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Dr. Prem Kumar on Allergies



Spring is a time of rebirth and renewal. People are motivated to do seasonal cleaning, mow their lawns and plant gardens. Trees bud, flowers bloom and pollen is omnipresent. All these things also initiate the sniffling, sneezing, runny nose and red eyes associated with allergies. Dr. Prem Kumar, professor and chief of the allergy and immunology section at Louisiana State University Health Sciences Center, gives us the ABC's of allergy season.

Q: Spring and allergies seem to go together. Why is that?

A: With the onset of spring and when the weather turns warm, that's the time you'll see lots and lots of tree and grass pollens coming up. When you see beautiful green trees and the weather turning warm, that's when pollen counts rise significantly, and lots of our people in this city are allergic to these pollens.

Q: Is it really worse during the spring?

A: Basically in this town, individuals who suffer from allergies have it bad year round. Unlike the North, let's say New York or Chicago where there's a hard winter freeze and a lot of snow and the molds die, we don't ever have a hard freeze. And since it's hot and humid here, we have a lot of other allergens that are present year round, like house dust mites. This is a tiny little bug that resides indoors in mattresses, carpets and sofas, and it's the mites that are the dominant cause of allergy in this part of the country. Eighty percent of those who suffer from allergies have a sensitivity to dust mites. So on top of the symptoms they have year round, there is an extreme exacerbation of symptoms during springtime because the pollen counts are very high.

Q: We had a hard freeze this winter, so do you expect lower pollen counts?

A: During the freeze, the pollen counts will be low, but once the weather begins to warm like it is now, the pollen counts do go up.

Q: Are there people who have allergies, but aren't aware of them?

A: Some people call it hay fever, but it's not due to hay and there's no fever with it. There are others who say they have sinus problems, others call it allergies and others say they get frequent colds during summertime, so a lot of people think they're getting viral respiratory infections when their symptoms may be due to allergies. Symptoms are pretty common and 20 to 25 percent of people in this city have allergies. Symptoms include sneezing, stuffy nose and post-nasal drip, and it significantly impairs quality of life.

Q: Sure, it's annoying, but is it life-threatening?

A: Remember upper airways are continuous with lower airways, and lower airways are lungs. Lungs with allergies means asthma, so people who suffer from upper airway allergies also are likely to suffer from asthma. If someone has hay fever, we call it allergic rhinitis, then about 20 to 30 percent of these people may have asthma. Asthma can kill — and it does kill. There are still about 5,000 to 6,000 deaths (annually). The numbers may not be too large, but the fact is this is one of those illnesses that can be adequately treated. There is no reason people should die of asthma.

Q: So why do 25 percent of us suffer from allergies, but not the other 75 percent?

A: Genes. It's a genetic predisposition and exposure to allergens. Most people with allergic rhinitis will have positive family history of it. It's mostly genetic, and with the environmental pollutions of all of these allergens, it triggers the symptoms. For example, people living in England aren't exposed to our ragweed pollen, but they're genetically predisposed, so if they move to the United States and live here for a year or two, they start to get symptoms.

Q: What about treatment for allergies?

A: Lots of people with milder symptoms treat themselves at home. The ones we (doctors) see are the ones having severe symptoms. First, we evaluate and try to figure out what the person is allergic to: Is it pollens, which are predominantly outdoors? Is it dust mites, which is indoors? Or is it a cat, for instance, which is a very powerful allergen? So we do a detailed history, examine the person and run some skin tests to find out which allergens the patient is sensitive to. The management approach falls into three categories: environmental control, medications and desensitization or immunotherapy (allergy shots). Medications — by mouth or nasal spray — are symptom relief; they don't cure allergies, but are very effective.

  People aren't willing to give up the cat, so for environmental control, bathing the cats or getting rid of the carpets (where pet dander is located) can help. For house dust mite control, covering mattresses and pillows with specialty covers. Specialty air-conditioner filters, HEPA filters, will make sure outside pollen doesn't get in the house.

  Desensitization is a very effective form of treatment, but it requires a lot of patience. We look at the allergens the patient is sensitive to through their history and skin test, and we take extracts of these allergens and put together a cocktail in specific dosages. We give injections of this once a week or twice a week from six months to a year, and then you can reduce the frequency to once a month. The total therapy takes five years or longer. We have published extensively, reviewed hundreds of thousands of patient records, and there's no question this therapy is very effective for people who have severe symptoms that are not being controlled by medications.

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