Mind & Body, May 2003

With Allergy Season In Full Swing, New Treatment Choices Arrive

While most people are happy to bid farewell to the cold and snow of winter, not everyone is equally excited to see spring and summer arrive.

The reason: seasonal allergies, a problem that plagues some 35 million Americans beginning as early as March and often lasting through the first frost in the fall.

"Spring and summer allergies are extremely common, mostly because there are so many different allergens that come into bloom this time of the year," says Dr. Clifford Bassett, an allergy and asthma specialist at New York University Medical Center.

Whether it be trees, grass, flowers or weeds, when the small, dry, light pollen becomes airborne, simply taking a deep breath outdoors can leave a person sneezing, wheezing, tearing, and itching for up to six months of the year.

To heighten awareness of the problem and educate people about treatments new and old, May is designated Asthma and Allergy Awareness Month.

Hope for Those Most Affected

While some relief from allergies can be found through practical means, such as keeping windows closed and staying indoors when pollen counts are high, for many people spring and summer survival is made possible by any number of medications designed to stifle allergic reactions. These include antihistamines, nasal decongestants, and anti-inflammatory nasal sprays. Many of these are available over-the-counter, as well as by prescription.

However, a brand new class of prescription drugs is posed to join the anti-allergy arsenal. Known as anti-IgE, this new treatment may revolutionize not only the way seasonal allergies are treated, but also the treatment of asthma and food and drug sensitivities.

"It is the first phase of a new kind of treatment for allergy disease, and it holds some very exciting promise," says Dr. Lanny Rosenwasser, president of the American Academy of Allergy, Asthma and Immunology and a researcher and allergist at the National Jewish Medical and Research Center in Denver.

Regardless of what a person is allergic to, the cascade of biochemical events that make up an allergic reaction are remarkably similar. Key to the process is an immune system antibody known as IgE, or immunoglobulin E.

With a seasonal allergy, airborne pathogens, particularly pollen, are inhaled. As they enter the body they bind to the IgE antibodies. These antibodies, in turn, bind to nearby mast cells and basophils - immune system molecules that line your lungs, skin, and mucous membranes.

As this occurs, the mast cells and basophils become inflamed and irritated, which then sparks the release of a wide range of biochemicals. The end result is one particular chemical known as histamine, which floods your tissues. When it does, blood vessels and tissues in a person's nose begin to dilate and swell, while sensitive nerve endings become highly irritated. This produces an "allergy attack."

"In the case of seasonal allergies, histamine would initiate the classic sneezing, wheezing and stuffy nose, along with itchy, red, watery eyes," Bassett says.

Preventing Allergic Reactions

For many years, the treatment of seasonal allergies relied on preventing or reducing histamine production, as well as mast cell inflammation. While the treatments worked well, to get optimum relief they had to be administered before exposure because, once histamine production began it could not really be reversed.

However, the new anti-IgE treatments take an entirely different approach, working to help prevent the body from reacting to an allergen in the first place.

"An anti-IgE binds to IgE and ties it up, preventing it from activating and inflaming the mast cells," Rosenwasser says.

The body is "tricked" into believing there is no allergen present. So, it responds as if there were no allergy.
More importantly, anti-IgEs are not "allergen-specific." Theoretically, they can work to block almost any type of allergic reaction.

"It has promise in all allergic diseases," says Rosenwasser, "including drug and food allergies."
The good news is that the first anti-IgE medication, a drug known as omalizumab, may be approved by the US Food and Drug Administration (FDA) in time for the spring-summer allergy season.

The new drug must be administered by a physician. It is given by injection once or twice a month. And since it was tested primarily in asthma patients, it's true effectiveness with seasonal allergies has not yet been fully determined, experts say.

"For those who have standard hay fever, which can be easily controlled by nasal steroids or an antihistamine, anti-IgE medication may not be economically feasible - at least in the beginning," Rosenwasser says.

If, however, allergies are severe, and particularly if a person has not found relief from available treatments, Xolair may be worth a try.

