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.

I HAVE A CONFESSION TO MAKE: IN the thirty years I’ve lived in Texas, I’ve acquired a taste for greasy Tex-Mex and developed a passable drawl, but I’ve yet to suffer from the state’s unofficial disease: allergies.

This is a happy situation, of course, but there’s a fine line between pride and gloating, so it’s not something I advertise—not normally, and certainly not on this day, a Wednesday in late January, when I’m hanging around the Allergy Clinic on the sixth floor of the old Parkland Memorial Hospital building in Dallas. The forty to fifty patients who arrived here beginning at seven-thirty this morning are in no mood to hear about my good fortune: They’ve come for skin tests and immunotherapy shots and consultations with allergists about antihistamines and corticosteroid nasal sprays. They are not seasonal sufferers, but rather what might be called the hard core of Texas’ allergic subculture. For them, allergies are a perennial nemesis—and potentially deadly.

Theresa Floyd, for example, has been plagued by asthma and rhinitis (more commonly known as hay fever) since her childhood in Lubbock. “I was sensitive to everything,” the fifty-year-old says while awaiting a nurse in a treatment room. “Not just the typical stuff like ragweed and mountain cedar, but sunflowers and poinsettias. I started getting shots when I was in the first grade.” Nine years ago, after numerous near-fatal asthma attacks, Floyd sought care from the allergists at Parkland, and she has been coming regularly to the clinic ever since. She’s here today for her weekly immunotherapy shots for allergies to grasses and trees and to talk with a doctor about her cold—hardly the sort of thing that would send most of us to the hospital, but an emergency situation for a chronic multiple-allergy sufferer. “I don’t tempt fate,” she says. “A year and a half ago I was out raking leaves in the yard. Apparently, the mold from them got to me, because when I got inside, all I could do was lie down. I had one of those shutdown attacks of asthma. Fortunately, I was able to call EMS in time. I was in a coma for two days. I consider this a disability. I can’t run. I can’t laugh hard. I can’t even cry.”

While the vast majority of the state’s allergy sufferers can’t lay claim to that degree of pathology, grumbling and whining alone would suggest that most of us are tormented to one degree or another. In truth, all we know is that our allergy-afflicted population exceeds the national rate of 15 to 20 percent. “At any given time, you’d have to say that more people here are probably suffering from allergies than in, say, Maine,” says Donald Kennerly, an associate professor of internal medicine at the University of Texas Southwestern Medical Center in Dallas and the medical director of Parkland’s allergy and asthma clinics. “If you’re genetically predisposed, you’re going to have them here, whereas in Maine, the predisposition might never be triggered.”

More than anything else, what makes Texas the allergy capital of the United States is the pollens of two plants: ragweed and mountain cedar. The former, a member of the composite family, is found in other regions of the nation, but it is a particular problem in Texas, notably the Metroplex, in the fall. The latter, a juniper, is indigenous to much of Texas—especially Central Texas; it discharges its pollen from late fall to late winter. Mountain cedar is known to allergists as a kind of sarin gas of allergens—a pollen so potent that the allergic reaction to it is known as cedar fever. “No question about it: Mountain cedar makes allergies a year-round disease in Texas,” says Austin allergist William Howland. “For most people who move here having never had an allergy problem, it’s usually the culprit.”

Beyond the pollens, though, there are other reasons for our ignominious distinction. For one thing, Texas’ location in the center of the country means it is fertile ground for the allergen-producing plants of both the West and the East coasts. For another, our generally temperate climate allows for generous growing seasons for those plants but few of the hard freezes that stymie pollination, so allergens are airborne during all seasons and are more plentiful here than anywhere else. In the northeast, for example, allergens “available to the host” (as allergists put it) are airborne, at worst, from March to September. In Texas the nasty stuff is with us practically every month of the year, and it’s supplemented by mold spores, which flourish in the moist clay soil that runs through the center of the state. This toxic cloud is carried by strong winds all over Texas, exposing more of us more often to multiple allergens; while the average Northerner becomes allergic to only two substances, Texans can be susceptible to more than a dozen. If the winds don’t get you, the humidity will: Muggy temperatures encourage the growth of fungi and molds, whose spores are devastating to the allergy-prone. Texas’ rapid urbanization exacerbates the problem because construction stirs resting allergens, and industrial pollution—though not an allergen itself—worsens respiratory allergies. Add to these outdoor allergens the long list of indoor irritants, such as dust and dust mites, and you have an environment in which high doses of allergens fill the air nearly 365 days a year.

How Allergies Work

ONE OF THE CRUELEST BIOLOGICAL IRONIES IS that allergies are caused by the human immune system, the very thing in our bodies that’s supposed to keep us free of disease. In evolutionary terms, the immune system developed to distinguish between the self and the non-self—to provide the necessary biochemical armaments to protect the former and block, repel, or destroy the noxious elements of the latter. The precise immunological mechanism that causes allergies originally evolved, scientists believe, to intercept and destroy foraging parasites; today, its main function is to play war games with essentially harmless pollens and dust. An allergic reaction is, in essence, a case of mistaken identity: If you’re allergy-prone, pollens,

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