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« "So Long, Mom. I'm off to drop the bomb." | Main | King Tut Reunited with Family Jewels »

My Histamines, Myself: The Science of Hay Fever

Category: Medicine
Posted on: May 3, 2006 9:15 AM, by Katherine Sharpe

Hay fever, as those of you who have it know, can be a most remarkable feeling.

Your eyes itch, and your joints ache. You feel as though you were coming down with the flu.

Time itself can seem distended, warped. Your hands feel like balls of dough, and you're sleepy...so sleepy.

You feel preternaturally calm on the one hand; on the other, you can't focus (your mind, or heck, sometimes even your eyes) to save your life. You start to wonder whether this is what it feels like to have ADD.

I'm dizzy today. I feel as though someone had wrapped my head in several layers of cotton wool. There's a lavender fog in my mind that no amount of coffee can penetrate. It's allergy season, and I've got it bad.

Sneezing and itching because of irritants in the air makes sense, but it's the less-tangible symptoms of hay fever that interest me more. How can pollen make us feel weak and muddle-headed? For something that I've suffered from a little bit all my life, I have precious little understanding of what 'seasonal allergies' are, or why the treatments for them work (what is a histamine, anyway?) Today seems as good a time as any to do a little research and see what I can find out about this minor affliction.

What causes seasonal allergies?

Allergens, silly. Seasonal ones. Often pollen, but sometimes other things (I guess that would be the "mold" that my mother always told me was responsible for winter allergy symptoms.

According to WebMD,

In the spring, pollinating trees are responsible for causing hay fever. Over the summer, grasses and weeds produce the pollen. And in the fall, ragweed is usually the culprit. Hay fever can also be caused by fungus releasing its reproductive cells, called spores, from late March until November.

That sounds about right: The PollenCast feature on weather.com confirms that tree pollen levels in the 11010 zip code, where Seed's offices are located, is "very high" today. (And I can look forward to them being "very high" tomorrow, too.)

The suffering is caused, essentially, by a misplaced immune reaction. As the Mayo clinic explains,

If you have hay fever, you may react to one or more common inhaled allergens. No matter what you're allergic to, the underlying cause of your misery is the same. During a process called sensitization, your immune system mistakenly identifies the allergen as an invader and produces an antibody against it called immunoglobulin E, or IgE. The next time you're exposed to the allergen, your immune system launches an allergic reaction. The IgE antibodies trigger the release of an inflammatory chemical called histamine, which swells the mucous membranes in your nose, sinuses and eyes, causing a runny nose, watery eyes and sneezing.

What are the symptoms of seasonal allergies?

The big medical sites emphasize physical symptoms like runny noses, itchy eyes, and sneezing. Message boards where people swap stories of their individual experiences have more to say about the woozy, spaced-out feelings that mean 'allergies' to me.

The users of HealthBoards.com expound on the symptoms that other sites refer to euphemistically as "irritability" and "nervousness."

What is a histamine, anyway?

This unprepossessing-looking biogenic amine is the subject of an intriguing discussion on Wikipedia, which provides fodder for many questions, even if it's not super forthcoming with answers. Histamine plays many roles; besides mediating local immune reactions, it is also a neurotransmitter--and I have to wonder whether the part that histamine plays in the brain has something to do with how down-right wonky I feel during a seasonal allergy spell. Has anybody studied this? Histamine deficiency has been traced to problems as diverse as "ideas of grandeur," "the feeling of being controlled," "hearing/seeing things abnormally," and "allergies" (which is interesting, given that we turn to 'antihistamines' to ward off an allergy attack. One has to assume this is one of those substances that behaves very differently in the rest of the body than it does in the brain). An overabundance of histamine, in turn, is associated with "hyperactivity," "obsessive-compulsive disorders," "mindblanks," "lean build," "chronic depression," and, as if I weren't confused enough already, "seasonal allergies."

Why do some people get seasonal allergies, and others not?

Unfortunately, nobody knows. Says WebMD:

Hay fever affects 10% to 20% of the U.S. population and is the most common allergy in the country. It is unknown why some people get allergies while others do not. However, there is some evidence to suggest that hay fever and other types of allergies are hereditary.

Sudafed, Benadryl, and Claritin, oh my! Treatments for seasonal allergies

WebMD has some sexy treatment ideas:

The most effective treatment is simply to avoid the allergen. Some air conditioner filters can remove 99% of airborne pollen. Facemasks, similar to those worn by surgeons, can significantly reduce the amount of allergen you inhale while outdoors. If you have eye allergies, try wearing wraparound or goggle-type sunglasses to protect your eyes from pollens. If you are exposed to pollen, wash your eyes and your eyeglasses frequently with soap and water. Use cool compresses to relieve eye symptoms.

