SPRING ALLERGIES!
Right now our community is experiencing a fierce burst of allergies, so it makes sense to go over what this is, and what can be done.
Why such a rough year? I believe it is because an unusually cold spring kept the grass and trees (see below) from blooming for many weeks, leading to a supercharged, nearly instant, explosive amount of blooming. A very unusual phenomenon that has, locally, created such a pulse of pollen that it is overwhelming therapies.
What are allergies?
The word allergy is derived from the Greek words for other and energy, and so it literally means energy from otherness.
What it really means is that something that is not you, from outside your body, gets your immune system to react in certain particular ways that we call allergies.
At its heart, an allergy occurs when your body develops an antibody to a particular molecule, and everytime your body contacts that molecule, the immune system attacks, causing inflammation.
There are three key differences between the inflammation caused by allergic reaction and other inflammations (like infections, auto-immune disorders), and the are:
1. The inflammation in allergies itches
2. The inflammation in allergies does not tend to cause severe pain.
3. The inflammation in allergies causes very little damage.
On this last point consider the inflammation seen in untreated bacterial pneumonia or arthritis- one actually can destroy the lungs and the other, the joints. Allergic reactions tend not to destroy tissue or organs, once the allergic reaction passes, your body returns to very much how it was before the allergic inflammation.
The inflammation of allergies is so distinctive, in these three ways, because there is a special class of antibodies that cause it, the E-class. Infections are dealt with by M and G type of antibodies, only the E type of antibody, or Immunoglobulin E, or IgE, cause true allergies.
And so, one cannot be allergic to something unless you make IgE to that particular thing.
Spring Allergies
The allergies that are afflicting Ohio now are all due to the E-class of antibody, or IgE, to pollen.
If you are having itchy eyes, sneezy nose, cough, from allergies and it just hit the last week or so, you are allergic to pollen, via having the antibody (E-class) to pollen.
Pollen is the grain that holds the sperm of plants and some plants need to make zillions of such grains to get their seeds fertilized, or pollinated.
All the misery of this time is due to two types of pollen- tree and grass. Not so much flowers. Why? Because garden flowers simply do not pump the volumes of pollen into the air that grass and trees do.
So these spring allergies are due to pollen in the air, and so, the areas of the body that react and get inflamed (and miserable) are the parts the pollen hits- eyes, nose, throat, and lungs.
In each instance, the story of cause and effect is the same, pollen hits the body, the body, if it has the right IgE antibody to that pollen, reacts with itchy inflammation- including swelling, redness, itch, and fluid
Let's see how it shakes out then at each site:
Eyes
The pollen hits the eyes, and if your allergic to it, the eyes get red, intensely itchy, swollen, and fluid (mucus) accumulates. If you lie down overnight, the swelling and mucus can combine to cause the eyes to swell shut and be matted with dried, caked mucus. When all is said and done, though, the eyes return to normal, there is no change in vision, no harm done, only intense suffering during the period of inflammation.
Nose
The pollen hits the nose, and if your allergic to it, the nose get red, intensely itchy, swollen, and fluid (mucus) accumulates. If you lie down overnight, the swelling and mucus can combine to cause the nose to swell and be matted with dried, caked mucus. When all is said and done, though, the nose returns to normal, there is no change in smell, no harm done, only intense suffering during the period of inflammation.
Throat
The pollen hits the throat, and if your allergic to it, the throat gets red, intensely itchy and sore, swollen, and fluid (mucus) accumulates. When all is said and done, though, the throat returns to normal, only intense suffering during the period of inflammation.
LungsThe pollen is breathed in to the lungs, and if your allergic to it, the lungs get red, intensely itchy, swollen, and fluid (mucus) accumulates- causing the main experience of lung allergies: cough and wheezing.
When all is said and done, though, the lungs return to normal, there is no change in breathing, no harm done, only intense suffering during the period of inflammation.
No Anaphylaxis
Although reported, the very dangerous reactions seen to some drugs and foods where breathing actually is compromised and blood pressure drops, known as anaphylaxis, is very, very rare in spring allergies to pollen. Another reason to know the terrible allergies being seen now are miserable, but not dangerous.
What to Do?
There are basically three therapies that help control allergies:
- Antihistamines and other blockers- These drugs block key sequences in the chemical pathways that cause the itchy inflammation to occur. Good blocking means no reaction, no suffering, problems controlled.
- Steroids- These drugs kill the cells of the immune system that cause all inflammation, including allergic inflammation. When these drugs work allergy symptoms tend to improve since the cells making the reaction happen are wiped out.
