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

On April 3, Dr. Mehmet Oz hosted a segment on his TV show called “How to Survive the Allergy Epidemic”. In keeping with many news reports released this spring, Dr. Oz declared: “This year, you’re going to feel even more miserable than ever before.”

New York allergist and Allergic Living contributor Dr. Clifford Bassett was invited to help explain to viewers why this may be. He said that climate change factors, such as warm seasons starting earlier and ending later, are to blame. He also noted that tree pollen and grass pollen seasons can overlap resulting in a “pollen bomb” that can cause misery for allergy sufferers.

Dr. Oz did an excellent job explaining how certain weather patterns can cause what allergy specialists and botanists now call ‘the priming effect’ – where pollen levels rise, fall and rise again in late winter and early spring. When it’s unseasonably warm, plants begin producing pollen early. When the temperature drops again, they stop, and then begin again once the warmer weather returns. In pollen-sensitive individuals, this can cause worsened allergy symptoms that are tougher to control because their immune system has been ‘primed’ for pollen allergens.

The topic of conversation then moved to treatment. Most medications for spring allergies work by blocking histamine receptors, so the histamine in one’s body has nowhere to bind to and cause symptoms. These treatments are effective for most people, but they treat the symptoms but not the underlying allergic disease. Upon each re-exposure, the symptoms will have to be blocked again.

This is why doctors often recommend immunotherapy, or allergy shots, in which a small amount of the allergen (i.e. pollen) is injected into a sensitized individual on multiple occasions over a long period of time. The goal is to allow the patient to build tolerance to the allergen and eventually no longer be sensitized to it.

The trouble with this traditional type of immunotherapy, which Dr. Bassett noted has been available for almost 100 years, is just that – the trouble: injections are required several times before each allergy season for several years, resulting in many, many hours in the allergist’s office.

Fortunately, Dr. Bassett informed Dr. Oz’s audience that sublingual immunotherapy (SLIT), which is a type of immunotherapy that uses under-the-tongue tablets or drops instead of needles, is gaining ground. It is far less invasive: once an allergist determines the proper dosage, a patient can actually conduct this immunotherapy by themselves, at home.

While not yet approved by the FDA, several clinical trials have demonstrated that this type of treatment can be effective, and it has been available in Europe for years. One brand, Oralair, was recently approved for prescription use in Canada.

See the full episode of The Dr. Oz Show here

See also:
Peanut Drops Hold Treatment Promise
Milk OIT Not Lasting
Dr. Oz on Nut Proteins in Olive Oils

Dr. Watson: There are many factors that contribute to the development of asthma in children. Having a mother or father with asthma is only one of the risk factors.

There are studies looking at an index called the Modified Asthma Predictive Index. In children with three or more wheezing episodes, one of which is documented by a physician, major risk factors include family history, personal history of allergy and allergies to inhalant allergens.

You also ask whether taking precautions will prevent asthma. There isn’t enough evidence to support any recommendations. For example, exposure to pets in children has been  protective in some studies, yet contributed to the onset of asthma in other studies. For children who developed asthma or hay fever, month of birth seemed a risk factor.

The bottom line is that these are things you really cannot control. If you have pets, there is not enough evidence to say to keep or get rid of them. The only option would be if your child develops symptoms around the pets, then you should give them away.

As far as the springtime, there are no special precautions to protect your child. Watch instead for early symptoms and, should you have concerns, speak to your doctor. As a father of an 18-year-old and a 22-year-old (and an empty-nester), the most important piece of advice I can give you is to relax and enjoy your child.

We welcome your question to Allergic Living’s Ask the Allergist. Thank you for understanding that the specialists aren’t able to answer every question received.

Dr. Wade Watson is a pediatric allergist and Professor of Pediatrics at Dalhousie University. He is also the head of the Division of Allergy at the IWK Health Centre in Halifax.

Spring is here: temperatures are rising, trees are blooming and spring fever hangs in the air. But for many people, the season brings on a fever of a different sort – the mad rush to manage tree pollen allergies.

Across America, virile male trees are busily spreading their highly allergenic pollen. The microscopic grains float around like a fog, blanketing some areas with a yellowish-green mist. Even when you can’t see pollen, it’s there, causing up to 40 million Americans to endure itchy eyes, painful congestion, running noses and sleepless nights.

Certain trees are notorious pollinators. Gender also plays a role: male dioecious (separate sexed) trees trigger the worst reactions, although monoecious (dual sexed) aren’t much better. Since avoidance is one of the strategies to fight hay fever, it’s helpful to know which trees are the most allergenic – and where to find them. So grab the road map and an antihistamine; it’s time for Allergic Living’s tour of the worst pollen offenders.

Tree Pollen Allergy Tour: Western States

Juniper trees make spring the sneezing season in Colorado, says Susan Kirkpatrick, a certified pollen counter and an asthma educator with The William Storms Allergy Clinic in Colorado Springs. Poplar, cottonwood, aspen, elm, maple, alder and oak trees bring a parade of unhappy patients into clinics, too.

Finally, Coloradans should also beware the lodgepole pine, says Thomas Ogren, a horticulturist and author of Allergy-Free Gardening: The Revolutionary Guide to Healthy Landscaping.

In Washington state, it’s the cedar, juniper, alder, birch, poplar and cottonwood trees that bring on hay fever symptoms, says Dr. Frank Virant, who heads the division of allergy at Seattle Children’s Hospital. Also sure to trigger allergies for some western residents are walnut and holly trees.

Down in California, the eucalyptus tree is emerging as a cause of seasonal symptoms –  perhaps no surprise, given its ubiquity. “They say that you can drive from San Francisco to San Diego along the coast and never be out of sight of a eucalyptus tree,” says Ogren.

The silver wattle, almond and casuarinas (also known as beefwood or she-oaks) are some other relatively common allergy-producing trees in the west. Not to mention camphor trees. “The streets of Los Angeles are lined with camphor trees that are 100 years old and they’re gorgeous,” says Ogren. “But the people who live on those streets get quite miserable.”

The allergy prone ought to also be wary of these other California trees: Catalpas (also called stogie trees, as native Indians used to dry the leaves, cut off the ends and smoke them like cigars); bottle brush, whose red flowers resemble baby-bottle brushes; Cryptomeria (also called Japanese cedar, these trees are the No. 1 cause of allergy in Japan, according to Ogren); Cyprus trees; box elder and ash-leaf maple.

Next page: Allergy trees in South Central U.S.

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

Currents Spring 2011