They’re not crazy, Canadian or snow loving, winter sports fanatics. They’re simply allergy sufferers.
While many welcome spring’s sunny return with open arms and outdoor activities, pollen-allergy sufferers are left to simply try to survive the annual pollen onslaught that occurs every year for months during the early spring through June time frame. 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. Some don’t even have to wait for the following spring because their misery reappears every fall when ragweed pollinates and pollen proliferates once again. In general, tree pollen peaks during the spring, grass pollen in the summer and weed pollen in the fall.
The life of allergy sufferers doesn’t have to be this way, and to protect their future health, it shouldn’t be.
Elaine Turner, MD, Parag Patel, MD, and Jeffrey Schul, MD, are physicians with Allergy Partners in Richmond. They estimate that anywhere from 10 to 30 percent of the population suffers from seasonal pollen allergies, and they offer hope in the form of immunotherapy — allergy shots — that reduce patients’ allergic symptoms.
Pollen’s invasion and the body’s reaction
Pollen is breathed in through the nose and into the first part of the lungs, the larger bronchi, Dr. Turner explains. It doesn’t migrate to other parts of the body or enter the bloodstream. In some people, an allergic reaction occurs after exposure, which can then affect the nose, the sinuses and — in asthma — the bronchial tubes. It’s not what pollen contains that causes these symptoms, Dr. Turner says, but rather the body’s immune system reacting abnormally to the pollen.
“Proteins on the pollen interact with macrophages — a type of white blood cell — in a process called ‘sensitization,’” Dr. Turner explains. “This leads to the development of memory cells, which can subsequently produce IgE antibodies. Once the patient is sensitized, the next time pollen contacts the mucous membranes, the IgE antibodies will interact with a type of cell called a mast cell. When this happens, the mast cell degranulates and releases all kinds of nasty chemicals involved in the allergic reaction, including histamine. This in turn causes itching, swelling and excess mucus production, leading to allergic symptoms that can include sneezing, coughing, wheezing, a runny or congested nose, itchy eyes and shortness of breath.”
So pollen doesn’t enter the blood stream. Rather, the various chemicals that result from the allergic reaction are what cause the symptoms as they act on mucous membranes in the nose or bronchi.
As for why some people’s immune systems react abnormally to pollen exposure while others never experience pollen allergies, the physicians agree that the culprit is genetics.
It’s actually genetics combined with environmental exposure, Dr. Turner explains. Some people are more genetically predisposed, and if those people have enough environmental exposure to pollen, they’ll develop allergies. In some cases it’s been shown that an interaction with a virus could be to blame because after children had a virus, they developed allergies because the virus interacted in some manner with their genetics and environmental exposure.
While it isn’t guaranteed or even a direct link, Dr. Schul says that if your parents have allergies, you’re predisposed to developing allergies too.
Patients typically don’t outgrow their allergies, Dr. Patel adds, particularly if they continue to experience persistent or worsening symptoms as they grow older.
Seeking relief from the havoc pollen wreaks
So what can allergy sufferers who’ve been exposed to pollen do to help alleviate their symptoms? The first step is to reduce exposure. Remaining indoors with the windows closed and the air conditioning on to filter out pollen helps lower pollen exposure levels. And taking a shower immediately after being outside helps remove pollen and further reduce exposure.
Once they’ve reduced their exposure, allergy sufferers should work with their physicians to determine which of the various prescription and over-the-counter medications available will help alleviate — but not cure — their symptoms.
Medications that are used to combat allergic rhinitis include:
• Antihistamines to block the histamine released during an allergic reaction.
• Singulair to block leukotrienes released during an allergic reaction.
• Steroid nasal sprays to reduce inflammation.
Medications used to treat the asthma that those with allergies often experience include:
• Inhaled bronchodilators that relax the smooth muscle surrounding the bronchi, which can tighten during an asthmatic episode.
• Inhaled corticosteroids, which calm inflammation and reduce swelling and mucus inside the bronchi.
A third step on the path to relief is working with an allergist. Allergists are physicians who specialize in allergy and asthma management. They can help patients by:
• Identifying the specific environmental allergens, such as pollen, mold, dust and pet dander, that can cause respiratory symptoms.
• Treating patients’ eye, nasal, sinus and lung symptoms with medication management and potential immunotherapy treatment, if appropriate.
• Providing advanced diagnostic testing to best assess asthma and, when appropriate, recommending advanced asthma treatment with biologics such as omalizumab (Xolair) and new treatments that are on the horizon.
Working with an allergist is the only way allergy sufferers can determine whether the gold standard in allergy treatment — immunotherapy — could significantly reduce their suffering. While medications can help, the only solution that works directly on the immune system is immunotherapy, Dr. Schul says.
More commonly referred to by patients as “allergy shots,” immunotherapy is the only specialized and customized treatment that can tackle not only patients’ symptoms but also the cause of respiratory allergies, Dr. Patel explains. Immunotherapy can help reduce sinusitis and better control and possibly even prevent asthma, thereby improving overall quality of life. And the benefits can last for years, even after treatment ends.
Immunotherapy works by reducing allergic sensitization and thus reducing allergic symptoms and the need for medication, Dr. Turner says, and is the closest thing to the body developing immunity to pollen’s effects.
Preventing allergic progression
Another reason to pursue immunotherapy is that it can help prevent allergic rhinitis from progressing into asthma. According to Dr. Patel, treating and controlling allergic inflammation in the upper airway (nasal passages and sinuses) helps control and possibly even prevent allergic inflammation in the lower airways (lungs).
“It’s important to remember that it’s all one airway,” he says. “Treating the upper airway also helps treat the lower airway.”
Adding credence to this “one airway” philosophy is the fact that approximately 70 to 80 percent of asthmatics have underlying allergic inflammation that is typically caused by environmental allergens.
Immunotherapy doesn’t deliver benefits overnight, but Dr. Schul says some patients see improvements in as little as six to eight weeks after beginning treatment. “Studies show that optimal improvement takes a year, but a majority of people see improvement measured in months, not years.”
As for effectiveness, Dr. Turner estimates that allergy shots deliver relief to approximately 85 percent of patients who receive the treatment.
Another reason to treat pollen allergies with immunotherapy is to decrease symptoms of oral allergy syndrome. Dr. Turner says that a reaction to pollen can cause a cross reaction with certain foods, known as the "oral allergy syndrome." It usually involves an allergic reaction to tree fruits, such as apples, pears, cherries or peaches, with sufferers experiencing an itchy mouth or swelling when the raw fruits are in the mouth (but not after they are swallowed) or when cooked fruits are eaten.
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 solution that immunotherapy can provide.
~ Elaine Turner, MD, Allergy Partners of Richmond
~ Jeffery Schul, MD, Allergy Partners of Richmond
~ Parag Patel, MD, Allergy Partners of Richmond