Spring Allergies vs Fall Allergies: Which is Worse

For those who suffer from seasonal symptoms of hay fever, there always seems to be that time of the year that is absolutely dreaded. For some it includes the spring, and for others it’s the fall. Seasonal allergy sufferers may also suffer from both or even more seasons, but one will usually dominate. So which is worse? Well, it depends on the specific allergen and when it is most abundant in the regional area at a specific time of the year.

Spring Allergies- Spring appears to be the time of the year when trees release the most pollen. Some of the top trees responsible for this abundant pollen release are Oak, Sycamore, Maple, Elm, Birch, Walnut, Hickory, and Cypress. The warming of the weather still accompanied by heavy winds also aggravates these allergens. Mold is still a prime allergy source in the spring, however it will worsen in the fall.

Oak Tree

Fall Allergies- The biggest culprit during the fall season is ragweed. Ragweed begins to pollinate in August normally, which makes it stay in the air and “attack” those for the following months. It’s also a very light particle that travels well in the wind. This allows it to act as an allergen to many nationwide, even if you don’t live near growing ragweed. Also in the fall, mold proliferates the most. Although mold is stated to be a major contributor to spring allergies, fall has higher levels because of the increase in spore release. The release of these mold spores also wreaks havoc to those susceptible to mold allergies. Another additional burden that fall allergies do play is with children. Because it is the start of the school year children will begin to have more exposure to certain school time activities, which may aggravate their allergies even further. This appears to be correlated with children asthma attack spikes in the fall as well.

Ragweed

So which one is worse? Well, of course, it changes for each individual because allergies are triggered by different allergens. For both spring and fall allergies, the best defense is avoiding the triggers in combination with medication in order to manage symptoms. These options were discussed in previous blogs.

How Big of a Problem is Hay Fever

It’s pretty obvious that Hay Fever is a big problem that affects many people worldwide. We know that it happens to children and adults and that we probably have a little of it (or a lot) ourselves. But really who all is suffering?

According to the CDC, the United States has had 17.7 million adults newly diagnosed with hay fever within the past 12 months and another 7.1 million children have reported having hay fever. The Revolution Health Group reports that hay fever causes about 14 million doctor office visits, 90% of which are seasonal and 70-80% have perennial as well. By the age 6-19, 17% of all children have an allergy to some environmental factor, and the severity and occurrence tend to greatly increase with age with no apparent discrimination to race or gender. Most importantly, the rates in the U.S. have been rising dramatically for unknown reasons.

So what does this even mean? That a significant number of people are suffering from hay fever and that this is an increasing problem. It appears that by this data alone that quality of life for these individuals is also affected. For example; for the doctor’s visits alone take into consideration the time, money (co-pays, medications, transportation etc.) and overall hassle of even getting the visits. This does not even include the symptomatic burdens associated with this chronic condition. Also, because having hay fever puts you at a higher risk for other hypersensitivity conditions from an overactive immune system, there is the increase for food/drug allergies, asthma, and other types of hypersensitivity reactions and the other issues that go along with them.

The most interesting thing about this condition is that even though it affects so many people, leads to so many undesirable effects, symptoms, medication usage, and even possible complications, there is no cure.

http://www.cdc.gov/nchs/fastats/allergies.htm

http://www.revolutionhealth.com/conditions/allergies/allergies-basics/introduction/the-demographics-of-allergies

The Hay Fever Diet

For everyone, especially those will an illness or aliment, it seems as if the doctor will often state the importance of an appropriate diet and frequent exercise. For some things, this can be a very specific diet, such as the DASH diet for those needing to lower blood pressure and the BRAT diet for many pediatric patients. But is there a diet, or any dietary recommendations to help alleviate the symptoms of hay fever.

The Hay Fever diet-

Also derived as the Mediterranean diet because, as will be stated, the diet consists of many fresh fruits and vegetables, fish, nuts and other high antioxidant loaded foods.

Dig In

 Because hay fever is results in inflammation, it is advised to eat foods that have anti –inflammatory properties.

