Uncovering allergy trends

Optometric Management, Sep 2000 by Bekker, Mary Coupe

You're seeing more allergy sufferers in your office. A leading expert tells why, and what you can do to help them.

It's been a congested summer for allergy sufferers in the Northeast and Mid-Atlantic states. Excessive rainfall, which causes high mold counts, put a damper on the respite between spring and fall hay fever season for many.

You may have noticed more red, itchy or dry eyes in your patients over the summer months - or perhaps even all year round. If you have, you're not alone. It seems there's an allergy "epidemic" afoot. But with your increased prescribing ability and the newer remedies available, you can offer better relief to these patients than ever before.

To fill you in on the latest treatment trends and causative factors, we asked a leading allergy expert what he's seeing more of these days, and why.

More causes, more sensitivity

So why the increased numbers of allergy suffers? Leading allergy authority William Bergen M.D., M.B.A., of Mission Viejo, Calif., who recently penned Allergies and Asthma for Dummies, says there are a few obvious answers.

"There's more planting going on," he says. "People have decided to plant more lawns and trees and non-native types of foliage in places such as southern California and Arizona, which at one time were mostly deserts." Consequently, there's more pollen in what was at one time a "safe" environment for allergy and asthma sufferers.

Dr. Bergen a member of the task force that developed national guidelines for treating allergic diseases, and a former staff allergist for the U.S. Olympic Swim Team, shares the example of Phoenix residents planting mulberry trees.

These trees produce huge amounts of pollen all year because there's no winter season. "Phoenix used to be a good place to go, but now, people are suffering," Dr. Berger says.

Another reason for the increase in allergy sufferers is the growing trend of people relocating to other areas of the country. Dr. Berger relates the story of his own father, who was raised in continental Europe. Where he grew up, there was no ragweed, but once he came in contact with it here - allergies. Relocation may be the reason why some patients later in life believe they have a sudden onslaught of sensitivities.

Hypersensitivity doesn't appear later in life or disappear as you grow older. "Hypersensitivity is a genetic trait, similar to the color of your eyes or your hair," Dr. Berger emphasizes. "You may get a little older and a little grayed but you can still tell that it's you. It's the same with allergies. You've always had them."

A new theory

The theory that more people are allergy sensitive because our culture is becoming "too clean" has been getting attention. According to the theory, our bodies are building up immunity against infection and are therefore becoming less immune to allergic responses.

A study was conducted between West Germany and East Germany before the collapse of the Berlin Wall. West Germany - the urban half with modern medical treatments - had a much higher incidence of asthma and allergies than its more backward neighbor. After Germany unified, researchers found that actually, former East Germany had a much higher incidence of allergy and asthma.

"Remember that this is a theory," Dn Berger cautions. "But it's pretty sound."

Treatments new and old

Allergic rhinitis, or hay fever affects 30% to 40% of the population and is the most common chronic condition in children, notes Dr. Berger. In fact, asthma is the leading cause of missed school days, and 90% of asthma patients have nasal symptoms.

Nasal allergies are also associated with other problems: recurrent sinus infections, ear infections and ocular problems.

"About 50% of these patients have allergic conjunctivitis, so be prepared to treat them for eye symptoms as well," says Dr. Berger. This condition usually results in acute superficial conjunctivitis, but it can also mean the more serious vernal kerato-- conjunctivitis (VKC) and giant papillary conjunctivitis (GPC).

Dr. Berger affirms that there has been great progress in understanding the inflammatory pathway associated with Type I hypersensitivity reaction. Today, many of the cells and factors involved in the allergic response are known, and it's clear that the biochemical mechanism responsible for these allergic conditions is the same for everyone, regardless of the causes. That's helped create new treatments for allergies, with more on the way.

Here are the top three allergy treatments today:

Avoidance. Sometimes this is simple. For example, if you're allergic to cats, avoid them. Sometimes it's more difficult. Indoor allergens have a more pronounced effect and cause more problems for allergy sufferers, Dr. Berger observes.

"When you barbeque outside, the smoke dissipates. But if you're in the house, the smoke fills the room," he explains. Similarly, allergens are often trapped indoors with no escape. Dust mites multiply in bedding and in heating vents, moldy basements and insect debris. Cleaning these areas, as well as using new allergen-fighting products, can diminish contact with allergens.