1. A BETTER PILL
If you’re among the many who need an antihistamine to survive tree pollen season, it’s time to branch out. The diphenhydramine and chlorpheniramine pills that mom used to give you do help fight the drippy, weepy symptoms, but who needs the daily drowsies? One Canadian allergist describes seeing patients feeling sleepy up to four days after stopping these pills.

To the rescue: there are second-generation antihistamines on pharmacy shelves that are far less sedating. These include the brands Allegra, Clarinex, Claritin, Zyrtec, plus generic versions. In Canada, the brands include Aerius, Claritin, Reactine and Allegra.

Here’s a hot tip: try finding more than one brand that works for you. New York City allergist Dr. Paul Ehrlich, author of Asthma Allergies Children: A Parent’s Guide, recommends switching between drugs if, after several weeks, you find your body stops responding as well to one of the pills.

2. CLEANSE YOUR GARDEN
Your worst hay fever foe could be planted right outside your window, warns horticulturalist and author Tom Ogren. Take stock of your plants: if one has fruit or berries, it’s not male and won’t release pollen (female plants don’t produce pollen). If you can’t identify a plant on your own, take a clipping to a nursery for help identifying its gender.

“If you’ve got a highly allergenic plant, particularly if it’s in proximity to your doors, you should replace it with the exact opposite,” Ogren says. “You will have just made a wonderful change in your yard.”

Some examples of allergy-friendly flowering plants are: peonies, hydrangea, roses, foxglove, fuchsia and poppies. Click to see more allergy-friendly plants.

3. TAKE THE STING OUT
Have you got a stinging insect allergy? Then it’s high time you reclaimed spring and summer. Any reaction to the sting of a honeybee, yellow jacket, hornet or other insect that turned into more than itching and swelling at the sting spot suggests you’re at risk for a serious reaction.

“Almost all the time, patients who had a slight reaction the first time then had a more severe reaction the second, and they’re going to have a real problem if they get stung a third time,” Ehrlich says. “Each sting is worse than the previous one.”

That is, unless, you get allergy shots. The American Academy of Allergy, Asthma & Immunology recommends that those who have had a systemic reaction to an insect sting, and who test positive to that venom, get immunotherapy. Doing so reduces the risk of a full-body reaction phenomenally – to less than 5 per cent. Dr. Paul Keith, a Canadian allergist, says an immunized person should be able to receive up to 50 stings at once before the body is overpowered by toxins.

Next: The Robot That Mows

Spring and early summer present a constant dilemma for people allergic to grass. It’s a choice between dodging pollen behind tightly sealed windows, or engaging in a battle with the blades, hoping antihistamines, nasal sprays and eye drops will keep the worst of the symptoms at bay.

A lot of us are making this daily choice between nose-streaming suffering and indoor boredom. It’s estimated that about 26 percent of North Americans are sensitized to either Timothy or rye grasses, and 18 percent to Bermuda grass, often used on golf courses.

Allergy shots have long been an option for those who can’t bear all the congestion and mucus any longer, but they require a serious commitment to needles and doctor’s visits, week after week, allergy season after allergy season, for several years.

For the moment, those shots are the only game in town. But that may be about to change. Needles may soon give way to small tablets, placed under the tongue and allowed to dissolve for about a minute. And, impatient people, rejoice: the tablets – called sublingual immunotherapy or SLIT – may significantly improve hay fever symptoms within a month. The best news? Two SLIT pills have recently completed the final phase of testing in the U.S. and their makers getting ready to apply for regulatory approval.

Dr. Linda Cox, a Fort Lauderdale, Florida allergist who organized a large study for one of the drugs, has spent years looking at the limitations and safety of immunotherapy for environmental allergens like grasses. She points to European research that followed patients who took grass SLIT tablets to note how life-changing the drug can be. Years after patients stopped taking the tablets, the protective effects still lingered. “No [other] medication does that,” Cox says. “You can’t take a drug for a season and expect the next season it will have [still] fixed your problem.”

With pollen seasons becoming longer in many areas, such therapies could be all the more important, as allergy sufferers are faced with the threat of even longer stretches of congested misery.

