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Something to Sneeze At

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Dr. Shankar Lakhani, of Peninsula Allergy & Immunology in Dover, says people can develop allergies at any age. Photograph by Jared CastaldiJust as spring brings longer days, buds and blossoms, it also brings misery to the roughly 35 million Americans who suffer from seasonal allergies.

 
Seasonal allergies, also known as allergic rhinitis or, more commonly, hay fever, are a short-term cyclical inflammation of the mucous membranes that line the nasal passages. In allergies, airborne pollen from seasonal plants—or spores from mold—enter the eyes, nose and throat, triggering an allergic reaction.
 
The immune system does not usually respond to such harmless substances, but in sensitive individuals, the immune system recognizes these invaders as infectious agents, so it mounts an attack, unleashing a cascade of chemicals that cause inflammation and discomfort. The symptoms of an allergic reaction typically occur from five to 10 minutes after exposure, then subside in about an hour, though they may return several hours later.
 
The start of allergy season varies by region. In Delaware, most trees pollinate in April and May (though the maple’s pollen season can begin as early as February). Grass pollens are prominent from May through October. Weed pollens are the major offenders during late summer and early fall. Mold spores enter the picture when fallen leaves and vegetation begin to decay in late fall.
 
And contrary to what you may have heard, Delaware is not the worst location for allergies. “We’re not even in the top 10,” says Dr. Shankar Lakhani of Peninsula Allergy & Immunology in Dover.
 
Allergies usually develop before age 20. The average age of onset is between seven and 10 years, but it is not unusual for people in their 60s or 70s to develop seasonal allergies. “You can develop allergies at any time in life if you have the genetic predisposition and increased exposure to the allergen,” says Lakhani.
 
Like other problems involving an abnormal immune system response, allergies tend to run in families. “If one parent has allergies, you have a 40 percent chance of having allergies,” says Dr. Jerome Groll of the Family Practice Center in Lewes. “If both have allergies, then you have an 80 percent chance.”
 
Because the problem is rooted in your DNA, one thing is certain: If you were born with a genetic predisposition toward allergies, you will have your sensitivity for life. Some allergy sufferers believe they have outgrown their allergies, though all that has changed is the offending substance or the symptoms.
 
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“Kids have more itchy watery eyes and runny noses, while adults will have more congestion, post-nasal drip, headaches and sinusitis,” says Dr. Gregory Marcotte, chief of the division of allergy and immunology at Christiana Care Health System.
 
To determine the cause of your symptoms, your doctor will review your family history and conduct a thorough physical examination to rule out other medical problems that mimic allergy symptoms.
 
Allergy skin tests help to identify which allergens are causing the symptoms. This involves pricking or scratching the skin with needles, then applying miniscule amounts of suspected allergens to the areas. If a treated area becomes red, itchy or swollen, that allergen is the culprit.
 
Allergic rhinitis rarely improves without treatment. Any care plan includes a three-pronged strategy of avoiding the allergens, medication and immunotherapy. Staying in a climate-controlled environment when pollen counts are high can be helpful, but not always practical.
 
“The problem is we all have to go outside, and that makes it difficult,” says Groll. “So you have the medications you can take at that point.”
 
Mild cases of hay fever can be treated successfully with over-the-counter, non-sedating antihistamines taken once daily during allergy season. For more severe cases, doctors can prescribe “second generation” formulations of these medications.
 
Decongestants can relieve congestion but often cause irritability and insomnia. They are not recommended for people with hypertension. Nasal decongestant sprays should be used with caution since overuse can have a rebound effect, causing more severe nasal congestion. Nasal steroid sprays and nasal antihistamine sprays usually take a few days to begin providing relief, but they can be used indefinitely.
 
A class of drugs called leukotrienes treats seasonal allergies by blocking production of the chemicals that produce inflammation during an allergic reaction.
 
Matching the patient to the medication is largely a matter of trial and error, but most allergy sufferers will experience some degree of relief when they hit upon the appropriate drug. “The medications are fairly effective,” says Groll. “I’ve got a lot of people who are happy just using the medications, and they’re controlled enough to stay with what they’re doing.”
 
But for those who get little or no relief from their medications, immunotherapy remains the only option. The treatment, which lasts from three to five years, entails injecting increasingly larger amounts of the allergen until your system becomes desensitized and stops overreacting in response. Unlike other therapies, immunotherapy can produce a permanent remission in some patients. It is often the best long-term treatment for cases of severe allergic rhinitis, according to Lakhani.
 
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But immunotherapy does have its drawbacks. The injection schedule can be inconvenient, and serious allergic reactions have occurred.
 
Herbal supplements, probiotics, acupuncture and hypnosis have also been offered as alternative treatments for seasonal allergies, though there is no solid evidence to support the effectiveness of these treatments, says Lakhani.
 
But take heart: Allergy symptoms may decline with age as the immune system weakens. “It’s one of the few things that gets better as you get older,” says Marcotte.
 

Allergies: The Facts

  • Allergy symptoms are fairly easy to recognize. A sudden onset of sneezing, itchy, watery eyes, and a stuffy nose that occurs at the height of spring or summer often indicates a seasonal allergic reaction.
     
  • Allergies usually develop before age 20. The average age of onset is between seven and 10 years, but it is not unusual for people in their 60s or 70s to develop seasonal allergies.
  • Hay fever is the fifth leading chronic condition in the United States and the most prevalent health complaint in the workplace.
     
  • Seasonal allergies cost employers more than $250 million a year in lost productivity, significantly more than stress, depression and anxiety. Source: American Academy of Allergy, Asthma and Immunology 
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