gEORGE BESSINGER IS YOUR TYPICAL, MISERABLE ALLERGY SUFferer. Since he moved to Dallas in 1995, the simple act of breathing has been nothing but trouble.
Bessinger’s problems struck him with a vengeance during his first fall ragweed season here. Living on Benadryl, the 51-year-old realized that the allergic rhinitis, or hay fever, that had plagued him in New Jersey as a child was now back. And worse than ever. Bessinger needed relief, and his PPO led him to the allergy clinic at University of Texas Southwestern Medical Center and the office of David Khan, M.D.
“It was kind of an eye-opener,” says Bessinger, remembering the skin tests he had during his initial visit. “I found out I am allergic to 48 different weeds, grasses, and trees. And I found out that it was probably the case that I had never breathed normally.”
So began a grueling regimen of medication, experimentation, and restructuring of his environment, all aimed at trying to enable him to breathe easily in a city where pollen seasons are long and allergens profuse. Bessinger tried corticosteroid nose sprays, which affected his concentration and gave him “angry dreams.” He spent a lot of money thwarting dust mites in his house, putting in hardwood floors instead of carpeting, installing a new furnace with a special allergy filter, and buying mattress pads that could be changed frequently. But year-round, Bessinger still couldn’t breathe well, and eventually, despite the recommendation of his general practitioner, he turned to immunotherapy, getting weekly and then biweekly shots that make him itch and that swell his arms up like balloons for 24 hours.
Bessinger worries about the shots: “It’s not exactly intuitive to put things you’re allergic to back into your body. What if they accidentally make the shots too strong one time?”
But Bessinger believes that it’s a trade-off he has to make. “They make life tolerable,” he says. “Sometimes that has to be enough.”
And, really, pitiful as it may sound, tolerable may the best Bessinger and other Dallas hay-fever sufferers can expect from their lives. Because in 1998, while science has brought us anti-aging antioxidants for the skin, the successful birth of septuplets, and even sheep clones, we’ve yet to find a way to stop tiny, determined, male fertilizing pollen particles from wreaking havoc on the immune systems of 10 to 20 percent of the population.
The bottom line is this: If you have allergies and you live in Dallas, chances are, you’ll survive. But you’ll have to weed your way through a lot of controversial, often contradictory information in the search for relief.
Controversy No. 1:
WHAT IS HAY FEVER?
Seasonal allergic rhinitis is most popularly known as hay fever. But, of course, it has nothing to do with either hay or fevers. The term comes from an early 19th-century British physician who started sneezing and feeling sick every summer during the English haying season, so he correlated his symptoms with the season. His reasoning was wrong, but the term stuck, setting the precedent for a history of confusion concerning the disease.
Disease? Are allergies a disease? Some experts say yes, others no. And that’s just the beginning of the conflicting opinions about what allergies are and how they should be treated.
The American Academy of Allergy, Asthma & Immunology adheres to the view of traditional medicine: “Allergy is an abnormal sensitivity to a substance which is normally tolerated and generally considered harmless.” Bob Lanier, M.D..KXAS-TV Channel 5 family physician and allergy researcher, clarifies: “Your body thinks it has breathed in something dangerous. It’s trying to expel these allergens from your body. That’s why your nose runs, your eyes get watery, you sneeze, cough, and drain.”
Allergies, says Lanier, are a manifestation of a strong (but confused) immune system, an immune system that goes into overdrive when confronted with pollen, mold, dust, or animal dander that it mistakes for an invader.
Seems simple enough, but the problem is that not everyone agrees with the basic premise that a strong immune system is what causes allergies. Alternative medicine theories are based on the premise that allergies are the sign of a weak immune system and that the key to conquering allergies is to bolster that system.
Controversy Ho. 2:
TAKE RX AND CALL ME IN THE MORNING
Gary Gross, M,D., has spent 23 years treating allergies. The 54-year-old doctor seems troubled at first with the idea of a consumer-based story on allergies. His festive Tickle-Me-Elmo tie is at odds with the deepening furrow on his brow. “Are you interested in facts or a story that is entertaining?” he asks during an interview at his office at the Dallas Allergy & Asthma Center, across the street from Presbyterian Hospital.