- Allergy Shots- This technique creates a different class of antibody to the thing you are allergic to, so when that thing comes in contact with you, there will be no reaction.
Antihistamines and other blockers
One of the key tools in finding relief from all the swelling, itch, and fluid of allergies are antihistamines.
There are basically four oral forms and several eye forms available, and they are available to everyone since they are all over-the-counter and so safe even young infants can use them safely.
All four are truly very safe medications, the only significant side effect seen is sleepiness, and three of the four are formulated to make that uncommon.
It turns out everyone is different when it comes to which work. For some, this one works and that one does not, so it is best to try one, if it doesn't help, try the other.
Here are the four:
- Loratidine or Claritin- each dose (ranges 5-10 mg) lasts 24 hour, less drowsy
- Cetirizine or Zyrtec- each dose (ranges 5-10 mg) lasts 24 hour, less drowsy
- Fexofenadine or Allegra- each dose (ranges 60-180 mg) lasts 24 hour, less drowsy
- Diphenhydramine or Benadryl- each dose (ranges 6.25-25 mg) lasts 4 hours, more drowsy
People tend to try the three non-drowsy, once a day preparations first, but keep in mind that diphenhydramine is the most powerful of the four, so if the allergies are very irritating, some drowsiness may be worth the relief diphenhydramine can sometimes deliver.
EYE ANTIHISTAMINES are a powerful and wonderful therapy.
They come in over-the-counter brands and prescription brands. Potency in OTC and prescription brands is comparable, but changing the brand when one does not works makes good sense.
One more blocking drug to mention is Singulair, which has very few side effects, does not cause drowsiness, and is taken once a day. It blocks another chemical in the allergy chemistry, and can work very well, too.
Steroids
There are many types of steroids, the ones used for allergies are technically the glucocorticoid steroids, not the ones used in sports. As noted these steroids kill the cells that orchestrate the whole allergy cycle, so they work better than anything.
One problem- steroids have an encyclopedia of very serious side effects.
The solution- use the topically. Essentially all of the hazards of steroid use can be avoided with the topical strategy for two reasons- the amount needed is a small fraction of that needed in oral treatments, and the drug is being applied to the inflamed area directly, allowing for a much smaller dose to still have a big impact.
The most familiar example of topical steroid use is steroid cream for eczema. Rub a little hydrocortisone cream on a patch of eczema and the inflammation clears, with very little hazard.
There are two topical strategies of steroid use in spring allergies: the nose and the lung.
The nasal steroid systems are essentially nose sprays that deposit a small amount of steroid on the lining of the nose. There are many, many brands of these sprays, and they all work about equally well. There is not much point in switching brands except for price.
The lung steroid systems are inhaled steroids and they are delivered by a hand-held inhaler or a mist making machine called a nebulizer. Again, the brands work about equally well, only price should cause a change in brand.
Both the nasal and inhaled steroids work well and are very safe.
There are oral steroids too, Prednisone and Prednisolone, but this strategy requires a much, much larger dose of steroid use and it being delivered to the entire body. This is a far riskier move, and we typically reserve its use for more serious conditions such as life-threatening allergic reactions and severe breathing distress from severe asthma attacks. We do not recommend the use of oral steroids in the routine of treatments for spring allergies.
Allergy Shots
Allergy shots create antibodies to the pollen that block future allergic reactions. When they work, you are left no longer allergic to the pollen your treatment targeted.
The problem with allergy shots is that it requires a weekly injection, sometimes for years. The benefit can take quite a long time to realize.
We recommend trying all the available antihistamines and topical steroid treatments first.
These treatments work well for most people, spring allergies tend to be well-controlled by them, and treatments with them are painless, do not require a doctor's visit every week, and give relief nearly immediately.
BOTTOM LINE
This year we are seeing a true explosion of spring allergies. Here are some key points to remember:
- This is an unusually severe year of allergy. Don't make long-term treatment plans based on the severity of this year's reactions.
- Spring allergies are the result of an allergy to pollen, mainly the pollen from grass and trees, not flowers. There is no need to go searching for what your child is allergic to if their symptoms are itchy eyes and runny nose without fever in the spring during peak blossom times- the cause is pollen allergy.
- Treatments include oral antihistamine for all allergic symptoms, and:
- Eye antihistamines for inflamed eyes
- Nasal steroids for inflamed nose
- Inhaled steroids for inflamed lungs
- Spring allergies are harmless- they cause great agonies, but no harm. And they are very temporary, passing as the blooming intervals pass. And they are very treatable.
So no need for panic. The cause is easy to describe, the treatments are readily at hand, and the outcome is outstanding.
Here is to an enjoyable Spring for us all.
Dr. Lavin
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