Let’s Talk About Allergies – a Physician’s Account of Allergies in the Southwest
Matthew Hinsley, MD
Most of us living in northern New Mexico have experienced the sneezing, watery and itchy eyes, itchy and sore throat, runny nose and post-nasal drainage that come with allergies. I’m going to cover the basics of inhalant allergies and help you understand how you can get some relief from these bothersome symptoms.
In a nutshell, allergies are caused by an oversensitive immune system. Our immune system protects us from the dangers of the environment; it fights off viruses and bacteria and even helps prevent cancer. However, when immune system mistakes something like tree pollen as a threat, an allergy results.
Let’s look at what happens when juniper pollen is inspired into the nasal cavity. A special type of white blood cell, the mast cell, captures the pollen and releases chemicals called histamine and leukotrienes that cause the nasal blood vessels to become leaky. The nasal tissues swell, the sneeze reflex is triggered, and the mucous producing glands are stimulated into overdrive. This immune system overreaction is called the allergy cascade.
When allergies affect the nose, it is called allergic rhinitis. When it affects the lungs and lower airway, it is called asthma. Some individuals experience only allergic rhinitis or asthma, some get both.
The offending agent in an allergy reaction is a protein called an allergen. Allergies can be seasonal or perennial. Seasonal allergies are due to pollinating trees in the spring, grasses in the summer, and weeds in the fall. Year-round allergies can be from dust mites, mold, pet dander, or cockroaches.
Allergies can usually be diagnosed by the patient’s symptoms. Allergy testing can be performed to confirm the presence of an allergy, and also helps tailor each patient’s individual treatment plan. Testing is performed on the skin or in-vitro. Skin testing is most common and involves delivering a tiny amount of allergen under the skin by a small scratch or injection. In-vitro is a test performed by a blood sample that is evaluated in a lab. It is useful for small children and those occasional patients who don’t react with skin testing.
Allergy treatment focuses on three main modalities:
Avoidance of inhalant allergies like pollen can be challenging but there are some strategies that can help. First, try to stay indoors with the windows closed when the pollen count might be at its highest. You can keep up-to-date on the daily pollen count by checking in at the Southwestern Ear, Nose & Throat website, swentnm.com. Pollen counts vary during the day but are usually highest in the morning to mid-day. Temperature, wind, and moisture can affect pollen counts. Those with mold allergies should avoid damp, moist basements, and ensuring that their bathrooms are free of mold. Dust mites are ubiquitous organisms that live on our skin and collect on mattresses, pillows, bedding, carpets, and upholstery. Those with dust mite allergies are advised to avoid carpet and wash bedding in hot water (130 degree Fahrenheit) at least once a week. Dust mite pillow covers may also help. In those with cat or dog allergies, avoidance of pet dander allergens is important; however, most people are unwilling to part with their pets.
Fortunately, most people get significant relief from medicine. In my allergy practice, the mainstay of allergy treatment includes a regiment of antihistamines and nasal corticosteroids. Antihistamines, taken orally or by nasal spray, reduce the allergy cascade by blocking the histamine receptors on mast cells, and are generally well tolerated but can cause drowsiness. Nasal steroids are prescription anti-inflammatory medications that require daily use for optimal effect. Intranasal application avoids the systemic side effects that plague oral and injected steroids. Other treatments, like leukotriene inhibitors may help some patients.
In those with severe symptoms not improved with medicine, I offer immunotherapy to desensitize the immune system to offending allergen(s). Immunotherapy involves injecting an allergen under the skin or by placing drops under the tongue, and is highly effective in reducing symptoms in approximately 80% of individuals. The injections are performed weekly in the office for three to five years. Alternatively, sublingual drops are self-administered daily. The primary risk of immunotherapy is anaphylaxis, which is a rare life-threatening reaction.
For those of you who suffer from inhalant allergies, it is important to understand that there are effective treatment strategies available. Please see your medical provider to learn more.