It takes two to tango and it takes two parties to produce an allergythe allergen and an immune system (albeit an overactive one). Allergens can be anything from a grain of pollen to your aunt Fanny's favourite feline (actually, the dander it produces).
Many drugs as well, including sulfonamides as well as other antibiotics, aspirin and even some blood pressure medications can perform as allergens. But before you can have an allergic reaction, your immune system has to recognize the antigen as a gatecrasher and raise the alarm. The party begins in a rather formal way when a presenting cell introduces the antigen to special T-cells. But things go downhill from there when antibody-producing B-cells get involved. They, in turn, initiate a cascade of events resembling the introduction of a fox into a hen house. The real trouble-makers are the mast cells and basophils (normally helpful members of the immune corps) who open the door to all kinds of inflammatory riffraff. These characters, cytokines and histamine, bring out the worst in the host, producing unwanted and sometimes debilitating symptoms that call a halt to any pretense of civility.
If the reaction is severe (anaphylactic), a shot of epinephrine (epi-pen) and a call to 991 are in order. For less severe complaints, for example what we in the profession call sneezonal allergies, antihistamines provide the most reliable treatment. If you are allergic to nuts or certain drugs, the best solution, of course, is avoidance. But that is often not practical or possible, especially when the allergen is airborne. One initial caution: the classic (older, first generation) antihistamines are not always appropriate. Benadryl and Chlor-tripolon are examples. They may work as wellin fact even better for severe reactions, to bee stings, for example, or as adjunctive therapy in anaphylaxisbut they are more likely to have side effects in people who have certain medical conditions such as glaucoma or enlarged prostate. Drowsiness, sometimes acute enough to affect the ability to drive, is a common side effect.
The newer, second generation antihistamines (Claritin, Allegra, Reactine and Aerius) are much less likely to have side effects and often provide consistently good relief. Tolerance can develop with extended use but usually switching to a different member of the same class restores effectiveness. Arerius (or its generic) also helps to relieve the nasal stuffiness that often accompanies seasonal rhinitis.
Some of the other second generation antihistamines come in combination with pseudephedrine, a nasal/sinus decongestant, but it adds another dimension of possible, sometimes serious, unwanted effects. Sneezonal allergy is also known as allergic rhinitis or hay fever, goodness knows why since hay is rarely allergenic and fever is definitely not a symptom. The most common and bothersome symptoms include sneezing, runny nose, watery, itchy eyes and sometimes nasal stuffiness. For many people the affliction is limited to eye symptoms and can be managed simply with an eye drop. There are a couple of prescription drops, but there are several over-the counter products that contain antihistamines. There is also a drop called Opticrom that contains a mast cell stabilizer that keeps those naughty mast cells keep from releasing histamine.
As we promenade out of winter, happy for the rising mercury and the longer, brighter days, a good many curse the catkin-strewn paths of spring and the warm, pollen-laden breezes of summer. If you have a partner with that dilemma, at least keep some Kleenex handyit's the least you can do.
BUD MASSENDER
special to the Undercurrent
