Spring – A Time for Love … and Pollen

A pine tree releases up to five lbs. of pollen, which will be distributed for miles by the wind. February is the start of pollen season. (Image source:Wikipedia)

Whether you’re eagerly anticipating the end of the freeze and the arrival of spring, or dreading it, depends almost entirely on whether you have allergies. If you’re an allergy sufferer, you may already be experiencing those dreaded symptoms; February is the official kickoff of pollen season for trees in many parts of the country.

So what is pollen anyway, and why does it make you feel so miserable? If it didn’t make you feel like sticking your head in the sand until the scorching summer months, the answer would be, if not romantic then at least a little racy. Pollen is a collection of powdery grains made up of microscopic proteins that male tree parts release into their air with the hope of pollinating female tree parts … ideally of a different tree. The wind carries these grains for miles, dispersing them over the terrain to find the perfect mate(s) and increase the chance of successful reproduction. Since this is a very hit or miss delivery technique (slightly more so than an internet dating service), trees — and other plants — release millions of grains of pollen. Put enough pollen out there and, like with internet dating, eventually something good will happen.

With all that pollen circulating in the air looking for companionship, it’s inevitable that sooner or later some will come in contact with your respiratory system. Since the pollen is a normal part of the environment, your body should just be able to ignore it and carry on with little more than an occasional sneeze. However, a pollen-allergic immune system mistakes pollen as a serious invader and immediately summons defenses to fight it off. The result is a wall of mucous and swelling designed to keep the invaders out and a barrage of symptoms that may include runny nose, congestion, sinus headaches, conjunctivitis, skin rashes, coughing, and asthma flare ups; they’re often worse than the symptoms of an internet match gone wrong!

There are a variety of treatment options to quell these symptoms. You can find more details about them in our Which Allergy Treatment is Right For You post. But seeing as it is virtually impossible to avoid these mate-seeking airborne grains, allergic patients should strongly consider the only solution that is actually a “cure” because it teaches your body to ignore pollen season after season: immunotherapy. That’s important considering that at this very moment, pollen from Ash, Alder and Juniper trees, among others, may be swirling around your home. Too bad we can’t offer immunity to bad matches on the internet scene. Welcome to spring!

Allergies Took His Breath Away, Drops Gave it Back

Allergy drops have made a huge, positive difference in the life of nine-year old Faris,  from Tulsa, OK.

Since shortly after he was born nine years ago, Faris from Tulsa, Oklahoma has been allergic to tree pollen. So allergic, he often found it difficult to breathe. And with Tulsa’s temperate climate, his allergy symptoms — which trigger asthma attacks, as well — typically persist year round. But one year ago, he started taking allergy drops and, in the words of his ecstatic mother, Michelle, “the drops literally changed his life! He can breathe now!”

Not only can he breathe, Faris recently returned from sleepover summer camp, in the woods, which he enjoyed without symptoms. In addition, he’s signed up to play soccer this fall for the first time, a feat which would have been impossible before. Previously, Faris used nasal sprays and took twice the ADULT dosage of Claritin daily. In addition, he also regularly used QNasal, Singulair, Qvar and an emergency inhaler. He has now stopped Claritin entirely and no longer requires daily nasal spray, though he does maintain his asthma medication as a precaution.

Faris heard about the drops on a visit to his doctor’s office, KIDS Pediatric & Adolescent Care, an AllerVision-affiliated provider in Tulsa. Sammi Byrne, a nurse there, told Faris and Michelle about the drops and Faris was eager to try. “He could not be a happier customer,” said Michelle, beaming.

“We are ecstatic with Faris’ response to the allergy drops,”Sammi expressed. “It is a unique opportunity for our office to be able to provide testing in a familiar environment and offer a less invasive form of treatment to our patients,” 

Now that he is happily and carefully taking allergy drops, both Michelle and Faris are excited about all the normal activities he can finally take part in, starting with breathing.

The What, Where and When of Allergies

The AllerVision Allergy Map will show you the biggest allergen offenders in your area and when they cause the most damage. Click here to see it.