The hesitation, though, proves short-lived as Gross begins to delve into the details of a profession for which he clearly has a passion. He explains a typical new patient’s experience at the clinic: Patients are first given skin tests-pin pricks on areas to which various allergens have been applied. “Up to 80 allergens can be tested at a time,” says Gross. “We have lots of molds, trees, and weeds in Dallas that do not cross-react, so we have to test for each individually.”
If seasonal allergies are found, then medication usually begins. Gross gives a roll call of current allergy products available both over-the-counter and through prescription: decongestants; antihistamines, including new generations that cause only minimal drowsiness; and corticosteroids, which, Gross says with growing enthusiasm, have been very effective.
Gross ’ enthusiasm for advances in allergy medication in the last few decades is echoed by medical doctors throughout the area who note that bigger and better treatments are on the way-some of which may even prevent allergic reactions from happening.
But if all these medications are providing effective relief, why do so many people still feel so miserable all the time?
“Why do they?” asks Gross with a smile. “Isn’t that funny?”
But he knows it’s not funny, Gross then explains, seriously, that not all people are receptive to all treatments. And receptivity can change with age and time. Often it’s a matter of trial and error to find what works for a given individual at a given time.
He throws out another suggestion: “Maybe if you can’t find relief, it’s because you don’t have true allergies. Allergies have become kind of fashionable. Be careful not to fall into thinking that everything that’s presented as an allergy is truly an allergy.”
Controversy No. 3:
ARE ALLERGY SHOTS THE BEST ANSWER FOR EVERYONE?
Four years ago, Roz Freeman decided she’d had it with allergy medications. Bom and raised in Dallas and “allergic to almost everything;’ the executive assistant at Parkland Memorial Hospital says she spent decades taking combinations of over-the-counter and prescription medicines and says she did find relief from her allergies once-for four days, during a trip to Phoenix.
She tried antihistamines.
She tried nasal sprays.
She bought new mattresses and hypoallergenic pillows, started changing the bed linens every other day, abandoned the idea of perfume, learned to drive with the windows always up, and dusted constantly.
In return, she was miserable. She went into sneezing fits from the nasal sprays and contracted frequent upper respiratory infections. “I was always either too drowsy to do anything, or I was suffering,” she says. “You have to make that decision about which way you want to be that day.”
Finally, she decided it was time for immunotherapy.
And, soon, for the first time in 33 years, she could breathe.
“You don’t understand what a difference these injections have made in my life,” says Freeman. “Things in my world are manageable now. They’re tolerable. I feel almost normal. I tell you, I’m really blessed.”
For more than six million American severe allergy sufferers, immunotherapy, a non-drug format that creates tolerance and resistance to allergy, is a blessing-albeit a mixed one.
On one hand, patients can avoid the risks and side effects of drugs and have the prospect of remission. Allergy shots, which are covered by most insurance plans, also can make economic sense for a patient-one recent study by a physician in Atlanta showed that by the second year of shots, immunotherapy, even with its initial testing fees that range from $400 to S500, becomes less expensive than taking prescription drugs for year-round allergies.
On the other hand, the injections, which put small amounts of allergens into the patient’s body, can be risky. The dosage of allergen must be exact. And sometimes, even if a doctor does everything right and the patient has been responding well to a program, suddenly the shot can cause an allergic reaction.
For this reason, while many patients say immunotherapy is the best answer, “most allergists will try to medicate first,” says Rebecca Gruchalla, M.D., director of Allergy and Immunology at UT Southwestern Medical Center, who adds this warning: “You have to look at this reasonably. This isn’t just a magic bullet.”
Controversy No. 4:
ALTERNATIVE THERAPIES
Fifteen percent of chiropractor Ralph “Chip” Stokes’ patients come to him strictly for allergies. “But it’s almost like a universal thing,” he says. “They come in for something else and mention that their allergies are acting up.”
So the former businessman, who set up his own office in Richardson four years ago, treats these patients who say they have allergies, using a variety of techniques grounded in homeopathy, chiropractics, and acupuncture.
Stokes says that an allergy is simply an adverse reaction in your body to something it doesn’t like. This idea meshes with allopathic views. But beyond that statement, Stokes’ ideas have little in common with traditional medicine.
“You need to boost your immune system so that it’s strong enough to overcome what you’re allergic to,” Stokes says. “One thing you can do is introduce what you’re allergic to back into your body, homeopathically.”
