Spring Fever

The first breath of spring brings green leaves, blossoms… and pollens. With the long-awaited outdoor beauty also comes allergies.
Seasonal Allergy Solutions
By Charlotte Boatwright, R.N., PH. D.
Chattanooga residents frequently com- plain of itchy, runny eyes and noses and sneezing. Not surprising to them, the Asthma and Allergy Foundation of America recently listed Chattanooga as the fourth-worst city in the country to live in if you have asthma.
An allergy is an abnormal response by a person’s immune system, causing the body to release chemicals in response to a trigger which is normally a harmless substance. Allergic responses may manifest as nasal symptoms such as hay fever, skin reactions, or life-threatening responses affecting the entire body. Allergies may be triggered by foods, medications, insects, or even latex gloves. During the allergic response, the allergen or substance responsible for causing the allergy, binds to antibodies present on allergic cells in the body. The cells release chemicals, such as histamine or leukotrienes, which cause allergy symptoms.
Allergies have become more common in recent decades for many reasons, including a growing number of environmental triggers. Some people attribute the increase to the “hygiene hypothesis,” explaining that our immune systems do not need to fight as many infections as in the past because our environment is cleaner and more sterile. Many people do not grow up around animals or play or work in dirt. We have vaccines and antibiotics to protect us, so the immune system is less stimulated to fight infection and instead switches to allergy mode.
Many of the allergies seen by physicians in the Chattanooga area involve the respiratory system. According to Dr. Susan Raschal, a board certified physician in allergy and immunology with Covenant Allergy and Asthma Care, environmental irritants such as pollens and pollution can initiate a reaction called vasomotor rhinitis that people may mistake for allergies.
“People often think they have a sinus infection because they feel the pressure in their forehead, but it is due to weather or temperature changes, cigarette smoke, sprays, pollution, or allergens,” she says. “Atopic dermatitis, allergic rhinitis, and asthma frequently coexist. ‘Allergic march’ refers to the progression of allergies beginning during infancy, starting with atopic dermatitis, asthma, and allergic rhinitis.”
Dr. Raschal says that early diagnosis of allergic rhinitis is particularly important for young children. “If we aggressively control this condition, in some cases, we can prevent asthma,” she says. “This is huge, because asthma is a potentially life-threatening condition and it is incurable.
Almost 5,000 people die from asthma each year in the U.S., and most people do not know it can be prevented. A child with severe allergic rhinitis has a 40 to 50 percent chance of developing asthma. The only way to change this outcome is with allergy shots. If a child develops asthma after the age of six, studies indicate that it is, for the most part, incurable, although it can go into remission. If eczema develops from food allergies, including breast milk, within the first six weeks of life, 40 percent of those children will develop asthma. If the baby is allergic to milk, the mother needs to omit milk protein from her diet.”
Allergies are diagnosed by history, physical examination, and skin or blood tests. Tests used are determined by the type of allergy. Skin testing is very safe when performed by an allergist. Atopic dermatitis (eczema) is diagnosed by history and physical examination, usually a rash with itching.
“Inhalant allergens like trees, grass, weeds, and animals are most accurately diagnosed with a thorough history and positive skin tests,” says Dr. Raschal. “We can administer allergy shots with that data. With food allergies, skin testing in diagnosis is only about 50 percent accurate, but combined with a history of allergic reaction each time the food is eaten, the diagnosis is confirmed. That is why history is so important.”
A radioallergosorbent (RAST) test measures the numbers of antibodies present in the blood that specifically react to an allergen. “Used with a positive food test, a CAP-RAST test can predict the likelihood of a life-threatening reaction if the food is ingested,” Dr. Raschal says. RAST is useful in determining that a child has outgrown an allergy. “Only 20 percent outgrow peanut allergies and it is the number one cause of fatal food anaphylaxis (death due to whole body allergic reaction).”
Dr. Marc Cromie, a double-boarded pediatric and adult allergy and asthma specialist at the Chattanooga Allergy Clinic, points to pollens as one reason for Chattanooga’s move up to number four in the study by the Asthma and Allergy Foundation.
