Blowin’ in the Wind
Why are allergies so bad in Texas? What causes an allergic reaction? How do you choose an allergist? And what’s the best treatment: drugs or shots? The Answers, my friend, are Blowin’ in the Wind.
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For many allergy sufferers, this is it—the full extent of their agony. But for others, the agony has just begun. In addition to the above-mentioned phases, they must endure a hyperresponsive phase, in which the respiratory system becomes so primed with histamine and other mediators that it reacts symptomatically in response to lower volumes of an allergen than that initially inciting the allergic response. Worse, the punch-drunk respiratory tract begins responding to all manner of non-allergic stimuli, everything from aerosol sprays and newsprint to bright lights. Some allergics also suffer a delayed nasal response days after their contact with the allergen. This is what drives most allergy sufferers to distraction. “My cedar fever could last for weeks,” says 44-year-old Austinite Robin Howard Moore, who suffered near year-round rhinitis for a good ten years. “I probably missed only a few days of work because of it, but when it set in, I was truly sick.”
Indeed, while allergic rhinitis is frequently bum-rapped as some sort of ritualistic hypochondria, there’s no disputing its real-life impact. Hay fever causes 28 million days of restricted activity in the U.S., plus 5 million lost work days, 3 million absences from school, and 5 million days of required bed rest each year. That adds up to $200 million in lost wages and $500 million in health care expenditures.
What Allergies Are—And Aren’t
AS UBIQUITOUS AS ALLERGENS MUST seem to the besieged multiple-allergy sufferer who lives in the Hill Country—the epicenter of the corridor of misery that runs through the center of Texas—fewer substances are capable of producing an actual allergic reaction than you’d think. We know this because allergists tell us so.
Don’t laugh: The study and treatment of allergies is a real medical discipline with hard science behind it. Coined soon after the turn of the century, the word “allergy” initially meant any “altered reactivity” by the body. By the twenties, European scientists had narrowed the definition to reactions involving antibodies and antigens. Still, little scientific evidence supported the so-called immunologic theory of allergy until IgE was discovered in 1967: The antibody provided a hook on which to hang allergic diagnoses and treatment—a way of seeing allergies as a specific set of reactions to a specific set of substances governed by specific immunological machinery.
Simply put, a hay fever allergen is a substance that is (a) easily carried by the wind and small enough to be inhaled, (b) chemically composed in such a way that it triggers IgE antibodies, and (c) readily available to human hosts. The second criterion, the IgE response, is critical to distinguishing true allergies from hypersensitivities to mundane airborne irritants ranging from cigarette smoke to perfume. In most cases, the symptoms are similar—runny nose, watery and/or itchy eyes, chest congestion, asthma—but the pathology is different. While allergies proceed from the IgE—mast cell apparatus, sensitivities (or adverse reactions) tend to be neurologically based: An irritant antagonizes the nerve endings in your nose, which relay a message to your brain, which, in turn, relays back instructions to the tissues in your nose to begin running or swelling. Repeated exposures to the agent can turn the response into a kind of re�ex that looks very much like an allergy—but it is not. While this may seem a distinction without a difference, it becomes extremely important when you’re seeking treatment, since true allergies can be treated medically, whereas sensitivities to environmental irritants generally must be managed by avoidance.
By and large, the instigators of allergic rhinitis are pollens of trees, grasses, and weeds. There are some seven hundred species of trees native to North America, of which only 65 or so consistently cause allergies. In Texas the heavy hitters among trees—which discharge their pollen primarily in the spring—are oak, elm, cottonwood, mesquite, and hackberry. In the summer, when grass pollens fill the air, the most common allergy instigators are Bermuda and Johnson grass (Saint Augustine, the other common Texas lawn grass, doesn’t produce airborne pollen). Autumn is weed season, and in these parts, the chief offender is ragweed; it is also the season for the pollen of the oddly named cedar elm tree, which is rarely found in other parts of the nation. And in winter, of course, while noses around the rest of the nation are mostly getting a break from assault-by-pollen, those of allergic Texans are assaulted by the fearsome mountain cedar.
The bad guys vary from region to region: Though fall ragweed and winter mountain cedar infest nearly all parts of the state, the former is miasmic in North Texas, while the latter especially cripples the Hill Country. West Texas, which is arid, is plagued by tumbleweed and sagebrush. Oddly enough, humid Houston tends to have less of a pollen problem than North or Central Texas, though its mold spores are legion. “There are regions in the Midwest that will show as high an incidence of pollens as Texas during certain seasons, but their window of exposure closes a lot more quickly,” says Fort Worth physician Lazarus Loeb, who has been treating allergies for nearly forty years and is considered the unofficial dean of Texas allergists. “You don’t get a break here, and the mold just adds to the irritation.”
