Ah-chooo! : Allergy Sufferers Can Breathe Sigh of Relief With New Drugs

About this time each year, the immune systems of millions of Americans run amok.

A cruel and ironic mix-up occurs. The internal chemistry that is supposed to keep them healthy makes them sick. They drip and sniffle. They wheeze. They sneeze. They itch in places that they can only fantasize about scratching.

They have what is sometimes known as allergic rhinitis or, quaintly, autumnal catarrh. To almost everyone, however, it’s hay fever, the spring and fall allergy that is a far worse evil than its mildly whimsical name suggests.

As only these victims of nature can appreciate, the disease has the power to reduce strong men and women to eviscerated shells, sad shadows of their once peppy selves. In the grim, pollen-choked days of September, it may even set the mind to wondering whether life is really worth living.

3 New Treatments

There is no easy cure for hay fever. But over the last couple of years, three new kinds of drugs have been introduced that provide merciful escape from the symptoms. And unlike many of medicine’s earlier answers to hay fever, these treatments are not worse than the disease.

In fact, Dr. Michael Kaliner, chief of the allergic diseases section of the National Institute of Allergic and Infectious Diseases, can now make a statement that he says would have been unrealistic just two years ago:

“People should not have to suffer. Proper use of the drugs we have today should control essentially everybody’s symptoms. There’s been dramatic improvement.”

The new drugs are Seldane, a form of antihistamine, and two kinds of nose sprays--Nasalcrom and topical steroids. All of them, in different ways, take the punch out of histamine, the natural body secretion that gets out of whack during allergy time.

20 Million Affected

Hay fever is an allergy to pollen. It afflicts roughly 20 million Americans. In the central and eastern parts of the country, ragweed is the big offender in the late summer and fall. But people are also allergic to grass and trees in the spring and early summer.

However, hay fever certainly isn’t the only allergy. An equal number are thought to be be allergic to cats, dust, insects, medicines, molds, foods or feathers, among lots of other things.

In all of these allergies, the body’s immune system identifies some harmless intruder as a danger and opens war. The real internal troublemaker is an antibody called immunoglobulin E, or IgE. This antibody was not woven into the body’s chemistry simply to make folks miserable. It’s useful for warding off parasitic infections. But people with allergies have too much of it.

Here’s what happens:

With lots of IgE floating around, thousands of the antibody molecules stick to the surface of mast cells. These cells line the skin, nose, throat and other parts of the body. Trouble starts when an allergen appears on the scene.

An allergen is anything that causes an allergy. For a hay fever sufferer, it might be a few innocuous grains of ragweed pollen. The allergen combines with the IgE. This reaction, in turn, stimulates the mast cells to manufacture a burst of chemicals. Among these secretions is histamine.

Histamine makes people feel rotten. It swells the blood vessels and makes them leak. It inflames the skin and tightens the air passages. It makes the corners of the eyes itch. The symptoms range in severity from annoying to disabling.

“It’s always said that people who don’t have allergies really can’t appreciate them,” Kaliner says. “Those of us who have allergies recognize that they’ll ruin your life.”

Imagine having a nose that runs constantly, a cold that never seems to go away. People with allergies have a powerful urge to jam their fingers into their eyes to quell the awful itch. Some run a low fever.

“They are incapacitated,” says Dr. Albert Sheffer, allergy chief at Brigham and Women’s Hospital in Boston. “They have a general feeling of malaise. The itching is bad enough. The lack of sleep is terrible. But the lack of motivation, the lack of feeling well, makes them think they are infected.”

The first line of defense against allergies has long been--and still is--antihistamines. For many seasonal sufferers, the kind available over the counter do a fine job of keeping the nose clear. But some people refuse to take them because they make them sleepy.

A new prescription form of antihistamine, known as Seldane or terfenadine, is not the most powerful available, but it has a unique property: It doesn’t cross from the bloodstream into the brain. So it doesn’t make people tired.

‘A Tremendous Improvement’

“This has been a tremendous improvement and benefit for our patients,” says Dr. Ross Rocklin, head of allergies at New England Medical Center. “Now people can take medication for their hay fever and operate machinery and drive around without falling asleep at the wheel.”

Antihistamines interfere with histamines once they are released. Another and entirely new approach to treating allergies is a kind of medicine that stops mast cells from making histamine and other chemicals. This drug is a prescription nose spray called Nasalcrom or cromolyn.

Nasalcrom is slow to have an effect once allergy symptoms begin. But if people use the spray daily before their miseries start, they may be able to ward off hay fever symptoms entirely. The stuff doesn’t make people feel run-down or carry other noticeable side effects.

“It’s like preventing a disease from occurring rather than treating the disease after it occurs,” Kaliner says.

Spray-On Steroids

However, probably the biggest advance of all, Kaliner says, is spray-on steroids, which he says have revolutionized the treatment of hay fever. Cortisone-like drugs have long been used for severe allergies. But when they circulate throughout the body, they can cause dangerous side effects.

The new prescription sprays deliver tiny amounts of steroids directly to the irritated tissues, where they soothe the inflammation. Any of the drug that reaches the bloodstream is quickly removed. Doctors believe that they can be used safely through the entire hay fever season.

Since the new drugs all work in different ways, they can also be combined effectively to blunt the body’s overreaction to pollen.

“Our experience,” Kaliner says, “is that every patient with allergic rhinitis can be adequately controlled with medications.”