Achoo!

How to survive pets, pollen and pollution.

By Martha Bauman

Oh, it’s just an allergy.” You’ve heard it, and probably said it as you sniffled and sneezed through the season. You’re more likely to be annoyed than frightened by the condition. Still, allergies do take a toll on one’s well being. In addition to the typical runny nose and scratchy throat, allergies can affect hearing and balance. Allergies may bring dizziness and shortness of breath or trigger an asthma attack. Sleep is often disrupted.

Dr. Li Liang of Allergy and AsthmaSpecialists of Nashua (www.allergy-asthma.net) says the culprit is an allergen, a harmless substance that the body perceives as dangerous. The sneezes, runny nose, rashes and hives are the body’s attempts to subdue and eliminate the allergen. He lists four types of allergens.

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Inhaled allergens are by far the most common. They cause that seasonal plague we call hay fever — though pollen is more likely than hay to be the cause. In New England, early spring means pollen from maple and elm trees. Late spring brings beech, oak and birch pollen; a reaction to birch can trigger a sensitivity to citrus fruits. In the fall, many people react to pollen from weeds. Inhaled allergens are also the cause of household allergies, with dust mites and cat dander the most common. Liang says that it is literally impossible to get rid of cat dander, which will remain in the house for two decades after the cat is gone.

Ingested allergens are troublesome for some. Peanuts and seafood are the most common food allergies. Though most reactions are mild, these allergies can be life threatening. Increasing awareness has led to a ban on peanut products for many childcare centers and schools. The”‘patch test” is often used to identify the allergens.

Contact allergens typically result in skin problems such as rashes and hives. “We have skin cells that resist allergens, but in some people those cells are not activated,” says Liang. “The most common contact problem is a reaction to nickel, which is present in many products.” Many metal products, including stainless steel, contain some nickel. This means caution is needed in selection of eyeglass frames, jewelry and tools. Rubber is another substance to which many people react. Chemicals in soaps and makeup cause problems for some.

Allergic reaction to medications is the fourth category. This is a highly variable response; no one medication reaction is the typical problem. Liang notes, however, that a person who is allergic to seafood may also be sensitive to iodine, which is often used in diagnostic procedures. The problem of medication reaction increases with the proliferation of medications.

If you think that allergies are increasing, you’re right, says Liang. But why? Is it the result of living in cities? Of increased air pollution? “No,” he says. “The hygiene hypothesis is the explanation generally agreed upon in the medical community.” He explains that we have immune systems to protect us from assault, but the immune system has to be activated.

We actually encounter fewer germs now than in the past. Our immune systems are less well developed. Liang cites studies done in West Germany, an area noted for its cleanliness. Allergic reactions were higher there than in other areas with less-advanced practices.

So shall we send our children out to play in the dirt? To some degree, yes. All of us need to be exposed to build immunity to ordinary allergens. We need not use antibacterial soap, for example, or worry too much about hygienic conditions. There are, of course, exceptions to this more relaxed approach. If someone in the family is allergic to dust mites, for example, precautions should be taken. (See sidebar.)

The environment matters, but the genes matter more. Most of us have a genetic ability to resist the intrusion of allergens, but the genes must be activated. Likewise, it is genetic predisposition that makes some people hypersensitive to certain allergens.

Before seeing a physician about allergies, it’s helpful to track symptoms. How long has the condition lasted? Is there a family history of such reactions? Are there patterns of symptoms that relate to seasons, foods, home or work environment? Has there been a change in environment (a new house, for example, or a new pet) or in medications taken? This information will make for faster diagnosis.

Treatment of allergies often begins with environmental adjustments. The person with hay fever may limit outdoor activity. With air conditioners, one can keep windows closed. But staying indoors in the spring and fall is usually not possible or desirable.

Medication will likely be the next step in treatment. Over-the-counter antihistamines and decongestants can help. New, non-sedating antihistamines are available. If that’s not sufficient, a physician may prescribe other medications. If avoiding triggers and using medication cannot control symptoms, allergy desensitization shots may be used.

This process will likely take up to two years and may give long-term protection. It is similar to a vaccination in that the body builds resistance by responding to small amounts of the allergen. For most people, lesser measures will give relief. But if symptoms are severe or long lasting, consult a physician.