The Contenders

One of the SLIT drugs is called Oralair in Europe, and is produced by the French company Stallergenes. It contains extracts from five northern grasses, including orchard grass, Kentucky bluegrass, perennial ryegrass, sweet vernalgrass and Timothy grass, most of which are found in nearly every North American state and province. Like other immunotherapies, the drug works by repeatedly exposing the body to tiny amounts of allergen over several months, which helps to desensitize the allergy sufferer just in time for a spring blast of pollen.

In a U.S. study of Oralair, 473 grass-allergic adults in several northern and central states got either the drug or a placebo for six months. Researchers found a 28 percent improvement in allergy symptoms and medication use compared to the group getting the sugar pills. Oralair was particularly good at relieving itchy and watery eyes, and patients also said they slept better.

The other tablet that could soon be on North Americans’ relief radar is known as Grazax in Europe (where SLIT tablets have been on the market since 2006). Danish company ALK makes the tablet, but drug-manufacturer Merck is spearheading the American research and push for approval. Unlike Oralair, Grazax focuses its immunological attack on just one pollen: Timothy grass, which is found everywhere in North America except Nunavut and Puerto Rico.

In one U.S. study of Grazax, adults showed about a 20 percent improvement in symptoms. In another, children’s allergy symptoms improved by 26 percent. “If somebody takes Grazax, and uses nasal steroids and antihistamines on top of it, then this would be by far the most effective

Coping with Colleagues

Q. How can I impress upon my colleagues and supervisors that my allergy is serious?

A. Dr. Mitch Persaud, a Saskatoon allergist, says be specific. Use one anecdote to explain what you were exposed to and how, and what reaction resulted. If that doesn’t work, Dr. Donald Stark, a Vancouver allergist, suggests that you show your colleagues your MedicAlert bracelet and get your allergist to write a letter to your employer.

Q. How can I stay included in work events such as restaurant outings or potlucks?

A. Bring your own entrée to a potluck and take the first serving to avoid cross-contamination, says Stephanie Boll, a 36-year-old injury prevention adviser from Vancouver. Elizabeth Cooper, 24, is a group home worker who lives in Winnipeg and has allergies to nuts, citrus and shellfish. She volunteers to organize parties at restaurants she trusts. Or she’ll host the party at her house and check the food as guests come through the door.

Q. How do I ask a colleague to stop wearing a scent that makes me sick?

A. Ottawa civil servant Lynne Vail, 33, has endured violent asthma-like reactions to perfumes on the job. Most of her colleagues get the seriousness, as she has been left gasping for air after exposure to cologne. Vail will approach a co-worker one-on-one and ask him or her to leave the fragrance at home. She also gives co-workers examples of products that don’t bother her, and has even offered to buy such scents.

Q. How do I avoid appearing rude at a business lunch when my food choices are limited?

A. Rob Kania, 23, says his peanut allergy stops him from ordering dessert in restaurants. To keep business associates eating their chocolate mousse from thinking: “This guy wants to get out of here,” Kania orders a bottled water or another coffee. “That usually gets people off your back.”

The Rudeness of Others

Try as we might to put on a happy face when telling colleagues and clients about our allergies, polite explanations are sometimes rewarded with snide remarks, know-it-all suggestions or just an embarrassment of questions.

• Sandra Carpenter of Lewisporte, Newfoundland, is a consulting nurse. She is at risk of anaphylaxis to ASA and its derivatives, including sodium benzoate and tartra-zine. She can’t eat many fruits and vegetables, most prepared foods, and anything with colours and preservatives. Colleagues often ask her to list what she can and cannot eat. Their responses are not always sympathetic – or sensitive.

“Just as well you were dead, if you can’t eat all that,” one said to her. “I’d rather be dead than not be able to eat chocolate.” She has also heard: “What does your husband say? He must really hate it.”

• For Andrea Forsyth, who must avoid fish, seafood, and tree nuts, a conversation about her food allergies occasionally prompts comments about her physique. “So that’s why you’re so thin,” the Torontonian has been told, and it bothers her. “A lot of people just assume that I don’t eat, that I’m allergic to everything.”

