Ah, December! The month when the temperatures finally dip below 100 degrees and many of us prepare for the season by rushing out to stores, cash and credit cards in hand, looking for those perfect items for the tree.

Unfortunately, the season is allergy season, the items are antihistamines and decongestants, and the tree is the mountain cedar — a (sadly) drought-resistant evergreen that produces the pollen that makes many of us miserable from mid-month to late February.

The first time a particular type of pollen travels across your nasal membrane or through your lungs, your body kicks into gear and develops allergic antibodies to that pollen trigger, says Dr. Jackee Kayser, pediatric allergist at 'Specially for Children and Dell Children's Medical Center. When your body encounters the pollen trigger again, your immune system is waiting with the pre-formed antibodies. Histamine and other mediators head into a battle of overreaction, causing the classic allergic and even asthmatic symptoms.

Kayser says some research suggests that the immune system has to be exposed to at least two allergy seasons in order to produce an allergic reaction, which could explain why some people who have lived here for years without symptoms might suddenly find themselves affected.

Summertime's grasses and fall's ragweed join winter's mountain cedar and spring's oak pollen in testing our love for Central Texas, not to mention the molds and dust present year-round. Mountain cedar can be a bad pollen for patients, but not necessarily the worst, Kayser says, recalling an oak pollen season a few years ago when we were all driving around with the allergen covering our cars.

Prevention is the first step to battling seasonal allergies. Keep windows and doors closed. Launder pillowcases frequently, because pollen can collect in hair and be transferred to pillowcases to be breathed in throughout the night.

But once the telltale signs appear, the first step in treatment is determining whether you have a seasonal allergy or the common cold. Nasal congestion or runny nose can occur in both conditions, Kayser says, as can headaches.

One way to rule out a seasonal allergy is to remember that "cedar fever" is a misnomer. "A fever should not really accompany an allergic flare," Kayser says. If you're a generally allergic person and your allergy medication provides no relief, that can be another sign that allergens are not to blame.

Allergies can cause fatigue, because sufferers often don't sleep well. But severe, flulike body aches should not result from allergies. "True muscle aches makes me concerned that there's something else going on," Kayser says.

It can be confusing. That's why she recommends that patients consult an allergist. Hypersensitivity skin testing is one way to find out which environmental triggers or pollens, if any, are the cause of allergic symptoms.

Kayser usually starts with the skin prick device, which she calls "a very friendly, little device" that precludes the use of needles. A bit of the allergen is placed on the patient's skin. Fifteen minutes later, both the bump and redness it produces are measured. Those results determine the patient's sensitivity to that particular allergen. Once that's known, a course of treatment can be prescribed.

In addition to prescription solutions, "nasal saline rinses and neti pots are a fantastic, nonpharmacological, therapeutic way to approach allergies," Kayser says. In fact, she often recommends that patients use these systems before applying nasal sprays so that the sprays aren't blocked by all of the mucus that's being produced.

"In patients that really have significant disease, it's usually not the sole option, but it's a fantastic addition to helping with allergies."

Kayser says that when patients find the typical nasal sprays and oral antihistamines ineffective (or their side effects unbearable), allergy shots help decrease sensitivity to allergens.

"It definitely is something that patients have to want to do, because it does require weekly participation for quite a while and it is a shot," she explains. "But we know it works. If patients are just miserable and their allergy medications are not working, there's an option out there."

And there are other new options on the horizon.

Kayser says there is a lot of research on oral immunotherapy — popular in Europe — taking place here. Formulations containing small amounts of the problem allergen are placed under the tongue, where the substances can be quickly absorbed into the bloodstream. Although the practice has not yet been adopted as an effective therapy by the United States medical community, homeopathic remedies such as Cedar Allergy Mix can be found locally at People's Pharmacy. It comes in drop, spray and tablet form and contains allergic agents in homeopathic dosages.

Since this is Austin, it should come as no surprise that alternative allergy treatments — including Chinese therapies that employ acupuncture and herbs — are popular here. Michelle Schreiber, a licensed acupuncturist with Austin's Central Family Practice, has treated allergy sufferers with these methods for almost nine years.

"If somebody is coming in with severe (allergy) symptoms, there's a good chance they're going to leave here feeling a lot better than when they walked in," Schreiber says.

In an initial consultation, she takes a health history and discusses diet and lifestyle. Then she takes the patient's pulse and looks at the tongue to determine a treatment strategy (the color, coating and shape of the tongue, Schreiber says, can give a picture of what's going on in internal organ systems). For somebody who is suffering from a seasonal allergy such as mountain cedar, she typically recommends a combination of acupuncture and herbs.

Acupuncture involves the use of small needles to stimulate points close to the body's surface that practitioners contend correspond to its internal organs. "Surprisingly, it does not hurt," Schreiber says. "Most people get very relaxed when they receive acupuncture."

Because the practice can strengthen the immune system, she says, Schreiber recommends that people who suffer from seasonal allergies come in before the season begins. If a person is already experiencing symptoms, though, she can target acupuncture points that would treat them.

"My experience has been that many people get results with acupuncture and herbs without having any sort of traditional Western medical intervention, but it certainly can be used in conjunction with it as well," Schreiber says. For example, she sometimes administers acupuncture and herbal therapy to people who also receive allergy shots.

She says the treatments are "moderately priced" and that some insurance plans cover them (check whether your plan covers out-of-network providers, she adds).

If you're a yearly cedar fever victim who had hoped that Austin's record drought might mean a milder allergy season, you're likely to be disappointed.

"I'm afraid it might be worse," Schreiber says.

Kayser, is likewise pessimistic. Although the area experienced a weaker ragweed season than usual, she notes that the mountain cedar typically grabs any moisture available first. "So, I imagine it has had enough water, despite the minimal amount we've had here in Austin, to actually cause trouble this winter. It doesn't need much."

droe@statesman.com; 912-5923