The Agony and the Allergy
People with allergies don’t have to live in a glass bubble. They just wish they could.
For as long as I can remember, I have carried a Kleenex at the ready. A hunter could easily track me by my trail of wadded tissues—stuffed under my pillow, down among the bedclothes, in every available pocket, tucked under skirt belts and up blouse sleeves, making little white mounds in my purse, on my desk, under the cushion of my favorite reading chair, inevitably drifting down to the floor of whatever room I visit, even briefly.
My nose is usually slightly red. Sometimes my face itches, my eyelids puff and water, and the whites of my eyes turn pink. My ears ring and the roof of my mouth itches. I occasionally suffer from mild nausea or diarrhea. Sometimes my sinuses feel like they’re made out of cement, and sometimes I have trouble breathing. I have a whole repertoire of headaches from the one that feels like eyestrain to the big mamou that settles over my head, neck, and shoulders like a sick, dense smog of pain. Often I am sleepy, achy, and lethargic.
Still, in terms of heavy allergy suffering, I am a mere piker. Once while my sister was cooking dinner she got the allergy dizzies and dropped a 29-ounce can of tomatoes on her food. She was in a cast for weeks. I know a state bureaucrat who insists that wearing wool makes the insides of his lungs feel raw, an officer with the ACLU whose hands swell when she eats fish, and a musician who sneezes when he goes into bright sunlight. All perfectly legitimate complaints. That’s not to mention the filmmaker who is constantly sneezing and tearing with hayfever (a general term for pollen allergies) and wheezing with asthma. Riding a horse gives him rashes on his thighs and elbows, and eating peaches makes his chin itch (from the inside where he can’t get at it, he insists). One of the most pathetic cases I ever encountered was a fellow who was allergic to alcohol. He’d drink himself into a stupor and then scratch himself raw.
I used to think that I was sensitive only to outdoor pollens, but when I quit my editing job and started writing at home, my allergies seemed to worsen. There were days when I could hardly drag myself out of bed. Chronic headaches. Was it psychological? Writer’s procrastination?
I decided to see an allergist. It seemed more reasonable than moping around the house hoping that my ailments would voluntarily vanish. An acquaintance recommended a group of allergy specialists in Austin. I have since learned that not all the doctors who bill themselves as allergists have specialized training. It’s easy to check with the local medical board, however, to see if a doctor has been certified by the American Board of Allergy and Immunology. Specialists in this field also usually belong to two national allergy societies—the American College of Allergists and the American Academy of Allergy. My allergist turned out to have all the proper credentials.
I called for an appointment, and a receptionist informed me that the initial consultation would cost somewhere between $150 and $190, depending on how many tests the doctor decided were necessary—this seems to be a representative fee for the service. I arrived groggy at 8:45 in the morning, whereupon a nurse had me fill out a questionnaire about my health history, took my temperature, blood pressure, and weight, snapped a Polaroid portrait, and handed me over to a cheerful young doctor with a beard.
I auditioned my repertoire of symptoms for him, and he pronounced my sinuses to be “slightly swollen.” Then he started extracting information about my personal habits. I seldom drink and have never smoked. Yes, smoke irritates my eyes. Yes, I have a pet, a cat who has the run of the house and loves to nap on my bed. But he doesn’t make me sneezy or anything. Yes, I use a feather pillow, even take it with me on trips. I could tell he was suspicious of the cat and the pillow, and his eyes fairly gleamed when I admitted that I clean with a broom because of a Luddite antipathy for household appliances. I didn’t even mention the decrepit goat-hair rug I shake by hand.
Then he sent me in for testing. The nurse swabbed my arm with alcohol and pulled out a tray of vials containing such exotic extracts as Common Mugwort, Wheat Smut, and Mold Mix No. 2. She dropped a drip of Black Willow on my arm and then scratched it with a sterile toothpick. Black Willow was followed by 29 other extracts. I was instructed to wait fifteen minutes to see which of the scratches on my arm would swell up like mosquito bites.
In the meantime there was some required reading in a booklet on allergies. It explained that an allergy is an abnormal reaction to a substance that is harmless to most people—your own personal poison, so to speak. The substance—an allergen—may be taken into the body by being inhaled or swallowed or by contact with the skin. The most common allergens are pollens, molds, and household dust. Some of the more unusual are heat, cold, and ultraviolet light. There is always a physical basis for allergies, but attacks, particularly asthma attacks, can be precipitated or aggravated by anxiety, fear, anger, excitement, or other strong emotions.
