Time - Man of the Year/Time_Man_of_the_Year_Compact_Publishing_3YX-Disc-1_Compact_Publishing_1993.iso/moy/062292/06229933.000

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                                                                                COVER STORIES, Page 54

ALLERGIES

Nothing to Sneeze At


It's the height of allergy season -- a particularly nasty one
in some places -- and millions of sufferers have no easy escape
from the airborne assault

By LEON JAROFF -- Reported by J. Madeleine Nash/Chicago, Andrew
Purvis/New York and Dick Thompson/Washington


    Spring was suddenly in the air, a little later than usual,
and trees were tardily emerging from their long winter
dormancy, budding and flowering with vigor. Arboreal petals
opened, exposing pollen-covered anthers to the breezes, which
wafted pollen grains into the air, carrying some of them for
many miles. By June, while the late-blooming trees were still
in blossom, flowering grasses began contributing to the airborne
assault, and many regions in the East began reporting record
pollen counts.

    As nature intended, the sheer number of pollen grains --
the botanical bearers of sperm -- ensured that at least some
would reach and adhere to their natural goal: the stigma, a
moist and sticky receptor of the female organ of the flower.
That would start a fertilization process eventually resulting
in seed and the propagation of the species. As a result of one
of nature's oversights, however, many of the pollen grains
reached another moist and sticky target first: a human eye or
the mucous membranes of a nose or bronchial tube, where they set
off a chain of events with a decidedly different outcome.

    -- "It's been hell," says Mari Cox, 37, a medical
assistant in Kansas City, Kans. A wet spring and wind in the
region have whipped up pollen counts, so debilitating Cox that
she hasn't been gardening -- her hobby -- or even playing with
her five kids. Instead she is lying low, taking antihistamines
and decongestants. "I'm miserable," she says.

    -- On a Fire Island beach near New York City, weekenders
are peacefully sunbathing when the wind suddenly rises,
blanketing them with swirling clouds of pollen. Coughing,
wheezing, their eyes tearing, some of the bathers beat a hasty
retreat from the beach. "It was just like yellow smoke," says
an awestruck city dweller.

    -- "The new grass, the trees, especially those goofy
cottonwood things that fly around here," laments Dorothy
Jiganti, 48, an oncology nurse at Chicago's Grant Hospital. "It
absolutely kills me." If you forget to take your pills, she
says, "you just feel like you've got a cold all the time. It's
a constant feeling of blah."

    The malady afflicting these people is allergic rhinitis,
more commonly called hay fever. It has nothing to do with hay
and rarely produces a fever, but the Medical Gazette used that
term in 1829, and the name stuck. The years since have produced
no vaccine, no guaranteed cure and ever rising numbers of
sufferers. In the U.S. alone, the sneezing, wheezing, teary-eyed
multitudes are now estimated at 22 million.

    What has improved is scientific understanding of the
mysterious chain reaction that causes tiny pollen grains to make
a human being miserable. Fresh insights into the process,
combined with the new techniques of molecular biology and
genetic engineering, offer hope that this plague will someday
be brought under control.

    That is little comfort, however, in this excruciating
season of sniffles, which will not fade until ragweed -- the
antagonist that may claim more victims than any other plant --
stops flowering in the fall. There is no precise way to measure
how bad an allergy season is, since pollen counts are
notoriously unreliable and as variable as local weather. But in
the East, where spring was unusually concentrated this year,
some readings have gone off the charts. At this time in 1991,
Robert Hamilton, a researcher at Johns Hopkins University in
Maryland, generally measured 1,000 to 2,000 pollen grains per
cu m of air. This year there have been several days when the
reading topped 8,000.

    Personal anecdotal testimony is more emphatic. "This year
has been the worst," pronounces Marina Gomes, 36, of Monroe,
N.Y. Her head is constantly stuffed, her eyes water and itch,
and she can't sleep. "It's horrible," she says. Dr. William
Davis, director for pediatric allergies at Columbia Presbyterian
Medical Center in New York City, calls 1992 the worst year in
a decade. He says he is seeing patients who have not suffered
such nasty symptoms for years, and his first-time visits are up
20%.

    Those allergic to pollen are only the most numerous group
in a much broader class of people who react badly to invisible
tormentors usually in the air. In a sense, hay fever sufferers
are among the lucky ones, since they have at least some idea of
what is bothering them, how to minimize the problem and when it
will stop. Millions of others are vulnerable all year round and
unexpectedly come down with a dismaying variety of symptoms.
They swell up, break out in hives and blisters, develop eczema
or upset stomachs, and have breathing difficulties. After the
initial reaction comes the frustrating detective work to find
the culprit among such widely disparate menaces as dust, cat
dander, mold spores, foods, medications and insect bites.