Maybe you’ve had an allergy test and you have a list of allergens that cause your symptoms. (If not, click here and AllerVision can help you find a provider who will give you the answers you deserve!) But unless you’re a botanist, you probably don’t know what most of those allergens looks like. And even if you do, you may not know when you need to watch out for them. Don’t worry, we have you covered! …

Click on the caption under the image at right to visit the AllerVision allergy map. Once there, click on your region of the country to see the trees, weeds and grasses that cause the worst allergy problems in your area. (AllerVision-affiliated providers test you for sensitivity to those pollens when you visit them for an allergy evaluation.) If you hover over the names of the plants, you’ll see pictures and the season(s) in which each allergen does the most damage. Take the seasons listed with a grain of salt, though — global climate change is, well, changing the environment. Many doctors and allergy specialists blame those shifts for the huge increases in pollen — and, consequently, allergy symptoms — produced each year.

That said, if you’re experiencing allergy symptoms or generally not feeling well right about now, there’s a good chance you can blame pollen from grasses including Rye, Bermuda and Red Top, among many others. As summer fades to fall, weeds become the more primary villain, with Ragweed topping the list as public enemy number one. Pollen tends to take a rest in early winter, but come late winter and early spring, Ash, Alder Cypress and other trees begin spewing pollen like there’s no tomorrow — and allergy patients suffer mightily.

Unfortunately, indoor allergens never go away. Dust, pet dander, cockroaches and mold can cause allergy misery all year long. The allergy symptoms they trigger tend to stand out in the winter because people spend so much time indoors but even in mid-summer any one of them can be the cause of your discomfort.

Given that outdoor allergies are cyclical, you may be able to stuff yourself with medication until your worst season is over — but next year you’ll experience the same problem. Or, you can turn to immunotherapy, which teaches your body to ignore allergens so the disease goes into remission for years. Immunotherapy lets you enjoy many, many seasons without symptoms. To learn more, click here so you can stop worrying about allergies wherever you are, whatever the season.

When Pollen Strikes!

When the wind blows, the pollen inside these sacks will be released, filling the air for miles.

One of the major causes of allergic disease, such as allergic rhinitis (also known as hay fever), is airborne pollen. All plants produce some pollen as part of their reproductive cycle. There are thousands of plant species that grow in the United States but only a small number of those are significant sources of allergenic pollen. Plants that DO produce important allergens have several characteristics in common: First, they are wind pollinated rather than insect pollinated. Next, they produce pollen that is buoyant and is spread readily by the wind. Because wind pollination is relatively inefficient, these types of plants have to produce huge quantities of pollen to keep their species alive.

To be clinically important, allergenic plants must be abundant in an area. Trees such as oak and maple grow over hundreds of acres with pollen traveling up to 200 miles; ragweed can colonize large fields and affect patients for many miles around; and grass allergens can cover hundreds of acres. Despite what your nose and eyes may suggest, brightly colored flowers are rarely allergenic. Often they are insect pollinated, and they typically don’t produce pollen that can be spread by the wind. However, the pollen from allergenically important plants lands all over their beautiful flowers, and THAT pollen is what your body rejects when you stop to smell the roses. Those pollens are also often at least part of the cause of your allergic symptoms when you snuggle up to your favorite pet. Fur is a great landing spot for all kinds of pollen!

Tree pollen allergy affects millions of people. Many allergenic trees are abundant and large, shedding and spreading huge quantities of pollen. Typically, trees shed their pollen in the spring and are the first species each year to affect patients. In warmer climates, like California and Florida, pollen season often begins in February. With the late winter on the east coast this year, pollen season there is just reaching full swing.

Because pollen can travel so far, it can be difficult to determine the exact cause of your allergies. That’s where an allergy test and evaluation comes in. We encourage you to ask your doctor about an allergy skin test — a painless procedure than can tell you in just 15 minutes specifically what you are allergic to. If your doctor doesn’t offer this test in his or her office, AllerVision can help you find one who does — or can talk to your doctor on your behalf.

If pollen is the cause of your allergies, it’s virtually impossible to avoid. You can take medication to temporarily alleviate symptoms. But with medication you’re only covering the symptoms up, and next time you encounter the pollen you’ll have the same reaction. Immunotherapy, on the other hand, teaches your immune system to ignore the pollen and thereby puts your allergies into remission — usually for years or decades. You can learn more about immunotherapy here.