            Nuts- With a high amount of magnesium and vitamin E, nuts can help improve lung function, which is especially beneficial to asthmatics as well. Also because Vitamin E boosts the immune system, it can help the body fight against URIs (upper respiratory infections), and from damaging free radicals, which also cause inflammation.

             Apples, Oranges, Tomatoes, and other Vitamin C fruits- Because Vitamin C is an antioxidant, has many of the properties like Vitamin E such as protecting the body from free radicals thus reducing potential oxidizing tissue inflammation and damage.

Grapes (Red with skins)- Grapes are also filled with antioxidants, but also have resveratrol, which is the same chemical in red wine that gives it some healthy heart benefits when taken in moderation.  Resveratrol works not only for Hay Fever by reducing inflammation, but can also lower LDLs, the “bad cholesterol”.

            

            Fish- Cold-water fish, algae, and supplements, have high amounts of the omega-3 fatty acids DHA and EPA, which are believed to reduce inflammation in the body. Some of the popular fish diet options include salmon, mackerel, trout, herring, sardines, and albacore tuna. Fish oil or omega-3 supplementations are also believed to be as beneficial.

            

           Tea- Especially a hot tea with lemon or honey is usually recommended for those with hay fever first thing in the morning. Some anti-inflammatory compounds in teas, flavonoids, work along with boosting immunity as well. Tea also works by “waking up” the cilia, the tiny hairs in the nasal passageway, to sweep out the pollen and dust. This will also allow mucus to flow more naturally therefore decreasing stuffiness or the morning sneeze attacks. 

Proceed with Caution

Spicy foods work well by be easing congestion and thinning mucus, but can be harmful by irritating the throat which may cause even more excessive mucus and cough. These include; Cajun spices, Garlic, and Horseradish

Steer Clear

Margarine is made of artificial unhealthy fats, which boost inflammation. A diet high, or even containing margarine, is stated to increase the risk of having allergies and respiratory wheezing.

Children and Hay Fever

Hay Fever is a condition that can affect everyone, even the children. Although there are many similarities between children and adults in regards to hay fever, the differences are very important to be aware of, especially if you're a parent. 

So what's similar? 

Well, children often have similar presenting symptoms (rhinitis, sneezing, stuffy nose, sore throat etc). Another thing very important to keep in mind is the similarities of the triggers. For children, often triggers include dust, pollen, mold, pet dander and more. Therefore treatment in avoiding these triggers is the same as for an adult. (for more information on this please see previous blog entry). Pharmacological treatment is very similar as well and most of the same medications have indications for children doses on the backs of the packaging. Common medications recommended for children allergy relief include Claritin and Singulair. Keep in mind that it is important to discuss new medications for a child with a doctor and to ensure accurate dosage.

So what is different?

Many children are often predisposed to other conditions, ie asthma and eczema. Therefore hay fever symptoms may often exacerbate the symptoms of these conditions. This could be especially dangerous with asthma because inadequate oxygenation may occur.

Also, children are at a higher risk for otitis media, also known as a common ear infection. This occurs from the congestion in the sinus passageway. The reason that children have a higher risk of this is because of the passage (Eustachian tube) connects into the nasal passageway. In younger children the tube in more horizontal as opposed to the more diagonal route of an adult Eustachian tube. As a result, it is easier for it to become infected and inflamed.

Lastly, because the development of a child is crucial and much of this is done at school, it is important to address the symptoms of hay fever in a child. Not only are the symptoms bothersome, but also it can actually impede in the learning process and worsen attention. Hay fever can even decrease self-esteem with the constant concern about how their symptoms are affecting their schoolwork and it’s affect on the body.

Final Notes

Like all hay fever sufferers, it is important to address the symptoms and take care of them. With children these this need even increased. Make sure if you think your child has hay fever visit your doctor to have him/her evaluated and see what treatment is appropriate.  

Check out http://www.keepkidshealthy.com/welcome/commonproblems/hayfever.html

Allergy Capitals

Allergy Capitals

Where you live has a huge impact on those who have outdoor/seasonal allergies. Certain places are notorious for having low allergy levels where as for others, places can be known as allergy capitals.

According to the Asthma and Allergy Foundation of America (AAFA) 40 million have hay fever/nasal allergies and 10 million have allergic asthma. Although not all of these people, and perhaps yourself, have outdoor allergies, a big chunk does.