What it is about the chemical composition of, say, mountain cedar pollen that causes the IgE antibodies to mistake it for a dangerous trespasser is largely a scientific mystery. Most allergists believe it has something to do with the protein at the core of most plant pollen and how it is read (or misread) by the immune system. Or a particular pollen may become a menace simply because of its degree of availability to the human respiratory system. Whatever the case, scientists have been able to figure out what conditions are most conducive to allergen invasion. In general, late afternoon to evening is the worst time for allergy sufferers because offending pollens, which have gradually risen well above our noses in the atmosphere in the heat of the day, begin descending with the setting sun and lower temperatures. Likewise, warm, dry, and windy days are always worse than cold, humid, or rainy ones: On damp days, pollen absorbs the moisture and becomes heavier and less aerodynamic; a good rain can literally wash pollen from the air.
None of these environmental vagaries, however, affects indoor antigens, which cause their own share of grief. Dust and dust mites, for instance, are proof to many allergy sufferers that their af�iction must be the handiwork of the devil: Neither can be completely eliminated from a house or apartment even by the most obsessive cleaner. And because dust is not a single substance but an amalgam of many—including animal dander, dried insect droppings, and mold spores—a hypersensitive person can be allergic to it on several levels. About the only break Texans get from indoor allergens is an inadvertent one: At the height of the summer’s heat, when we run our air conditioners 24 hours a day, the inside of our homes becomes so dry that the dust mites, molds, and fungi wither and die.
How to Treat Allergies
ESPECIALLY IN AN ALLERGY-FRIENDLY state like Texas, it’s tempting to chalk up your repeated or protracted nasal or bronchial problems to allergies. In fact, 60 percent of rhinitis is caused by non-allergic pathologies: a deviated nasal septum, overuse of nose drops, a persistent virus, and the like. So before you embark on a time-consuming or costly course of treatment, it’s best to first consult with your primary-care physician or an ear, nose, and throat specialist. If they rule out these other possible causes, they can give you an allergy skin test to confirm your suspicions. Once the diagnosis is made, your allergy can be treated in several ways.
Avoidance The most obvious and effective remedy is to stay away from offending allergens. Obviously, outdoor pollens, molds, and fungi are hard to avoid unless you move to another region. But allergists say you can diminish your allergic response by keeping your distance from parks and other areas where multiple pollens are found and by remaining indoors as much as possible during the pollen-rich late afternoon and evening.
Once inside, you can do a lot to sanitize your environment. Allergists say that aside from wet-mopping and dusting frequently and washing your sheets and pillow cases in hot water, you should focus on the rooms where you spend most of your time—the bedroom, for example—and on items that serve as good nests for mites—say, carpeting. According to allergist Peter Boggs, the author of Sneezing Your Head Off?, one of the best things you can do if you’re particularly susceptible to dust and dust mites is rip the carpeting out of your bedroom. Yet another way to purify your indoor atmosphere is with an air-filtration system: It’s more expensive, but it can be remarkably effective in weeding allergens out of the air. Fans, by contrast, only provide the illusion of clearing the air; they actually increase your exposure to allergens by stirring them up, though they’re extremely good at drying out dark, damp areas where molds grow.
Avoidance tends to be an underused allergy treatment because in a lot of cases it’s impossible: You may be able to get your house under control, but then you find yourself deluged with allergens at the office. That’s when you turn to…
Drugs There are four types of medications designed to treat allergy symptoms: antihistamines, decongestants, antitussives, and expectorants. Each addresses some but not all of the common symptoms, and even then the relief is only temporary, and the underlying cause of the symptoms remains unchanged. You can also develop a tolerance to many of the medications rather quickly—in the case of nose drops, for instance, it can be a matter of a few days—and all of them pack possible unpleasant side effects, including, ironically, a potential allergic reaction. Yet symptom-first medications are an important component of allergy treatment because so many of us suffer only occasional or minor symptoms, and they work well enough at simply stopping the snif�ing and unblocking the nasal passages.
The best way to determine which of the hundreds of allergy drugs are for you is to talk to an experienced allergist. Beyond that, any prudent patient-consumer should consider the following when seeking either prescription or over-the-counter medications:
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