Pollen from trees, grasses and weeds are likely to keep your immune system busy until the fall or winter, and then return again next year. Now that you know what you’re up against, you may want to ask your provider about immunotherapy — so you can enjoy the great outdoors instead of suffering from it.

This blog includes information from ALK-Abelló “Virtual Pollen Guide” DVD, used with permission. The company offers a helpful patient education website at fightthecauseofallergy.org

 

Top 7 Questions (and Answers) About Allergy Skin Testing

After antigens are applied to a patient’s back, her skin reacts with bumps and/or wheals — and, possibly, itchiness. After about 15 minutes, the provider wipes away the antigens are the reaction(s) fade away.

In our last post, we explained why nearly every doctor should offer allergy skin testing. (If you missed it, click here.) Here are patients’ top seven questions about the test.

1) Should I have an allergy skin test? Allergies cause many more symptoms than the average person realizes, including rashes (dermatitis), sinus infections, migraine headaches, dizziness, conjunctivitis, respiratory problems, fatigue, muscle and joint pain, and the list goes on. If you get any of these symptoms regularly, you should discuss the possibility of allergies with your doctor, who will likely suggest the test and a review of your health history.

2) Can my child have the test? The test is safe for children as well as seniors. In fact, it is appropriate for virtually everyone, with the exception of pregnant women, patients with unexplained episodes of anaphylaxis, patients with active hives or active severe asthma symptoms, and people with significantly suppressed immune systems.

3) What does it test for? AllerVision-affiliated providers test for a wide variety of airborne antigens common to your region of the country — such as pollen from local trees, grasses and molds — as well as molds, dust, animal dander, cockroaches and certain foods. If you suspect allergies to specific foods, your provider may test you separately for those individual items.

4) What happens during the test?  Your provider presses several plastic applicators coated with antigens onto your back. As your skin reacts to certain antigens, you may feel itchiness. After 15 minutes, the provider measures any bumps (or “wheals”) that develop — indicating positive results — and record them. Then he or she cleans your back to relieve any discomfort.

5) Does it hurt? No. You’ll temporarily feel minor pressure from the tines of the testing devices as they’re applied, but they don’t penetrate your skin and they’re specially-designed to prevent pain. Even young children rarely complain. Itching caused by positive results begins to resolve as soon as the antigens are wiped away.

6) Is there anything I need to do to prepare? The most important thing to remember is that you shouldn’t take antihistamines for three days before testing because they can prevent the very reactions your provider needs to see. Also, be sure to inform your provider if you’re pregnant, have asthma, are suffering from severe illness, or have experienced a strong allergic reaction.

7) How long does it take to get results? In just 15 minutes, your doctor will have a clear picture of your allergic reactions so you can plan and begin a treatment program immediately.

 

The Important Difference Between Clinical Allergy and Allergy Sensitization

A doctor’s review of patients’ medical history is as important as skin test results in diagnosing clinical allergies.

I’m sure you have patients come into your office and say: “I was once tested by an allergist and told I was allergic to everything green!” I’m  always dismayed when I hear that patients were given results in this manner. Almost no one is allergic to “everything green.” Patients may be sensitized to multiple allergens but most likely they’re not allergic to them all. Making the distinction between clinical allergy and allergy sensitization requires the doctor to study each patient’s health history in conjunction with allergy test results.

Let’s demonstrate with a food allergy example… A patient visited my office and told me that he attended a party and ate a piece of cake. Within 15 minutes, he developed hives (urticarial) all over his body. He wasn’t sure what was in the cake but was worried about what he should avoid in the future. I tested him and the results showed a positive for tree nuts — walnuts, cashews and pistachios. The skin tests also showed positive for milk and eggs, but he told me that he eats eggs and drinks milk all the time without a problem. We found out that the cake contained walnuts, so I diagnosed him with walnut and tree nut allergy. I explained that his positive allergy tests to egg and milk demonstrated that he has allergic sensitization to the raw pure proteins in those foods, but, with no clinical complaints, he can still continue to eat them.