Fall Allergy Capitals

If you happen to be one of these unfortunate souls you may wonder, am I living in the right place? Or is my residence one of the causes of my worsening symptoms.

The AAFA established the “Most Challenging Cities to Live with Fall Allergies” for 2011.

http://www.aafa.org/pdfs/Public%20LIST%20FALL_2011%20v2.pdf

 High on the list are 1. Knoxville, TN, 2. Dayton, OH, 3. McAllen, TX, 4. Jackson, MS,  and 5. Oklahoma City, OK. Other high contenders were scattered about the eastern states, south and southwest, and some west coast (mostly California).

So what do you do if you live in one of these places?

            If moving is an option and symptoms are severe, that is always a very valid choice. However this may not be ideal for everyone . The next best thing is avoidance. This could be staying indoors, using ventilation[HEPA filter]/ac instead of opening windows, using pharmacologic interventions, checking daily pollen counts (in your local paper or online). Other avoidance ideas are discussed in previous blog entries.

If you are interested in checking pollen counts online, such resources exist such as http://www.pollen.com/allergy-weather-forecast.asp . This website can be used to search different allergy triggers according to city/zip code.

http://www.pollen.com/allergy-weather-forecast.asp

So what are some of the best cities for the seasonal sufferer? This is more subject to change than the most challenging cities. According to the AAFA such “low allergy” cities include Canton, OH, Spokane, WA, Portland, OR, Springfield, MO, and Scranton, PA.

So unless your planning on moving or just trying to tough it out, no city is “free from allergies”, the best you can hope for is less. 

Using a Neti Pot for Hay Fever

Neti Pots

What are they?

Neti pots, or nasal saline irrigation is a system of cleansing out the sinus and nasal cavities. in order to help a range of nasal symptoms from colds, allergies, sinusitis or just for hygiene.  Although the idea of the Neti pot has been around for centuries but has recently been increasing in popularity.  This is especially true for those with hay fever because of it acts as effective maintenance of clearing out the allergens with minimal side effects. This especially applies for those year round hay fever sufferers.

How do they even work?

To understand how the Neti pot works, the anatomy and physiology of the sinuses needs to be stated.  Sinuses are air cavities in the cranial bones which help reducing weight of the skull, create resonance in the voice, and most relatable for this, for humidifying the air in the nasal passageway. The paranasal sinuses include the maxillary, frontal, sphenoid, and ethmoid. The body is constantly producing mucus in these cavities which normal works as a protective and lubricating barrier and should just go down the throat as a post nasal drip and be swallowed.  However if  infectious agents, allergens, dirt, dust or other particles are present this mucus can thicken up and have a harder time being removed. This build up causes pressure in the sinuses, worsening symptoms of nasal congestion and rhinitis, and even can lead to cough, sore throat, and hoarseness. With the Neti pot, the solution is designed to thin out the mucus and irrigate it through the sinuses and out the nostrils. Attached is a youtube video of a more in depth explanation.

So do they work?

Studies show that they do help in relieving symptoms. Ear nose and throat  [ENT] surgeons often recommend them to their patients after having nasal surgery because how effective their irrigation works. Research has backed up the claims of both companies and users of the Neti pot. However this may vary from person to person. Don’t start a new regime without constulting your primary care physician. 

My Personal Results

As a fellow hay allergy sufferer I decided to give this device a whirl. I bought the  Neil Med Nasal Flow one at Target for 17.99. When I first started it made my head feel full and I had to make sure my head was tilted just right over the sink otherwise I would taste the salty solution in the back of my throat. However, it didn’t take long and was painless- the best news is I saw results almost instantly. I physically saw mucus in the sink (gross I know, but better out of my sinuses than in!), also I felt better. I was able to breathe better almost instantly. There was the occasional trickle of solution for then next fifteen minutes but nothing bad. I did however feel a little lightheaded for about an hour. I have now tried this regime three nights in a row- deciding I would slow down as soon as I had a successful (little or no mucus left) go around. I have noticed have had little or no congestion in the morning and throughout the day and barely even sneezed. Personally I am loving the Netipot.

