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When “Gesundheit” Just Won’t Cut It

Article posted on Wednesday, March 31, 2010

When "Gesundheit" Just Won't Cut It

By: Dr. David Stone

The Sneeze

I sneezed a sneeze into the air
It fell to the earth I know not where
But hard and froze were the looks of those
In whose vicinity I snoze.

-- Anonymous

There is an old Scottish superstition that one sneeze is lucky and two sneezes are unlucky; and an English wive's tale used to forewarn that if anyone sneezes for three consecutive nights, someone in their household would die. Thankfully, those superstitions are not true, but while allergic rhinitis is not life-threatening, it can be QUALITY-OF-LIFE-threatening. Allergic rhinitis affects nearly forty million Americans each year. It carries a total economic impact of approximately $1 billion in direct and indirect costs, with about one-fourth of that being prescription medications. A number of years ago, allergic rhinitis was found in one study to be responsible for 811,000 missed work days and 824,000 missed school days, contributing to the high indirect cost of the condition.

It's not always associated with hay, and it doesn't cause fever, so why is it called "hay fever?" This term, used to describe what we now call "allergic rhinitis" has been around since it was coined by Dr. John Bostock as early as 1819. Back in those days, the term fever was used generally to describe "feeling unpleasant," but today it describes an elevation in body temperature, which is not typically caused by allergic rhinitis. As we know it today, allergic rhinitis is the complex of symptoms associated with sneezing, itchy nose and eyes, runny nose, and stuffy nose that many folks in the Pee Dee area suffer from during the spring, summer, and fall-some even year-round.

Seasonal allergic rhinitis is caused by microscopic grains of pollen produced by trees, grasses, and weeds. While flowering plants are pretty and many are blooming during pollen seasons, pollen from these ornamental plants is carried by insects. The pollen that causes the majority of the problem is the pollen that we can't see that is carried by wind currents and stays airborne for long periods of time. It is this pollen that interacts with allergic antibodies produced by our immune system to cause the allergic reaction that produces the symptoms. In the Pee Dee region, tree pollen causes symptoms predominantly from February to the end of April, grass pollen starts in mid-April and continues through early July, and weed pollens can cause symptoms from mid-to-late-May through the first frost in the fall. Some outdoor mold spores may mimic pollens and cause seasonal symptoms in the spring and fall as well.

Pollen counts are highest in the early morning hours, and are increased on dry, clear, windy days. Rainy, cloudy, and windless days tend to be the best for allergy sufferers (unless you also have a form of non-allergic rhinitis that is worsened by high humidity), since pollen does not tend to move around as much nor get airborne on those days. Some people feel that they are affected only by the pollen from trees in their immediate vicinity, but the truth is that they can be affected by the pollen from trees a hundred or more miles away from their home.

If seasonal allergies are getting you down, the first step (other than moving to the Arizona desert) is appropriate medical treatment. Anti-inflammatory nasal steroid sprays are not addictive and can be significant help in preventing and treating seasonal allergy symptoms. Also, prescription and over-the-counter antihistamines are helpful for the treatment (but unfortunately not the prevention) of sneezing, itchy nose, and runny nose. Decongestants are more difficult to come by these days, but when needed are helpful for treating the symptoms of stuffy, congested nose and head. Be careful about decongestant nasal sprays, though, which may cause dependence if used for more than four days in a row.

If your trouble persists, or if you have allergy symptoms for many months out of the year, evaluation by a board-certified allergy-immunology specialist may be beneficial. Such an evaluation starts with a detailed medical and allergy history and physical examination. Afterward, allergy testing is performed to determine which allergens you may be causing your problems. These allergy tests are compared to your clinical history to determine whether specific allergen avoidance or other specialized treatment, such as allergen immunotherapy (or "allergy shots"), is likely to be of benefit. These shots are vaccinations of the allergens that are causing a patient's symptoms for the purpose of desensitization or regaining tolerance to those allergens.

While they won't have the same benefit for every single allergy sufferer, there are some other non-medicinal things you can do to help yourself with your allergies, including:

• Keep windows closed at night to prevent pollens or molds from drifting into your home. Instead, if needed, use air conditioning, which cleans, cools, and dries the air.
• Minimize early morning activity when pollen is usually emitted-between 5-10 a.m.
• Keep your car windows closed when traveling.
• Try to stay indoors when the pollen count or humidity is reported to be high, and on windy days when dust and pollen are blown about.
• Don't mow lawns or be around freshly cut grass; mowing stirs up pollens and molds.
• Don't rake leaves, as this also stirs up molds.
• Don't hang sheets or clothing out to dry. Pollens and molds may collect in them.
• Don't take more medication than recommended in an attempt to lessen your symptoms.
• Take medications prescribed by your doctor regularly, in the recommended dosage and stick to the regimen prescribed by your allergist/immunologist.

Springtime should be a time for shaking off those winter cobwebs-a time to get outdoors, play, and enjoy yourself. If you, or someone you love, suffer from allergies and have persistent nasal, eye, or asthma symptoms; need management and education regarding environmental triggers; and are considering allergy shots for desensitization, an evaluation by a board-certified allergist may be just the ticket to a more enjoyable allergy season.

A native of Mullins, South Carolina, Dr. David Stone is a board-certified Allergy-Immunology specialist who resides in Florence and practices with Allergy, Asthma, and Sinus Center in their Florence and Hartsville offices.

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