Here is another example of a potentially confusing situation that you may encounter using the AllerVision skin testing panels: you test a patient and find she is allergic to several tree pollens, grass pollens and ragweed pollen. The patient’s history says she only has symptoms in the spring — from March until June. She has no symptoms in the fall. My assessment would be that she has clinical allergy to the spring pollens, trees and grasses, and allergic sensitization to ragweed. This distinction becomes important not just in educating the patient, but in determining the patient’s course of immunotherapy. In this case, you might decide to treat the patient for the trees and grasses but leave the weeds out of the equation.

The allergy world is buzzing with research on diagnostic techniques to delineate clinical allergies more clearly. One company is working on a blood test that involves Resolve Component Testing. That measures a protein called Ara h2 — highly specific for peanut allergy. Preliminary studies indicate 95% accuracy. In the meantime, don’t forget the importance of clinical history in conducting the “detective work” required to distinguish clinical allergy from allergy sensitization. And remember that, as always, the AllerVision clinical team is available to work with you and discuss your cases any time you have questions.

Dr. Dean Mitchell

Is the Pollen Count Helpful in Medical Practice? Yes and No.

Millions of grains of pollen, in this case from a cottonwood tree, can easily fill the air and travel great distances when picked up by the wind.

Now that the weather has turned warmer and more pleasant, TV news anchors and meteorologists need something other than the weekly snow fall and deep freeze to grab your attention. Enter the pollen count. During the spring months, when trees and grasses release their pollen, official pollen counts get a lot of attention. This isn’t news to you. What you may not know is that in most areas of the country, the publicized pollen counts may be at least partially inaccurate.

In fact, the graphs and numbers reported on television, radio and the internet might actually be yesterday’s news. That’s because, in many cases, the pollen stations report collections from the previous 24-72 hours. You might then ask yourself “why would I read yesterday’s news?” The answer is two-fold. (1) As with weather forecasts, history is used to forecast changes in pollen concentration.(2) Yesterday’s pollen may be at the root of today’s sick visits. That said, you should always remember that a forecast is nothing more than an educated guess. That guess is not only as variable as the weather forecast, but it is highly affected by frequent and unexpected fluctuations in weather.

Pollen.com allows you to type in your zip code and retrieve just such a forecast. Whether or not the forecast is completely accurate, the site does do a nice job of revealing individual pollens that are prevalent in your area. It also provides excellent graphics that reveal pollen sources. Both are valuable features. Reviewing the individual tree pollens is particularly interesting, as the data indicates that while many trees cause allergic symptoms, not all achieve high pollen counts.

For even more specific — and potentially more accurate — data, find out if hospitals in your community have a certified pollen and mold counting station. In my area — New York/New Jersey — we have an excellent one, www.nynjpollen.com, which reports daily on weekdays. Like pollen.com, they provide ranges of pollen units classified as low, medium or high to make it easy for patients to understand the basic pollen outlook for the day.

So what is the best way for you to use the pollen count in your office? It is a good idea to print pollen counts from reliable sources and post them in your office each day where they are easily viewed by both patients and staff. This “in-your-face” technique can often help everyone connect the dots. Once the patients understand the connection between their symptoms and the pollen counts, they are less likely to come to you with the complaint of “sinus infection” in search of an antibiotic, and more likely to come with the expectation of a diagnosis and treatment plan for their allergic disease.

I’m sure you have some of those super-sensitive allergic patients whose nose and eyes seem like radar detectors for increased pollen levels. The moment the levels rise, these patients are at your doorstep with their rhinorrhea, conjunctivitis, sinusitis and tight chests. In my practice, these canary-in-the-coal-mine patients serve as my own reminder to begin collecting information from my local pollen count stations to see if they match up with each patients’ specific allergy test results. If a patient’s tests results indicate allergy to Birch, Oak, Maple and Elm trees, for example, and the pollen count is high for one or more of these trees, then I know targeting her treatment will be relatively easy. However, it is important to figure in the potential combination of that tree allergy with grass allergy, along with the other allergenic elements affecting the patient. The person who has been suffering with tree pollen allergy in April and then gets hit with the double whammy of grass pollen on top of that in May is one you know you will see repeatedly with multiple allergy-related issues…. until you get her or him on immunotherapy.

