HEALTH Nothing to Sneeze At

WHEN HEATHER ARONSON moved to Dallas from Connecticut last year, she was looking forward to a break from the Northeast’s ice and snow that frequently kept the family house-bound for days. How pleasant it would be, she thought, to be outside more, to garden and just enjoy the beautiful fresh air of North Texas.

After the moving cartons were gone and the furniture was in the right place, the Aronsons settled in to Dallas. But Heather was miserable. She’d had a short bout with allergies years ago, but nothing like the symptoms that hit her in Dallas. It was like a never-ending cold. On top of chat, she was having difficulty breathing.

Welcome to the club. Heather. Many culprits hiding in our homes and floating in our air make Dallas the unofficial sneeze-and-wheeze capital of the United States. Allergists know it well; their offices are jammed with drippy-nosed, hive-ridden and puffy-eyed patients every spring and fall-many of whom have waited four miserable weeks to get an appointment. When it’s not officially “allergy season,” many are still sneezing. Why is Dallas such hostile territory to folks with allergies?

“I hear it over and over,” says Dr. David Khan, assistant professor of allergy and immunology at the University of Texas Southwestern Medical Center (where the two-year allergy residency requires an internal medicine or pediatric residency first). “Patients say they never had allergies ’til they moved to Dallas.”

An allergy, with its attendant sneezing, coughing, itching, puffy red eyes and runny nose, is in fact just your body’s immune system-its defense against bacteria and ?ruses-overdoing its job. Allergy patients are actually made sick by their own body’s violent temper tantrum response to simple irritants, a too-hasty flip of the Immunoglobulin E (IgE) ignition switch. Let pollen be inhaled and an allergy patient’s IgE cells inflame, fighting off what cells believe are parasite invaders.

That was what the system was developed to do; now that we are relatively parasite-free, the system cells release histamines in response to allergens. (Interestingly, in parasite-rich third-world nations, patients have high IgE levels but few allergies. Allergists say their bodies are too busy battling parasites to think twice about pollen.)

And unfortunately, some of the same environmental factors that draw people to the Dallas area and make it a great place to live also make it, for some, a terrible place to breathe. Many new Dallasites find themselves sneezing and coughing three to four years after they settle here, even if they’ve never suffered from allergies before. The factors listed below not only cause allergy problems separately for North Texas residents, they work together to make the Dallas area a pollen paradise.



AN ALLERGY SUFFERER’S LIST OF VILLAINS

1 A year-round growing season: Yes, we have a generous growing season-that leaves eight months of pollen in the air, Actually, the flowers are not to blame; trees and grasses are, especially mountain cedar.

2 Few strong freezes: We all love Dallas’ mild weather and year-round green lawns, especially those of us who grew up in 80-degree-below wind chills. The price we pay, however, is a year-round fungus season and few freezes to kill off the pollen. At least we’re warm while we sneeze.

3 Blowin’ in the wind: Strong North Texas winds blow airborne pollen across the flat topography from Weatherford to Tyler, and back-but wind alone is not the problem. Some meteorologists say Dallas is windier than Chicago, but Chicago has far colder weather, yielding a shorter life span for pollen. So Windy City folks will sneeze for maybe six weeks in the fall, while Dallasites will sneeze for several months. Then, say allergists, there’s an almost domino-like “tipping factor” effect: If you are allergic to a certain type of fungus, that allergy can heighten your body’s allergic reaction to ragweed, priming you for more misery.

Dr. Khan, who worked at the Mayo Clinic in Rochester, Minn., during his training, found that allergy patients in the North were allergic to an average of two items. In Dallas, he often finds patients who are sensitive to 15 or 20 allergens. Six months of winter apparently give Northerners’ immune systems a break.

“The longer your exposure to allergens, “he says, “the more things you will become allergic to.”

4 Air quality-LA., here we come: Allergists say that air pollution by itself can cause more allergic symptoms and breathing difficulties. And ozone primes allergic reactions, making them worse than normal.

Dallas air is on the cusp of being declared hazardous by the Environmental Protection Agency. No, we’re not as bad as the L.A. basin, as Channel 8 meteorologist Troy Dungan knows firsthand. When Dungan, who suffers from asthma and allergies, visits California, he says he has real asthma problems: He arms himself with medication, stays away from cats and doesn’t jog in LA.

