Breathing Freely

The flocks of tourists and seasonal residents who come to Southwest Florida in the spring may look forward to blue skies and warm temperatures, but they might also find an unexpected local feature: year-round allergies.

In northern climates during winter months, those who suffer from allergies generally find respite because trees, grasses and plants aren't pollinating then. Not so in Florida, where, says Dr. Larry Castillo of Lee County's Allergy and Asthma Care Center, "there's always something pollinating."

"A lot of people think that by being close to shore, they'll be OK," says Dr. William Dakos of Allergy and Environmental Medicine in Fort Myers. But the same breezes that may lessen the presence of some irritants when blowing in one direction may increase the spread of others when they change course. Dakos cites one study that found pollen particles up to five miles in the air and 25 miles out to sea.

"Most of the winter residents are shocked when they come in January and they're having hay-fever symptoms," says Castillo. Fortunately, seasonal residents, tourists and year-rounders have plenty of options to ease their discomfort when sniffling, sneezing and wheezing threaten to derail a day at the beach.

Allergic Reactions

First, it's helpful to understand the way allergy works in the body. The propensity for allergic reactions is a genetic trait, usually hereditary, that predisposes people with that trait toward immune-system reactions against substances-called allergens-that the body identifies as harmful.

The primary culprit is an antibody called IgE, or Immunoglobulin E, found only in people with allergies. Dr. Shawky Hassan, an allergist who has had a Naples practice since 1983, calls these allergen-specific IgE antibodies "allergy gasoline." They help trigger what Dakos terms a "chemical explosion" -the release of histamines and other chemicals that cause the common symptoms of allergies: swelling of tissues, sneezing and coughing.

More than 50 million Americans suffer from various types of allergy, and the number is growing, according to the American Academy of Allergy, Asthma, and Immunology (AAAAI). More than 17 million people in the U.S. suffer from asthma-the most common cause of which, according to Hassan, is allergic reaction. Up to 78 percent of asthma victims also suffer from allergic rhinitis-hay fever, a type of allergy that afflicts about 35 million in the U.S. alone, says the AAAAI.

Other types of common allergies include sinusitis, characterized by inflammation of the nasal sinuses; otitis media, or ear infections; eczema; hives; and anaphylaxis, a severe systemic reaction usually caused by food and insect sting allergies.

Treatment Options

Treatments for allergies vary, depending on severity of the reaction in each patient, exposure to allergens, and medical history, among other factors.

The first step is to find out what you are allergic to, which can be determined by a qualified doctor. Using a combination of a patient's history along with various methods of skin testing, allergy specialists can determine exactly what substances a patient is sensitive to. Then the physician and patient can determine avoidance measures-like removing old carpets or covering mattresses and pillows with airtight encasings, for example, to cut down on allergies, or banishing a pet from the bedroom to diminish animal-related allergies.

Depending on the severity of their allergies, some sufferers will see a substantial improvement with only these kinds of management techniques, along with use of various medications. These medications range from antihistamines like Claritin and Allegra to decongestants that counter postnasal drip to nasal steroid medications that control swelling and inflammation of tissues. Asthma sufferers may get adequate relief from inhalers that ease constriction in the airways.

But for more persistent or severe cases, greater measures may be necessary. Immunotherapy delivers small doses of a patient's particular allergens subcutaneously-via allergy shots-in gradually increasing doses over time to decrease sensitivity to those allergens.

On the downside, the therapy may take anywhere from two-and-a-half to five years-and in a few cases as many as seven. But after the first several months, the frequency of shots decreases to about once a month. The patient may begin to see symptoms start to decrease as soon as four to six months after beginning treatment.

Also on the plus side: Patients can get simultaneous treatment for a number of allergens-not only for those here in Southwest Florida, like citrus and Australian pine, but also for specific northern culprits and for those found all over the U.S., like oak. A patient who comes to Southwest Florida seasonally can work with his or her allergist locally along with one back home to keep symptoms under control.

Immunotherapy isn't a cure for allergy: The treatment is estimated to provide around a 70- to 85-percent reduction of symptoms in 70 to 85 percent of patients, according to various sources. Many patients will see a marked and permanent improvement in their symptoms once the course of treatment is completed; others may not experience as much relief, and may even relapse after immunotherapy ends.

"People expect 100-percent impro-vement, and that's not going to happen," says Castillo. "The disease is very complicated."

But in the majority of cases, patients who choose to undergo immunotherapy experience a marked reduction in frequency and severity of allergic reactions. "We tell [patients] the facts," says Hassan, "and all of a sudden they are masters of their own disease. "

Managing Allergies

In the meantime, there are a number of things you can do during the local peak allergy season-roughly from November through April-to make life more comfortable.

The AAAAI advises allergy sufferers to resist the warm-weather temptation to throw open doors and windows, and to keep the house closed up-particularly overnight, advises Castillo, because pollen and mold counts are at their highest in the early-morning hours. "If you're sleeping with the windows open, you're going to be a mess in the morning," he says.

That includes driving with windows open-a no-no for allergy sufferers. Running the air conditioning in house and car can clean, cool and dry the air inside, minimizing dust and mold allergens.

Also ill-advised: Exercising in the morning, from around five to 10 a.m., because higher pollen and mold counts combined with increased air intake from exertion can hit allergy sufferers with a double whammy.

Stay inside, if possible, on days when the counts are particularly high, as well as on dry, windy days, when allergens will be more widely circulated. Avoid mowing the lawn or raking leaves if grass and tree pollens make you miserable.

The fresh, outdoor scent of sheets and clothes hung outside to dry isn't worth the tradeoff for people who suffer from hay fever: Pollen and mold collect easily on moist fabric. Indoor plants can cause problems. Wet soil encourages mold growth. Minimize your greenery inside, and don't over-water.

According to Castillo, the bedroom is where you want to concentrate avoidance measures, since most people spend about a third of their lives there. It's an especially good room for bare floors rather than carpet. The latter's a haven for dust, mold, animal dander, cockroach feces and other allergens. Special bedding can be purchased to keep irritants at a minimum.

Your doctor or allergist/immunologist can provide other tips to help keep you comfortable as tourist season arrives hand in hand with allergy season. The AAAAI offers a toll-free physician referral and information line: (800) 822-2762. Or you can visit its Web site at www.aaaai.org.