• June Traptow, a Red Deer, Alberta businesswoman, can’t eat dairy, gluten, eggs or nuts. She gets annoyed when a colleague sitting next to her at a banquet says: “Why can’t you just take the coating off the chicken?” Traptow has a comeback she’s threatening to use: “Let’s drop your food in the mud, let’s wash it off, and you eat it.”

See Also: On the Job with Allergies

First published in Allergic Living magazine, Winter 2006 (c) Copyright AGW Publishing Inc.

Idea: Hypoallergenic Cat

What’s Involved: Genetically engineering a cat that doesn’t have the gene that makes Fel d 1 protein, which causes the majority of allergic reaction. Once a colony of hypoallergenic cats is established, kittens could be bred using “traditional” methods.

Where We Stand: In 2006 a company called Allerca Inc. claimed to have bred the world’s first hypoallergenic kittens and Time magazine hailed them as one of the best inventions of the year.

But the company and its founder have been the subject of controversy, with the media and a dedicated website questioning whether the firm, now called Lifestyle Pets, really has sneeze-free cats.

But this is not the only company in the hunt for the hypoallergenic kitty. Dr. David Avner, an emergency room physician in Denver, has been working with molecular biologists on silencing the Fel d 1 gene for years, and so far has come up empty-handed.

This past summer his team thought they had successfully knocked out the gene, which could lead to the breakthrough they’ve hoped for.

While Avner admits to being “optimistic” in predicting when his company, Felix Pets, will have cats on the market, he says there’s little doubt that in 10 years, a hypoallergenic cat will be in people’s homes.

“Without question, someone is going to do it. It’s too obvious an application of the technology, and the desire for people to have allergen-free cats is too high for it to go unrealized.”

Idea: Herbal Tablets for Asthma

What’s Involved: The Antiasthma Herbal Formula (ASHMI) is a tablet containing three traditional Chinese herbs. A study of patients in China shows it improves lung function and reduces use of bronchodilators.

Where We Stand: Dr. Xiu-Min Li at the Mount Sinai School of Medicine and her colleagues continue to study ASHMI in mice and people, comparing it to using corticosteroids. New, unpublished data show that eight weeks after mice stop taking the corticosteroids, their asthma symptoms return when they are exposed to triggers.

However, the mice on the herbal formula are still protected eight weeks later. Safety studies in humans have been completed, and Phase 2 efficacy studies are continuing.

One of the benefits to using ASHMI, instead of a steroid, is that there are fewer side effects, such as weight gain. However, Li says corticosteroids will be the standard treatment for asthma for years to come.

“The practical protocol will be to have a herbal remedy that will reduce the steroid’s side effects and help to maintain the protective effect,” she says.

Idea: Quick-Acting Allergy Shots

What’s Involved: Currently, immunotherapy to environmental allergies such as trees, grass, ragweed and cats, sometimes called allergy shots, requires numerous needles over several years. The shots also carry the risk of anaphylaxis in some individuals. Now, a few companies are developing therapies to make the treatment process far shorter and also safer.

A person may be generally predisposed to have food allergy and be allergic to multiple, unrelated common allergens such as peanut, egg and milk. Or, a person may be allergic to multiple foods only because those foods share similar pro­teins. He emphasizes that being allergic to more than one member of a food “family” varies by the food group, and should bediscussed with your allergist. Sicherer describes a number of relationships among food allergies:

