Is 2012 really the worst year for seasonal allergies (hayfever)? If you’re allergic to pollens, you may be sneezing and snorting your way through spring this year – and you’re not alone. Early warm weather and above-normal pollen counts have made spring miserable for the more than 50 million people with seasonal allergies in the United States. Yet spring has more in store for allergy sufferers as pollen counts around the country begin to peak.
YourMedicalSource spoke with Dr. Stanley Fineman, President of the American College of Allergy, Asthma, and Immunology (ACAAI) about the 2012 spring allergy season, why allergies have so severe this year. While we were at it, we asked him for some tips for finding relief from allergies.
YourMedicalSource: What is an allergy? Why do only some people have problems with allergies?
Dr. Fineman: An allergy is an unusual immunologic reaction to something that’s really natural and normal in the environment. As far as why some people have allergies and some don’t — that’s the peculiar thing about an allergy. We’re not sure why some people react the way they do.
YourMedicalSource: Are any particular people more likely to develop allergies?
Dr. Fineman: If your parents have allergies, you’re predisposed to having allergies yourself. Allergies tend to run in families. Ethnicity doesn’t seem to matter.
YourMedicalSource: How common are allergies in the United States?
Dr. Fineman: One in three adults has trouble with some kind of allergic response. In children, the percentage is a little higher, more like 35 to 40 percent.
YourMedicalSource: That’s a significance difference. Why are allergy rates higher in children than in adults? And what happens to allergies in children as they grow into adults?
Dr. Fineman: Children tend to produce more of the “allergy antibody” called IgE than do adults. Allergic responses are caused by overproduction of a substance called IgE. IgE is an antibody produced by the immune system.
Generally, IgE seems to peak in the second decade of life and tends to fall after that. Although anyone can develop allergy and allergic responses at any time in their lives, it’s more likely during childhood and adolescence.
Although responses vary greatly in adults, in general the response is not as strong.
YourMedicalSource: Asthma and allergies often go hand in hand – and some of the same things that trigger allergies also trigger asthma. According to the Centers for Disease Control, the number of people with asthma is rising – from seven percent of the population in 2001 to eight percent in 2009. That’s an increase of five million people. Why the increase?
Dr. Fineman: We’re seeing a higher prevalence of asthma for two main reasons: Number one, we can recognize it better. Number two, our lifestyles may be predisposing us to develop asthma as a population. We spend a lot of time indoors, breathing recycled air; we’re less active and more sedentary. All of these things can contribute to developing asthma.
On the other hand, there is some good news about asthma. One of the good things is that we have better tools now than 20 years ago to take care of patients. We have better medications and other tools to help patients.
YourMedicalSource: Is there a difference in allergy incidence between the United States, other developed countries, and the developing world?
Dr. Fineman: In general, incidence of allergic disease and symptoms tends to be higher in more developed countries. Very underdeveloped countries tend to have a lower incidence of allergies. The most widely accepted theory behind this difference is called the “hygiene hypothesis.”
The hygiene hypothesis recognizes the fact that people who live in underdeveloped countries are exposed to more infections, and live among livestock and in less hygienic areas. They tend to have a immune response that reduces the likelihood that they’ll develop allergy. In contrast, in developed countries there’s an emphasis on living in a clean environment and antibiotics are used frequently. In those people who live in very clean — or hygienic — environments, the immune response tends to become overblown. This is simply a theory, but it seems to be borne out by research.
YourMedicalSource: What’s different about this year’s allergy season?
Dr. Fineman: We had warm weather early, which meant that the trees were pollinating early. So people have had troubles for a longer period.
This year’s pollen season started about four weeks earlier than we usually see it start. We had very high pollen counts in Atlanta as early as February. Normally we would not see counts that high until beginning of March. That means people with tree pollen allergies started having symptoms sooner and now seem to be having more severe symptoms.
This is due to something called the priming effect. The priming effect is seen when someone is exposed to an allergen and has an allergic reaction, thus “priming” his or her system to react to the allergen. If that person is re-exposed to that same allergen or even exposed to another allergen, he or she is going to have a more violent reaction.
So this year, people started being exposed to pollens and other allergens early – and they will continue to be exposed throughout the spring and summer. For many people, longer exposure, combined with the priming effect,will lead to more severe symptoms.
YourMedicalSource: What should we expect to happen next?
