Although allergy season seems to have started a bit early this year (with medium-high levels of tree pollen being reported as early as mid-February), as an allergy sufferer, you know that the worst is yet to come.
Allergist Saju S. Eapen, MD, of the Asthma and Allergy Center of Roanoke and Salem notes that our area of Virginia has more than its share of allergy-causing substances in the air around us. The verdant hills and lush grasses of the mid-Atlantic states have few rivals in terms of producing the pollens that make people wheeze and sneeze. And Virginia has the dubious distinction of being among the national champions when it comes to pumping out tree and grass pollens. Richmond ranks high on every yearly list of allergy-heavy cities in the U.S., and experts say that there’s not a lot of difference between the capital area and other regions of the state.
Roanoke residents, furthermore, are well aware of the “bowl effect” that results from the city’s location. The mountains that surround Roanoke serve to trap air and all of the pollutants within it. This trapped air can be rough on allergy sufferers.
Immune system gone awry
Allergies (which are medically known as allergic rhinitis) are always bothersome, and there’s lots of data that shows that allergies are the #1 cause of absenteeism from jobs and school. They can even be life-threatening.
Allergies are the result of your body’s immune system gone awry. The immune system normally attacks the body’s genuine enemies such as bacteria or viruses, but allergy-sufferers’ immune systems launch an all-out attack on otherwise innocent substances called allergens. The body mistakenly identifies the allergens as harmful and begins spewing histamine and other substances to fight them off. You feel this battle in the form of itching, sneezes, red eyes and a runny nose within minutes of exposure, followed by the typical congested nose and cough and maybe even a hammering headache.
The cause of this misery — allergens — are found both indoors and outdoors. They can come from plants, foods, pets and even some household products.
The power of pollens
Pollens are produced by trees, weeds and grasses and are light and dry, picked up by the wind and deposited on everything in sight during the spring, summer and fall. (Flowers also make pollen, but flower pollen is usually spread by insects, without much escaping into the air.)
Locally, tree pollens dominate early in the year. According to Dr. Eapen, tree pollens usually begin to appear in early March, but this year’s mild winter has resulted in an early season for tree pollen that began in February. Tree pollens typically extend into April or early May, when our region transitions into grass season. And then, in mid to late summer, the weed pollens (especially ragweed) come into play.
When mold makes its move
Dr. Eapen notes that autumn is the season that brings the environmental mold allergens, such as leaf mold that is stirred up while raking wet leaves.
Mold also lives indoors all year, on window sills, in refrigerators, and in damp areas such as basements and bathrooms.
When dust mites and dander attack
Dust mites are microscopic eight-legged creatures that eat dead flakes of human skin. If you are allergic to dust mites, you are reacting to the mites’ droppings. The mites don’t bite or spread disease. Dust mites thrive in damp warmth with humidity of over 50 percent. They live mostly in carpeting, bedding, furniture and furry objects such as stuffed animals.
Animal dander is dandruff-like loose skin cells shed by animals. Dander from pets such as dogs and cats may contain saliva or other substances from these animals. The cells can become airborne, where they will be inhaled.
Is it a cold or an allergy?
The symptoms of colds and allergies can sometimes be similar, Dr. Eapen says, but there are some essential differences. For one, allergy symptoms are persistent, and they are bothersome for longer than the week or 10 days that it takes for a cold to run its course. The symptoms are also quite specific: There’s the telltale red, itchy eyes, the runny nose, and in some people, skin symptoms such as red and swollen hives, all of which point to an allergy.
How to address allergies
Medicine has developed quick and reliable ways to pinpoint the causes of allergies in individuals. The most common test is a skin prick test, in which small amounts of allergy triggers are placed on the surface of the skin and then lightly scratched in. Swelling or redness indicates an allergy to the substance placed on that part of the test area, and the results are available in 10-15 minutes.
Dr. Eapen also notes that blood tests are available for people who have a skin disorder or if certain medications prevent the performance of skin-scratch tests.
Once you know what’s causing your allergy, you can begin to fight back. You’ll know how to reduce your exposure to airborne allergens by keeping your windows closed and cranking up the air conditioning at home and in the car, by staying inside as much as possible when the pollen count is high (see sidebar), by taking a shower and washing your hair to rinse the allergens off before you go to bed, by keeping your pet out of the bedroom, and by running a high-efficiency air cleaner in your home.
