Americans spend billions every year trying to tame their allergy symptoms – mostly with prescriptions and over-the-counter drugs. Know your alternatives.
By the time Arik Hendrickson was 40 years old, he had suffered from asthma and moderate-to-severe allergic rhinitis — a fancy term for seasonal allergies like hay fever — for more than 35 years. That’s 35 sneeze-filled springs, 35 sniffly summers and 35 congested autumns.
It was only in winter, when the grasses and ragweed shrubs had receded, that Hendrickson, a funeral director in La Crescent, Minn., felt somewhat normal. The rest of the year was a long parade of irritating, energy-sucking symptoms: watery eyes, an itchy throat, a constantly runny nose and near-daily asthma episodes during which, he says, “I felt like I was trying to breathe through a straw.”
On top of all that, he had to endure the side effects of his allergy medications. Even though the pills and inhalers made it easier for him to get through the day, they carried their own downsides. “At one point I was using Advair, which is an inhaler with a black-box warning because it has some really serious side effects,” says Hendrickson. “But I really didn’t care about the risk. I was willing to do anything.”
What finally broke the cycle for him was a novel treatment called Specific Immunotherapy, or SIT. The treatment involves applying liquid drops of allergens under the tongue multiple times a day for at least three years, and up to a decade. Hendrickson, who’s been on the therapy for more than four years now, remains symptom-free.
“I don’t want to jinx myself and use the word ‘cured,’ but that’s what it’s like,” says Hendrickson, who is now thinking about phasing off of the drops. In fact, his symptoms have improved so much that he recently adopted a cat named Boots. He’s also an avid deer hunter and likes to take his tractor out onto his property to harvest firewood. “I’m doing things I never, ever dreamed I would be able to do,” he says.
Unfortunately, a happy ending remains out of reach for the millions of Americans — their numbers rising — who suffer from allergies. According to a report from Harvard Medical School, 40 to 50 million Americans suffer from some type of allergies, including food sensitivities. The American Academy of Allergy, Asthma & Immunology (AAAAI) puts the figure even higher, around 60 million. That means more Americans are suffering from allergies than from diabetes and high cholesterol — combined. And, most of these people rely not on alternative treatments but on prescription and over-the-counter drugs that not only do not treat the root causes of allergies, but also have a slate of negative side effects.
“Even the lowest figures indicate to us that allergies are at epidemic proportions,” says Diego Saporta, MD, an otolaryngologist in New Jersey who specializes in allergies.
One Syndrome Leads to Another
What doctors like Saporta mean by “allergies” is a family of related conditions that include food allergies, eczema, allergic conjunctivitis, asthma, rhinitis and a host of other maladies.
The official umbrella term is “allergic disease” or “atopic syndrome.” Sufferers of allergic disease tend to have more than one condition, or a progression of conditions, throughout their lives.
In particular, allergic infants and toddlers tend to first be diagnosed with a scaly, itchy skin rash called eczema. As these children grow older, the eczema transitions into allergic rhinitis. Then, the condition moves into asthma during school-age years.
“We call this the ‘allergic march,’ and it is very, very common,” says Linda Cox, MD, an allergist and immunologist in Fort Lauderdale, Fla.
The allergic diseases are so interconnected, in fact, that immunologist Estelle Simons, MD, a past president of the AAAAI, proposed in a recent paper that the terms “allergic rhinitis” and “asthma” are confusing and should be done away with altogether. Her proposed name change for both conditions is rhinobronchitis.
“Each person expresses allergic disease differently, with an individual array of symptoms, but the underlying condition (a dysfunction of the immunological system) is the same,” Saporta says.
So how do allergies develop? They happen inside the body of a person with allergic disease when the immune system gets confused and identifies something very normal, or even good, as a threat.
It’s helpful to imagine your immune system — housed in your gut, your lymphatic system and many other tissues — as a vigilant administrative assistant tasked with manning the front desk in an office. The assistant’s job is to make sure that important clients (for example, nutritious food proteins) get right in to see the boss. When other innocuous but annoying particles, such as pet dander or pollen spores, come in and ask to use the bathroom or the phone, the assistant makes sure they get what they need and then move along. The assistant is supposed to call security only if some violent virus or bacteria charges into the lobby, vowing to do serious harm to the boss.
In an allergic person, the immune system gets confused and misidentifies an important client — like food — as a terrorist, or gets inexplicably frightened by some scruffy-but-harmless piece of pet dander.
Heeding the call of the immune system, the corporate rent-a-cops — a class of antibodies called immunoglobulin E (IgE) — race in and set a new, draconian corporate policy: All future pet danders or pollen spores or a certain food must be extracted from the building immediately. Then the tough-minded IgEs set up stakeout points on specialized histamine-filled cells called mast cells.