Attached are some links you may be interested in about the products.

Check out http://www.amazon.com/Himalayan-Institute-Ceramic-Neti-Pot/dp/B000WJIC3G

http://www.sinucleanse.com/netipotlanding.htm

http://www.neilmed.com/usa/adword_np.php

Allergy Skin Tests

Allergy Skin Tests

With hay fever, the most common thing you are told is to avoid your triggers. But what if you don’t know what the triggers, how are you supposed to avoid them? How do you find out what they are?

Allergy skin tests are designed to help expose whether or not a suspected allergen is actually what is causing the allergic reaction. To gather information on what could be a possible suspected allergen is through the medical history.  During the medical history some questions that may be asked include: How long have you had the allergy? Where do you live? How long do the symptoms last for? Where do you work or what are some environmental exposures?

After gathering the information, the suspected allergen will then be introduced in one of three ways- a skin prick test, skin injection test, and patch test.

            Skin Prick Test- is done with a lancet injected different allergens. The results usually come in about 15 minutes. It can be done with as many as 40 different substances to see if the allergies are from pollen, mold, pet dander, dust and even food allergies. If a skin prick test is positive, there will be a skin response This could be a raised, red itchy lump- somewhat like a mosquito bite.

            Skin Injection Test- a test that, like the skin prick, injects a small amount of allergen extract into your skin. The difference is that instead of a lancet, it is used with a needle to be a little deeper as an intradermal test. In about 15 minutes, there will be signs of an allergic reaction- this test isn’t very common for hay fever like the skin prick test, but more for allergies to venoms or specific medications.

            Patch Test- tests to see if there is an allergic reaction by not injecting an allergen, but instead applying it to a patch, which will be placed on the skin. Like the injection test, this isn’t very common for hay fever, but more for contact dermatitis, such as latex or preservative allergies. The patch will be worn for 2 and irritation will indicated a positive test.  

All of these tests are used in order to pinpoint what your allergies are in order to avoid them. This means may not be necessary for everyone, but more for those who really need to know, are more susceptible, and have very severe allergies. Talk to your doctor about if this interests you to see when/how you can receive this testing. 

Cold or Allergies

Cold and Allergies- How do I tell the difference

It’s that time of the year where everything is seeming to bloom and be harvested, but it is also the time where there seem to be more sick friends and coworkers poping up as well. As you start to sneeze and your congestion builds up that tickle in the back of your throat keeps you wondering- am I sick? Or is it just allergies?

Colds are infections caused by viruses and the classical symptoms of the cold are caused by the immune system attack on the contagious pathogens. These symptoms are the occurring because the body is doing what it should be to get rid of this harmful organism invaded.

Allergies on the other hand, and as explained in previous posts, are the body’s hypersensitive response to a harmless stimulus, or allergy, which the immune system recognizes as a danger. Allergies are not contagious and continue as long as the allergen is present.

So how do we know the difference? 

If you are still not sure what you have don’t hesitate to call a physician to check it out. Also, try to avoid possible allergy triggers to see if symptoms improve.  This can even be taken a step further by taking an allergy medication, such as a Claritin to see if symptoms are alleviated. Do you have a history of allergies? Have you had allergies before and does this feel similar or different? These may be signs that you are the allergy sufferer. On the other hand if nothing seems to be helping, the cold is the more likely cause. For colds, also think about anyone you know who has recently fallen ill or that anyone you associate with has after you. Do you work in a place with children, sick people, or just a high volume of public exposure?

Either way symptom relief is the treatment you are most likely to go with for either way. If you suspect a cold, and for just regular health promotion, make sure to wash your hands often, cover your mouth when you sneeze or cough, and carry hand sanitizer around. Also for a cold, get adequate rest, drink plenty of fluids, and possibly try some OTC medications for symptom relief. As for allergies symptom relief can be taken from a variety of medications and avoid the allergy triggers. Make sure that you talk to a doctor before you start any medication regimes or plans. 

Immunotherapy- A Medication Alternative

Immunotherapy- The Medication Alternative

Pills aren’t working? Are those alternate therapies not doing the trick? Or are you just sick (physically and mentally) of your symptoms being so intense and irritating every day or allergy season?

