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"In the spring a young man's fancy lightly turns to...." (hay fever)

...thoughts of love," wrote Alfred, Lord Tennyson in 1842, but for many of us, spring signals the onslaught of sneezing and sniffing, runny noses, and itching eyes. These are the most prominent symptoms of allergic rhinitis, which can be of three types--perennial (year-round), occupational, and seasonal.

The seasonal variety is commonly referred to as hay fever (which has nothing to do with hay or with fever), but doctors usually reserve this term for the specific allergy to rag-weed, which pollinates in the fall. Allergic rhinitis occurring in the spring is commonly called rose fever (again, involving neither fever nor, usually, roses). Tree and grass pollens are the common offenders, with the tree pollen season beginning between February and April and lasting through the end of July, depending upon the area of the country. The grass pollen season can begin as early as March and last until the end of June. (Only a small percentage of the many varieties of grass causes allergic reactions.)

Like many allergies, allergic rhinitis often begins in childhood. Although many of us who develop such allergies may outgrow them as we get older, for others the affliction lasts a lifetime. Allergies are often inherited, but not necessarily all members of the same family will have them; often, they will skip a generation, being passed down from a grandparent to a grandchild. The kinds and severity of allergies also will vary among siblings of allergic parents or grandparents.

In allergic rhinitis, the antibodies formed against the particular allergen (pollen) become bound to immune system cells located within the lining system cells located within the lining of the nose. When these sensitized cells are exposed to the same allergen, they release powerful chemicals--including histamine, prostaglandins, and leukotrienes--that produce the sneezing, watery nose, itching eyes, and nasal congenstion. One of the first symptoms to herald the onset of an allergic attack may be itching of the soft palate at the back of the mouth--a particularly annoying kind of itch, because it can be "scratched" only by rubbing it with the back of the tongue.

The first line of treatment, of course, is to avoid the offending allergen if possible. Air conditioned homes, cars, and offices have made life much easier for the allergy sufferer, as have clothes dryers and electronic air filters. Staying indoors when the pollen count is highest--particularly in the late afternoon and early evening--is helpful.

The diagnosis of allergic rhinitis can be confirmed by a skin test, but the problem is often self-diagnosed just by its seasonal occurrence. Specific identification of the offending allergen is usually of little importance because of the ubiquitous nature of grass and tree pollens, unless the problem is so severe that desensitization is recommended by one's physician.

(Persons who know they are sensitive to ragweed, which is indigenous to North America, and are free to travel from mid-August until the end of September, can find relief in the Pacific Northwest or outside the United States.)

Allergy shots, in which extracts of the offending allergens are continuously inoculated into the skin over time, are less frequently used to treat allergic rhinitis, now that improved antihistamines and other drugs are available. Antihistamines help dry nasal secretions and decrease itching, but most of them induce drowsiness, which is to be avoided when driving. One brand, Seldane, is less likely to make one drowsy, but it is costly and available only by prescription.

Neither antihistamines nor decongestants deal with the inflammation that is the underlying cause of the symptoms, however. The most notable advance in the treatment of allergic rhinitis has been the development of corticosteroid and other preparations that can be inhaled into the nasal passages, where they directly attack the sensitized immune system cells. Most persons using these nasal inhalants attain complete control of symptoms without having to resort to antihistamines or decongestants, even when pollen counts are highest.

Among these preparations are Nasalcrom (cromolyn sodium), Nasalide (flunisolide), Beconase (beclomethasone), and Decadron (dexamethasone). The last three are synthetic adrenocortical steroids, and all require a prescription. Some physicians seem reluctant to prescribe inhaled nasal corticosteroids, presumably because they fear that, if absorbed, these powerful drugs can suppress normal adrenocortical steroid production.

In our opinion, this is unfortunate, because inhaled nasal steroids bring amazing relief to most patients using them, with little or no evidence that the drug is absorbed into the blood-stream sufficiently to produce any suppression of adrenocortical activity. It's true that some patients experience brief stinging of the nasal mucosa immediately after using some of these preparations. Nevertheless, this seems a very small price to pay for the complete relief of symptoms when one uses the inhaler only once or twice a day.
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Publication:Medical Update
Date:May 1, 1993
Previous Article:Denis Parsons Burkitt - surgeon, humanitarian, and friend.
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