Allergies and the Air We Breathe
By Alan A. Wanderer, M.D.
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Woman with sinus allergies
Montana
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It’s mid-April in Montana. The rivers are flowing without impediment, the ice jams have melted, and the water remains crystal clear before the runoff begins in a month or two. There are occasional rain showers but mostly the skies are clear and the air is invigorating and clean. Or is it really clean? Surprisingly, despite living in one of the most pristine regions of the country, air quality may not always be good.
A major cause of air pollution originates from natural sources. I am referring to pollens and mold spores that we are all exposed to from the beginning of spring to the end of the fall every year. These ultra-small, microscopic reproductive particles from plants and fungal organisms are responsible for many medical problems. Their concentration will vary each year depending on the rainfall, number of cold snaps, length of hot sunny days, and other factors that are not yet completely understood.
Nevertheless, when the pollen and mold counts start rising, so does the misery of people afflicted with respiratory allergies. Seasonal allergies can include classic symptoms such as runny nose, itchy red eyes, itching in the roof of the mouth, excessive mucus from the nose, cough, wheezing, and shortness of breath. Less well known symptoms can be fatigue, mental fuzziness, mouth breathing, snoring, sleep disturbances, sinus infections, ear blockage, and even poor academic performance of school children.
As a rule, tree pollination is the first to occur. The most common pollinating trees are elms, maples, cottonwoods, aspen, willows, cedar, and ash. Each tree pollinates when certain conditions are met. Such conditions involve temperature range, moisture index, and frequency of sunny days. When the pollen clock begins, trees bud, and pollen is produced as part of the cycle to create seedlings which grow into trees. Tree pollination occurs from mid to late April through the end of June.
Grasses are another source of pollens. They include cultivated timothy grass, which is a favorite for ranchers, plus many other varieties of wild grasses (rye and redtop). All grasses generally pollinate when warmer temperatures develop, from mid-June to late August. The last pollinators are weeds, such as pigweed, Russian thistle, and sage. Fortunately, the well-known ragweed variety, which causes severe allergies, does not grow in our region. The weeds will start in late June, peak in late July and August and continue until the frost is well established. I haven’t forgotten mold spore exposure, which is perennial but increases during the wet conditions of the spring and late fall months.
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Inhaler
Montana
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A second cause of air pollution is man-made. Although there have been no definitive warnings regarding air purity, the valleys set between mountains create a classic setup for inversions. As growth of the area increases, air pollution from automobile emissions, forest fires, and wood burning will eventually become a concern for all residents living in this region. The evidence is real and occasionally one can see significant haze on distant horizons. Noxious gases such as nitric oxides, sulfur dioxide, and ozone have inflammatory effects on the lining of the entire respiratory tract.
Inflammation means swelling of tissues, excess mucus formation, and reduced action of hair-like cilia located in cells that line the respiratory tract and function to sweep out foreign materials from the nose, sinuses, and lungs. When inflammation occurs it can cause symptoms that may include cough, pain emanating from sinuses, discolored nasal discharge, breathing distress, and wheezing.
In addition, there is increasing concern about the accumulation of industrial sources of air pollution that include heavy metals (i.e., mercury and lead), and dioxins, which can potentially affect the physical health of our families, especially children. Sources, such as tire burning have been shown to increase air concentrations of many of these toxic agents. Citizens and community leaders must work together to limit these sources for the sake of the health of all life.
The question most asked is what you should do if you have symptoms of seasonal allergies. The first is to determine the actual cause of your problem because symptoms can be misleading and there are many causes for respiratory ailments. For example, causes of nasal congestion can include sinus infections, benign nasal tumors called polyps, and anatomical obstruction by a deviated septum. Likewise a cough can be caused by reflux of stomach acids, sinus infections, or even asthma without typical wheezing and shortness of breath.
Treating oneself with over the counter medicines can lead to unnecessary problems. The most common problem that I see is addictive use of nasal sprays, such as 4-Way, Neosynephrine, or Afrin, all of which cause dependency problems leading paradoxically to swollen nasal membranes. Moreover, if you are middle-aged or older, these medicines can cause or worsen high blood pressure.
If you suffer from any of these symptoms, it is worthwhile to have an allergy evaluation by a physician with training and credentials certified by the American Board of Allergy & Immunology. The evaluation may include a comprehensive medical history, a physical exam, diagnostic tests and an appropriate treatment plan. Many of the problems may be simple and require only a medication or two, while others will need more comprehensive therapies. Common treatments include non-sedating anti-histamines, eye drops, nasal sprays to reduce inflammation in the nose and, if asthma is present, a similar spray for the lungs. On occasion, allergy injections (immunotherapy) to airborne allergens may be indicated. When an allergy evaluation is completed, it is also possible that an evaluation by an ENT surgeon may be necessary to correct the problem with a surgical procedure. Finally, for the chronic sinus sufferers who have had surgery and continue to have symptoms, you may want to find out about drug therapies that are available for your condition.
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Dandelion allergies in the air
Montana
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What does this all mean to your health? If you are afflicted with chronic respiratory diseases, such as chronic bronchitis, COPD (chronic obstructive pulmonary disease), asthma, chronic rhinitis (nasal inflammation), hearing blockage, and sinusitis, you may notice an increased intensity of your symptoms during the spring through the fall, either from allergies, infections or air pollution. Proper medical attention to these conditions will often reduce the intensity and frequency of your symptoms and allow you to enjoy the beauty of Montana.
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