The Pollen’s Blowing --and If You Have Allergies, So Are You
If you’re prone to seasonal allergies, your nose already knows: It’s a bad year.
Tree pollens are high, grass pollens are high and weed pollens are moderate, but don’t get too excited--they’re expected to get worse.
Factor in the gale-force winds that have been blowing around Southern California this week, and you’ve got the perfect prescription for itchy eyes, runny nose and scratchy throat.
“Winds can easily increase the pollen count fourfold,” says Dr. Robert Eitches, an allergist on staff at Cedars-Sinai Medical Center and a UCLA assistant clinical professor of pediatrics.
“And it’s going to get worse,” predicts Dr. Bernard Geller, a Santa Monica allergist on staff at Santa Monica-UCLA Medical Center and St. John’s Hospital and Health Center.
The heavier than average rainfall in Southern California over the past few years, resulting in more vegetation and higher pollen levels, is also to blame, he says.
Even some patients who have remained fairly misery-free after years of allergy injections, known as immunotherapy, are suddenly returning for treatment this year, Geller observes.
But there’s good news if you’re among the 22 million Americans suffering from seasonal allergies. There are more medicines than ever before, including new formulas for children:
* Astelin (azelastine), a topical antihistamine spray available only by prescription, went on the market last month.
“It’s the first topical antihistamine released in the U.S.,” Eitches says. The recommended dose is two sprays per nostril twice daily, according to the manufacturer, Wallace Laboratories. It usually works within an hour, Eitches says, providing relief by blocking the histamine receptors in the cells. Histamine is one of the main chemicals released when cells come into contact with pollen and other allergens.
* New forms of oral prescription antihistamines that don’t cause drowsiness are also available.
Claritin (loratadine), for instance, now comes in RediTabs, designed to rapidly dissolve on the tongue. The prescription medicine is taken once a day, according to Schering-Plough, the manufacturer.
Claritin and Zyrtec (cetirizine), a non-sedating antihistamine available by prescription from Pfizer Inc., are also now available in a flavored syrup for children 6 and older. Both syrups can be given once a day.
* Nasalcrom (cromolyn sodium) nasal spray has gone from prescription to over-the-counter status and works by stabilizing the nasal cells before they can react to allergens, according to literature supplied by the distributor, McNeil Consumer Products. Consumers are advised to use the medication several days before coming into contact with allergens and to ask their doctor about exact doses.
Among other anti-allergy options are corticosteroid nasal sprays, absorbed topically and designed to be used throughout the season. Sometimes allergists will prescribe two or three nasal sprays if symptoms are particularly severe.
Prescription eye drops are sometimes recommended to reduce itchiness and watering.
And for patients not helped by medicines, immunotherapy can provide relief. Injections of the allergen extract “desensitizes” the patient over time.
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The Seldane Saga
The Food and Drug Administration is continuing its effort to withdraw approval of Seldane (terfenadine), announced in January.
Since its introduction in 1985, Seldane had been linked to potentially fatal heart problems when taken with certain other drugs, including the antibiotic erythromycin and the anti-fungal ketoconozole.
Allegra (fexofenadine), a prescription antihistamine approved last year by the FDA, is now recommended by the FDA over Seldane. In the FDA’s view, fexofenadine “provides nearly all of terfenadine’s beneficial effects but does not appear to cause a potentially fatal heart condition when taken with some other commonly prescribed medications.”
But a spokeswoman for Hoechst Marion Roussel, which manufactures both Seldane and Allegra, says the company requested a hearing last month and will try to keep Seldane on the market. (Seldane is still prescribed by many allergists, who say they first screen patients.)
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OTC Treatment
There are plenty of over-the-counter options for allergy relief, but experts advise caution and, in some cases, checking with a physician first.
Topical decongestant nasal sprays can cause a “rebound” effect after more than three days’ use.
And extensive use of OTC decongestants may cause stroke in certain susceptible people, according to a small study presented at the American Academy of Neurology meeting earlier this month. Five patients, ages 35 to 49 and not at high risk for stroke, were taking OTC decongestants for allergies or upper respiratory infections for several days or much longer before the strokes occurred.
Dr. Eric Raps, director of the division of stroke and neurointensive care at the University of Pennsylvania Medical Center and lead author, advises people to seek a doctor’s opinion before taking these OTC decongestants for extended periods. He suggests that people whose blood vessels have a tendency to constrict more easily than others--such as those who suffer migraines, as some of his patients did--may be more sensitive to the side effects from decongestants.
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Resources
For referrals to allergists or educational brochures, call:
* Asthma & Allergy Foundation of America, Los Angeles, (800) 624-0044.
* The American Academy of Allergy, Asthma and Immunology, (800) 822-2762.
* The American College of Allergy, Asthma & Immunology, (800) 842-7777.
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Clearing the Air
Paying attention to the environment can reduce allergy symptoms.
* In warm weather, close the windows and turn on the air-conditioning to reduce the pollen count indoors.
* Consider special air filters for use in the furnace and air-conditioner.
* Avoid exercising from 5 to 10 a.m. on high-pollen days.