5 Field of weeds: Dallas is home to many undeveloped fields and marshy areas, jam-packed with many varieties of weeds, including man-sized ragweed plants growing in the Trinity River flood plain. The wind blows this pollen right to our yards. To the dismay of environmentalists, developers may provide allergy victims some relief when they put in asphalt and a shopping center. But the way they construct those buildings yields more problems, which brings us to…

6 Airtight homes and buildings: The summum bonnum of modern building is energy efficiency, and nobody doubts its value. Ironically, however, energy efficiency is also an allergy hazard: As we get better at sealing in artificially cooled or heated air we are also doing a better job of trapping indoor allergens. Some people develop allergies to building materials and their by-products; some get deathly ill from what’s known as “sick building syndrome.”

Filtered indoor air may screen out pollens, but it lacks the proper mixture of ozone and other trace gases. Then there are the mites {see below). Energy-efficient homes and office buildings become air-tight mite brothels and toilets.

7 Blame the bugs: No matter how many times you call the exterminator, inevitably you have a few freeloading cockroaches hiding in your home. In extreme cases, studies have found that 10 percent of inner-city children with severe asthma are allergic to cockroach droppings.

Also, we are allergic to dust mite feces. Our bodies shed microscopic flakes of skin, about a gram per day on average. This produces nutritious meals for the dust mites that live in our upholstered furniture, mattresses, pillows and curtains. One dust mite produces 20 to 30 fecal particles per day. Disgusting but true: We breathe these microscopic organisms and their feces 24 hours a day.

8 Higher humidity: High humidity helps fun-gus grow, and there is speculation that the many water- reservoir lakes around Dallas may have made our climate more humid than it was 40 years ago.



ARE YOU REALLY SICK OR IS IT AN ALLERGY?

WE’VE ALL HEARD SOMEONE SAY, “I’M NOT sick but I feel terrible. Maybe it’s an allergy.” But what is the difference between an allergy and a cold?

Basically, allergies cause plumbing problems in the nose. Doctors tell us the nose has several functions including smelling, breathing, warming and moisturizing air en route to the lungs, vocalization and filtration.

But in an allergic patient, the histamines rear up like a spooked horse with every breath of pollen-laden air, causing nasal membranes to swell. The poor nose is just trying to do its job- get that air circulated through the turbinates, the air conditioning system of the nose, and into the sinuses for moisture. As the swelling continues and membranes dry out, the sinuses finally become sealed-off cesspools that bacteria can hardly wait to find-and the result is sinusitis. Or maybe allergic rhinitis-sneezing 50 times in an hour; puny, itchy eyes; congestion, a nose that runs like an open faucet.

Other patients develop asthma, a condition in which muscle squeezing, swelling and excess mucus blocks airflow into and out of the lungs.

For others, the allergens attack and their bodies respond wildly by breaking out in itchy, red patches and bumps-hives.

Allergy capital though Dallas may be, allergies are on the rise nationwide. In 1975, 35 million Americans suffered from allergies. This year allergists estimate more than 50 million Americans arc allergy-afflicted. The National Institute of Health says allergies are the sixth most common health ailment.

While no one dies from a drippy nose, asthma claims more than 5,000 lives per year, and 12.4 million Americans suffer from it. Asthma is one of the most common reasons for emergency room or doctor’s office visits. Doctors say the asthma rate increased almost 30 percent from 1980 to 1987, whether from air pollution, more inside living or both.

“People are inside more,” says Dr. Gary Gross, a Dallas allergist. “Television, computers, fear of crime. They are exposed to more interiors, more dust mites. We know exposing children to dust mites early on will enhance their chances of getting asthma later in life.”

Life with allergies can be highly unpleasant, Children with allergies don’t concentrate as well in school, say doctors. Patients complain of fatigue, frustration, reduced activity and irritability. USA Today cites a Roper Starch poll claiming allergies account for more lost work time than the winter cold and flu season. One in six Americans sneezes and coughs his or her way through spring and fall.

Each year, 42 percent of allergy sufferers leave work early or call in sick; and allergies cost employees $200 million in lost wages. The employer bite is bigger-$639 million in lost time and productivity.

Yet allergists say some primary care physicians still hesitate to refer HMO patients to them because of insurance company driven cost-containment. In Oregon, a large managed-care state, the Oregon State Health Plan for Medicaid recipients only covers severe allergies-severe having many definitions, including suffering for more than three months of the year.

WHEN TO SEE AN ALLERGIST

YOU CAN TREAT MILD ALLERGY SYMPTOMS with over-the-counter medications, but doctors warn that some can be harmful with repeated use. Nasal sprays such as Afrin can damage nasal membranes and make them swell more; decongestants can raise blood pressure and affect glaucoma.

