As reported by USA Today, March 21, 2007.

Treatments Mean 'No One Has to Live In Misery' of Allergy Season

By Mary Brophy Marcus

Dagmar Fisher's sneezing spells are so impressive this time of year they serve as comic relief for her office mates.
"A few weeks ago the sneezing started. Really violent spells. I'm like a bad cartoon," the 29-year-old New York City resident says.

But to Fisher, the symptoms she suffers from every spring — sneezing, an itchy and runny nose, watery eyes and congestion — are less than humorous. The discomfort invades sleep, work, and her weekly runs in Central Park.

Fisher is one of 35.9 million Americans who have seasonal allergies, according to the American Academy of Allergy Asthma and Immunology.

But with the right diagnosis and treatment, allergies can be managed well.

"No one has to live in misery," says Fisher's allergist, Clifford Bassett, an assistant clinical professor of medicine and otolaryngology, at Long Island College Hospital-SUNY Downstate Medical Center.

Seasonal allergies can affect any one at any age. Sometimes called hay fever or seasonal allergic rhinitis, they are triggered by substances called allergens, such as pollens from trees and weeds.

The body is fine-tuned to fight invaders such as bacteria and viruses, but when a person inhales an allergen, the immune system recognizes it as an intruder.

The body starts producing Immunoglobulin E antibodies, or IgE. IgE antibodies attach themselves to mast cells, which in turn release potent histamines and leukotrienes. The release of these chemicals increases mucous secretions causing symptoms such as a runny nose and watery eyes.

"We are beginning to increasingly realize that our immune system, our defense against foreign invasion, is very complex. It's a delicate orchestra and can get out of control even as it protects us. In allergy that's what happens," says Michael Phillips, medicine professor for pulmonary, allergy, and immunology critical care at the University of Pennsylvania in Philadelphia.

Why some people get them and some do not is still up for discussion, experts says. But clearly a genetic link is involved, says Marshall Plaut, chief of allergic mechanisms at the National Institute of Allergy and Infectious Diseases.

Susceptible people may be affected by other factors as well, including hormones, stress and environmental irritants.

At last month's annual allergy academy meeting in San Diego, researchers from the University of Washington presented a study showing allergy sufferers are much more likely to react to non-allergic triggers such as cold air, perfume, cigarette smoke, exercise and household cleaning products.

Some are comfortable managing their allergies without a doctor, using over-the-counter antihistamines, decongestants, nasal sprays and sinus washes.

It's common for the allergy-afflicted to wait years before getting medical help, especially the expertise of an allergist.

"There are a lot of jokes about allergies. Some people consider seasonal allergies a trivial disease, but they are not," Plaut says.

Left untreated, they can lead to ear, sinus and bronchial infections that may require antibiotics.

Fisher dabbled with a variety of over-the-counter drugs, delaying for a decade before she sought out an allergist earlier this month.

"I can't control my symptoms anymore," she says.

The biggest key to helping patients is creating a personalized regime, says Louis Mendelson, clinical professor at the University of Connecticut School of Medicine in Farmington.

"Find a board-certified allergist, think about getting skin testing to help you learn which seasons affect you, work with your doctor to see which medicines help," Mendelson says.

Doctors may recommend antihistamines, such as diphenhydramine and fexofenadine, or a medication that inhibits leukotrienes. Allergists also may suggest saline washes, nasal steroid sprays, which help reduce swelling of nasal passageways, and eye drops to help quell watery eyes.

If symptoms persist, inhaled medications or immunotherapy — allergy shots — may be prescribed. Immunotherapy involves injecting an increasing dose of allergens a patient is sensitive to over weeks and months. It is successful in 90% of patients with seasonal allergies, according to experts.

One of the most promising areas of treatment is sublingual immunotherapy, Plaut says. Doctors place drops containing allergens under the tongue where they are absorbed by the lymphatic tissue. Now used in Europe, sublingual immunotherapy needs more research before it is considered for FDA approval.

Some patients are determined only to take medications when symptoms become intolerable. Mendelson says that's too late. He and other experts recommend starting medications as soon as allergy season hits.

"Be preventative. You put your seatbelt on before the car accident, not after," he says.

"We do not have a cure yet, but we can control allergies. You don't have to live like there's a clothespin on your nose and salt and pepper in your eyes."