The next time that harmless pet dander comes sauntering in, the rent-a-cops are ready. The IgEs blow the whistle, which causes the mast cells to release a host of storm-trooper chemicals, including histamine, leukotriene C4 and interleukin-2. These chemicals trigger a physiological response that food- and nonfood-allergy sufferers know well: watery eyes, runny nose, wheezing and skin conditions.
Most of the time, this just makes people feel miserable. If this chemical response is, however, too powerful, it can send the body into a very scary whole-body state called anaphylaxis — a condition that may include hives, a swollen throat, vomiting, coronary spasms and even loss of consciousness. About 1,500 Americans die from anaphylaxis each year.
Malady of the Wealthy
Although researchers are still developing theories on why the immune system makes such a security error, they do know that allergic disease — even food-related allergic disease — is confined almost entirely to developed, wealthy nations. Beyond that, there seems to be little reason why it may be prevalent in one part of the world and not another.
The United States has high rates, but not nearly as high as Scotland, where one in three residents is affected by allergies at some point in their lives. In New Zealand and Australia, nearly 30 percent of the population suffers from at least one allergic condition.
Researchers have noted across-the-board increases in developed nations in recent years. According to a 2007 report from the Centers for Disease Control (CDC), U.S. food allergies increased by 18 percent from 1997 to 2006. Also, according to the CDC, about 20 million Americans suffer from asthma today, compared with 10 million 20 years ago.
A separate study by researchers at the Jaffe Food Allergy Institute at Mount Sinai School of Medicine in New York found that the rate of peanut allergy in children tripled from 1997 to 2008.
Varied hypotheses about why this might be include diets low in immune-boosting vitamins and antioxidants, climate change, increasing pollution, modern landscaping practices that use predominately pollen-producing male trees and shrubs, the waning popularity of breastfeeding, building codes that emphasize air-tight structures, even genetic shifts.
The most prominent and accepted theory, according to allergist Linda Cox, is the hygiene hypothesis, which posits that we’re interfering with the natural development of the immune system with overly disinfected spaces, too much antibiotic use, and not enough exposure to farm animals and microbe-laden dirt. (For more on this, watch for our upcoming article in defense of dirt in our September issue.) “But on the whole,” Cox says, “my best guess is that it’s probably a little bit of everything.”
Accordingly, most alternative treatments focus on reducing exposure to allergens, or retraining the immune system to cope with them more successfully.
Most alternative therapies, including the immunotherapy approach Hendrickson embraced, also allow for simultaneous treatment with conventional drugs, including antihistamines, to manage symptoms.
But it’s important for allergy sufferers to remember that as long as their bodies are attempting to launch an all-out defense, ongoing exposure to allergens will place significant demands on their bodies’ resources — even if their outward symptoms like itching and sneezing are suppressed. And medications can impose additional toxic burdens of their own.
So if you suffer from allergies that aren’t being properly addressed at the source, it’s probably worth getting a consultation from an alternative-treatment provider. Whether you manage to ditch allergy meds altogether or just lessen your dependency on them, you’ll be taking good, proactive care of your body. And that’s nothing to sneeze at.
Testing for allergies is a complicated ordeal. Here’s a look at what you can expect at the doctor’s office.
Basics: There are several blood allergen tests, including the ImmunoCap, the ELISA and the EIA antibody test. One of the most popular is the RAST test, created by Pharmacia Diagnostics in Uppsala, Sweden.
How it works: Your physician takes a blood sample. Various allergens are placed in the wells of a special tray. A small amount of blood is added to each well where the allergen extracts are located. If the blood has an antibody against the each of the allergens contained in each well, antibody molecules will attach to the antigen molecules, and this can be then measured in a quantitative way. In other words it will be determined if there are antibodies against a certain antigen and how many.
Good for: People who are so sensitive that doctors are concerned about performing other tests. Also good for measuring the effectiveness of immunotherapy treatments over time.
Upside: Only as painful as having your blood drawn, and up to 100 allergens can be tested at one time.
Downside: Sometimes it is not very accurate. “In my career, I have seen many false negatives results from blood tests,” says New Jersey otolaryngologist Diego Saporta, MD (“like for example a case of a patient that develops asthma if exposed to cat dander or dust but the blood test results come negative”). Also, blood testing is expensive, about $200 to $400 per screening, and some insurance companies will not cover blood tests if skin testing is possible.