• The peanut allergic have only a 5 per cent chance of reacting to other legumes. The one exception, he says, is the lupin bean. European studies have shown half of people with peanut allergies react to beans from the lupin plant.
• People allergic to one tree nut have a one-in-three chance of allergy to other tree nuts. However, certain nuts tend to pair together, Sicherer says. Cashews and pistachios are similar, walnut and pecan allergies can come together, and almond and hazelnut reactions sometimes go hand in hand.
• Although tree nuts and peanuts are unrelated foods, reacting to both is common. The odds vary by study, but Sicherer says that between one-third to half of peanut-allergic people also have a tree nut allergy.
• A third of the people in the Food Allergy & Anaphylaxis Network’s peanut and tree nut allergy registry also have an allergy to egg. Allergy to chickens’ eggs also increases the likelihood of reacting to other bird eggs, such as quail.
• An allergy to one kind of shellfish puts you at a 75 per cent risk of being allergic to another crustacean.
• It you’re allergic to one type of fish, such as sole, there’s a 50 per cent chance you’ll react to other fish, like cod or bass.
• Allergies to a grain, such as wheat, put you at a 20 per cent risk of reacting to another grain, like barley.
• Twenty two per cent of the nut and peanut allergic people in the FAAN registry are also allergic to milk.
• A person allergic to cow’s milk has a 90 per cent chance of allergy to the milk of most other mammals. About 10 per cent of people who react to milk may also have a problem with beef.
• Allergy to fruit puts a person at a 50 to 90 per cent risk for reacting to other fruits, Sicherer says.

See Also:

• Multiple Food Allergies on the Rise
• Girl with Multiple Allergies: An 11 year-old girl’s story of her multiple, difficult allergies.

“I can’t believe it,” says Kristie Johnston, Ethan’s mom. “A year ago, he had anaphylaxis to milk, and now he’s drinking milk straight.”

Ethan is a patient of pediatric allergist Dr. Stuart Carr. In late 2007, Carr and Edmonton colleagues Dr. Timothy Vander Leek and Dr. Per Lidman began offering milk desensitization treatment, also called oral immunotherapy, to young patients who have a serious allergy to cow’s milk.

The aim is to build up tolerance to dairy protein through the consumption of precisely measured, slowly increasing doses over a period of at least six months. It starts with just one drop of a diluted milk solution.

Ethan’s success story is shared by most of the 20 patients taking part in the Edmonton milk therapy. But when speaking to the families involved, it becomes clear that this breakthrough allergy treatment comes with significant hurdles, with the most daunting being the emotional challenges of desensitization.

After all, these children are purposely swallowing (albeit in tiny amounts) a food known to cause them severe and frightening allergic reactions. “The psychological aspect of this is profound,” says Stephanie Wanner, whose 5-year-old son Josh Bjorndahl began the dairy treatment in January.

Josh had his initial oral challenge in Dr. Timothy Vander Leek’s office. “I felt horrible because I knew he was going to react,” says Wanner. Sure enough, the boy drank one millilitre of milk, and hives immediately popped up on his skin, he vomited, and the doctor gave him a shot of adrenaline within a minute.

Yet, less than a month later, Josh was able to start taking small, diluted milk doses at home. With those doses, the boy’s main side effect was an itchy mouth, but that eventually disappeared. Then, three months into the regime, Josh’s stomach began to hurt after taking his daily milk dose.

“He would cry about his sore tummy. Then you feel the guilt and wonder, ‘Am I doing the right thing?’” says his mother. “To have him sit in your lap and cry, you need to be committed. If you can’t handle that and still go on, there’s no point in starting.”

The beginning was by far the worst. But as Josh progressed to slightly higher doses, “the more he became motivated. He was starting to see the effects,” says Wanner.

Published in the New England Journal of Medicine in January, the study showed levels in the blood of a chemical called platelet-activating factor (PAF) along with levels of the enzyme that destroys PAF, have a relationship with the seriousness of symptoms during a reaction.

The study’s lead author, Dr. Peter Vadas, director of allergy and clinical immunology at St. Michael’s Hospital, explains that anaphylaxis is a “cast of many characters.” There are at least two lead actors: PAF is a “bad guy,” who brings on life-threatening symptoms like dropping blood pressure and a swelling airway, while PAF acetylhydrolase (PAF-AH) is the “good guy,” who stops PAF from setting off mayhem.

High levels of PAF had already been found in animals experiencing anaphylaxis, and scientists learned they could bring about symptoms of anaphylactic reaction by giving PAF to healthy animals. As well, drugs to block PAF have prevented allergic reactions in animals. But Vadas’s latest study, which was eight years in the making, is the first to demonstrate similar responses in humans. “With confirmation of these results, I think we’re going to have a diagnostic test that will help us to stratify the risk of having life-threatening or severe anaphylaxis,” he says.

