Saturday, August 19, 2017

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Ahhhhhhh Spring! Ahhhhhhh Choo!

Written by  Rick Piester

If you’re one of the 50 million people in America who suffer from allergies, you most likely greet spring with equal parts delight and dread, pleasure and pain, sunbathing and sneezing.  

Although allergy season seems to have started a bit early this year (medium-high levels of pollen were being reported in mid-February), as an allergy sufferer, you know the worst is yet to come.

Virginia is a hotbed for allergies. The verdant hills and lush grasses of the mid-Atlantic states have few rivals in producing the pollens that make people wheeze and sneeze. Our commonwealth has the dubious distinction of being among the national champs when it comes to pumping out tree and grass pollens.

In 2015, for example, the Natural Resources Defense Council rated Richmond the number one most challenging city in the country to live in for people with allergies. Our capital city was number eight on the 2011 Forbes list of allergy-heavy cities, and the city held the same spot in a 2014 ranking by the Asthma and Allergy Foundation of America. Experts also say there’s not a lot of difference between the state’s capital area and other regions of Virginia.

Immune System Gone Awry

Allergies are the result of the body’s immune system going awry. The immune system normally attacks the body’s genuine enemies, such as bacteria or a virus, 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 the battle in the form of itching, sneezing, red eyes, and a runny nose within minutes of exposure. That’s followed by the typical congested nose and cough, and maybe even hammering headaches. Allergies (medically known as allergic rhinitis) are always bothersome, but they can even be life-threatening.

The cause of the misery, allergens, are found both indoors and outside, according to Richmond allergist Barry Feinstein, MD, of Advanced Allergy and Asthma of Virginia. They can come from plants, foods, pets, and even some household products.

The Power of Pollens

Pollens produced by trees, weeds and grasses 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, with little escaping into the air.)

Here in Richmond, tree pollens dominate early in the year, beginning in late February, according to Dr. Feinstein. They peak in April and extend into late May. By then, our region has transitioned into grass season. In mid to late summer the weed pollens, especially ragweed, come into play.

When Mold Makes Its Move

Autumn brings the environmental mold allergens, Dr. Feinstein notes, such as leaf mold stirred up while raking wet leaves.

Mold also lives indoors all year, in damp areas such as basements, bathrooms, on window sills and in refrigerators.

When Dust Mites and Dander Attack

Dust mites are microscopic eight-legged living 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 a humidity of over 50 percent. They live mainly in carpeting, bedding, furniture and furry objects, such as stuffed animals.

Animal dander is loose skin cells shed by animals. Dander from pets such as dogs and cats may contain saliva or other substances from the animals. The cells become airborne and are inhaled by people.

Is It a Cold, or Is It an Allergy?

The symptoms of colds and allergies can sometimes be similar, Dr. Feinstein says, but there are some essential differences: allergy symptoms are persistent, and they are bothersome for longer than the five to seven days it takes for a cold to run its course. Symptoms are also quite specific: the telltale red, itchy eyes, the runny nose, and in some people, the skin symptoms such as red, swollen hives, all of which point to an allergy. Dr. Feinstein also notes that the allergy symptoms appear perennially, coming and going in concert with whatever allergens a person is most sensitized to.

How to Address Allergies

Medicine has developed quick and reliable ways to pinpoint the cause of allergies in individuals. The most common test is a skin prick test — Dr. Feinstein notes that it feels more like a “kitty cat scratch” — where small amounts of allergy triggers are placed on the skin. Swelling or redness appears within about ten minutes, indicating an allergy to the substance placed on that part of the test area.

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 windows closed and cranking up the air conditioning at home and in the car. Staying inside as much as possible when the pollen count is high (see sidebar), and taking a shower to wash the allergens out of your hair before bed, are other coping strategies. Keeping your pet out of the bedroom or running a high-efficiency air cleaner in your home may help as well.

An Array of Remedies

If those measures don’t help much, there’s 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 make it to the doctor’s office. Instead, they rely on any of a somewhat dizzying array of medications in the local pharmacy that may offer effective relief. Dr. Feinstein says 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 a corticosteroid nasal spray, a safe and effective treatment. Pairing it 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 symptoms. And look for long-acting antihistamines (like Allegra, Claritin, and Zyrtec) that don’t have a sedative effect that will leave you drowsy.

If over-the-counter medications fail, immunotherapy (allergy shots) can be formulated for particular combinations of allergies. Dr. Feinstein notes that the expense and time investment of immunotherapy is often rewarded by an eventual shift in the immune system that makes treatment no longer necessary. In effect, you’re cured of your allergy. Immunotherapy is also an important treatment for youngsters, who can be spared later allergic asthma.

Immunotherapy has been refined over the last century to the point that prescription medicines that dissolve under the tongue are now coming onto the market — good news for the needle-shy, though not always approved for use in the U.S. by the Food and Drug Administration. Widely used in Europe, these sublingual remedies are currently approved in the U.S. for treatment of ragweed and grass allergies.

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, as 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. However, 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, at least temporarily, the daily pollen count.

 

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 reaction. A medium pollen count of 4.9 ‒ 7.2 is the point at which most allergy sufferers begin to notice symptoms. A medium-high count is 7.3 – 9.6, and a high count is 9.7 – 12.

Most daily newspapers carry that day’s projected pollen count, which is also available in the weather forecast portion of most television newscasts, as well as 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 a youngster’s allergic reaction to 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 advising parents to give their kids foods containing peanuts starting when they are infants, to help prevent life-threatening allergies.

The Institute recommends giving babies puréed food or finger food containing peanut powder or extract before they are six months old, and even earlier if a child is prone to allergies and doctors say it is safe to do so. One should never give a baby whole peanuts or peanut bits, experts say, because they can be a choking hazard.

As always, following this advice should be prefaced by the approval of your child’s physician.

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