The propensity to become allergic to anything is carried in your genes. Thus in addition to antibodies called Immunoglobulin G, which everyone has, the allergic person has extra antibodies called Immunoglobin E (IGE). Oddly enough, these special antibodies are what cause your allergic reaction. In an attempt to put up a defense against the allergen, your body dispatches an army of IGE antibodies in a futile search-and-destroy mission. Instead of destroying the allergen, however, the IGE antibodies link up with it, forming complexes. These in turn surround and stimulate certain cells that react by releasing a pesky compound called histamine. Histamine’s role is not yet completely understood, but it is known to cause the mucous glands to be stimulated so that they put great gobs of mucus into the nasal passages of bronchial tubes. Histamine also causes tiny capillary blood vessels to expand. The result is swelling. What symptoms appear and how severe they are depends on where the swelling occurs. If the fluid causes swelling in the tissue lining the nose, your nose will be stuffy, and you may have breathing difficulty and sinus headaches. Allergy swelling of the blood vessels causes a variety of headaches, including about 10 per cent of the migraines Americans suffer. If swelling occurs in the tissues that line the bronchial tubes in the lungs, the airways will be blocked and you will get the coughing and wheezing of asthma. In the case of hives or poison ivy or other forms of dermatitis caused by allergy, the swelling is on the skin surface, the result of increased blood flow and leakage of fluids into the space between skin cells.
That’s exactly what the skin on my forearm was doing, most dramatically on the test sites for redberry juniper, cedar elm, red cedar, and salt cedar. None of my other reactions were particularly severe. I was certainly luckier than my friend the filmmaker whose forearms swelled up like balloons only eight minutes into the scratch test. To get a more accurate reading on some of my marginal bumps, the nurse injected larger doses under the skin in my upper arm. This time my arm demonstrated an increased sensitivity to a number of trees and weeds, housedust, mixed feathers, and cat dander. The doctor drifted in just to check the puffed-up cat spot. “I was afraid of that,” he said.
We went back to his office, and the doctor recommended that I take injections specifically for cedar. Allergists are not altogether certain how desensitization works, but the most widely accepted theory is that the injection of (in my case, cedar) extract into the bloodstream produces an Immunoglobulin G antibody that immunizes by uniting with the cedar pollen, thus blocking the union of the IGE antibodies and the pollen, so no reaction can occur. He said he would start me immediately on two shots a week, gradually increasing the potency of the cedar extract. The shots would cost a lump sum of $28 a month, again, a representative figure.
For many years I have taken prescription antihistamines to counteract sneezes, runny nose, itching, and tearing. The doctor said I should continue to use them when needed, and he wrote out a prescription for an antihistamine that includes a decongestant for stuffiness. I told him that as much as the antihistamines helped, I was nervous about taking them. The Physician’s Desk Reference lists the following potential “adverse reactions” to the antihistamine I had used most frequently: drowsiness, confusion, restlessness, nausea, vomiting, drug rash, vertigo, palpitation, anorexia, dizziness, dysuria due to vesical sphincter spasm, headache, insomnia, anxiety, tension, weakness, tachycardia, angina, sweating, blood pressure elevation, mydriasis, gastric distress, abdominal cramps, central nervous system stimulation, and circulatory collapse. All of the prescription and over-the-counter antihistamines I have tried can cause similar problems. And the Physician’s Desk Reference warns that an overdose of some of the popular antihistamines may cause convulsions and death, particularly in infants and children.
Despite these dire warnings, I have never experienced anything more uncomfortable than a little dehydration after a double dose of antihistamines. But I have heard others complain of becoming drowsy or strung out or, as my filmmaker friend says, woolly-headed from antihistamines.
The doctor said that he takes a patient’s medical history into account before prescribing antihistamines. It is sometimes unwise to prescribe decongestants for patients with high blood pressure. He said he asks all patients to report adverse reactions so that he can change medication when necessary. What I was really concerned about was the possibility that twenty years from now I might discover I had kidney trouble or circulatory problems caused by antihistamines. Not to worry, the doctor insisted. Doctors have twenty to thirty years of history on antihistamines and they are among the safest medicines one can take. To date, there have been no reports of liver or kidney toxicity or any other form of bodily damage caused by extended use of antihistamines. But, the doctor emphasized, antihistamines merely suppress symptoms, just like aspirin suppresses the pain of a headache; they don’t cure allergies. The goal is to get a patient’s allergies under control so that he no longer needs antihistamines for temporary relief.