In Stokes’ medicine chest, he has dozens, maybe hundreds of bottles of assorted Chinese herbs, including natural antihistamines and decongestants. His corresponding three-ring binder, like a Facts on File collection, includes one-page briefs on each pill, listing its benefits-but not risks. Is he ever worried about side effects? No, he says.
Among Stokes’ collection is a bottle called Allergena, which he explains is a homeopathic solution that treats “all the allergies that are specific to the Dallas-Fort Worth area.”
Physicians caution, however, that many of these “natural” treatments have not been studied or regulated and that the risks may be high. Most vocal among them is Steven Barrett, board member of the National Council Against Health Fraud, who has called Chinese medicine treatments “loony as hell” and described homeopathy as “complete nonsense.”
Stokes says he’s never worried about giving a patient an overdose of an allergen in a homeopathic solution or herb pill that could set off an allergic reaction.
“It’s all scientifically figured out for me,” he says. “I just read what it says on the bottle and don’t worry about people taking too much. I don’t get into that.”
Controversy No. 5:
HOW DO YOU SPELL RELIEF? M-0-U-S-E?
Every day. thousands of researchers across the country conduct studies aimed at making life more tolerable for allergy sufferers.
At RHD Medical Memorial Center, Jeffrey Adelglass, M.D., who heads Research Across America, is positively jubilant about the tests he runs for the nation’s top pharmaceutical companies. New formulations of antihistamines and nasal sprays, he says, will provide ever-increasing levels of relief.
The problem is that all these medications are aimed at treating the symptoms rather than getting to the root of the problem. The promise is that this kind of information has also led to some efforts by pharmaceutical companies to find ways to stop allergic reactions from happening. Period.
Some of the most interesting research by a pharmaceutical company, conducted nationally in 20 sites and locally, but separately, by both Fort Worth’s Bob Lanier and doctors at the Allergy Clinic of Dallas, involves new allergy-fighting antibodies that try to fool the immune system. The idea is to combine human antibodies with mouse antibodies and inject them into a patient. The trouble-making antibodies that generally head right for mast cells when they detect the allergen get confused. They attach instead to the engineered antibodies, which “grab hold of the antibody and make it unusable by the human,” says Lanier.
“No matter what you’re allergic to, you don’t react,” says Lanier, “because all your antibodies are tied up.”
Lanier says it is not inconceivable that before long allergy shots will be injections of these anti-allergic antibodies.
A 1997 study by the Department of Internal Medicine at the University of Iowa involving 240 subjects found that those injected with the mouse antibody showed a decrease in the level of trouble-making antibodies, suggesting that the mouse antibodies “should be an effective therapy for allergic disease.”
Science is moving quickly, and, indeed, it looks as if traditional medicine will be able to someday soon clear up the confusion surrounding allergic rhinitis and start providing some better answers for patients. A study that appeared in The New-England Journal of Medicine in December 1997 showed that scientists at Washington University School of Medicine in St. Louis may have at last identified the specific genetic causes of allergies. This discover)1 is the first step in really solving the mystery of allergies, say scientists. But if you have allergies, it won’t help you. At least not for what will seem to you like a long, miserable while.
George Bessinger is talking, slowly and carefully, about his history with allergy shots. “Basically, the idea is that you get them weekly until you get up to a maintenance dose-which can take anywhere from six months to forever, depending on your reaction. It took me about 12 months.”
Bessinger’s struggles with allergies since he moved to Dallas continue. But while Bessinger, like many sufferers, is resigned to a life of compromise, he is not entirely discouraged.
While doctors and other medical practitioners continue to offer conflicting opinions about what to do about allergies and while science plays catch up with technology in what looks like the best shot at a real cure, Bessinger has devised his own plan for personal relief. And it’s simple.
“I don’t plan on spending the rest of my life here,” he says.
Unsolved Mysteries
Ask a few simple yes-no questions and get a few simple, often-contradictory, answers. When it comes to allergies, experts’ advice is often as clear as a mountain cedar pollen shower on a January day.
– Research Across America
THE QUESTION:
Do pollen counts count?
The folks at the National Allergy Bureau admit that pollen counts have problems: By the time they are published, they are at least a day old. And because weather affects the amount of allergens in the air, these counts may vary greatly from day to day. Still, they argue, the counts will give you a general idea of what’s in store for you. Are they must-see TV?
