By: John Donovan
August 25, 2015, 1:46 p.m.
It's possible to have a variety of allergy triggers, including some that previously did not affect you. (Photo: Barabasa/Shutterstock)
It's normal for people to sneeze their heads off in the spring. It's as much a part of the season as April flowers and May showers, as anyone with allergies will tell you.
But it's not just spring. The pollen of spring flowers gives way to grass and tree pollen, and the wet springs and wet summers bring mold. Then comes ragweed and other weeds. And we're not even going to get into dust mites in your carpet or dog dander on the kitchen floor or food allergies.
Yeah, this dealing-with-allergies stuff can be a year-round pain in the septum.
So you've got some sniffles
Dr. Stanley Fineman is a past president of the American College of Allergy, Asthma and Immunology (ACAAI) and he has been a practicing allergist for more than 35 years. He finds the whole subject of allergies and allergens fascinating — good for someone who spends many of his days up to his ears in Kleenex.
The wonder lies in the numbers. There are so many allergens out there, and so many people who react differently to allergens. And those same people can react differently to different allergens at different times of their lives and at different times of the year.
So something that can make you feel like hacking up a lung at 16 can be completely harmless at 35. And something you had no problem with as a kid can punch you in the nose in later life.
You can move somewhere new, with all sorts of different flora, and think you're breathing in pure, clean Rocky Mountain-type air. Ten years later, it's as if you're breathing in rocks. Fineman says he sees it all the time.
The possibilities, the pure permutations, are practically endless.
"I think it's a really exciting field to be in," Fineman said from his office in Marietta, Georgia. "We're doing research on new treatment options all the time."
The first trick in getting your allergies under control, you'd think, is avoiding the triggers. So if you're allergic to a certain type of pollen, avoid going outside when that's in the air.
But you can see the potential pitfalls there. Who stays inside all the time? Even if you can, who can keep pollen from leaking in? How do you know which pollen sets off the watery eyes and scratchy throat and all that hacking, and how much of it? Maybe what's setting you off isn't the pollen you think it is, anyway. Maybe it's pollen from another plant. Maybe it's a couple different pollens. Maybe it's not even pollen. Maybe it's cats ... or crustaceans.
Fineman explains it this way: We all have a bucketful of potential triggers that we can tolerate. But then comes another allergen from over there, and maybe another from behind the garage, and the one you think you know about happens to be flaring up this week, and pretty soon your bucket is tipping over and spilling all down the front of your face.
That's called the "threshold phenomenon," and it's why Fineman suggests that the first step to getting allergies under control isn't avoiding the triggers, but figuring out what those triggers are. To do that right, you need a skin test.
Finding out what ails you
A skin prick test is performed on the back or the forearm to determine whether or not a person is allergic to a particular substance. (Photo: wavebreakmedia/Shutterstock)
If you've never had a skin test for allergies, it may sound a little 16th century.
The test is simple, really: A doctor (or a nurse) will subject your skin to as many as 40 different allergens to see what happens. Different types of pollen, pet dander, food allergens and dust. You'll get a drop of extract of each potential allergen on a tiny portion of your skin — usually a forearm — which is then pricked barely into the skin surface. It's relatively painless.
Then everybody waits to see how your skin reacts, and to what. According to the Mayo Clinic, doctors (or nurses) also test the skin with two other substances: one that makes sure your skin will indeed react to potential allergens (a histamine) and one that makes sure your skin won't react too much, that it isn't too sensitive (either glycerin or saline).
Figuring out how to fix it
Once the results are in, the treatment can begin. Avoiding your triggers, now that you know what they are, is a start. But, as we've mentioned, that's not always practical.
So you can go with all sorts of over-the-counter or prescription medicines to try to control the sneezing and scratchy eyes and all that. Eye drops, nose sprays, pills. Inhalers, skin cream, syrups. Antihistamines, corticosteroids, decongestants. For emergencies, there's epinephrine.
Or you can go with immunotherapy, a series of injections over several years. The shots are spiked with the allergens that set you off, with the idea that introducing them into your body's system over and over again will eventually desensitize you. That therapy has been "highly effective," according to the World Allergy Organization.
Fineman reports new immunotherapy that can be taken sublingually (under the tongue). And, as he points out, other treatment options are being developed and tested all the time.
According to the ACAAI, nasal allergies affect as many as 50 million Americans. In the past year, some 17 million adults and almost 7 million children have been diagnosed with allergic rhinitis, known commonly as hay fever.
Allergies can't be cured. There is no one magic nose spray that will suddenly make the world's stuffed-up breathe and the puffy-eyed see clearly.
But once you know what's setting you off, allergies can be controlled. And that, at least, should bring some relief.