Pollen is not just pollen — it’s important to identify the real culprit. Targeted allergen immunotherapy, with either shots or drops, can prevent future seasons of suffering. The AllerVision program is designed to help you test for all of the relevant pollens in your area of the country and then to order a treatment set that provides relief and protection.

Again, an accurate pollen report posted daily in clear view can serve as a valuable resource in your practice. For most patients, it’s an education tool. But some patients tend to go into a panic immediately upon report of high pollen counts. I hear them cry, “I’m moving to another state to get away from this pollen.” Unfortunately, as we have all learned, there is almost nowhere left to run. Even Arizona, once a haven for allergy sufferers, has become a massive pollen breeding ground. Sufferers migrating from the southern and eastern states brought their allergenic plants with them and turned wide open spaces into golf courses. Therefore, a more sound recommendation for these patients is to plant only female trees around their home because they do not produce pollen. Of course, allergy sufferers have no control over the neighbors’ yards. The best advice: give serious thought to allergy immunotherapy for a lifetime of protection.

– Dr. Dean Mitchell

The Allergy Clock is Ticking: Spring Ahead, Don’t Fall Behind in Treatment

Spring usually brings beautiful weather — and lots of allergies.

It’s been a brutal winter throughout most of the country. Once we get even a few consecutive days with weather in the 60’s and sunshine, everyone will rush outside for extra-long lunch breaks. My New York City office is right around the corner from Central Park, which is flooded with fresh-air-seekers of all ages as soon as spring emerges. For individuals who suffer with allergies, excitement for Spring is tempered with the weary anticipation of inevitable symptoms. However, with the right strategy and treatment all of your patients can be enjoying the blossoming of flowers and the sweet smell of Spring.

The first step in helping your Spring allergy patients is identifying them! The best strategy is identifying them before the pollen starts to skyrocket. How can you do this? Run a report of your billing codes for April, May, and June, filtering for the diagnosis of sinusitis, asthma, otitis, dermatitis, bronchitis, conjunctivitis, and, yes, allergic rhinitis. This list will provide you with a valuable group of patients who notoriously wait until their allergy symptoms are severe to seek treatment from your office. Remember, most allergy medications are over-the-counter and patients are taught by their pharmacies and big pharma marketing to take treatment into their own hands. The problem is, most of these medications are not nearly effective enough to provide true relief when the pollen counts are high and patients’ symptoms are at their worst. My recommendation is that you contact these patients – as you would your flu patients before the season – and inspire them to come and get evaluated for a pre-treatment program before it’s too late.

The typical early Spring pollen culprits are the trees. The initial pollen in March comes from the Maple and Elm trees, soon followed in April by Birch and Oak. (The AllerVision Facebook page has featured a full-scale “Field Guide” of allergenic trees. Check it out at facebook.com/allervisionllc.) If your patients suffer with Spring allergies, they need to know these pollens can start early in the season if the weather warms up. The AllerVision screening and skin testing program will help uncover the connection between pollens symptoms, and encourage your patients to prepare.  The worst parts of this allergy season are typically the beginning of Spring and the time between Mother’s Day and Memorial Day. Why does it worsen in the later period? This is usually double-whammy time: tree pollens still float around as grass pollen starts its surge. Again, using the allergy skin test, the gold standard, enables you to set out a plan for your patient to beat the perceived enemy at it’s own game.

Once you identify your tree and grass pollen patients, it’s time to take action; get them started on Nasalcrom immediately. It’s an effective, safe, cromolyn sodium nasal spray designed to stabilize mast cells. The caveat is that it works best if started a few weeks before the pollen counts are high. The other great option, that is now over-the-counter but it is rarely recommended by doctors, is Nasacort.

Of course, there is only ONE disease-modifying treatment for allergic disease: immunotherapy. Your allergy sufferers deserve the option of definitive resolution. And they especially love the fact that immunotherapy, unlike the other options, is not a drug. Your patients will appreciate the natural option that fixes the problem with almost no side effects — who wouldn’t?! Allergy drops or shots are the solution to Spring and your patients’ ticket to the great outdoors!

The clock is ticking: Find those patients before they find your office in a miserable state yet again!

– Dr. Dean Mitchell