THE ANSWERS:
Yes “We do our pollen counts every day. They are very reliable. Ours are the only ones locally that have passed the stringent guidelines of the American Academy of Allergy, Asthma & Immunology. They give you a global assessment of what’s in the air. You can use them to draw a relationship from your symptoms to the pollen count. Every individual has a different threshold for every allergen.”
-Jeffrey Adelglass, MD., who provides pollen counts for WFAA-TV (Channel 8)
No “Doing pollen counts would take up time we could better devote to weather. We do try to point out when major seasons are changing. Those little numbers don’t really mean anything.”
-David Finfrock, KXAS-TV
(Channel 5) meteorologist
Maybe “Counts are very localized. If the counter is near a cedar tree, the count for that allergen will be unusually high. The counts shouldn’t be relied on for significant quantitative differences. I would recommend that you look at whether levels are high, medium or low, as opposed to worrying about absolute counts.”
-Gary Gross, MD., Dallas Allergy Clinic
THE QUESTION:
If I’m taking medications for allergies, can I expectthe same level of relief when I’m pregnant?
THE ANSWERS:
Yes “Pregnant ladies are limited to over-the-counter antihistamines and decongestants. But they do very well with these medications.”
-Richard B. Johnson, MD.,
Allergy Associates
No “The level of relief will absolutely go down. The best solution for pregnancy is to stop prescription drugs and go to some of the over-the-counter medicines.”
-Jeffrey Adelglass, MD.
THE QUESTION:
Is Dallas an allergen haven?
The concept : The Dallas area teems with nasal voices who will tell you, and swear that it’s so, that if you live in Dallas for seven months (or seven years, or whatever the current version of the urban legend you are being treated to says), you will have allergies. Dallas, they say, is the worst for allergy sufferers.
THE ANSWERS:
Yes “Yes, and for these reasons: 1 ) this area is perfect for dust mites (a perennial allergen) to thrive-it’s not too cold, not too humid; and 2) we have pollination from a variety of sources year-round.’’ -Rebecca Gruchalla, MD., director of Allergy and Immunology at UT Southwestern Medical Center
No “Absolutely not. People take great pride in saying their city is the worst in the country. Any place you have protein in the air, you’ll have trouble.”
-Bob Lanier, MD., president of
Lanier Education and Research
Network, Fort Worth, and KXAS-TV
(Channel 5) medical consultant
No “Dallas is no worse than anywhere else. I have a colleague in Phoenix who’s just as busy as we are.”
-Richard Johnson, M.D.,
Allergy Associates, Dallas
Kids and Allergies
Your husband has allergies, and now your baby won’t stop sniffling. Is it just another kid cold or is it something worse?
LEARN THE SIGNS OF ALLERGIES VS. COLDS
The signs of allergies are often similar to the symptoms of a cold. Kids with allergies tend to be cranky and tired all the time but lack a fever or other signs of illness. They have dark circles under their eyes and tend to have sneezing fits, recurrent ear infections, and recurrent, unexplained nosebleeds. They also rub their noses a lot in an upward motion: This Allergic Salute eventually breaks the tissue over the bridge of the nose, causing a nasal crease.
If your child has coldlike symptoms that linger for more than 10 days and if the symptoms match those for allergies as shown below, it’s time to see a doctor.
Source; lane Brody’s Allergy fighter, 1997
Allergie rhinitis affects more than 35 million people in the United States, including 10 to 20 percent of all school-age children whose sniffles and sneezes often cause them to miss school or perform poorly in the classroom, What can you do to help them?
Do some gene pool mathematics.
Genetically sneaking, the chances are pretty good your offspring may indeed have allergic rhinitis. If you or your spouse has allergies, your child has a 25 to 40 percent chance of developing them. If both parents are plagued by allergies, the likelihood increases to 60 to 80 percent. To make things interesting (and confusing), your child may not necessarily be allergic to the same things you arc;. Allergies can also skip a generation or suddenly appear in your child’s pre-teen or teen years. Further complicating matters, kids have been known to grow oui of their allergies-and then get them again 30 or 40 years later. Why? “No one really knows,” says Dr. Jeffrey Adelglass of Dallas’ Research Across America.