Dr. Fineman: In general, pollens peak in the south before the Midwest and before the North. So in northern states such as Washington or even New England, my colleagues are seeing patients now like we were seeing a month ago here in Atlanta. In the south, we’re seeing the tree pollens dropping from their peak. Grass pollens are on the increase now.
YourMedicalSource: Why would a physician be concerned about plants?
Dr. Fineman: We’re the ones who determine what trigger factors are out there. Skin testing can help us determine what exactly is triggering the patient’s symptoms. But to help our patients, we need to know the local flora. What exactly is blooming? What pollens are in the air? We need to understand the plants and the pollens. We do that so we can handle patients.
YourMedicalSource: I’ve spoken with several people who’ve mentioned that they’ve lived in the same area for most of their adult life and never had problems with allergies, but they suddenly find themselves miserable this year. Why?
Dr. Fineman: We can’t explain why some people suddenly start to have symptoms. Generally, it takes several years of exposure to a pollen before someone develops symptoms. So it’s possible not to have a sensitivity to a substance initially, but to develop one after a few years.
Everybody’s an individual, which is really why it’s not easy to tell sometimes. But it’s good to make sure of a diagnosis, instead of assuming that a condition is an allergy (or a cold). That’s where allergists come into play. They help people identify the cause of their symptoms, so they can find relief.
YourMedicalSource: How can I tell the difference between an allergy and a cold?
Dr. Fineman: The main symptoms of allergies and colds are similar: nasal stuffiness, itchy nose, runny nose, and sneezing. To determine for sure whether it’s a cold or allergies, one of the things we have to do is allergy skin testing.
But there are some other ways to tell them apart. If the person also has a fever, and if symptoms last five to seven days then go away, the problem tends to be viral – some sort of virus causing an upper respiratory tract infection. But if symptoms linger longer than that, especially if there’s a temporal relationship to an exposure to something that triggered it, suspect allergies. For instance, if symptoms occur every year at the same time, it could possibly be related to an allergic response.
YourMedicalSource: What steps can people with allergies take to get some relief?
Dr. Fineman: The best thing is to know exactly what you are allergic to – and avoid it. Stay indoors, keep the air-conditioning on, limit outdoor activities, use appropriate medication, and get allergy shots.
Treatment really depends on the severity of the symptoms. I saw a woman this week who was absolutely debilitated by her allergy symptoms. She had to miss work; she was run down; she described herself as dragging through the day. She was really struggling with allergy symptoms. That’s an example of someone who was debilitated by her symptoms.
But allergies aren’t that bad for many people. Often, an oral antihistamine, which you can purchase over the counter, is okay. It may be all you need. But it is helpful to find out exactly what’s triggering things. A skin test is the only way to do that.
What’s tricky for patients is for them to really tell – is it really the allergy that’s triggering their symptoms? Are they at risk of developing a complication? Infections? Asthma? Those are some of the things that an allergist can help you navigate.
YourMedicalSource: What about managing allergies in kids? Managing allergies in seniors? Or managing allergies in other specific populations?
Dr. Fineman: There are several different strategies for special populations.
As far as children: Make sure you give them a treatment that they tolerate. Most of the allergy medicines are well tolerated. A number are approved for use in pregnancy.
In elderly patients, we’re concerned about medication interactions. If you’re taking other medications, always check with your physician before taking any over-the-counter allergy medications.
If it’s really a significant problem, allergy shots can be the best way to manage the disease. While allergies can’t be cured, allergy shots are a disease-modifying treatment. After the course of the injections, you may not need to get more, and you may not need as much medication or treatment. Injections can be used in children and adults, and even carefully through pregnancy and in the elderly.
YourMedicalSource: What’s your take-home message about allergies for our readers?
Dr. Fineman: It’s important to make sure have an appropriate diagnosis. Find out what triggers your symptoms, and exactly what’s causing it – don’t want to misdiagnose it. Then get the appropriate treatment. Not everyone needs to see an allergist. But if allergies are interfering with your life, schedule an appointment with one in your area.
Additional Resources
Accuweather Allergies Forecast (Offers both pollen and “dust and dander” forecasts): http://www.accuweather.com/en/us/dearborn-mi/48126/allergies/333728
American College of Allergy, Asthma, and Immunology (ACAAI): http://www.acaai.org/Pages/default.aspx
American College of Allergy, Asthma, and Immunology (ACAAI) Patient Information Site: http://www.allergyandasthmarelief.org/
