Allergies – not just sniffles and sneezes
By John Messmer, M.D., Penn State Milton S. Hershey Medical Center

Spring has arrived. The scent of fragrant flowers is in the air. Birds are singing... and noses sneezing. Allergic rhinitis, often called "hay fever," comes from the immune system's response to a foreign substance, typically plant pollen. The word "rhinitis" refers specifically to inflammation of the nose, but allergies often affect the ears, throat, eyes and lungs as well. Plant allergies are common, but allergy sufferers can also react to many other things such as pet dander.

Allergic problems are not benign. Perhaps a quarter of all Americans are affected, resulting in 3.8 billion missed days of work and school per year at a cost of $4.5 billion annually. There are actually an estimated 5,000 deaths attributed to allergies each year according to the Centers for Disease Control and Prevention (CDC).

The root cause

Most allergies are provoked by pollens, tiny particles that trees, grasses and weeds release into the air. Trees release pollen in March and April, grasses in April and May and weeds in May through June and again in August through October in Pennsylvania depending on the weather. Some people react to proteins found in pet saliva, skin cells or urine while the most unfortunate allergy sufferer is sensitive year round to dust mites, tiny organisms that live in our houses no matter how clean we are. Mold, another common offender, is found in damp areas of the house and in fields, grasses and piles of vegetation.

In order to have a response to foreign material, called an "allergen," a person with a genetic susceptibility is exposed to it, often several times. Although many people develop allergies in childhood, it is quite common for adults to have their first allergy problems later, even in middle age. Moving to a new area of the country might expose a person to an allergen for the first time. You might have a cat for years before you begin to be affected.

Here's how allergies develop: when an allergen lands on the nose or eyes, is inhaled or swallowed, the immune system cells attack the allergen and digest it. In a person predisposed to allergies, their body produces antibodies that attack the allergens. During the attack, the chemical histamine is released causing sneezing, itchy nose and eyes, congestion, and so on. Some people also release leukotrienes that increase the reaction and can contribute to asthma.

Allergies are diagnosed based on symptoms and family history. A physical examination and sometimes lab testing or skin testing confirm the diagnosis. Treatment starts with avoidance if possible. Today's airtight houses often trap mold spores and dust mites so increasing circulation and controlling humidity can be an important first step. Dust settles on draperies, carpets, stuffed animals and in blankets and comforters so eliminating these if possible will help.

If pollen is an issue, air conditioning with HEPA filtration can screen much pollen. People with cat allergies ideally should give up the cat. Some have found it helpful to sponge the cat's fur regularly to clean off the dried saliva that carries much of the allergens.

Medication can interfere with the reaction and reduce the symptoms. Antihistamines have been the mainstay of treatment for decades. However, some antihistamines can cause sedation so care in driving is recommended. Loratidine, a less sedating antihistamine, was previously available only by prescription and is now over the counter.

Some people use Cromolyn nasal spray in response to allegories and related congestion, but be aware that Cromolyn is not an antihistamine. It can help block the allergic reaction but works best if used before symptoms develop. Cortisone nasal sprays by prescription are very effective at blocking the allergic reaction. They have been used for about 15 years and have been thoroughly tested. Used as directed, they are safe for the long term. Montelukast, a drug previously used only in asthma, has helped some people with allergic symptoms. It has almost no side effects but does not work for everyone. Decongestants do not affect the allergic process but can relieve congestion. Some people cannot take them due to side effects.

Sometimes allergy shots (immunotherapy) are also used. Immunotherapy involves testing for the specific things one is allergic to and giving a series of injections of these allergens in gradually increasing concentrations to train the immune system not to react.

If you have congestion, runny nose, itchy nose and eyes and sneezing and have been unsuccessful at home therapy, see your primary care physician who can manage most people with allergies or refer to an allergist if needed. Allergies may be common, but it doesn't mean the suffering associated with allergies must be accepted as part of your rountine.

For more information, see http://www.aaaai.org/
or http://www.cdc.gov/niosh/asthmapg.html