4^th Newsletter 2009

Dear Reader,

As winter tightens its grip and temperatures drop, you as an allergy sufferer can now hope for some relief. This is because the colder it is, the smaller the number of pollen grains suspended in the air, and the lower the stress on your immune system. But in these times of climate change, we are experiencing shorter and warmer winters with increasing frequency. It seems that Mother Nature is confused! Soon pollen will be released all year round. Read about the implications of global warming for the allergy sufferer in our feature article.

With the colder temperatures and shorter days of the winter season, even the most enthusiastic pedestrians and cyclists turn to their cars to get to work. However, being cooped up in a car for prolonged periods of time can pose problems for allergy sufferers. But is public transportation a better alternative? And what can you do to avoid your car harbouring allergy-promoting agents?

Moulds frequently provoke allergies, and the common mould Cladosporia comes under close scrutiny in this issue. We also address the issue of "allergic march", explaining what it is and how it can be avoided.

Our usual question and answer feature this month deals with the development of allergy later in life, and highlights the fact that allergy can affect sufferers in the most unlikely circumstances, such as when blowing up a balloon or even licking a stamp! Finally, our experts provide tips on how to clean your house. You thought your house was already clean? Well as an allergy sufferer you have a little more to do in this regard to minimize your symptoms. Follow our simple rules to banish those allergens from your home once and for all!

Enjoy reading your newsletter!

Your "Rhinitis" Newsletter Team

Climate change burdens allergy sufferers:
Here's hoping for a hard winter!

Late autumn is now frequently a pleasant time of year, with the unseasonable mild temperatures ensuring extended use of our summer wardrobes! But as nice as it is to feel pleasant temperatures on one's skin, warm winters are an ordeal for allergy sufferers. Warm winters mean that nature simply never sleeps! There is now no time of year which offers respite to the allergy sufferer. Indeed even at Christmas time nature is just as likely to 'deck the halls' with pollen as with 'bells and holly'. In January, pollen which formerly caused us discomfort in March can be an unwelcome surprise. Increasingly more people suffer from allergies due to year-round pollen loading. Allergy sufferers all agree: here's hoping for a hard winter!

A mild breeze instead of snow and ice in the winter; that is what the future could look like. This is because the global atmospheric temperature has increased by approximately one degree Celsius on average in the last one hundred years. In the next one hundred years this warming trend is expected to accelerate. The atmospheric temperature will be at least 1.5 degrees Celsius warmer in the year 2100, and could be up to 6oC warmer. A number of animal and plant species will possibly become extinct as a result of this. The pollen load and thus the risk for allergies will, however, probably increase.

But all is not doom and gloom for the allergy sufferer. Not every winter will be mild, even if the overall average temperature becomes warmer. The more cold and longer-lasting the winter, the better the conditions are for allergy sufferers. This is because in a hard winter, plants don't release their pollen around the globe until the spring.

The season of winter also heralds the arrival of the common cold. It is becoming increasing important for allergy sufferers to differentiate between a winter cold and allergic rhinitis, as the drugs used to treat these conditions are different. In cases involving the common cold, nasal sprays which contain a table salt solution help. If the nasal mucous membranes are irritated, substances which allay the irritation of these membranes, such as dexpanthenol, are added. A spray with a decongestant substance can be temporarily used for a severely congested nose. The symptoms frequently abate after a week.

However, allergic rhinitis cannot be treated with these agents in the long-term. Allergy sufferers require medications, such as antihistamines, which inhibit the over-exuberant immune system response. Azelastine, is one such antihistamine, and is available as both eye drops and as a nasal spray. Unlike tablets, azelastine formulations have been designed for application directly to the site of inflammation (i.e. nasal passages and eyes) and so have the advantage of a rapid onset of action and a sustained effect. Azelastine eye drops or nasal spray starts working within 15 minutes of application, providing reliable and safe treatment of allergic rhinitis for approximately 12 hours. It couldn't be simpler to apply, and can be used regularly or just when you need it. As-needed application is useful in winter due to the unpredictable nature of pollen release during this time of year.