These are just some of the reasons why many patients venture to the care and treatment of hay fever through immunotherapy.

What even is immunotherapy though?

Immunotherapy is treatment targeted often to type I hypersensitivity, which uses desensitization therapy. Also, usually works best with hay fever patients. How it works is through the involvement of environmental control of external allergens in addition to the titrated pharmacologic exposure to them as well. With environmental control, a plan has to be made to decrease the exposure to the specific allergen(s). The pharmacologic desensitization process involves injections of the allergen (antigen) regularly through a course of time. This usually will last anywhere from months to years depending on the extent and progress. Throughout the time period, the dosages of allergen will be increased as tolerated. This will hopefully cause a change in the immunoglobins so that there will be an increase of IgG and IgA blocking antibodies as opposed to the abundance of IgE..

However immunotherapy doesn’t always work and may not be a complete treatment to allergy symptoms.  Also it has been reported that the relief to certain grasses and pollens usually last about 4-5 years.

Some considerations before getting involved

If you are thinking about getting immunotherapy keep a couple of things in mind. Such as the commitment it will take -the years of having to come in for the shots. Also it is an expensive process- you must weigh the costs of this with the costs of the medications you normally use.  Immunotherapy is not a definitive treatment and does not yield the same results for everyone.  Age is an important consideration- immunotherapy shots are usually not given to children under five and to older adults (65+ depending on medical status). Lastly, there are some medication conditions that may be present to prevent you from receiving immunotherapy. These include immunodeficiency diseases, recent heart attack or unstable angina, current use of beta blockers. 

Remember if you are considering this to ask your physician about any concerns or questions you may have. 

Prevention

Are taking medications not working or just not your thing? What else can you do if the symptoms of hay fever still haunt you? 

For those who are the seasonal allergy sufferers have it easier in the sense that symptoms only last a couple weeks or months. However, prevention of these seasonal sniffles is much harder to avoid, or fix. 

Because seasonal allergies primary cause is pollens the key concept is to stay indoors. It is advised to keep all windows and doors closed and use the air conditioner to stay cool. This also applies for while driving as well; but make sure that the car is in the “recirculation” mode. It’s also important that the air conditioner has a good air filter, which is to be washed weekly during high pollen season. Another thing to keep in mind is to keep in mind is to not have plants indoors.

As for the year round hay fever sufferers, prevention gets a little more difficult. Also, there are a lot more possible sources/causes of the allergens. The most common, which I will focus on are dust, dust mites, pet dander, and mold. For household dust, it’s beneficial to not have carpet and instead have a smooth surface, such as hardwood flooring. This allows dust to settle on top and be cleaned much more effectively and easily. If you are unable to get rid of carpet use a mask while vacuuming. Also limit surfaces, and furniture, for dust to settle on. Clothing could be a big issue when it comes to dust because it’s fabric, has a lot of surface area, and is normally stored in the bedroom. It is advised that clothing be kept out of the bedroom and/or in airtight vinyl clothing bags. Some other small changes that could be made are to use blinds instead of drapes, to keep the air conditioning vent closed in the bedroom, and to make sure there is a clean filter on the air conditioning unit. As for dust mites, these changes also apply in addition with some new ones. It’s key to wash bedding weekly in hot water (at least 130 F). It’s also important to not sleep/lie down on upholstered furniture and to keep the home cool and dry. As for pet dander, the most effective solution would be to remove the pets from the home. This could be keeping them outside or the better solution (in the mindset of relieving hay fever symptoms) is to get rid of the pets altogether. However this is easier said then done, so the next best thing is to make sure to get the home cleaned thoroughly and often, keep the pet out of the bedroom, and make sure that it gets groomed elsewhere regularly.

Mold is perhaps the most potentially dangerous out of the year round hay fever causes.  The three D’s: dampness, darkness and drafts are key to the growth of mold. Therefore the best way to avoid mold is to avoid those three things; however it may be too late and the growth as already begun. Make sure rooms have good ventilation by opening doors and windows. Put lights in dark places, like small closets and the basement. Also avoid places of high humidity. This can include green houses, barns, laundry rooms etc. Because mold can be potentially dangerous to ones healthy it is very important to get the mold checked out by a professional. They may be able to help remove the mold (or at least part of it) regardless of the danger as well.