The researchers on his team measured the blood levels of PAF and the good enzyme PAF-AH in 41 patients who had arrived in the emergency room having an anaphylactic reaction and compared them with blood taken from 23 healthy volunteers. They found that PAF levels went up with increasing severity of anaphylaxis, and PAF-AH levels went down with increasing levels of severity of anaphylaxis. Vadas describes it as a “yin yang” relationship.

Researchers also tested blood samples from 215 previous patients, including nine people who died from anaphylaxis after eating peanuts. The nine who died had significantly lower levels of the good enzyme. From a group of 63 children who’d had only mild peanut reactions, PAF-AH levels were found to be almost as high as those in people who had no allergies at all.

Once an independent group of researchers confirms the finding, Vadas says that within a year, allergists should be able to offer a blood test for PAF-AH levels. The results would provide specialists the first ever indicator of whether the person has this specific biochemical marker for the risk of a life-threatening reaction. Vadas compares it to being able to make similar assessments in other medical conditions – for instance testing for cholesterol, a specific marker of heart disease. Doctors would consider PAF-AH test results in context with other risk factors, such as a history of reactions and asthma, and give allergic patients a better prediction of how likely they are to be in jeopardy when a bee stings or if they accidentally drink milk.

Vadas is quick to point out that PAF and the enzyme that stops it are just two components ….

Excerpted from the Spring 2008 issue of Allergic Living magazine.
To order that issue or to subscribe, click here.

Who Reacts

Even our understanding of the prevalence of pet allergies is fuzzy. Although an estimated 20 to 30 per cent of young adults will react to at least one airborne allergen, studies have shown early exposure to animals (which researchers now suggest can have a protective effect), where you live, and whether you experience asthma, hay fever or both can all influence the development of allergies to animals.

New research from the U.S. National Institutes of Health shows that cats are the single biggest trigger for asthma, causing reactions in 29.3 per cent of asthmatics. A Swedish study, meantime, found 40 per cent of kids with asthma reacted to cats, 34 per cent to dogs, and 28 per cent to horses.

For the kids who got runny noses and itchy eyes, 49 per cent reacted to cats, 33 per cent to dogs, and 37 per cent to horses.

Dr. Jeffrey Davidson, an allergist in San Francisco and a clinical professor at the University of California San Francisco, says it’s fair to expect that as the incidence of allergic disease grows, so does the number of people reacting to animals. And while cat allergies are by far the most prevalent, people can be sensitized to any animals with feathers and fur, including dogs, guinea pigs, mice, birds, and ferrets.

The Symptoms

The range and severity of symptoms is vast, and includes itchy, runny nose and sneezing, irritated, watering eyes, wheezing and shortness of breath, eczema and hives. “Some people say they don’t have a problem unless they touch the pet and touch their eyes,” Davidson said. “And there are other people who walk into a room where there is a cat, or there has been one, and they will have an asthma attack.”

The Allergens

The culprits setting of these reactions are a series of proteins found in concentrated amounts in dander (flakes of dead skin), saliva and oil called sebum that hair follicles secrete to protect fur and skin. In some animals, allergenic proteins that originate in the blood are released through urine. The cat’s most prominent allergenic protein is called Fel d1, and its counterpart in dogs is Can f1.

Dr. James Ransom, an allergist in Topeka, Kansas and clinical instructor at The University of Kansas Medical Center, says cats’ constant grooming and indoor litter boxes mean these allergens are continuously evaporating into indoor air. A pet lover might reason a hairless cat or a short-haired dog should be fine. Not necessarily. Ransom says that, regardless of their fur, pets still emit the allergy-causing proteins from their skin, glands, dander, urine and saliva.

Plan B Solution

Ransom says if a patient has a severe reaction to animals or develops asthma, he’ll advise that the pet has to go. But “getting people to get rid of pets is very difficult.”