Allergy sufferers – caught in a mouse trap

As long as allergy sufferers do not leave the house, they can protect themselves well against an excessively high pollen load (see also "Tips from experts"). However, this would be an unreasonable response and an unrealistic expectation for all sufferers. Most working people have to leave the house. Those who do not use public transportation usually drive their own car to work. Pollen filters and closed car windows go some way to preventing allergen traffic into the car from the external environment. However, these measures are ineffective in eliminating allergens already present in upholstery, seatbelt material and the steering wheel, all of which can harbour pollen. Therefore, before buying a new car, it is advisable to take a look at the materials used within it.

Do you have any idea how many hours a day you spend in your car? One hour? Or perhaps more like two? In that case, you conform exactly to the average. Statistics show that central Europeans sit approximately 90 minutes a day at the steering wheel. For allergy sufferers this is a long time if the interior air is not free of allergens.

Sneezing fits, watery eyes and a runny nose are all common symptoms of allergic rhinitis and are a substantial distraction from what is happening on the road. While sneezing, the eyes are shut by a reflex! During this short period a great deal can happen before affected persons can see clearly again. Indeed, according to estimates of the German Skin and Allergy Help Association in Bonn, allergy sufferers have a 30 percent higher risk of being involved in an accident.

Although you might not feel it, you are lucky if you suffer from a grass allergy. The danger of food allergies as a cross reaction to grass allergies is much rarer. But tomatoes, peppermint, soy and peanut still remain a problem. Cereals - although they belong to the grass family - very seldom induce food allergies.

Pollen filters, which keep the interior air clean, are a good solution. But there are still too few vehicles which are equipped with them. In addition, the fact that these pollen filters have to be replaced at regular intervals is frequently forgotten. For many allergy sufferers this is a substantial cost factor. When one considers the misery of allergic rhinitis symptoms, however, isn't it worth the expenditure?

Pollen is often not the only problem for allergy sufferers when travelling by car. UV light from the sun can cause the release of some chemicals that are used in car manufacturing. These chemicals/irritants which are emitted by the upholstery or plastics in the interior frequently aggravate the allergic response.

Public transportation is not an alternative for the allergy sufferer. Vehicles used for public transportation are not in traffic for only 90 minutes, but rather in constant motion the entire day. Consequently, the interior air is frequently burdened with a higher concentration of nanoparticles, which can irritate the allergy sufferer.

Our advice for allergy sufferers therefore is as follows:

• drive your own car to work whenever possible;
• Keep all the car windows shut and use the recycle air function rather than drawing air in from the outside;
• have a pollen filter installed in your car, and replace it at regular intervals;
• Pay attention to the use of low-pollutant materials in your cars.
• If you suffer from fits of sneezing and watery eyes despite these measures, park your car for a few minutes and use appropriate medication, for example antihistamine eye drops or nasal spray.

Remember, topical medications, such as azelastine can provide rapid and sustained relief from allergic rhinitis symptoms, but can also be used pre-emptively before you leave the house. Elimination of allergic rhinitis symptoms may increase your road safety.

Profile: Moulds (e.g. Cladosporium species)

Family: Cladosporium spp.
Home: global

Cladosporium is a genus of fungi including some of the most common indoor and outdoor moulds. It is distributed around the world and contains approximately 500 species. Cladosporia species have frequently been found on dead plant material, in the soil, in potting earth, in woody plants, in groceries, on straw, in water, in damp flats, in air conditioners and in textiles (to name but a few!). Cladosporia are nearly always the dominant fungal flora in the outside air. The spores are not destroyed by UV radiation and can be transported over large distances.

Cladosporia produce more than ten known antigens, to which many mould-allergy sufferers can react strongly. Admittedly, the spore load is highest in July and August, but peaks of spore loading occur repeatedly throughout the year.

Acute reactions to Cladosporia can result in asthmatic attacks. In chronic cases of respiratory distress, pulmonary emphysema can occur.

