The CNRC and Allergic Living thank GlaxoSmithKline for an educational grant in support of this consumer health publication.

Currents Fall 2011

The CNRC and Allergic Living thank GlaxoSmithKline for an educational grant in support of this consumer health publication.

Currents Summer 2011

The CNRC and Allergic Living thank GlaxoSmithKline for an educational grant in support of this consumer health publication.

Currents Spring 2011

A quality of life survey conducted by Decima Research for Reactine gives lie to the popular notion that these 40 sufferers are not, well, suffering. Of the 40 employees with hay fever, the survey shows that 23 feel irritable, 22 experience reduced productivity, 17 find their social interactions to be hindered, 10 report reduced libido and five feel “unattractive or unbearable.” Sniffing and sneezing aside, the data suggest that many of them suffer in silence, and not only physically but socially, psychologically and professionally.

What’s in a Name?

Medical professionals say the very name “hay fever” conveys a merely irksome affliction that should be toughed out. Among non-sufferers, there are contradictory perceptions of this condition. In the Decima survey, 83 per cent of staff in an organization’s human resources department – the gatekeepers of employee performance evaluations – say seasonal allergies affect productivity at work. But only 66 per cent of those HR workers consider allergies to be a valid reason to take time off.

Toronto family doctor Dr. Alan Kaplan, chair of the Family Physician Airways Group of Canada, calls hay fever a misnomer, as it has little to do with hay and no fever results from an attack. He much prefers the medical term “seasonal allergic rhinitis,” which captures the congestion, mucous overproduction and sneezing symptoms of the season. The itchy, watery eyes that are usually part of the package are properly referred to as allergic conjunctivitis.

Dr. Jeremy Beach, an associate professor of medicine at the University of Alberta, says the term hay fever trivializes the condition, making people wrongly think “you shouldn’t really worry about it.” In fact, especially in concert with non-seasonal triggers, allergic rhinitis can have a significant effect. Beach, who has a particular interest in work-related asthma and allergies, believes that academics and scientists have “under-researched” this insidious affliction because “it is not seen as life-threatening whereas other types of allergy can be.”

Part of allergic rhinitis’s profile problem is that Canada has no broad national strategy to bring it into the spotlight, says Dr. Harold Kim, an allergist in Kitchener, Ontario, who holds academic appointments at McMaster University and the University of Western Ontario. He says family doctors search for symptoms of breast cancer, cardiac disease, high blood pressure and cholesterol, but most physicians, except for allergists, do not commonly ask about allergy symptoms. “In my experience, patients must be proactive and request an allergy assessment,” he says.

Kim is hopeful this could change with the publication in the Canadian Journal of Otolaryngology in April 2007 of “excellent guidelines” for doctors to diagnose and treat allergic rhinitis. Getting the guidelines put into practice, however, has gone slower than expected: “The problems of implementing revolve around issues of how to change human behaviour,” he explains. “It is not easy.” Having helped to produce the protocols, Kim’s priorities are to have them modified for patients, and to get the word out to doctors and patients alike.

At Work, But Not All There

It has been workplace and classroom productivity research that is gradually shining a light in this dim corner. Our society’s obsession with efficiency and productivity has clashed with the millions of people with rhinitis who just can’t keep up. The result is what management gurus and occupational health specialists call “presenteeism,” or lost productivity while at work.

Last year the Journal of Management Studies reported that increasingly “employees were substituting presenteeism for absenteeism”: they showed up while ill or injured more often than they stayed home. An article in Current Medical Research and Opinion singled out allergic rhinitis as the top reason for presenteeism and lost productivity at 47 workplaces studied in the United States. Calculations revealed that allergic rhinitis sufferers were absent only 3.6 days per year, but were unproductive on average for 2.3 hours per workday. The study determined allergic rhinitis cost the companies $593 per employee per year. That’s ahead of high stress ($518) and more than twice the amount for other conditions including migraines ($277), arthritis ($269), and respiratory infections ($181).

