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allergies

There is hope for Allergies
There is hope for Allergies Ah, spring! Jonathon always loved this time of year… the flowers poking up through the ground, and the blooms on the trees. Finally, the gray, cold, gloomy days of winter were coming to an end. For his wife, Sylvia, however, the spring brought a time of misery. Every bright, sunny day meant endless sneezing, a constantly dripping nose, and itchy and watery eyes. She was overcome with symptoms in the early spring, late spring and early summer, and again in the late summer and early fall, with only a mild reduction in between. She actually looked forward to the cold, gray days of late fall and winter.

This year, Jonathon was determined that his wife would not suffer through the spring and summer (he suffered too), so he made an appointment with an allergy specialist who was recommended by his good friend. The following is the doctor’s report.

I could tell from Sylvia’s history that she most likely suffered from tree, grass, ragweed, and pollen allergies. I confirmed the initial diagnosis with skin testing, and Sylvia did indeed show positive results to oak and maple tree pollens, grass pollen, and ragweed pollen. Her skin testing was negative to dust mites, animals, and molds, which fit with her history of having a symptom-free late, fall and winter. I then sat down with Sylvia and Jonathon and explained the options for treatment of her allergies.

The first approach to the treatment of allergies is to try to avoid what triggers the symptoms. Avoidance of pollens, however, is difficult, if not impossible, if you want to lead any sort of normal life, but there are a few things that you can do. Try to avoid outdoor activities at the time of day that pollen counts are at their peak. This varies with the type of pollen to which you are allergic. For example, grass pollen typically peaks in the late morning to early afternoon, and ragweed in the early morning. Keep the windows closed during those same times of day. If you don’t have central air conditioning, a window air conditioner can be helpful. It keeps the house cool, and also filters the air to some extent. Be sure to keep the vent closed on the air conditioner so you aren’t bringing in outdoor air.

Since the opportunity to avoid the pollens is limited, other forms of therapy are a more important treatment for Sylvia ’s allergies. I explained to Sylvia that the allergic reaction is due to the presence of IgE antibodies that her immune system produced and directed against seemingly harmless proteins in her environment, such as plant pollens. These antibodies are attached to cells in her nasal and eye tissues, called mast cells. When she is exposed to these pollens, they interact with the IgE on the surface of the mast cells, triggering the release of chemicals, such as histamine, which have effects on various organs in the body, triggering the allergy symptoms. In addition, some of these chemicals recruit other cells into the tissues of the nose or eyes causing inflammation and the release of more chemicals, leading to chronic symptoms.

When avoidance isn’t possible, or is insufficient to control the symptoms, allergists employ a variety of medications. Usually the first medications tried are antihistamines, which block histamine from triggering its effects on the various cells and organs involved in the allergic reaction, such as the nerves in the nose responsible for sneezing, and the blood vessels responsible for the congestion. The advantages of antihistamines is that they can be purchased in pill, liquid or nasal spray form and used as needed to treat both nasal and eye symptoms. The newer antihistamines have fewer side effects and are more convenient to use because they are to be taken only once daily. Medications instilled directly into the eye are most commonly antihistamines, and are usually required for people with more than mild eye symptoms. Oral antihistamines, however, are often not strong enough to relieve a patient’s more severe symptoms. In those cases, nasal spray antihistamines or other medications may be more effective.

Since Sylvia’s severe and chronic allergic reactions indicated the presence of ongoing inflammation in her nose and eyes, I recommended treatment for the inflammation. Corticosteroids are the most effective treatment for allergic inflammation. These are not to be confused with the “steroids” that some body builders and athletes are reported to abuse. These are quite different and affect the body’s inflammatory processes, not muscle growth. When used in oral form over time, these medications can have significant potentially serious side effects. For that reason, scientists developed forms of the medications that can be applied to the surface of the nose, increasing the effectiveness of the medication on the inflammatory process, while markedly reducing the absorption of the drug into the body. As a result, these nasal steroid sprays can be used safely for years. In addition, they do not result in “dependence” as over the counter nasal sprays do. Regular use of the nasal steroid spray was recommended during Sylvia’s pollen seasons, in order to maintain control of the symptoms and to prevent their occurrence. In most patients with allergies like Sylvia’s, symptoms can be controlled with intranasal steroid sprays and antihistamine eye drops.

The final form of therapy for allergies is immunotherapy, or allergy shots. In immunotherapy, the allergist injects small amounts of the substances to which the patient is allergic, carefully advancing the dose to what is called a “maintenance dose” which should control the symptoms. This process results in a decrease in allergic sensitivity to the allergens, and patients can often discontinue their medications and tolerate exposure to their allergens without any reaction. This form of therapy involves many injections initially, and a slight risk of allergic reactions to the shots, so it is not for everyone. However, immunotherapy is very effective for pollen allergies, with a significant reduction in symptoms in 80-90% of patients when properly used.

In Sylvia’s case, I recommended a nasal steroid spray and eye drops. If symptoms were not controlled, then I would recommend immunotherapy. What patients with allergies need to know is they do not need to suffer; very safe and well-tolerated therapies are available to control or even eliminate symptoms.

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"There is hope for Allergies"
   authored by:
ALLERGY
Dr. Paul Williams is a practicing allergist in a large group of allergists in Washington State, and also serves as a Clinical Professor of Pediatrics and Environmental Health at the University of Washington School of Medicine. Dr Williams received hi...



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