While many welcome spring’s sunny debut with open arms and outdoor activities, pollen-allergy sufferers are left to simply try and survive the annual pollen onslaught that occurs every year for months beginning in spring. They live in misery or in a heavily medicated state or both, with allergic rhinitis — swollen, itchy eyes; stuffy and running noses; and in some cases, wheezing and difficulty breathing.
Forced indoors to seek relief — however minor it might be — they wait until the tree pollen’s spring bloom has subsided, and along with it, their allergy symptoms. Their relief is short-lived, however, as spring inevitably returns each year. Some don’t even have to wait for the following spring because their misery reappears every fall too, when ragweed pollinates and pollen proliferates once again. Pollen allergy sufferers can often tell the changing of the seasons based on their allergy flare-ups because tree pollen generally peaks during spring, grass pollen in the summer and weed pollen in the fall.
The life of an allergy sufferer doesn’t have to be one of misery, however.
Luis Matos, MD, is the director of research for the Asthma and Allergy Centers of Roanoke, Lynchburg and Salem. He says that there is hope for allergy sufferers — beyond just over-the-counter or prescription medications — through two forms of allergy immunotherapy. A new method using oral pollen tablets, recently approved by the FDA, and traditional allergy immunotherapy referred to by many as “allergy shots.” These proven methods help the body become desensitized to and tolerant of pollen’s effects on allergic patients.
Allergen Immunotherapy, also known as allergy shots, is a form of long-term treatment that decreases symptoms for many people with allergic rhinitis, allergic conjunctivitis (eye allergy) or stinging insect allergy. Allergy shots decrease sensitivity to allergens and often lead to lasting relief of allergy symptoms even after treatment is stopped.
What pollen is, how it invades, and the body’s reaction
Pollen is supposed to go to flowers and trees to fertilize them, Dr. Matos says, but when it falls on moist surfaces — such as the eyes and nose — people who are susceptible to developing allergies will experience an allergic reaction. This reaction and its subsequent symptoms represent the body’s defense mechanisms attempting to keep the pollen from entering the body because the immune system is mistakenly identifying the pollen as an infectious agent, when it isn’t.
“Pollen has different proteins that the body identifies in some people as a worthy opponent and that triggers an allergic immune reaction, becoming an allergen. If you’re allergic to the pollen, as soon as it touches your body it binds to the allergy antibody, and that signals the body to sweep it away and then drainage begins in an attempt to flush it out,” Dr. Matos explains. “The reaction is a defense mechanism to keep it from invading. Some people have more severe reactions, such as the closing of the bronchial tubes, which can lead to allergic asthma, but usually the first steps in the reaction are itchy, watery eyes and sneezing fits. The pollen isn’t like an infection; it’s just triggering the symptoms.”
Specifically, histamine triggers the reactions, Dr. Matos says. The body releases histamine as part of the immune system’s response to the threat it perceives. When the histamine reaches nerve cells, it causes itching. When it reaches the mucous glands, it causes mucous development, and when it encounters the blood vessels, it causes them to dilate and swelling results.
Histamine isn’t the only chemical that causes the reactions either, according to Dr. Matos. Leucotrienes also are responsible for some delayed symptoms associated with allergic reactions.
As for why some people develop an allergic reaction to pollen while others do not, Dr. Matos says that genetically, some people just have the ability to become allergic.
“Let’s say you move to an area with a tree pollen you’ve never been exposed to before,” Dr. Matos says. “It’ll bother your nose and your eyes — just like breathing in pepper. It’s an irritant. If you have the ability to become allergic, you can start to see the buildup of the allergy process. Then next season, the pollen comes back around and the body says, ‘Oh. This is important,’ and generates a response and reaction. Then, by the third season of exposure, you’re having allergy symptoms when you encounter this pollen.”
Seeking relief from the havoc pollen wreaks
Patients can find temporary relief with over-the-counter antihistamine medications that are designed to block histamine, Dr. Matos says. There are also nasal steroid sprays that block the swelling and inflammation, as well as antileucotriene medications that help block the leucotrienes causing the allergic reaction. These medications essentially are trying to stop and then “clean up” the reaction and symptoms caused by the cells’ release of histamine and leucotrienes.
Unfortunately, the body usually doesn’t develop immunity to pollen’s effects without treatment, Dr. Matos adds. Once an allergy is turned on, each pollen season will boost the allergic effects. For patients suffering from chronic allergies, allergy immunotherapy is the only long-term solution.
Allergy immunotherapy can be delivered via an injection or new oral pollen tablets placed under the tongue daily to treat grass and ragweed pollen allergy. In order to work, allergy immunotherapy has to deliver the allergen to the internal immune system and help the body develop immunity or an alternate defense, ultimately reducing the allergic reaction, Dr. Matos explains. An allergist can develop the best form of allergy immunotherapy for a patient only after identifying exactly which allergens are causing the patient’s symptoms.
Based on those findings, a weakened dose of the allergen will be formulated specifically for that patient as part of the injected allergy immunotherapy. Because the dose contains such a small amount of the allergen, the chances of a patient experiencing an allergic reaction are reduced.
Through a series of injections, the dosage strength is slowly increased until an “immunizing dose” is reached, indicating the body has developed an immunity to the allergen and now tolerates exposure to it with no reaction.
It takes approximately six months of receiving shots weekly or twice a week to reach the immunizing dose level, at which point the shots are spaced out to occur every other week or every three to four weeks, with the success rate approaching 90 percent.
An immediate coping strategy, Dr. Matos says, “is try and avoid whatever is causing the allergic reaction. If you know you’re going out and the wind is blowing, wear goggles or a mask to help reduce pollen exposure.”
Other suggestions include remaining indoors with the windows closed and the air conditioning on to filter out the pollen and taking a shower to help remove pollen after being outdoors.
With the help of a skilled team of allergists, allergy sufferers can improve both their quality of life and their health by first reducing exposure to pollen and using medications that alleviate the immune system’s reaction and accompanying symptoms following pollen exposure, while pursuing the permanent solution that only allergy immunotherapy provides.
American Academy of Allergy Asthma and Immunology – www.aaaai.org
Luis Matos, MD with Asthma and Allergy Centers of Roanoke, Lynchburg and Salem