“Obviously, Chattanooga has had an increase in pollens this year,” says Dr. Cromie. “We have a very long pollen season because we have very mild winters, so frost does not kill the ragweed. We have such a warm spring that trees start pollinating in January or February, rather than in April or May, as they do in other areas. We have more species of trees pollinating in the spring than any other place in the world, except a small city in China. We live in a bowl, so all the pollen from the mountains gathers down in Chattanooga.”
“Seventy percent of patients with asthma have allergies as a trigger,” Dr. Cromie comments. “Although we have great medicines to treat the symptoms, there is nothing to prevent the ‘allergic march’ except allergy shots. That is why these patients should see a board certified allergist, as our testing and treatments are often different than that of other doctors. Typically, a referral is not required, but if necessary, it is usually easy to obtain from the primary care doctor.”
Allergy medications include antihistamines, such as Benadryl® or loratadine, which are now available over-the-counter. Prescription medications, such as cetirizine (Zyrtec®), work within a few hours, are relatively inexpensive, easy to take, and can be given as needed to treat a runny nose and sneezing.
Numerous topical nasal steroids are available by prescription, such as fluticasone (Flonase®) and mometasone (Nasonex®). Excellent at controlling allergic rhinitis, the sprays should be used daily for best effect and don’t work well when used only as needed. Side effects are usually mild and limited to nasal bleeding and irritation.
Two prescription nasal sprays are available, a nasal antihistamine and a nasal anticholinergic. The antihistamine azelastine (Astelin®) effectively treats allergic and nonallergic rhinitis. Ipratropium (Atrovent Nasal®) dries nasal secretions and is indicated for treatment of allergic and nonallergic rhinitis and common colds.
Over-the-counter nasal sprays include cromolyn (NasalCrom®) and topical decongestants such as oxymetazoline (Afrin®) and phenylephrine (Neo-Synephrine®). These sprays should be used no more than three days every two to four weeks or they can cause rebound nasal congestion.
Allergy prevention depends on knowing what allergen is causing your symptoms. “We can tell you after a short visit what triggers you need to avoid in preventing allergies,” Dr. Cromie explains. “If you have a seasonal allergy, you can take preseason medication to prevent or reduce symptoms. The most important treatment is allergy shots. We give teeny shots of pollen or mold or whatever causes the allergy over several months so that the immune system stops reacting and you no longer have the symptoms. It may take three to five years, but without the shots the patient will be allergic for the rest of his life.”
Diagnosis and treatment of asthma is very important in the Chattanooga area as the problem is prevalent. Dr. Curt Chaffin, board certified allergist with Asthma Immunology and Allergy Associates, says that the diagnosis of asthma is not always straightforward. “We often get questions from parents with children aged two to five years that have some wheezing and have been on steroid treatment,” he says. “They sort of assume that it is asthma, but it is very difficult at that age. There is a breathing test that we can do which gives us some clues as to whether or not it is asthma, but we may need to follow the patient for a while to be sure. Once asthma is diagnosed, it can be controlled very well. Treatment involves taking daily medications much like diabetes. In the last few years, we have found that if you can catch people early, about 70 percent have allergies that trigger asthma, so we focus on educating patients on triggers.”
“We also work on treatment and one type is maintenance medication like inhaled steroids,” says Dr. Chaffin. “We educate patients on what we are doing, because if we are treating it right, they will have few symptoms. We have rescue medications that are used if they have trouble. We have to evaluate risks for side effects from medications against those for uncontrolled asthma. The difficulty in sorting this out is that uncontrolled asthma leads to some of the same problems.”
If you are one of those people who develop allergies with the first breath of spring, consult with your local allergy and asthma specialist. You can find more information about allergies and asthma at www.webmd.com under the topic of allergies, or go to www.yourtotalhealth.ivillage.com/ allergy-asthma-drugs, or www.allergies.about.com/od/noseandsinusallergies.
Charlotte Boatwright is a native Chattanoogan. She has a doctorate in health care administration and is a registered nurse and licensed professional counselor. Charlotte has been involved with health care for 35+ years and is the founding member and president of The Coalition Against Domestic & Community Violence of Greater Chattanooga, Inc./ Chattanooga Family Justice Alliance.