Prevent problems with infants.
The correlation between early allergen exposure and development of allergies is clear. Studies with animals show that if the animat is exposed to allergens shortly after birth, the risk of allergies increases.
Mite and animal dander allergies in children has been linked to the amount of early exposure to these allergens. If you think your child may be susceptible to allergies, try the following:
■ Use plastic covers on mattresses and pillows
■ Wash bedding in hot water once a week
■ Avoid high indoor relative humidity
■ Remove carpets, upholstered furni Hire, or objects that collect dust in the bedro
■ If you want your child to have a pet, stick with fish or a turtle
Call the doctor.
Blood and skin tests are the best ways to find out if your child has true allergies. Training for all allergists/immunologists includes medical school, followed by three years of postgraduate work in either pediatrics or internal medicine, with two additional years in allergy and immunology. Look for an allergist whose specialty is pediatrics.
Just treat it.
Both over-the-counter and prescription medicines can offer some relief for your child. For example, new pediatric versions of the minimally sedating oral antihistamines cetirizine (Pediatric Zyr-tec) and loratadine (Pediatric Claritin) have been approved by the FDA for ages 6 and up, and Tylenol offers Children’s Tylenol Sinus and Children’s Tylenol Allergy-D fan antihistamine with a decongestant and an analgesic). The FDA also cleared Flonase Nasal Spray for children 4 and up in November 1997.
In addition, many allergy-symptom-relieving drugs have not been approved for children, but that does not necessarily mean the drugs aren’t safe: It only means they haven’t been tested in clinical studies with children. Ask your doctor for his or her recommendation, and if medications do not seem to be giving your year-round allergy-suffering child the relief he or she needs, you may want to consider immunotherapy, which can begin as early as age 3.
Living With Allergies: Avoidance
Like most things in life, your allergies won’t go away if you try to ignore them. While life with allergies is miserable, you can take some common-sense suggestions to help keep the symptoms at bay.
■Pay attention to the weather:The worst times to be outside are on sunny, windy mornings when the pollen count is high.
■Keep the windows of your home, car, and office closed, and, when it makes sense, turn on the air-conditioning to decrease humidity,
■Don’t cut your grass yourself, keep your grass well trimmed at all times, and shun Bermuda grass at all costs.
■If you like to garden, plant insect-pollinated flowers and shruhs (such as azaleas) and trees (such as magnolias). Wear a dust mask while outdoors, and shower and wash clothes in hot water as soon as you come inside.
■Avoid makeup that contains chamomile, a botanical relative of ragweed.
■Don’t smoke or allow others to smoke in your home.
■Look for hidden allergy sources. Some foods have proteins that seem to mimic those of pollens, and eating these foods may set off allergic reactions during a given pollen season. If you are allergic to the following pollens, you may want to avoid the foods listed here:Ragweed: bananas, cantaloupe, chamomile, honeydew melon, watermelon
Birch: Anise, apples, caraway, carrots, celery, coriander, cumin, hazelnuts, parsley, parsnip, peaches, peanuts, potatoes
Mold spores: Beer, buttermilk, aged cheese, cider, dried fruits, mushrooms, olives (cured), pickled fish and meats, pickles, sauerkraut, vinegar and foods with vinegar
■ If you suffer from year-round allergies, get rid of the breeding grounds of dust mites. Eliminate open shelving, dried (lowers, baskets, and knickknacks. Get rid of carpeting and go for hardwood, vinyl, or tile floors. Say goodbye to cloth upholstery and hello to leather and vinyl, and use vertical or roller blinds instead of horizontal blinds or draperies.Turn off ceiling fans: They keep allergens moving about in the air. Wash sheets and bedding in hot water at least once a week; use synthetic pillows and bed covers, and cover mattresses with plastic,
Try an electrostatic air filter or High Efficiency Particulate Air filter in the bedroom.
■ If you suffer from year-round allergies, keep mold and mildew to a minimum. Use mildew-resistant interior wall paint, Keep humid ifiers clean so mold doesn’t incubate. Clean bathrooms regularly with a fungicide. Don’t allow wet towels or clothing to sit in the washer: dry immediately by machine (laundry hung outside can pick up pollen). Limit indoor plants, as mold can grow in wet soil.
■ Control animal dander by keeping pets clean and off the furniture.
