Feeling the sneeze: More of us seeking relief from allergies

For more than two decades, Stephanie Berentsen has had more than her share of allergies' misery: sneezing, severely itchy eyes and nose and the attendant complications of sinus and bronchial infections.

Grass, most trees, weeds, dust mites, dogs and cats. She reacts to them all. She is a patient for all seasons.

"My immune system is right up there," Berentsen says with a laugh about her sensitive system.

Berentsen, 44, is part of the wave of an increase in allergies that has built through the years.

Experts estimate that 40 million to 50 million people in the U.S. — nearly 20 percent of the population — suffer from allergies. Environmental allergies — or nonfood allergies, such as those that plague Berentsen — are among the worst, and scientists don't know for sure the causes of the increase.

Many allergists believe the "hygiene hypothesis" may help explain it: Unlike many years ago, children are exposed to fewer germs early in life because homes are cleaner, families are smaller and farm animals aren't around generally. Thus, children's inexperienced immune systems over time may overreact to harmless substances such as pollen and animal dander.

Another theory about the surge in allergies points to energy-conserving, tightly insulated homes that seal in dust and mold. Many scientists believe an increase in environmental pollutants, especially diesel exhaust particulates, may contribute to the increase. Even some urban landscapers may be part of the problem: They plant male trees that have plenty of pollen but not many seeds to clean up.

Whatever the causes, "it's definitely been proven by population analyses that allergies are increasing. Surveys show it," said Dr. Leonard Altman, an allergist at Northwest Asthma & Allergy Center in Seattle and clinical professor of medicine at the University of Washington.

Berentsen's allergies started coming on full in her late teens. She also has mild asthma, which often is set off by allergies. The combination messed with her life, big time.

"It was just disruptive ... to exercising and being outdoors. Sometimes it was so bad, I was just really down sick for days," said Berentsen.

In her late 20s, Berentsen began having increasing bouts with allergies, including painful sinus infections. The infections got worse through the years and a CT scan showed that scarring blocked three areas in her sinuses.

Surgery to clear the scarring helped reduce the infections. A combination of antihistamine medications, shots and an asthma drug also have made her life much better. And working as a patient-services representative at the Northwest Asthma & Allergy Center keeps her well-informed about the latest treatments.

"I have a good understanding of it," said Berentsen. "I just deal with it and take everything I can to make it manageable and not let it interrupt my lifestyle."

Allergies are set off when a "foreign invader" such as pollen, pet dander, mold spores or pieces of dust mites enters the body by inhalation or skin contact. Antibodies called IgE (immunoglobulin E) spring into action and alert mast cells of the nose or lungs to release histamine and other chemicals to deal with the invader.

These substances, in turn, cause blood vessels of the nose to dilate and release blood serum. The serum inflames the mucous membranes and causes a drippy, itchy nose and eyes or sets off asthma symptoms in the lungs.

This cycle of drip, sneeze and misery may not be completely avoidable for those with allergies.

Keeping the offending allergens at bay by simply avoiding them can go a long way to stave off allergy attacks (see tips on page F 1). But an array of medications are available to deal with the suffering.

Antihistamines are the time-honored workhorses of allergy drugs. They block histamine, which developed through evolution to flush out parasites that are carried by few people in developed countries. The drugs prevent histamines' common allergy woes: itching, sneezing and runny noses. Another drug, cromolyn sodium, is used as a nasal spray and helps some patients. It prevents the release of histamine, especially when used before symptoms develop.

Corticosteriod nasal sprays also treat these classic symptoms by preventing or decreasing inflammation in the nose.

Immunotherapy, or a series of allergy shots, is designed as a long-term solution to environmental allergies. It involves testing a patient to determine allergies, then injecting increasing amounts of the allergens to decrease sensitivity to them. During a "build-up phase" lasting three to six months, injections may be given one to two times per week. A "maintenance phase," with injections every two to four weeks, lasts as long as three to five years.

After the maintenance phase, some patients may have lasting remission while others may relapse, according to the American Academy of Allergy Asthma & Immunology. In children, it can prevent the progression from simple allergy symptoms to asthma.

Warren King: 206-464-2247 or wking@seattletimes.com