay a toll. Frequent handwashing and cold weather lead to dry skin, compromising the skin barrier and exacerbating eczema in atopic individuals. Don’t forget to moisturize and hydrate.

Nine Ladies Dancing and Ten Lords a-Leaping

All that social interaction brings plenty of opportunities to spread germs, including the common cold, influenza, and COVID-19. Many holiday “allergy” symptoms turn out to be infectious.

Eleven Pipers Piping andTwelve Drummers Drumming

While not directly allergic, it is worth remembering that an association between atopy and inner-ear disorders, particularly Ménière’s disease, has been observed. Susceptible individuals should remain attentive to sodium intake during holiday meals.

Take-Home Message

Winter “allergies” are often a blend of true allergens, irritants, and viral infections. Recognizing seasonal triggers helps patients manage symptoms more effectively—and enjoy the holidays with clearer breathing and healthier skin. If symptoms persist, evaluation by an otolaryngic allergist can help distinguish allergies from other causes and guide appropriate treatment.