A wide array of remedies
If those measures don’t help that much, there’s also an abundance of over-the-counter remedies you can try.
According to the Asthma and Allergy Foundation, four out of five people with allergies don’t even have to go to the doctor’s office. Instead, they rely on any of a somewhat dizzying array of medications in their local pharmacies that may offer effective relief. Physicians say that a perfectly reasonable first approach is to let your symptoms be your guide for taking over-the-counter medications.
A congested or runny nose can be treated with an over-the-counter corticosteroid nasal spray such as Flonase or Nasacort, a safe and effective control. Pairing this with an antihistamine to prevent the body’s release of histamines would be a good first step. It’s always a good idea to start taking an antihistamine before the start of a pollen-heavy season to control your symptoms. Look for long-acting antihistamines (Allegra, Claritin and Zyrtec are examples) that don’t have a sedative effect that will leave you drowsy. Dr. Eapen says that it’s important to use over-the-counter medicines consistently for peak effectiveness.
If over-the-counter medications fail, immunotherapy (allergy shots) can be formulated for particular combinations of allergies. Dr. Eapen notes that the expense and time investment of immunotherapy is often paid off in a few years in most patients by altering the immune system so that treatment is no longer needed. In effect, you’re cured of your allergy for anywhere between 5-20 years. Immunotherapy is also an important factor for youngsters who can be spared later allergic asthma.
Immunotherapy has been refined over the last century to the point that prescription medications are now coming onto the market that dissolve under the tongue — good news for the needle-shy. These sublingual remedies are not always approved for use by the U.S. Food and Drug Administration, but they are widely used in Europe. Additionally, certain sublingual remedies have been approved in the U.S. for treatment of ragweed and grass allergies, and, in early March, the FDA approved a sublingual tablet (Odactra) for treatment of allergies induced by dust mites.
Dr. Eapen sums up by saying, “The question is: When should a person seek an allergy specialist’s help for their allergies? The answer: If a person’s symptoms aren’t controlled by over-the-counter medications and if chronic symptoms affect the quality of one’s life, it’s time for a specialist. Lots of people go through life thinking that nasal congestion and all that goes with an allergy is part of the norm. It’s not. There’s help for you.”
Pollen and the weather
To get a sense of how severe an allergy season might be, keep an eye on the weather. Weather conditions can either increase or decrease the levels of pollen in the air around us.
Mild winters generally produce an early pollen season because trees will start pollinating earlier in the year. Dry, windy weather spreads pollen quickly. Rain can reduce the pollen count by washing pollen into the soil before it becomes airborne, but rain in the late fall or winter can spur tree pollination, and a rainy spring induces grass growth, increasing the amount of pollen from grasses and weeds.
A freeze late in the winter can delay tree pollination, which decreases the daily pollen count (at least temporarily).
What’s a pollen count?
Every day in locations all over America, a rod covered with a sticky substance is attached to the roof of a building. Over the next 24 hours, the rod will be tested for the amount of pollen that sticks to it. Samples are analyzed microscopically to determine how much pollen is in the air.
A daily pollen count is the number of grains of pollen in a cubic centimeter of air. As the number increases, people who have allergies will sense an increase in their allergic reactions. A medium pollen count of 4.9 to 7.2 is the point at which most allergy sufferers begin to notice symptoms. A medium high count is 7.3 to 9.6, and a high count is 9.7 to 12.
Most daily newspapers carry that day’s projected pollen count, which is also available in the weather forecast portion of most television newscasts and online at such sites as www.weather.com and www.pollen.com. Some online sites also offer daily pollen count email alerts and other helpful information.
New thinking on peanut allergies
One of the most frightening of foodborne allergies, especially for children, is that caused by peanuts and peanut products.
Though rare, peanut allergies are responsible for more anaphylaxis (constricted airway) deaths than any other food allergies, resulting in an almost universal ban of peanut butter and jelly sandwiches from school lunchrooms.
But conventional wisdom has been turned on its head over the past year, with new guidelines from the National Institute of Allergy and Infectious Diseases for parents to give their kids foods containing peanuts starting when they are infants in order to help them avoid the life-threatening allergies.
The Institute recommends giving babies puréed food or finger food containing peanut powder or extract before they are 6 months old or even earlier if a child is prone to allergies and their doctors say it is safe to do so. One should never give a baby whole peanuts or peanut bits, experts say, since they can be a choking hazard.
And as always, this advice should be prefaced by approval from your child’s physician.