    At their worst, these allergens produce sudden death -- a
result of what is called anaphylactic shock -- in 2,000
Americans a year. Another occasionally deadly complication is
asthma, a chronic breathing disorder that kills 4,000 Americans
a year (see following story). Altogether, allergies and asthma
affect as many as 50 million people in the U.S., costing them
up to $5 billion annually and accounting for 1 of every 9 visits
to the doctor, including 1 of every 5 trips to a pediatrician.
Despite the mass discomfort, the allergy branch of the National
Institutes of Health spent only $29 million on studies of
allergic disease in fiscal 1991 and another $15 million on
asthma-related research.

    Yet scientists report that they are making progress. In
both academic and private labs, molecular biologists are
unraveling the complex process that produces allergies, and
geneticists are homing in on the genes that direct it. "What has
changed dramatically over the past decade is an appreciation of
how the inflammatory response is orchestrated," says Dr.
Stephen Wasserman, chairman of the medicine department at the
University of California, San Diego. "We are beginning to
understand the fundamental regulators of the entire process."

    Allergies, like autoimmune diseases such as arthritis and
lupus, result from aberrant functioning of the human immune
system, the body's remarkable defense against dangerous
invaders, including viruses, bacteria and parasites. In the case
of hay fever, the immune system perceives the fuzzy grain of
pollen as a threat. The cause of the confusion, explains
botanist Walter Lewis of Washington University in St. Louis, is
a chemical message encoded by proteins in the pollen grain's
cell wall.

    When this message is delivered and read by a stigma in a
flower of the same species, the fertilization process begins.
But when the grain lodges in the mucous membrane of a person
susceptible to allergies, its protein message is heeded by the
human immune system, which confuses it with a menacing invader.
Alarmed, the system immediately begins churning out legions of
IgE (for immunoglobulin E) antibodies, stationing them on "mast
cells," which patrol the body's tissues.

    The next time similar pollen grains are detected, the
antibodies signal the mast cells, which release a flood of
chemicals, including histamine, against the harmless intruder.
It is histamine that causes swelling, itching and other
irritations all too familiar to hay fever sufferers. At the same
time, additional IgE antibodies are produced and placed in
position on mast cells, so that the next exposure to the pollen
may produce a more severe response.

    Another type of immune cell that swings into action at the
first hint of pollen produces a substance that is toxic to
parasitic worms. "Probably the IgE response is there primarily
to protect people against parasites," says Dr. Harold Nelson of
the National Jewish Center for Immunology and Respiratory
Medicine in Denver. Its response to pollen, he says, is simply
a mistake.

    What causes the error? "The improper choice of parents,"
says Wasserman. "Probably there is a genetic predisposition to
respond with IgE, and if you're unlucky enough to have both the
exposure and the predilection, then you're more likely to have
allergies."

    David Marsh, a specialist in the genetics of allergy at
Johns Hopkins, believes his laboratory has found evidence of a
recessive gene that is at least partly responsible for
susceptibility to allergies. And allergies indeed tend to run
in families. If one parent has allergies, the odds are that
close to 1 in 4 of the children will also be allergic. If both
mother and father are allergic, probably most of their offspring
will be too.

    While pollen is the No. 1 troublemaker for allergy
sufferers, hundreds of other substances can provoke the immune
system into an irrational IgE response. Among the more
formidable and difficult to avoid are the droppings of the dust
mite, a microscopic insect that thrives by the millions wherever
dust collects in a house. Living on sloughed-off flecks of human
skin (dander) and other unappetizing protein, it leaves
droppings that are about the size of pollen grains -- and just
as easy to inhale. Mite dung, unfortunately, is an allergen that
produces the familiar sneezing, coughing, itching symptoms in
half of all people who have allergies.

    Other pervasive allergens are the spores made by molds,
both the outdoor kind that grow on crops, grass and dead leaves
and the household variety found on foods, leather, furniture
and in air conditioners. All these fungi spores can produce
vigorous allergic reactions. "Molds are boggling," says
Washington University's Lewis. "There can be hundreds of
thousands of mold spores per cubic meter of air." And, he points
out, a person inhales about 10 or 12 cu m of air each day.