Traditional treatments include old-fashioned antihistamines, like Benadryl, which are renowned for making people sleepy (does anyone know why?) Newer medications like Claritin and Alavert (both forms of a medicine called Loratidine) are also antihistamines, which tend not to make people sleepy (again, why?). Some folks take over-the-counter decongestants containing pseudoephedrine. Others find relief from prescription corticosteroid nasal sprays, which work by decreasing the amount of histamines locally in the nose, or immunotherapy, in which doctors inject a patient with purified forms of an allergen, aiming to reduce their sensitivity to it over time.

Some people also claim good results from acupuncture.

Now if you'll excuse me, I need to see if I can get this Alavert blister-pack open with my dough-ball hands.

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Dear Miss Katherine, here are some insights from a pharmacologist and fellow allergy sufferer:

The headaches and wonky feeling in your noogin come from the desired biological effect of histamine in increasing the permability of blood vessels to allow macrophages out into extracellular spaces to combat infections. Unfortunately, this also lets out plasma proteins that osmotically cause an increase in extravascular/extracellular fluid that cause your brain to swell (same reason you get puffy eyes, sinuses, and runny nose).

Most antihistamines also possess antimuscarinic/anticholinergic activity that dries you up and makes you sleepy. Benadryl/diphenhydramine is the most effective antihistamine out there but makes you more drowsy because it passes across cellular membranes, including the blood-brain barrier, most efficiently. In contrast, the non-sedating class of previously-prescription-only antihistamines don't cross the blood-brain barrier as efficiently. If we drilled a hole in your skull and administered a non-sedating antihistamine, it would make you drowsy as well.

Personally, I find that the lower lipid-solubility of non-sedating antihistamines usually causes them to not be as effective for me as diphenhydramine.

Since I live in a place where I have allergies from April through September, I take Benadryl/diphenhydramine continuously for six months or more. After an initial period of drowsiness during the first week of taking 25 mg twice a day, my body becomes tolerant to the sedating effects yet allows me to enjoy the outdoors. However, you have to be careful using any antihistamine when exerting one's self in the heat - I believe that Revere(s) at Effect Measure had a post about the danger of hyperthermia will antihistamine use in the summer.

Individual response to the antihistamines varies quite a bit. I've had bloggers comment that Benadryl doesn't work for them or that Claritin is the only antihistamine that works for them. So, individual results will vary.

Now, if only there was a drug for the North Carolina humidity...

Posted by: Abel Pharmboy | September 4, 2006 09:33 AM

One last thing: I have heard some biologists and botanists say that our planting of most male trees has been a major contributor to the increase in allergies over the last several years. Since female trees usually drop fruits that rot, male trees are often chosen exclusively for urban and residential areas. With the paucity of female organs to receive and sequester the pollen, it ends up in our eyes and noses.

Posted by: Abel Pharmboy | September 4, 2006 09:36 AM

I've had seasonal allergies for as long as I can remember. I recently read an article about OAS (pollen-food syndrome). This really caught my eye because it's exactly what I have, particularly the birch related vegetables. I'm allergic to every one on that list--but only in raw form; they don't bother me when they're cooked.

What I find curious is that for my pollen allergies (worst in the Spring), I need to take antihistamines to keep them under control. But for my food allergies (suppose I don't notice the raw shredded carrots in my salad) usually just eating some bread and drinking some water (or better yet something carbonated) to wash the allergen out of my mouth does the trick--no need to take antihistamines.

Posted by: The Science Pundit [TypeKey Profile Page] | September 4, 2006 10:34 AM

> female trees usually drop fruits that rot, male trees are often chosen
> exclusively for urban and residential areas.
Good so far.

>With the paucity of female organs to receive and sequester....
Er, no.

Yes, the male trees produce pollen, in huge quantities; most of it is wasted.
That's the male reproductive tactic. No matter how many female trees are present, they don't somehow receive and sequester much male pollen.

Reduce the total number of males -- drastically -- and you may eventually get below the level of pollen that makes your allergies go off. But the number may be less than one. One male can fertilize -- or set off allergies in -- every likely female tree or person for miles downwind.

Posted by: hank | September 5, 2006 02:05 PM

Thanks for the correction, hank - I was just spouting off something I heard on NPR.

Posted by: Abel Pharmboy | September 9, 2006 06:47 PM

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