Basics: The oldest and most conventional allergen test, the skin prick was traditionally done with needles or lancets; now most allergists use a multi-prick device with plastic prongs that don’t actually puncture the skin.
How it works: Allergen extract is added to the tip of a device with eight to 12 prongs. The tips are usually placed on the inside of the forearm or the middle of the back. The allergist rocks the device back and forth gently so the top layers of skin get exposed to the allergens. When itchy, red patches, called wheals, appear around the application spots, it means that the patient is reactive (allergic) to that allergen. The allergist then measures the size and scope of the wheals and sometimes the surrounding redness (erythema).
Good for: Most everyone who can tolerate the itchiness and aggravation of the procedure. The test of choice for most allergists.
Upside: There’s no need to wait for test results from a laboratory; the procedure is covered by most insurance plans.
Downside: It will be painful and rather itchy, and only a limited number of allergens can be tested at one time because of skin space.
Basics: Considered to be the most sensitive of all the allergen tests, the intradermal tests uses actual injections to test for a reaction.
How it works: Your allergist injects a small amount of diluted allergen extract just barely into the skin. After a few moments, a red puffy bump and potentially other allergic symptoms will appear around the site of injection, allowing the allergist to quantify the response.
Good for: People who suspect they are allergic to a certain allergen, but come up negative on the skin-prick or blood tests.
Upside: Relatively quick and cheap. No need to wait for laboratory results. Also, the test is very sensitive. If you come up negative on an intradermal test you can be pretty sure you are not allergic to that allergen.
Downside: It will be painful and itchy. Only a limited number of allergens can be tested at one time. This test carries a small risk of eliciting a severe allergic reaction.
An Allergy Cure?
If you’re interested in ditching your Claritin or Zyrtec for good, there is a treatment called Specific Immunotherapy (also called SIT) that goes to the heart of allergic disease. The therapy uses allergen extracts to coax the immune system into accepting the allergen without pitching a fit. Despite the fact that SIT is roundly approved by the scientific community and is the only treatment that actually addresses the root cause of allergies, only 2 to 6 percent of all allergy sufferers attempt the treatment. “It’s time consuming, and people are very overscheduled,” says Linda Cox, MD, an allergist and immunologist in Fort Lauderdale, Fla. “It’s hard to get people into the office to do the therapy, and the treatment may last for several years.” Here’s a look at the two major types of SIT: subcutaneous IT and sublingual IT:
The basics: Subcutaneous IT is the oldest and most well-established treatment for allergic disease, with a history going back more than 100 years.
How it works: Allergy sufferers are extensively tested to get a full profile of the allergens they react to. Your allergist injects a custom-blended mix of allergen extracts into the body, usually around the shoulder. Over the first few months, most people receive shots each week; then the shots are reduced to once a month. Over the course of four or five years, allergy sufferers will see their symptoms decrease or disappear. Upside: Once the treatment is over, there is a high likelihood that you may never have to battle your allergies again.
Downside: The treatment is time-consuming and involves needles. Studies show that many people who start subcutaneous IT never complete the treatment.
Common side effects: Pain and inflammation at the site of injection.
Risk: Almost nil. Since 2008, there have been more than 16 million injections administered and no fatalities from subcutaneous IT.
Cost: The treatment is expensive, though the vast majority of insurance plans will cover it. According to a 2010 study published in the Annals of Allergy, Asthma & Immunology, the parents of allergic kids spent $3,247 on immunotherapy, doctors’ visits and other drugs during an 18-month period. The parents who were treating their kids with prescription and over-the-counter meds actually spent more — $4,872 — during the same period.
The basics: First developed in the 1970s, the treatment is very popular in Europe. It has yet to catch on in the United States, owing perhaps to the fact that it is not covered by most insurance companies. [Source’s note: 1986 was the first SLIT study-there is no FDA approved sLIT product and that is why it has not 'caught on']
How it works: Allergy sufferers are extensively tested to get a full profile of the allergens they react to. A custom-blended mix of allergen extracts is mixed with glycerine. Allergy sufferers apply the drops under their tongues daily. Over the course of four to five years patients should see their symptoms decrease or disappear.
Upside: Same benefit as subcutaneous IT, only without the shots.
Downside: You have to remember to actually apply the drops three times a day for years. And you have to find an allergist who is trained in the method. Currently, the treatment is available in 43 states. See www.allergychoices.com for a searchable physician finder.
Common side effects: Itchy feeling in the mouth.
Risk: Much lower than subcutaneous. So low-risk, in fact, that some doctors have begun using this approach to treat food-allergic people.
Cost: The doctor visits typically will be covered by your insurance plan. But, the allergen drops, which cost about $1 per day, will not.