My chronic symptoms, he explained, were primarily caused by allergens in my home environment, the three biggest culprits being cat dander, house dust, and feathers. Staying home all day, I was constantly breathing air that was chock-full of things that made me sick. I was fortunate, he said, because with a little effort I could clean up my environment. “Avoidance measures are the soundest method of treatment,” he said. “If I had only one function as an allergist, the most important thing I could do is convince my patients to get their animals out of the house. Cats are the worst of all because of their fine dander—not just hair but skin cells and protein from saliva. They’re the very worst.”
The doctor said he would not even try to immunize me against cat dander because the treatment was rarely successful. It would be virtually impossible to boost the doses high enough to allow me comfortably to keep a cat in the house. Before I left the office he extracted a solemn promise that I would banish poor Kitty Lou that very day. I had visions of him devoting his professional career to earnest counseling on the importance of making Fido an outdoor dog and donating the hamsters to the pound.
I was given an instruction sheet on how to reduce the dust and particle content of my house. Inspired by hopes of a headache-free future, I immediately bought plastic covers for my mattress, box springs, and bed pillows. At home I bent to serious cleaning of the bedroom, where, the instruction sheet point out, you spend more time than in any other room. I boxed the moth-eaten goat-hair rug for delivery to Goodwill and took the blankets and bedspread to the Laundromat (I now wash the blanket and spread once a month). My instructions said that cotton and other natural materials should be considered old after a year. The older they get the more particles they contribute to household dust. A six-room house in a metropolitan area generates about forty pounds of dust a year. This is not yard dirt or mud off your shoes but fine particles from animals, stuffed furniture, carpets, carpet padding, curtains, clothing, even decomposed insects. I am supposed to damp mop the bedroom floor a couple of times a week and dust thoroughly every day.
I mopped and dusted feverishly for a week. My environment was definitely getting cleaner. The doctor said it would take a couple of months to get the full benefit of removing the cat, but after only two weeks my ears stopped itching and ringing. The sound in my head, however, was replaced by the pathetic wails of Kitty Lou, clinging to the screen door.
I was also reading allergy books from the library. Some of them made my clean-up efforts seem absolutely slovenly—for example, these instructions from one of the better reference books, The Complete Allergy Guide, by Dr. Howard G. Rapaport and Shirley Motter Linde (Simon and Schuster, 1970):
“Frequent heavy cleaning of the hayfever patient’s room is essential . . . Preparatory to cleaning, as much as possible of the furniture, carpets, curtains, and drapes should be taken from the room or moved to the center and all of the closets should be emptied. The closet should contain only necessary things in current use and should be as dust-free as the room. Seal off the registers and furnace pipes if the room is warm enough without them. . . Wash down the walls and ceilings, the woodwork, the floors, the radiators or registers, the closets, the furniture. Be sure to wash off things like the backs and corners of the furniture and tops of doors, window frames, sills, moldings, lights, and closet shelves. [And then my favorite line] The patient should always be out of the room or out of the house when it is being cleaned.”
Since “the patient” has to do most of the cleaning in my household, I appreciated the suggestion of wearing a surgical gauze mask for heavy housecleaning. It looks pretty peculiar, but it does help.
Another book recommended purchasing a vacuum cleaner that filters dust into water rather than into a disposable bag. Bag cleaners invariably recirculate some of the house dust with the exhaust, but particles trapped in water can’t escape. Unfortuantely, the only water filter vacuum I could find was a Rainbow, which at over $300 was too expensive for my budget.
Any air filtration system, from an air conditioner on up, is beneficial to the allergic person. As an experiment, I rented for a month an Enviracaire laminar air purifier, which is advertised as an aid to allergy sufferers. The filter, which rests on a stand, is bigger, but lighter, than a portable TV and sounds like a large fan. The company brochure claims that within two hours it cleans the air in a normal-size bedroom. I paid $40 to rent the unit for the month. (The rental agency was selling them for $350, which seemed steep since once can buy an equally efficient electronic filter for a central heating and cooling system for between $300 and $600. That’s the cost of putting a filter in a new home unit, rather than an old one. Not all old central air systems can be retooled to use an electronic filter, and it is more costly to make the changes in an old system.)
I set up the Enviracaire unit at the foot of my bed in hopes that while I was sleeping I would clear my head and unclog my sinuses. The filtered air smelled clean and pure, all right, but my sinuses were still stuffed most mornings. The doctor explained that while breathing pure air for eight hours a day is an improvement over breathing pollen-filled air, eight hours is not sufficient time to cleanse the system of allergens. He pointed out that hayfever sufferers often continue to sneeze for weeks after the season has passed.