    Members of some 2 million U.S. families are allergic to
cats. Feline saliva contains the offending substance, a protein
called Fel d1 (for Felis domesticus 1) that is left on the fur
and skin during preening, a full-time preoccupation of most
cats. As a result, houses full of cat hair and dander cause
uncomfortable reactions in 25% of allergy sufferers. "Some 70%
of cat owners allow their cats to sleep with them in their
beds," says Dr. Joseph Wedner, chief of allergy and clinical
immunology at Washington University. "There's no better way to
make someone allergic to a cat or to make a cat allergy worse
than lying there with a cat pressed up against your face." Even
the innocent suffer. One example is Dr. Arthur Torre, a
Fairfield, N.J., allergist who occasionally treats cat owners.
"I'll go in the room with them," he says, "and I'll start
wheezing just from the cat dander they have on their person."

    At home or away, threats lurk in the form of foods that
produce allergic reactions ranging from nausea to death.
Shellfish and nuts, especially peanuts, are among the most
dangerous to the vulnerable, with the potential of causing
anaphylactic shock, which is marked by sudden bronchial spasms,
vomiting, plummeting blood pressure and heart arrhythmias.
"Peanut allergy is a life-threatening disease," says Dr. John
Oppenheimer of Denver's National Jewish Center. "The greatest
nightmare for someone with a peanut allergy is dropping dead on
a restaurant floor or at a potluck supper or a friend's dinner
party."

    While shellfish can be avoided, peanuts and peanut
products, including some forms of peanut oil, are ubiquitous in
foods, showing up unrecognized in such items as chili, stews and
meat patties. Canadian businessman Paul Motz has learned to be
wary -- and prepared. With seven severe reactions already in
his medical dossier, he always carries a vial of the hormone
epinephrine (for relaxing bronchial muscles and jump-starting
the heart). He also has a supply of cards to hand out to
waiters, each bearing the warning "I have an acute allergy to
peanuts. Any contact could kill me immediately. Please
double-check your recipes." An appropriate tip, to be sure.

    Equally lethal to some are insect bites, which cause a
fatal allergic reaction in some 40 Americans each year. As many
as 20% of people in the U.S. have a severe local response to
bites from yellow jackets, hornets, honeybees, wasps and fire
ants. An arm swollen to twice its normal size is not unusual.
Of the 2 million annually whose reactions to stings spread
throughout the body, a few hundred thousand will break out in
hives and suffer shortness of breath. Yet, according to the
estimate of Dr. Martin Valentine, an allergist at Johns Hopkins,
half of those people who would have such dangerous reactions are
unaware that they are at risk.

    Being aware offers little protection to those who fall
prey to the kissing bug in Southwestern states. The dark brown
insect, featuring a protruding proboscis and a splash of orange
at the edge of its wings, strikes at night, quietly feasting on
the blood of the slumbering victim. Most involuntary donors
awaken the next morning itching from what seems to be a mosquito
bite. But some immediately develop alarming and occasionally
fatal allergic symptoms. Dr. Jacob Pinnas of the University of
Arizona suggests that kissing-bug deaths may be underestimated.
Some people who die in their sleep and have their death
attributed to other causes, he says, may be victims of the
not-so-amorous insect.

    Other allergies abound, including one surprisingly
associated with the aids epidemic: sensitivity to latex gloves,
which are being worn in increasing numbers by health workers to
guard against infection by the deadly virus. Latex, it seems,
contains an allergen that can produce reactions as drastic as
anaphylactic shock in allergy-prone people.

    Despite energetic research into the nature and mechanics
of the allergic immune response, and some improvement in
treatment, no easy, surefire cure is in sight. Without question,
says Washington University's Wedner, "the very best way of
curing an allergy is to take away the allergen. No one is
allergic to something that isn't there." In a few cases, that
prescription is simple. Sufferers can get rid of the cat, for
example, or avoid obviously allergenic foods and switch to
nonlatex (but more expensive) gloves.

    Avoiding pollen, especially ragweed pollen, is another
matter. North America is host to 17 species of ragweed, a
coarse, hairy plant with a slightly noxious odor and small
yellow flowers. In most regions it blooms from August until
October, each plant producing a billion pollen grains during an
average season. These grains, carried by winds, can travel up
to 400 miles -- even out to sea, where they can bedevil
sufferers seeking relief aboard a cruise ship. Other places once
considered havens because of less airborne pollen -- Tucson and
Phoenix, for example -- are no longer ideal. Immigrants from
other regions have brought their lawns, bushes and mulberry
trees with them, making both the desert and pollen counts bloom.

    Still, one sure way to cut down exposure to pollen is to
take refuge in sealed, air-conditioned office buildings and
houses, where filters cleanse most of the offending grains from
incoming air. But even here, sufferers cannot win. Indoor
allergens -- particularly spores from molds that grow on
irregularly cleaned evaporative coolers and humidifiers -- can
be circulated throughout the structure, bringing on the familiar
allergic symptoms often attributed to "sick-building syndrome."
In houses, keeping air-treatment units free of molds will not
suffice; sealed-in, circulating cat dander and dust-mite dung
often more than compensate for the absence of spores.