Research Continues for New Drugs

Besides Xolair, other IgE drugs are in development to help treat various types of allergies. Earlier this year, studies published in the New England Journal of Medicine showed how one anti-IgE medication reduced the life-threatening affects of a peanut allergy.

In addition, Rosenwasser and colleagues at the National Jewish Medical and Research Center are developing yet another allergy treatment called Anti CD23. It works by thwarting the connection between allergens and the immune system at an even earlier stage than the anti-IgE drugs, and similarly disrupting the sequence of allergic responses. This treatment could be available within several years.

Always consult your physician for more information.

Online Resources

(These links are provided for the education and convenience of our Neighbors. AAMC is not responsible for the content of Internet sites.)

American Academy of Allergy, Asthma and Immunology

Asthma and Allergy Foundation of America

National Institutes of Allergy and Infectious Diseases (NIAID), of the National Institutes of Health (NIH)

US Department of Heath and Human Services

US Food and Drug Administration (FDA)

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Asthma Affects Millions of Americans

You begin to take a breath, and find your chest has inexplicably tightened. Wheezing and coughing, you struggle to take in air.

Your airways have become blocked or narrowed. The small tubes that carry air through your lungs, the bronchi and bronchioles, have suddenly become inflamed. They are suffering a double assault -- constricted by tightened muscles outside and flooded by mucus inside.

Millions of American may be worrying whether their next breath will come easy. May is Asthma and Allergy Awareness Month, a time when doctors and activists hope to spread more information about the disease.

Asthma attacks can be triggered by allergens, tobacco smoke or exercise - particularly when exercising in cold air.

If an attack is serious enough and left untreated, it can be fatal. The US Department of Heath and Human Services says low-income and minority groups are more likely to die during an asthma attack, probably due to lack of access to proper medication.

From 1993 to 1995, there was an average of 38 asthma-related deaths per 1 million African Americans, compared with 15 deaths per 1 million Caucasians during that same period.

Many doctors believe the increase in Americans' susceptibility to allergies and asthma may be linked to the fact that children are leading healthier lives in cleaner living spaces.

The body typically grows resistant to allergies while fighting off childhood infections and diseases, says Dr. Henry Li, an allergist with the Institute for Asthma and Allergy.

But children are facing fewer infections as they grow up, which could leave them more susceptible to asthma, Li adds.

"When a society has developed, and we have a cleaner and cleaner environment, there is less chance of getting childhood infections," Li says.

Heredity also plays a large part, says Stacey Schubert, an asthma sufferer who also works as an epidemiologist with the asthma program at the Oregon Department of Human Services.

Schubert's mother has asthma and her father suffers from allergies. Her brother also struggles with asthma. "There's definitely a genetic component to asthma," she says.

Schubert has had asthma since she was a child, and has seen great improvements in the treatment of the disease. The newer drugs have improved to the point where she can lead a very active lifestyle with few asthma attacks. Schubert enjoys step aerobics, kickboxing, weight lifting, and biking, and she enjoys them without the ever-present fear of losing her breath.

"Generally speaking, I don't have flare-ups or exacerbations," she says. "Controlling my asthma is very easy. I take my medications."

Always consult your physician for more information.

Medications Designed To Relieve Symptoms

The two commonly types of asthma medications used to treat asthma include long-term control medication and short-term, quick-relief medication. Though the goal of both medications is to treat asthma symptoms, they are used for different purposes.

Long-term control medication is usually taken every day to control asthma symptoms and to prevent the occurrence of asthma attacks.

Quick-relief medication is primarily taken to relieve the sudden onset of asthma symptoms (such as during an asthma attack), and in cases in which the asthma symptoms only occur occasionally.

In addition, a relatively new treatment using anti-leukotrienes is being used to help control the symptoms of asthma. These medications help to decrease the narrowing of the lung and to decrease the chance of fluids in the lungs. These are usually given by mouth.

The type of medication prescribed by your physician to treat your asthma symptoms depends on the type and severity of your asthma, as well as your other individual medical needs.

Always consult your physician for more information.