If he were allowed just one question to determine how bad a new patient's seasonal allergies were, Dr. Stephen J. McGeady of Thomas Jefferson University Hospital in Philadelphia might ask: "Do you wish you were dead around Memorial Day?"
And if the answer was yes? "I'd know I was talking to someone with a bad grass allergy," said Dr. McGeady, director of Jefferson's Allergy and Clinical Immunology Division.
Let's call it . . . pollen panic -- although the millions of Americans who go through it every year hardly need to be informed that those drippy, stuffed-up, sneezy days are here once again.
In many parts of the United States, spring and summer are high seasons for allergies.
"Memorial Day -- that's the high point for grass," said George R. Green, chief of the division of Allergy and Immunology at Abington Memorial Hospital in Philadelphia. "And Labor Day -- that's ragweed. People tend to spend a lot of time both weekends outside, picnicking and playing. So they really get a snootful -- and they're miserable."
It appears that this year's long, wet spring bodes an unusually trying summer for the pollen-paranoid. "It's shaping up to be a bell-ringer," predicts Dr. McGeady, who says he is already seeing more patients than usual.
Now, we're not talking a small problem here. Some estimates say people with seasonal allergies make up 20 percent of the American public -- one of five people. Though the symptoms may strike the uninitiated as trivial, a really bad case of allergies is nothing to sneeze at.
Dr. McGeady, who has severe allergies ("How do you think I got into this field?"), describes it: "You feel sick. There's incredible congestion, intense itching in your eyes and the back of your throat. You may sneeze 40 or 50 times in a row. You get headaches from sneezing so much. You're tired, apathetic, just miserable. It's not good at all."
"People who don't have allergies tend to think it's amusing," he added, "but imagine yourself in a situation where you have to stop whatever you're doing and sneeze 25 times in a row. People get really tired of it."
"I've got a patient who says every time she sneezes she feels like she's blowing her brains out," said Dr. Green. "If she's driving a car, she actually has to pull off the road."
Another of Dr. Green's patients, Frances Moran, describes how she used to feel this time of the year: "Like I had a lot of little feathers in my throat . . . my eyes would itch terribly, my nose would run uncontrollably, I couldn't breathe at night . . . it was very bad, very annoying."
If that wasn't enough, people with seasonal allergies may be at increased risk for developing asthma, sinus infections, even -- if they smoke -- chronic lung disease. All of which explains why the National Institutes of Health recently called seasonal allergies "one of the nation's major health problems." For reasons not fully understood, it's a problem that seems to be increasing.
Not that everybody suffers quite so acutely this time of year. Allergy sufferers range from those "who literally do wish they were dead" to "the guy who sneezes a few times, takes his Allerest and does just fine," said Dr. McGeady.
In an allergy sufferer, the body reacts to a normally harmless substance by producing antibodies that cause certain cells to release powerful inflammatory chemicals that cause the symptoms of allergy -- the sneezing, itching, irritation and so on.
People inherit the tendency to be allergic -- even if only one parent has allergies, a child has a 1-in-4 chance of being allergic. The other necessity for an allergy to develop is exposure.
Allergies usually surface in childhood, adolescence or early adulthood. Occasionally, they show up later in life -- "it's possible at any time, but less likely," said David Lang, the director of
Allergy-Immunology at Hahnemann Medical College & Hospital in Philadelphia.
Though people can be allergic to myriad things, that pesky pollen -- the microscopic, airborne grains that various plants use for reproduction -- is the major problem at the moment.
Various tree pollens begin their journeys in late February and continue through early May. "Right now it's the maples -- park your car under a maple and it will actually be yellow in the morning, which gives you some idea of the quantity of this stuff," said Dr. Green.
Starting mid-May, grass pollens are the major culprit, going through June. Then there's a breather of sorts for a month and a half; in mid-August, the fall pollens (with ragweed as the heavy hitter) appear, staying around until frost.
Well, there is a gap between grass and ragweed -- but, as Dr. Lang points out, that tends to be the domain of yet another allergen, mold spores. And, as luck would have it, those pesky little guys -- with their fondness for moisture -- tend to appear on the damp and rainy days when wind-borne pollens are least likely to be about.
You can't win.
When it comes to pollen, a dry, windy day is the worst scenario for an allergy sufferer -- and just being outside is usually enough to do damage. Sometimes, however, even what you've done before can come back to haunt you.
"We talk about a 'priming' effect," said Dr. Green. "If you get one really bad weekend -- let's say you're out cutting the lawn -- you may be much more sensitive for the next couple weeks to even minor exposure."
Some folks start wheezing at the mere mention of any airborne pollen or mold; others are allergic to only one. And many have not only seasonal allergies but other year-round ones as well. "There's no evidence that seasonal allergies predispose you to being allergic to other things, like foods, but not infrequently they do go together," said Dr. Lang.
Dr. Green said patients often have come in with seasonal allergies and, years later, "outgrow" them and have more trouble with year-round allergies. "But then young people are more outdoor people," he said. "That might explain why they seem to have more trouble with pollens."
Whatever your allergy, there's probably a treatment available. Often, treatment begins with a skin test, involving the introduction of tiny amounts of suspected allergens into your skin with needle pricks, scratches or injections, to pinpoint the offender.
Once the allergen is pinpointed, there are three general avenues of treatment:
* Avoidance: The best method, allergists say, is to simply avoid whatever you're allergic to. Though pollen and mold allergies can be greatly alleviated by keeping away from the stuff -- David Lang, director of allergy-immunology at Hahnemann Medical College & Hospital in Philadelphia, says the pollen count drops 90 percent to 95 percent if the windows are kept closed and the air conditioning is kept on, for example -- most people won't do it.
"Short of making yourself a recluse, or going on a sea voyage -- which is what people did in the old days -- there's not really much you can do to avoid pollen," said Dr. Stephen J. McGeady, director of the Allergy and Clinical Immunology Division at Thomas Jefferson University Hospital in Philadelphia. "So we fall back on treating the symptoms."
* Medication: Mild or occasional symptoms might call for nothing more than an over-the-counter antihistamine, decongestant or nasal spray -- though allergists warn that some sprays can have a "rebound" effect in which they actually worsen congestion, and that thyroid conditions, glaucoma and prostate problems can be aggravated by antihistamines.
More severe symptoms may call for some of the newer prescription medication -- non-sedating antihistamines, antihistamine-decongestant combinations and steroid nasal sprays.
* Injection: For people who can't or don't wish to take medication, allergy shots "can be very helpful," said Dr. McGeady. The injections, which contain diluted amounts of the allergen, are usually given weekly for several weeks, then gradually spread out. Generally, after four to six years, they are discontinued.