Generally, if symptoms last more than a week after using over-the-counter medications, call your doctor. After examination and pin-prick/serum testing, allergists offer three levels of treatment: medication, removing the allergens and immunotherapy.

Many allergists will do a simple, cheap nasal smear to check out nose secretions. “Half the patients we see don’t get skin tests after the nasal smear,” says Dr. Michael Ruff.

Medication works on the symptoms, not the cause. Decongestants shrink blood vessels in the nose, relieving stuffiness. Antihistamines dry out the sinus liquid. Prescription nasal sprays work for many sufferers.

Consumers spend more than $2 billion annually on allergy relief, both on prescription and over-the-counter drugs. The trick is to find an allergy medication that will work without making you too drowsy to function.

Whenever a couple billion dollars in sales is at stake, you can bet that pharmaceutical companies pay attention. Big allergy drug makers, such as Schering-Plough, makers of Claritin, and Glaxo-Wellcome, makers of Flonase, have increased die money they spend on advertising by more than 100 percent. Two companies, Schering-Plough and Pfizer, are now engaged in a downright nasty sneeze-relief turf battle-Claritin vs. Zyrtec, the new kid on the block.

Several local pharmacists polled unscientifically agree that they fill more prescriptions for Claritin and Seldane than any other allergy medication, because these are the two second-generation prescription drugs that give snif-flers some allergy relief without drowsiness. Seldane has a few drawbacks-doctors say its 60 percent share of the allergy prescription market fell five years ago when it was linked to irregular heartbeats and possible deaths when taken with antifungals and some antibiotics such as erythromycin,

If misery comes from allergens in your home, perhaps from dust mites or pets, then allergists will suggest you eliminate the allergens. But molds and fungus are virtually impossible to eliminate, inside or out. Bathroom carpet that never dries, unknown leaks-there are many places tor mold to flourish in homes. The same is true for dust.

Pets also aggravate asthma and allergies, cats more so than dogs because their skin flakes tend to stay suspended in the air longer. Allergists recommend bathing pets often and confining the pet to one room in the house where you can vacuum and mop often, And keep pets out of the bedroom. An allergy sufferer’s bedroom should be as dander- and mite-free as possible-easier said than done.

To get rid of dust mites you have to be compulsively clean-vacuum floors and carpets (bare wood is better than carpet); vacuum mattresses (2 million dust mites can loaf in one mattress); wash bedclothes in water hotter than 130 degrees wen- other week; dry clean bedspreads and comforters. Dust often and avoid clutter.

What about a child’s room filled with books, toys, Legos and stuffed animals?

“Freeze ’em,” says Dr, Gross. “Sounds kind of cold but you could warm stuffed animals in the microwave before bedtime. Freezing kills mites.”

Some allergists also recommend electrostatic or disposable filters for HVAC units at home. Air duct cleaning is not as effective, they say, if duct dust is not causing the allergies. Cleaning air ducts may help alleviate mold allergies if the patient is not irritated by the spray sealant. North Dallas allergist Dr. Barbara Stark Baxter, whose daughter has allergies, uses alpine air purifiers in her home. Alpine machines produce negative ions and ozone and seem to help some allergy patients, she says.

Bottom line: Once you’ve eliminated as many allergens as possible, stay inside and breathe air-conditioned air.



IF YOU CANNOT TREAT THE SYMPTOMS and/or remove most of the allergens, then physicians recommend immunotherapy (allergy shots) to reduce the body’s allergic response to the allergen. Allergists say patients should have three months of constant symptoms before considering immunotherapy.

The shots work by exposing the body to increasing doses of an allergen obtained from the extracts of whatever it is testing shows the patient is allergic to. Exposure seems to quell the body’s overactive response, After the rest from histamines that immunotherapy gives the body, the patient can even go without shots ultimately. In general, allergists say some patients receive their maximum benefit alter five years of immunotherapy.

Research universities and pharmaceutical companies are getting close to finding new allergy control medications. One possibility is peptide immunotherapy-actual peptide protein fragments of the allergen to “turn off” the allergic response.

Some researchers are tinkering with the body’s immune response, blocking the IgE “ignition switch” that throws the door open to the body’s allergic temper tantrum. Anti-IgE injections apparently have a profound effect on hay fever and bronchial asthma. But immunotherapists wonder if disarming one part of the body’s immune system is a wise idea-what if we get too close to destroying the core of the immune system ? What if, in the process, we destroy another antibody that plays a vital role in the body’s defense against, say, common bacteria? Or salmonella?

We may not be able to eat, but at least we’ll still be able to live in Dallas with our pets and dust mites, without sneezing.