My enthusiasm for these various experiments with my environment soon ebbed. There came a time fairly early on when I had done as much cleaning and rearranging as I was willing to do. I suppose that for optimism lean breathing I should set up residence in a hospital or a motel. I have a friend with bad allergies who works in a museum and love sit. He says, “Anyplace an old oil painting can survive, I can survive—dust free, humidity controlled, air-conditioned, thoroughly vacuumed. I find that kind of terrifying in a way—to discover that it takes so much to make me comfortable. I have visions of becoming an old man living in a plastic bag.”
Yes, there’s the rub. Thirty-five million American allergy sufferers from the great grassy plains to the polluted cities are all trying to strike some practical balance between personal comfort and contact with the outside world. I have a friend who is dramatically allergic to cats and yet sleeps with two fat Siamese because she thinks the emotional trauma of removing her beloved pets would be worse than her chronically drippy nose.
That’s her choice of course, but avoidance is the soundest—and cheapest—method of treatment. If that’s not possible, a person suffering from severe allergies should consider taking desensitizing shots, even though they come with no guarantee of success. Allergists maintain that, contrary to popular belief, people rarely “outgrow” allergies, except the mild food allergies of childhood. I told my doctor that for the first 25 years of my life I had violent skin eruptions after contact with poison ivy. In the last few years, however, I have had only mild cases of poison ivy, leading me to hope that I am not as sensitive to the plant as I used to be. My doctor said he had heard similar stories from patients about outgrowing their allergies, but there is as yet no scientific evidence to explain such cures. It is more common, he said, for untreated allergies to get worse. And medical research indicates that allergies may be implicated in the development of major chronic diseases like arthritis and rheumatic fever, kidney disease, and even infertility. Some researchers indict allergies to some degree in the human aging process.
We tend to think of allergies as a contemporary affliction, but the symptoms are as old as recorded history. One of the earliest recorded allergy casualties was the Egyptian King Menes, who died of a hornet’s sting in 2641 B.C. Pythagoras, the philosopher and mathematician, was—at least indirectly—the victim of an allergy. He was being pursued by Greek soldiers when he came to a dead halt and said, “I wil not cross this field of beans.” Historians think it was probably cultivated broad beans, which are very troublesome to allergy sufferers. The soldiers caught Pythagoras at the edge of the field and killed him.
Although modern allergy treatment owes a primary debt to nineteenth-century immunologists, immunizing treatments for asthma and hayfever were originated early in this century and are used with only a few modifications and refinements. Grants for research into allergic diseases have increased considerably during the last thirty years, but allergy research has never been a generously funded branch of medical science. The basic questions that allergists are still trying to answer include why some people develop allergies and others don’t, the importance of hereditary factors, why certain parts or organs of the body are more predisposed to allergies than others, the importance of emotional factors in allergy attacks, and the importance of pollution and other environmental factors. The role of allergens and antibodies must be further defined, and a great deal more work should be done on specific allergens. Current research into immunology, organ transplants, and skin grafts should further the understanding of allergic reactions.
For those who want to try some of the more experimental methods of treating allergies, there’s acupuncture, although it’s difficult to find qualified acupuncturists in Texas. Some allergists are teaching their patients self-hypnosis as a means of controlling asthma and even hives. I know people who insist that vitamin C and/or pantothenic acid helps allergies as well as colds. My allergist won’t endorse of condemn the vitamin route. He says that vitamin C certainly isn’t going to hurt anyone, but there have been no double-blind tests proving its efficacy.
There are those who recommend eating local raw honey as a means of desensitizing allergies to local flora. A doctor I know insists that he has seen honey work in cases where nothing else would. One of my allergy reference books mentions honey as a possible aid and another discounts it, pointing out, among other things, that people are usually allergic to drab wind-pollinated plants rather than to the brilliantly colored, highly scented, insect-pollinated plants to which honeybees are attracted.
The only treatments I am confident have helped me are antihistamines and cedar shots. In seasons past, I could tell precisely when cedar season arrived, because I would be devastated by paroxysms of sneezing and a devilish tingling itch in my throat and ears. But bolstered by three months of cedar inoculations, I have experienced none of these special cedar symptoms this season. The doctor says that I am responding unusually well to the shots. I will continue a typical program of two shots weekly until the end of the season (usually around the first of March), and then the doctor will cut me back to one shot a month, just enough to keep up my immunity. Next season I’ll probably be increased to one shot a week. After three years of this routine, I will stop the shot treatment altogether. The doctor says the odds are about 20 per cent that I will be immune to cedar pollen for the rest of my life, and about 60 per cent that I will have partial immunity. About 20 per cent of his patients continue to have allergy reactions despite inoculations.