Vancouver allergist Dr. Donald Stark explains that “allergies are a type of chronic inflammation, so the body dealing with inflammation is tiring in itself. Even if [people with allergies] fall asleep, some don’t get into the deeper stages of sleep because their airways get obstructed, and they start to toss and turn to get to breath again.” Stark adds that allergy sufferers don’t even have to feel consciously tired to function poorly. “There are studies that show some adverse effect on performance at school or work – there is some amount of impairment.”

Robin Bayley of Victoria knows about lost productivity. Working from home as a privacy and policy consultant, she says the strong antihistamines she takes for rhinitis “blow (her) schedule out of the water.” She dreads the spring pollen season when her eyes water so much that the skin around them gets chapped. “I once went on vacation in Arizona, and my eyes were so watery and swollen I could barely see the Grand Canyon.” When his allergic rhinitis peaks, Gary Blaney, an Ottawa lawyer, says he gets so tired that he has to limit client meetings to the morning. “The air conditioning in my office helps keep me clear in the morning, but the aching and fatigue begin to take their toll after lunch,” he says. “By the time I get home, I feel miserable and wiped out.”

Suffer the Children

While many adults struggle with the discomfort of rhinitis by modifying routines, using over-the-counter meds or by simply toughing it out, the effect of allergic rhinitis on children is even more severe because their condition can remain undiagnosed ….

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

Related Reading

• Outdoor Allergies Resource Hub – a compilation of our best.
• Sneeze-free Garden – create the perfect low-allergen garden.
• Hay Fever Handbook – all you’ll need to cope.
• Trees that Make You Sneeze
• Ragweed’s Rule – investigating the worst of the allergenic weeds.
• Stinging Insect Allergies – when is it a serious reaction?

© Copyright AGW Publishing Inc.

When Ken Hegan traveled to Vancouver a couple of years ago, the city was experiencing one of its warmest Februaries on record, and the trees began showering unwitting visitors with an early blast of pollen. “It felt like my eyes were being assaulted by pollen,” says Hegan.

The filmmaker and humor writer recalls his eyes were red and teary, and this year he’s bracing for the same back home in Toronto.

“Sometimes I wake up and my eyes are caked shut. And when I walk my dog in the morning, I look like I’m crying. My neighbors just think I’m some sad sack guy who cries all the time,” Hegan says with a laugh.

Like millions of fellow allergy sufferers, Hegan’s eyes itch, burn, swell and redden every pollen season, and his vision blurs because of the non-stop tearing. (Others can get such eye symptoms from allergy triggers such as pet dander, mold and dust mites.)

As an avid cyclist, Hegan even fears red lights because when he stops moving, his baby blues well up – and the itch kicks in. “I’m always knuckling away at my eyes. I know I’m not supposed to, but my mom’s not there to tell me to stop,” he jokes.

Despite their mothers’ admonitions to quit that knuckling, people with allergic conjunctivitis – the inflammation of the membrane that covers the white of the eye and the inner eyelid – find that easier said than done.

Pollens’ Chemical Cascade in the Eye

The fact is, they are faced with an annoying and uncomfortable reaction that occurs when pollens or other allergens enter the eye and trigger the same allergic chemical cascade that can occur in the lungs, the nose or on the skin.

Canadian allergist Dr. Harold Kim has a strong interest in eye allergy symptoms. He explains that allergic patients’ eyes contain cells – mostly mast cells – that are primed for allergen exposure. When confronted with the allergen, antibodies called IgE will cause the mast cells to rupture and release chemicals including histamine, one of the main culprits behind the inflammatory response in the eye and surrounding tissues.

For most patients, the resulting symptoms are an annoyance. But the results can be much more serious, especially for those who experience swelling of the conjunctiva itself.

“It looks almost like jelly,” says Kim, who himself suffers from mild eye symptoms during allergy season. “It’s not vision-impairing, but it’s very irritating.”

However, in the most severe cases, the cornea itself can be affected if people don’t resist the temptation to rub and scratch.

“The mechanism is not completely known, but it may be partly from inflammation and partly from scratching, and that can be vision-impairing,” Kim warns. “So those patients should see an opthalmologist and be treated relatively aggressively.”

Next: Eye Allergies: Contact Lenses and the Role of the Nose