    Dander and dung can apparently be brought under control --
although in each case the victory may not be worth the trouble.
In the midst of experiments with cat dander, allergist Wedner
made a serendipitous discovery. "If you wash cats once a
month," he says, "then over a period of three to eight months
they will stop making Fel d1. In essence, you've created a
nonallergenic cat." To nail down his findings, Wedner now has
his cat-owning patients experimenting with the technique on
their pets.

    For those allergy sufferers unconcerned with domestic
decor, the National Institutes of Health recommends the
following steps to achieve a dust-free, and therefore
dust-mite-free, bedroom: Get rid of carpeting, upholstered
furniture, heavy curtains, venetian blinds, fuzzy wool blankets
and comforters stuffed with wool or feathers. Empty the room,
scrub it and everything that is to be returned to it, and
thereafter thoroughly clean the room every week. If replacing
curtains, hang some that are lightweight and can be laundered
weekly. Replace the comfortable chairs with wooden or metal ones
that can be scrubbed, keep clothing in plastic zippered bags and
shoes in closed boxes off the floor. Talk about suffering!

    Most people use the term allergic freely, but often
confuse allergies with other conditions that produce similar
symptoms. Surveys have shown that as many as 70% of Americans
believe they are allergic to at least one particular food.
"That's absolute nonsense," says Columbia Presbyterian's Davis.
"The actual number is less than 10%."

    To determine if a reaction is allergic, Davis and other
reputable doctors use a rather crude but effective technique.
They combine a careful study of a patient's medical history with
tests that involve injecting bits of suspected allergens, each
in a different place under the skin, or applying them to
scratches on the arm or the back. If a particular area swells,
reddens and itches, the patient more often than not is allergic
to the substance placed there. Ordinary citizens wondering
whether their clogged nasal passages and sneezes are signaling
an allergic attack or simply a cold can perform their own quick
diagnosis. If there is no fever, if the mucous secretions are
clear and if sneezes occur in rapid, multiple sequence, an
allergy is almost certainly involved.

    For temporary relief of mild allergies, doctors usually
prescribe antihistamines, drugs that block the action of
histamine, which is responsible for allergic symptoms. The
antihistamine drugs in use for decades reduced swelling and
other symptoms but led to drowsiness, an inconvenience in the
office and a clear danger behind the wheel. But a newer
antihistamine, terfenadine (trade name: Seldane), does not
induce the need to nod. Other drugs helpful to allergy sufferers
are cromolyn sodium, which in nasal-spray and eye-drop forms
suppresses the release of histamine, and beclomethasone,
triamcinolone and flunisolide, cortisone-based preparations that
some doctors find to be even better inflammation fighters.

    Permanent cures are more elusive. But for more severe
allergies, doctors have had some success with a course of
treatment that resembles the folk-medicine cure for hangover:
patients are immunized with a little hair from the dog that bit
them. In this seemingly primitive therapy, allergy shots
consisting of allergens taken from such exotic sources as cat
saliva, dust-mite droppings and pollen and mold spores are often
administered over a few years. Early on, the shots are given as
little as six days apart, but as the treatment progresses, the
frequency of shots is decreased until it levels off to a monthly
pace. Over the same span, the doses are gradually increased
until they reach a maintenance level.

    In some cases, the treatment pays off. "For pollen," says
Dr. Jacquelynne Corey, an allergist at the University of
Chicago, "the success rate is great, around 90%." For dust
mites, mold and animal dander, the results are more variable.
But why the shots do -- and sometimes don't -- work remains a
mystery. Medical researchers know, for instance, that
administering the allergens directly into the bloodstream
results in the production of immunoglobulin G, rather than IgE,
antibodies. Does the presence of IgG block the IgE response? Or
does the hair-of-the-dog procedure eventually desensitize key
cells in the immune system to the offending allergen? No one
knows.

    Most doctors are convinced that a faster, more successful
cure for allergies is bound to come. Using molecular-biology
techniques, researchers have already identified IgE receptors
on the mast cell, basically little berths in which the antibody
docks. If they can find or synthesize another substance that
blocks those receptors, they can prevent IgE from docking and
unleashing the mast cell's stream of debilitating chemicals. And
as scientists isolate and analyze more and more human genes,
they may find the ones that, when defective, cause allergic
reactions. Such discoveries could quickly lead to precise tests
for allergies and eventually to permanent cures.

    Until that time, millions of Americans will continue to
sneeze and suffer, victimized by errant genes, pollen grains,
mold spores, dust-mite dung and the family cat.