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Sneezing early?
It's El Nino's fault
Author: By Judy Foreman, Globe Staff
Date: MONDAY, March 30, 1998
Page: C1
Section: Health and Science
Just when you thought there was nothing left to blame on El Nino comes
this: We're in for an unusually early -- and perhaps long and nasty -- allergy
season this year.
Granted, everybody always thinks whatever allergy season they're suffering
through is the worst ever, but this year, it really will be bad -- and in some
places, already is -- because El Nino created perfect growing conditions for
trees and molds -- a mild winter in the Northeast, rains in the South and
North.
``We're in for a mega-season,'' says Dr. Donald Pulver, an allergist in
Rochester, N.Y., echoing a warning from the National Allergy Bureau, a program
of the American Academy of Allergy Asthma & Immunology. And this is on top of
a winter that -- because there was no killing frost in many places -- provided
no respite for those allergic to molds.
``We're seeing tree pollen in the air already, three to four weeks early,''
says Dr. Julian Melamed of Allergy and Asthma Specialists in Chelmsford.
Because of the ``priming effect'' -- once airways are inflamed by
allergy-causing substances, it takes less and less exposure to cause further
misery -- the key is to begin taking medications now, before things get too
far ahead of you, adds Dr. Frank Twarog, a Harvard allergist.
Allergies -- also known as hay fever and allergic rhinitis -- mean the body
is making an excessive immune response to specific triggers, or allergens, in
the environment.
About 50 million of us are allergic to something -- either seasonal, outdoor
things like trees and grasses, or year-round indoor things like mold, dust or
cats. Or both.
In the spring, the big culprit is pollen -- a packet of sperm that trees
and grasses release into the air to be carried to female organs in the same
plant or one nearby to form a seed.
Depending on your genetic makeup, pollen from a particular kind of tree,
say a birch, may cause an immune reaction -- release of a type of antibody
called IgE. This antibody sits on the surface of mast cells -- immune system
cells that line the nose, throat, gastrointestinal tract, and skin.
The next time this pollen enters your system, it combines with these
antibodies, causing the mast cells to release histamine and 44 other chemicals
that can trigger an allergic reaction. These chemicals make blood vessels
dilate and leak proteins into tissues, causing swelling -- the stuffy noses of
allergy sufferers -- or hives on the skin.
Usually, this is just annoying. But allergies also can cause asthma, an
inflammation of the bronchial tubes, and sinusitis, an inflammation of the
sinus cavities around the eyes and nose.
If the sinuses are blocked, mucus cannot drain properly, which means that
viruses or bacteria lurking there can thrive. Infected mucus then drips into
the lower respiratory tract, triggering bronchitis and asthma.
So what can you do? Plenty.
Basic preventive measures include staying indoors when pollen counts -- and
air pollutants -- are high. Close the windows and turn on air conditioners at
home and in the car. If you exercise outdoors, do it at dawn when plants are
covered with dew, after a rain, or at dusk, when pollen has fallen to the
ground.
You can also use a HEPA (high-efficiency particulate arrestor) air cleaning
filter -- roughly $200. A dehumidifier may help combat mold allergies, too.
The goal, says Pulver, is to keep indoor humidity at between 35 and 45
percent, which means you also have to get rid of any carpeting that's been wet
for more than 48 hours.
A growing array of medications can help, too, especially if you start using
them now.
If your allergies are mild, over-the-counter antihistamines like Benadryl
or Chlor-trimeton (or their cheaper, generic equivalents) may do the trick,
though they can make you groggy. Newer antihistamines, like the nasal spray
Astelin and pills like Allegra, Claritin or Zyrtec, don't cause grogginess,
except possibly for Zyrtec. But you can only get them by prescription.
A better solution, many allergists say, is one of the anti-inflammatory
nasal sprays that act by a different mechanism.
Nasalcrom, now available over the counter, is a nonsteroidal drug that
helps some people. Another nonsteroidal spray, which works by decreasing nasal
mucus, is Atrovent, available by prescription. A different formulation of the
drug is used to control asthma.
But often, allergy sufferers need the stronger stuff -- prescription
steroid sprays like Nasonex, Flonase, Nasacort, Nasacort AQ, Rhinocort,
Nasarel or Vancenase AQ/DS. It may take 24 hours to a week for the steroid
drugs to kick in, but once they do, they control allergies well if you use
them faithfully.
If you have asthma, it's especially important to treat allergies so smaller
problems don't become bigger ones, says Dr. Marshall Plaut, chief of the
allergic mechanisms section at the National Institute of Allergy and
Infectious Diseases.
For asthma, which kills 5,000 people a year, the mainstays of prevention
and treatment are inhaled steroids such as Vanceril DS, Flovent, Aerobid,
Azmacort, and the just-approved Pulmicort to dampen down the inflammatory
response in airways.
These drugs must be taken regularly -- not just during an attack -- to
allow delicate airways in the lungs to heal. Non-steroid inhaled drugs such as
Intal and Tilade also help, by incapacitating mast cells.
And for some people with asthma, bronchodilators may help.
Short-acting ``rescue'' bronchodilators, such as Proventil, Ventolin,
Alupent, Maxair, and Tornalate work by boosting the stress hormone adrenalin,
which opens airways.
These are available only by prescription and should not be used regularly
because they raise the risk of cardiac arrhythmias and stroke. If you use them
more than three times a week, it's a sign your asthma may be out of control
and you should see your doctor again.
And be especially careful with Primatene Mist, a short-acting
bronchodilator available over the counter. It provides relief fast -- in
little as 15 seconds -- but is often overused.
A long-acting bronchodilator called Serevent can control nighttime and
exercise-induced asthma by keeping muscles around airways relaxed, but it's
best used with inhaled steroids.
Increasingly, allergists are also prescribing a new class of drugs called
anti-leukotrienes -- Accolate, Zyflo and Singulair. These drugs block
leukotrienes, substances that, like histamines, are released during
inflammation.
If all this seems a bit overwhelming, take heart. It's well worth the trip
to the doctor and the pharmacy to keep allergies and asthma under control.
Whatever El Nino may do out there, there's no point in suffering if you don't
have to.
Judy Foreman is a member of the Globe staff. Her E-mail address, via the
Internet is:
foreman, (AT SIGN SYMBOL)globe.com
SIDEBAR 1.
For pollen data
For more information on pollen counts nationwide and tips for dealing with
allergies, you can try:
1-800-9-POLLEN (765536).
On the web, try
www.aaaai.org
(the American Academy of Allergy Asthma and Immunology)
SIDEBAR 2.
Telling symptoms
It can be hard to determine if you've got a cold, allergies or sinusitis.
Colds get better by themselves, but allergies and sinusitis persist and often
need medical treatment. Here are the distinguishing symptoms.
Symptom Sinusitis Allergy Cold
Facial pressure/pain
Yes
Sometimes
Sometimes
Duration of illness
More than 10-14 days
Varies
Less than 10 days
Nasal discharge
Thick, yellow-green
Clear, thin, watery
Thick and whitish or thin and watery
Fever
Sometimes
No
Sometimes
Headache
Yes
Sometimes
Sometimes
Pain in upper teeth
Sometimes
No
No
Bad breath
Sometimes
No
No
Coughing
Yes
Sometimes
Yes
Nasal congestion
Yes
Sometimes
Yes
Sneezing
No
Sometimes
Yes
SOURCE: American Academy of Otolaryngology.
Globe staff chart
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