Kicking Off Pollen Season with Cedar Fever

What's Up, Forsyth? The Forsyth County Office of Environmental Assistance and Protection officially began our pollen monitoring and forecasting program for the 2025 season on February 10th. In addition to reading our daily report, which you can access by following us on Facebook and X, checking our website, or subscribing to emails and faxes, we are excited to provide more in-depth information through a series of pollen-focused blog posts. These short blogs will feature some of our "worst offenders" throughout the year and will be written by allergy specialists from the Allergy and Asthma Center of NC. We're kicking off the series with cedar, which are abundant this time of year. 

Cedar Fever

Written by Dr. Joel Gallagher, Allergy and Asthma Center of NC, Cone Health Medical Group

Pollen season is traditionally thought of as occurring in the early spring – March into May – when the characteristic yellow plumes float through the air when we get a lovely breeze and car washing becomes more of a necessity. However, even before the golden gusts grace our presence, there is another enemy already afoot – cedar pollen. Cedars are a specific class of evergreens related to North Carolina favorites including firs and spruce. They are particularly abundant in arid, mountainous regions including the western United States and the Mediterranean. However, they are also present in the Piedmont-Triad region. There is some cross-reactivity between the cedar and juniper pollen as well, which is used as an evergreen in low-maintenance landscaping.

The major allergen in cedars is on the larger size compared to other allergens. Its protein is approximately 43 kilodaltons (kDa) in size, whereas most of other allergens range from 5 to 42 kDa in size. (See Images 1-3 for an example of what cedar pollen look like at 40x magnification). Because of this, most of the sensitization in the human body occurs in the nasal and upper airway passages, rather than deeper in the smallest parts of the lungs. The human immune system reacts to allergens by creating an antibody called IgE. Each IgE antibody that your immune system makes is specific for a particular allergen. This interaction between the allergen, your body’s IgE, and other cells of your immune system leads to the constellation of allergy symptoms. Cedar pollen is particularly potent because it can activate allergy-causing chemicals in both IgE-dependent and IgE-independent mechanisms. This is essentially more bang for the buck when it comes to allergen exposure! 

Image 1: Intact cedar pollen grain under a 40x magnification lens. 
This was taken moments before splitting, as shown in Image 2. 

Image 2: The outer shell/wall of the pollen is actively splitting, 
which is common with mature cedar pollen and makes it easier to become airborne.


Image 3: The wall has completely split away from the cedar pollen.

Symptoms are exactly like those experienced during the traditional allergy season, including runny nose, sneezing, congestion, itchy/watery eyes, dry cough, and generalized malaise. Although “fever” is in the name, allergies never cause fever as infections do. Diagnosis is based on allergy testing (skin prick testing with possible confirmatory blood work). Treatment can be accomplished with allergy medications, including allergy pills and nasal sprays. Avoiding the outdoors during the high pollen counts (early morning and early evenings) can be helpful, as can changing clothes and showering after spending time outdoors. Allergen immunotherapy (allergy shots) can be curative.

If you think you may be experiencing symptoms related to cedar or other pollen throughout the year, considerer making an appointment with a trusted allergy specialist. Find an Allergy & Asthma Center near you!

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