March 20 was the vernal equinox, also known as the end of winter and the start of spring. But even if you haven’t looked at your calendar lately, chances are your nose has already figured it out. That’s because 40 million Americans have nasal allergies, also called hay fever. Springtime allergies – primarily tree pollen – cause an itchy, runny nose, nasal and sinus congestion, repeated sneezing, watery eyes, swollen sinuses and, in severe cases, difficulty breathing due to these symptoms.
Nasal allergies can be even more problematic if you also have asthma.
Last week, the Asthma and Allergy Foundation of America announced its 2012 Spring Allergy Capitals ranksings, with Chattanooga placing seventh on the list. The annual report, which identifies the 100 most challenging U.S. cities to live in with spring allergies, is based on a scientific analysis of three factors, including pollen scores, the number of allergy medications used per patient and the number of board certified allergists per patient.
Dr. Marc Cromie, a fellow of the American Board of Allergy and Immunology and a diplomate of the American Board of Pediatrics, took a brief break from his work at the Chattanooga Allergy Clinic to answer questions about why Chattanooga ranks high on the list and what area residents who are suffering from allergies can do to alleviate their symptoms.
We’ve had a mild winter. Is that going to create problems for people with allergies?
No doubt about it. There was no frost this past winter, and there’s an increased growing season because of the rain and the moisture we’ve had. When you see the Bradford Pears bloom, that’s the first sign that the trees to which we’re allergic, which are the hickory, pecan, maple, oak, birch and beech trees, are pollinating. Those trees pollinate microscopic granules we can’t see. The levels peak around the first weekend in April. And that’s when at least a third of Americans and even more people in Chattanooga are miserable.
So, we started having pollen in February, which is a month early. While we’ve had some ups and downs because of rain, which washes the pollen out of the air, the moisture has increased the mold spores.
What’s the source of the gold pollen we see on cars?
The pollen we see on the cars is heavy pollen from pine trees, and what’s interesting is it’s not very allergenic because it falls. It doesn’t stay in the air, so it doesn’t get in our nose and we don’t breathe it in.
We’re allergic to the pollen of other trees, which are microscopic male germ cells that travel from one tree to another. Their pollen is tiny and airborne. They release it, it gets in the air, and it blows to the next tree. And that’s what causes nasal allergies –and there’s a lot of it.
How much is “a lot?”
According to the pollen count, anything over 120 is high, and our levels have already been up to 1,600. Last spring, we reached the 10,000 range, which is crazy. If you take a three foot by three foot box, fill it with air and count the number of pollen in there, that’s how you’d get that number.
What causes some people to react badly to pollen?
The first thing is genetics. Allergies are an inherited disorder called atopy. We all have antibodies, some of which are responsible for fighting off infections like bacteria, and some of which are responsible for allergies. Some of us have more of the second kind than others. Genetics usually determine how much.
Basically, an allergic reaction occurs when the immune system overreacts to something that’s harmless. There’s nothing dangerous about pollen or peanut better, but if your immune system thinks it’s bad, it will release chemicals that cause the itching and sneezing. And we try to cover those up with antihistamines.
The second thing is environment. If you have more exposure to what you’re allergic to, you’re going to have more symptoms. So, people who don’t live in the South don’t suffer as much.
Why do so many people in Chattanooga have allergies?
The whole theory of why we have more allergies than any other place in the world – not just Chattanooga but the entire Unites States – is we have a clean, sterile environment. We’re not like the third world countries, where the water is filled with parasites. So, since our immune system doesn’t have to fight off those things, it’s bored. It’s like a bored teenager that’s got nothing to do, so it looks for something to do. So, since our immune system isn’t exposed to infections early in life, it decides to react to pollen or food.
That’s called the Hygiene Hypothesis. In the U.S., we use a lot of antibiotics, and we’re clean, so our immune systems aren’t stimulated enough early in life. U.S. children that are born on farms and in rural areas have fewer allergies because they’re exposed to farm animals and dung and bacteria, and their immune system keeps them from being sick.
That’s interesting, although I don’t recommend getting an indoor cow if you don’t want your kid to be allergic. (Laughs)
What can people do to alleviate their symptoms?
Let’s talk about the three A’s of allergies. The first is “Avoidance,” the second is “Allergy medicines” and the third is “Allergy shots.”
First, it’s important to see a board certified allergist to find out what your allergies are. Skin testing is easy, and it’s the gold standard. Blood tests are not as accurate.
So, if you find out you’re allergic to dust mites, get the allergy mattress cover. Dust mites are microscopic critters that live in your bed. The average mattress will weigh five pounds more within three or four years of being new because of dust mites. They live on humidity and dead skin cells. Our beds in the South, where we have a lot of humidity, are a smorgasbord for dust mites. And dust mites are the first allergen to which children become sensitive because they spend a lot of time on the carpet and in bed.
The mattress covers are woven tightly to encapsulate the mattress and the pillow, but they’re breathable, and they’re not crackly and you don’t sweat like you do with hospital bedding. They’re silky and comfortable. We’re allergic to dead dust mites and their fecal matter, and by zipping up your mattress and pillow, you reduce your indoor allergens.
The second thing you can do is not open your windows or doors, even though it’s beautiful outside now, because that lets pollen in. We can’t live in a bubble, but you can make your home pollen-free, make your bedroom dust free, and if you’re allergic to dogs or cats, you can keep them out of your bedroom.
If you have an indoor pet or smokers, HEPA air filters are helpful. They’re not good for pollen and they’re not going to suck the dust mites out of the bed, so don’t spend money on things that aren’t going to be helpful.
What about medicines?
The over-the-counter medicines are better than they were. The benefit of our pharmaceutical industry is we have great drugs that eventually go generic, and right now, there are three generics on the market: Claritin, Allegra and Zyrtec. They’re all 24-hour allergy blockers, or antihistamines, which means they block the histamine response. They’re only a band-aid, though. There are prescription nose sprays like Flonase and Nasonex, which are steroid based. They reduce the way your nose overreacts so you can breathe at night. And there are allergy eye drops you can use in the spring when allergies are terrible or when you’re around cats or dogs.
And the third A – shots?
We like them, and insurance companies like them, because they’re all natural and they’re more of a cure than a cover-up. You can take Zyrtec every day for years, and the day you stop, you’re still going to be allergic. But allergy shots gradually change the way your immune system overreacts. A shot contains a tiny amount of what you’re allergic to, so once we skin test you and find out you’re allergic to pine trees, we put that in little vials we make up for you, and each week, you get a shot, and each week, you build up your tolerance. Once you get to the high dose, your immune system clicks and realizes it doesn’t need to overreact to pine trees.
Most protocols are five years, which might seem like a long time, but it can give you decades of symptom-free living. Also, if you start this in childhood, it reduces asthma by 50 percent.
Couldn’t that get expensive?
Allergy shots save on average two thousand dollars a year, even with the price of the shots, because you’ll have fewer visits to the emergency room for asthma and less need for antibiotics for chronic sinus infections. And you won’t have to take your daily medicines anymore, which reduces what you have to spend. So you’re looking at cost reduction, increase in quality of life, and more of a cure than a cover-up.
How many shots do you give a day?
We give about 500 shots a day. We take care of a lot of folks.