Allergies have been on the rise for decades, for reasons not clearly understood. Often the causes are the very things we enjoy. Do you appreciate Midwest life for our four seasons? Welcome to tree, grass and weed pollen, which keep noses running from spring through late fall. Don’t forget the mold thriving on fallen leaves: hay fever (also called allergic rhinitis) keeps 40 million Americans sneezing and glassy-eyed. Can’t imagine life without Fido or Fifi? Pet dander is another leading cause of allergies.
[woes for the nose]
our fair city
About 50 million Americans suffer from an allergy, making it the fifth-largest category of chronic diseases, according to the Asthma and Allergy Foundation of America (AAFA ).
“In St. Louis, the tree pollen season can go from February until early May, and that is followed by the grass pollen season, which generally goes from mid-May to late June. The ragweed season tends to run from mid August to the end of September,” says Dr. Mark S. Dykewicz, allergist and immunologist at Saint Louis University School of Medicine.
“Tree and grass pollens are real problems for lots of people. Oak pollen, because there is so much of it, seems to cause not just nose issues but bother the eyes, too,” he adds.
The Midwest’s mixing of polar winds and Gulf-coast humidity adds to its allergies, says Dr. Hamsa N. Subramanian, an allergist and immunologist at Signature Medical Group in Creve Coeur. “Sudden changes in temperature and humidity can cause similar problems. That condition is called non-allergic rhinitis.”
define allergies
AAFA defines a true allergy as “an overreaction of the human immune system to a foreign protein substance that is eaten, breathed into the lungs, injected or touched.” The body mobilizes immune system antibodies, intended for fighting actual infections, with unreasonable force. Tissues get blasted with histamines and other weapons, resulting in “coughing, sneezing, itchy eyes, runny nose and scratchy throat. In severe cases it also can result in rashes, hives, lowered blood pressure, difficulty breathing, asthma attacks and even death,” according to Foundation information.
Some nasal symptoms may be caused by irritations that don’t trigger antibodies, Subramanian says, “You can have symptoms without being allergic. The only way to absolutely diagnose allergies is by being tested, preferably through a skin test. Some people have a combination of allergic rhinitis and nonallergic rhinitis.”
treatment today
There are no known cures for allergies, but they can be treated. “The standard advice is to avoid what you are allergic to,” Dykewicz says. “During the pollen seasons, stay inside and have the air conditioning on when that is practical to reduce or avoid exposure. For some people that may be good enough.”
Wearing a filter mask outdoors also helps, he says. If the symptoms are more serious, medications abound. “There are safe medication options even for pregnant women, children and the elderly,” Subramanian says. And while many medications need a prescription, others are available over the counter and at reasonable prices. “For people who are having mild symptoms, an over-the-counter antihistamine may do the job,” Dykewicz notes.
Two nasal steroid sprays, Nasacort and Flonase, have been approved for non-prescription sale in the past year, he says, but suggests they be used with a physician’s guidance. “Often people use the sprays incorrectly and aren’t getting the full benefit.”
The next level of treatment is immunotherapy, which decreases sensitivity by exposing the patient to small but increasing amounts of specific allergens. The standard immunotherapy is given by injections that range from once or twice weekly to every few weeks.
new & improved
Allergists recently gained federal approval for “sub-lingual immunotherapy” (SLIT), which treats tree and grass pollens with pills placed under the tongue each day. “People prefer it because it doesn’t require shots and they don’t have to keep visiting a medical facility,” Dykewicz says.
However, this new protocol may not benefit all patients, Subramanian cautions. Many will need injections to cover other allergens, she says. “If you are susceptible to other allergens—such as dust and mold—in addition to trees and grass—we are leaving out those allergens if we just do the oral therapy.”
[trouble on the surface]
As we recall from high school biology class, the skin is the body’s largest organ. It is our barrier to an infinite number of potential allergens, so it is no wonder that one in five people will be affected by hives at some time in their life, according to the World Health Organization.
a bumpy road
“You can name anything, and somebody, somewhere, has an allergy to it,” says Dr. Joseph A. Muccini Jr. of Mid-America Skin Health & Vitality Center in Chesterfield. An episode of hives may last weeks, and it can by annoying, especially if you don’t know where it came from. “They do go away, but it is frustrating, and you’re itching and trying to figure out why it happened,” says Dr. Alison Basak of St. Louis Dermatology in Town & Country.
Like other allergies, those affecting the skin cause the body to overreact to something that generally is not harmful. The skin responds by producing raised, itchy bumps that can be red. The medical term for hives is urticaria, derived from the Latin word for ‘to burn.’