Of course, cedar is just one of my allergies. I still have headaches and itches and sneezes and the blahs, but not so often. The knowledge that I am allergic to my cat, feathers, dust, etc., has been as valuable to me as the cedar shots, because I now know what I’m up against.
One curious thing: now that my home environment is cleaner, I seem to suffer more pronounced reactions when I spend an evening in a dusty, cat-dandered house or in a smoke-filled club. The next morning I awaken with what feels like a hangover, even though I’ve had little to drink. Oh well, you win some, you lose some. Oliver Wendell Holmes once prescribed the only sure cure for allergies. “Gravel is an effective remedy,” he said. “It should be taken about eight feet deep.”
A Sneezer’s Guide to Texas
Don’t bother moving if you have allergies. If cedar doesn’t get you, then the dust storms will.
Texas folklorist J. Frank Dobie suffered greatly from hayfever in Austin. While a professor at the University of Texas in 1947, he requested a leave of absence for health reasons because of his allergies. The school’s Regents turned down his request, and when the controversial professor took his leave anyway, they fired him.
Dobie would probably have found some relief in dry West Texas. A few years ago researchers did a ragweed index of ten Texas cities. The only place they recommended for persons allergic to ragweed was Big Spring in West Texas, which has a bargain basement pollen count of 5 (Dallas was 115 on the index, Houston 68, and San Antonio 16). Alas, Big Spring, like most of West Texas, has terrible dust storms. “March and April are almost unbearable because of the dust,” a Big Spring nurse told me. Dust, like pollution, is an irritant rather than a genuine allergen. Doctors trying to discover why dust storms wreak such havoc on the sinuses have found that the storms do not import bacteria or pollen, just your basic ground-up rock.
There is no proven scientific basis for believing that plastics or diesel fumes, natural gas, cigarette smoke, or any number of other pollutants are true allergens. But as residents of Dallas and Houston and other cities with heavy industrial and auto emissions know from experience, pollutants are devastating to people who are already afflicted with allergies, especially asthmatics.
Every area of the state has its downside for allergy sufferers. The Gulf Coast gets lovely pollen-free breezes off the ocean, but the accompanying high humidity provides a perfect breeding environment for molds. And thanks to our temperate climate, no part of Texas freezes hard enough to kill molds. There’s nowhere in Texas free of weed or grass pollens, which can travel on the wind for at least a hundred miles. Flee as far as El Paso and you’ll tickle your sinuses on the tumbleweed or the Russian thistle.
Come spring, East and Central Texas teem with a dizzying variety of tree pollens—elm, oak, pecan, cottonwood, ash, mulberry, hackberry. Mesquite causes problems for the sensitive in Central, South, and West Texas from February to November. Fortunately, the fragrant pines of East Texas rarely—if ever—prompt the sneezes, because pine pollen particles are too big to be soluble in the bloodstream. (A true allergen must be soluble.)
The heaviest pollen discharges are usually in the early morning. There may be no discharges at all on damp or rainy days when the humidity is more than 80 per cent; rain washes pollen from the air. Hayfever attacks are normally the worst, of course, when the wind is blowing.
Cedar (actually Juniperus ashei) is the most infamous tree in Texas. It does its worst work within a 200-mile radius encompassing Austin and San Antonio. The dread cedar fever descends upon sufferers about Christmastime and lasts through March. The male trees turn fire brown and release great puffs of pollen. At times these early morning emissions are so extravagant that from a distance they resemble a small fire or explosion. Cedar pollen causes such misery that one Austinite wrote to a local paper proposing that all the male cedar trees in Austin be eradicated.
Remember the old saw about taking your sinuses to Arizona? The arid West was supposed to be especially beneficial for persons allergic to molds. But as Easterners migrated to Phoenix and Tucson for their health, they recreated their allergenic environment by landscaping with hayfever-causing East Coast vegetation that required frequent watering, which, in turn, encouraged the growth of molds. And besides, Arizona has plenty of pesky indigenous flora, the flowering sage to name one.
Allergists cannot accurately predict what sorts of allergies a patient might develop in new surroundings. Research indicates that the tendency to be allergic is inherited, but the specific allergies are not. With proper treatment, though, an allergy sufferer should be able to tough it out in any location.