So overall, what’s the best way to prevent the symptoms of hay fever without medications (or in addition to)? AVOIDANCE. Avoid as much as you can and you will start to feel better.

Some of the Physio

As mentioned before, the overall concept of hay fever is caused by the bodies sensitization to a specific allergen. But how exactly is this caused?

Our immune system is made up of several structures; this includes skin and mucous membranes, the mononuclear phagocyte system, the lymphoid system, and bone marrow which all have different types of white blood cells, also known as leukocytes. Leukocytes help protect the body through inflammation and immunity.  T Lymphocytes (or T cells) are the mediators of specific immunity which act by reacting to the presence of a specific antigen (marker of a foreign substance) body and stimulates B Cells to make antibodies, a protein complex which react to the antigen.

In hay fever this antigen is caused by the presence of an otherwise substance that isn’t harmful. This is an allergen that after repeated exposure causes a hypersensitive reaction. The primary antibody responsible for mediating this reaction is immunoglobin E, or IgE. The IgE binds to receptors on other cells in the immune system known as mast cells. This IgE Mast Cell complex can bind to passing antigens (the specific allergen) and create a crosslink (when two antibody ends attach to an antigen) therefore causing an increase of intracellular calcium in the mast cell. This increase causes local mast cell degranulation resulting in the symptoms of inflammation. This may cause other inflammatory cells, and as for the case of hay fever, basophils to also release chemicals. The primary receptors to these are histamine. (That is why a lot of allergy medications are classified as antihistamines). Histamine causes a variety of symptoms, which may vary in severity. Some of the effects of histamine include bronchoconstriction, vasodilatation, increased mucus secretion, and pruritus (itching).

This however depends how the allergen entered the body and how much. For those with hay fever the most common is the allergic rhinitis (because the allergen enters through the nasal passageway). These symptoms also occur only when the allergen is present (or in high enough levels) for the antibodies to react. That is why for those with seasonal allergies they vary on location and pollen levels and for those with chronic have to make lifestyle changes depending on the cause. 

What is Hay Fever?

Hay Fever- you or someone you know probably suffers from this condition. For most people, the feeling comes every spring. Do watery itchy eyes, congestion, nonstop sneezing, or just that constant tickle in your throat haunt you as the flowers start to bloom. As unfortunate sounding as this may be, the seasonal hay fever sufferers have it easy compared to the who suffer from perennial, or year round, allergies.  As a fellow "allergy sufferer" I can relate to having the constant wad of tissues secured in my pockets or purse for both the exacerbations in spring and having to be in the presence of mold year round.

However these symptoms are very well known, but the confusion begins with what Hay Fever really is. Hay Fever, or sometimes known as allergic rhinitis, occurs when the presence of an allergen which would be completely harmless, is perceived as being just that opposite and triggers an immune response. This allergen could be from pollen, mold, dust mites, pet dander, cockroaches etc. (The in depth pathophysiologic explanation will be brought up in a future post). The higher levels of these allergens cause a more intense response and sensitization with exposure- that's why for seasonal sufferer's, the very high levels of pollen in the spring can leave some feeling miserable.

The most common symptoms experienced by hay fever include the initial sneezing, watery itchy eyes, altered smell or taste, thin watery nasal discharge, sustained nasal congestion. Throughout chronic exposure there may be headache, congestion, pressure, nasal polyps, post nasal drip (which will exacerbate a cough). The constant congestion may also lead to snoring and daytime drowsiness from difficulty sleeping.

So what can you do? There are plenty of OTC medications (which will be explained more in a future post), such as antihistamines, mast cell stabilizers, intranasal corticosteroids, and leukotriene receptor antagonists (LTRAs). These are all triggered at symptom relief because there is no real "cure" once the antibodies have been made to the specific antigen- however immunotherapy (or allergy shots) can be used if trigger is identified and if medications are not effective. People often do nasal rinses or other alternative methods. The main thing that can be done is to identify the allergen and avoid it.