The allergen does not have to touch the skin—reactions to food and nasal allergens may induce hives. “By definition, urticaria comes and goes,” Muccini says. “The hives may disappear over four or eight or 12 hours, but there will be others a few centimeters away. If they don’t move around, you could have a rash that may or may not be allergic, but it probably is not hives.”
elusive issue
Hives often run their course before they can be analyzed. “Then it doesn’t do any good to do allergy testing because we usually don’t find anything,” Basak says. “About 50 or 60 percent of the time we classify it as idiopathic, meaning we don’t know the cause.” When hives are chronic—occuring almost daily for more than six weeks—a cause is worth pursuing.
“There is detective work involved. We do a history and look for patterns. Sometimes we do patch testing,” Muccini says. “We will put little squares of chemicals we think you may be allergic to on your skin and leave them there for 48 hours. Then we see if there is a rash in some of those squares.”
While an infinite number of substances may cause hives, a few culprits keep turning up. “It can be food, perfume, hair dye, detergent, pet dander, dust, mold or latex,” Basak says. “For some people it can be physical exercise or cold exposure. For others, it can be aquagenic—after they get out of water and warm up they get hives.”
common culprits
Latex allergy is a common trigger. “It can make you miserable, and latex is in more things than you’d think. It is in our shoes and the elastic in our underwear,” Muccini says. Shoes, in general, can be vicious culprits. “They have synthetic materials, glues, dyes and tanning agents,” Muccini says, “making shoe allergy such a terrible problem that there are companies that make hypoallergenic shoes.”
Another repeat offender is nickel, according to Muccini. “It is in any cheap metal amalgam: zippers, pens, jean rivets, earrings, necklace clasps and belt buckles.” Neomycin, an antibiotic used in Neosporin, is another leading suspect. “I don’t encourage people to use Neosporin for itchy spots unless an antibiotic is actually needed,” Muccini warns. “You could be exposing yourself to neomycin, which can easily give you a hard time with an allergy.” He stresses that “nine times out of 10, the biggest part of treatment is avoidance.”
out, damn spot
“One of the most common first-line treatments is steroids,” Muccini says. “If the hives are mild, we would use topical, over-the-counter steroids. There are prescriptions that are many times stronger, pills or injections, that the dermatologist will use if it is a
worse reaction.”
For symptoms like swelling of the lips, tongue or throat, “get to an emergency room,” Basak cautions, because it may signal a loss in breathing or a dangerous blood pressure drop.
[food troubles]
According to the Asthma and Allergy Foundation of America, about 90 percent of food allergies are caused by eight foods that have sustained humanity for ages: milk, soy, eggs, wheat, peanuts, tree nuts, fish and shellfish. So what is going on?
problems on the rise
“The prevalence of food allergies is thought to be 5 percent in adults and 8 percent in children,” says Dr. Tiffany Dy, an instructor in medicine, allergy and immunology at Washington University School of Medicine. “What is impressive is the rise in prevalence. When the CDC looked at the statistics between 1997 and 2012, the prevalence for children rose 50 percent. It is not known exactly why.”
Even more noteworthy might be the number of children with peanut allergy, which tripled from 1997 to 2008. The ‘hygiene hypothesis’ may, in part, be to blame. “We face less microbial exposure due to clean water and the eradication of diseases, and we spend less time outdoors. This may be steering our immune system to become more allergic. It is spending less time fighting infections and now is skewed toward overreactions to food or environmental triggers,” she says.
One clue is found in children growing up on farms—they play in real dirt around real animals and are less likely to develop allergies than city kids, Dy says. Another theory considers the load of artificial substances we touch and consume, says F. Afua Bromley, an acupuncturist at Acupuncture Saint Louis. “When you look at the amount of chemical exposure we have in our food and our environment, it is astounding. I am sure it affects us in ways we don’t understand.”
how can you tell?
Food allergy symptoms, which may appear within minutes or an hour of eating, include vomiting, diarrhea, cramps and hives. “Some patients unfortunately have manifestations of anaphylaxis, a severe allergic reaction characterized by respiratory distress, chest tightness, hives, dizziness and vomiting,” Dy says. “Patients may end up in the hospital and need to have a breathing tube placed.”
Peanuts, in particular, pose a serious problem. A tiny bit of a single peanut can launch dangerous reactions in patients with severe allergies, warns the National Institute of Allergy and Infectious Disease. “Peanut is difficult to avoid. People with peanut allergies live in fear of having an allergic reaction at school or on an airplane,” Dy says.
allergy vs. sensitivity
Widespread avoidance of food groups, in particular gluten/wheat and dairy, has caused some confusion about food. “It is important to differentiate between a true allergy and an intolerance,” Dy says. “Intolerance is the inability to properly digest something, so you get bloating, indigestion and diarrhea. Most allergies are caused by a protein as opposed to lactose, which is milk sugar.”
An avoidance trial can help determine if a patient has a reaction to a particular food. A skin or blood test can determine whether the body is having an actual allergic response, Dy says. Identifying and then avoiding an allergic food is the first step in treatment, she adds. People with a history of severe reactions should carry emergency medicine at all time, she advises.