His Plan B is to tell the family to minimize the exposure. First, someone not allergic to the animal should wash it once a week. Next, the pet should never be allowed into the allergy sufferer’s bedroom. The pet’s roaming area in the house should be reduced to exclude areas where the allergic person spends much of his or her time. Finally, cloth-covered furniture and carpeting (which Ransom calls the “reservoir of allergens”) must be replaced with leather or vinyl furniture and hard floors such as linoleum or tile.

Although some shampoos and sprays claim to reduce how much allergenic protein your pet totes around, Davidson says washing a pet with water alone is probably just as effective. Wipe down a cat with a damp cloth instead of bathing him, the specialist advises, to avoid “losing your forearms.”

Next Page: The Cat Comes Back

WE CAN blame the deciduous trees’ attempts at procreation for our watery, red-eyed snuffling and other springtime rhinitis symptoms. Catkins, which often appear as elaborate cones or buds, are a tree’s reproductive organs, and they bloom before the leaves bud. Male catkins will release literally millions of pollen grains into the air in an attempt to find a female catkin match.

Dr. Wilf Nicholls, director of the Memorial University of Newfoundland Botanical Garden, explains that wind pollination is “super inefficient” because only a fraction of the huge amounts of tiny grains the tree churns out will arrive at their intended destination, the female catkin. Instead, great quantities of them will be inhaled into noses and throats and set off reactions in the tree allergic.

It’s an unlucky break that most deciduous trees in northern climes are wind-pollinated. Birch, elm, maple, oak and poplar are some of the most allergenic trees across Canada and the northern United States. But where you are, the month and the weather all influence the onset of symptoms.

West Coast

On the foliage-rich west coast, red alder is public enemy number one. Robert Guy, head of forest sciences at the University of British Columbia, says much of the forest surrounding coastal towns and cities is full of red alder. Depending on the weather, these trees can pollinate as early as mid-February, or as late as the end of March, and they spread pollen for about three weeks.

Vancouver allergist Dr. Donald Stark says red alder is particularly insidious because it produces a ton of pollen; it often has the highest pollen count of any plant on the coast. People allergic to it may also react to birch trees, which pollinate about a month after alders, prolonging the misery.

Stark identifies the Garry oak as another culprit on the west coast.
In most of Canada, ragweed is the worst offender for triggering hay fever, followed by grass, then trees. Stark says the west coast is the exception: here, trees pack the hardest punch.

Next: Traveling Eastward

AS FRIENDS herald spring’s arrival with the glee of a lottery winner, it’s often hard for the allergic to join the celebrating. They know that their tree foes – birch, elm, maple, alder, poplar and their nasty ilk – have begun to churn out clouds of tiny allergy-causing pollen.

Not only do a third of us battle hay fever – with runny noses, sinus and eye symptoms – but for a significant proportion of allergy sufferers, the spring bloom is just the start of their allergy woes. Dr. Antony Ham Pong, an Ottawa allergist and clinical researcher, estimates that up to 10 per cent of the general population has a condition called oral allergy syndrome, or OAS.

It’s a less severe form of food allergy, directly related to pollen reactions, that’s known to set off tingling and unpleasant itching in the mouth, throat and lips. Reactions are caused by a variety of fruits, vegetables, nuts, seeds, and even spices; all of which share allergenic proteins with specific hay fever-causing trees and plants.

“Nobody talks about the foods causing oral allergy syndrome because it’s not considered a life-threatening allergy,” says Ham Pong, the author of several articles educating patients and doctors about oral allergy syndrome. “But it’s actually more common than peanut, milk, egg, and fish allergy.”

In springtime, two of the biggest cross-reaction offenders are birch and alder trees. Depending on where you live, anywhere from 20 to 70 per cent of people who are allergic to birch and alder pollens will also have oral allergy syndrome.

Ham Pong estimates about a third of birch-allergic North Americans are affected, but the incidence of oral allergy syndrome is even higher in some European countries. Although OAS is relatively common, he doesn’t think it is increasing, at least not in North America. Rather, doctors have become better at spotting this condition.

But how can a tall, skinny tree that gives you the sniffles cause an itchy mouth if you chew on a celery stick?

Next: How the immune system gets confused