Avoid "allergic march"

Many pollen allergy sufferers do not take their illness seriously enough. Some only suffer a few weeks a year from the typical complaints such as fits of sneezing, watery eyes, congested or runny noses. Frequently, the complaints can be tolerated, but that is the danger; in nearly 89 percent of all cases asthma is attributable to allergy. Or in other words, asthma can develop from a poorly treated or untreated allergy. Experts term this an "allergic march." No one should allow things to go that far, particularly since there are effective medications available.

The classic pollen allergy is an inflammatory reaction of the upper airways. The nasal mucosa and the eyes are affected. However, in the course of time the focus of inflammation moves increasingly further downwards into the bronchi, and then into the lungs if the allergic reaction is not stopped regularly. The bronchial mucosa becomes inflamed and swells up. The lower airways are now affected, and the allergic march has occurred. Spasms of the bronchial mucosa are a consequence. Subsequently, slight to severe dyspnea can occur. In the long term irreversible damage cannot be avoided.

In order to prevent this development, close cooperation with the attending physician is important. It is necessary to always treat the typical symptoms of a pollen allergy, even when they are not severe. For instance, Azelastine is a potent and fast-acting antihistamine which is extremely effective for the acute treatment of allergic rhinitis. For long-term therapy, other treatment modalities such as hyposensitisation play an important role.

In the meantime, allergic reactions of varying severity repeatedly occur, and must receive acute treatment. Azelastine-containing eye drops and nasal sprays for instance are particularly appropriate for this. These drops and sprays could be used when symptoms actually occur. They provide reliable and effective relief from symptoms within a few minutes of application, with an effect that lasts for approximately twelve hours. Eye drops and nasal sprays are easy to use and well-tolerated.

Additional protective measures to avoid the allergic march are more general ones. Every allergy sufferer should quit smoking. There is also a great danger in passive smoking. Mites, pollen, and moulds should be minimized in living areas. Furthermore, infections when they occur should be treated promptly as these weaken the mucous membranes.

Allergy sufferers cannot afford to be negligent if they wish to enjoy a high quality of life. Early and consequent treatments can combat allergies of the airways and prevent the allergic march.

Frequent questions from people suffering from allergies, Q + A:

I never had any problems with allergies my whole life long. Now at 60 years of age, my nose has started running and my eyes itch. Can this be hay fever?

Formerly, pollen allergy was considered a disease of juveniles or young adults. Today such disorders are seen in a different light. An increasing number of older people are developing allergies to pollen from trees and bushes, herbs and grasses as well as to house dust or fungal spores. Thus, it is highly likely that you have developed an allergy at 60 years of age - however grass pollen (hay fever) may not be the trigger. To determine the causative factor, we recommend that you consult an allergologist. With the aid of blood and skin tests, such specialists can check whether it is really an allergy in your case, and which allergen triggers your symptoms. This is important in order to be able to avoid the allergens. However, the treatment is frequently the same regardless of the triggering factor. For watery and itching eyes as well as a running nose, fast acting topical medication such as azelastine eye drops and nasal spray respectively are advantageous. They work in minutes exactly where they are needed. The drops and spray are easy to use and very well-tolerated.
Get well soon! Your editorial staff

When I blow up balloons for a child's birthday, my eyes immediately begin to water and I have to sneeze. What can be the reason for this?

Balloons contain the natural substance latex, which can trigger an allergy in many people. It is possible that you are a member of this affected group. A latex allergy is not that uncommon. However, you should attend an allergologist to formally identify the allergen(s) which trigger your symptoms. If a latex allergy is confirmed, also remember not to moisten any more postage stamps with your tongue in the future, as the glue on stamps also contains latex. Some protective gloves contain latex and these too should be avoided. However, if you inadvertently overlook a source of latex, fast acting medication exists to treat your symptoms. For example, eye drops and nasal sprays containing antihistamines, such as azelastine, will provide fast and effective relief from your symptoms. You only have to use them as-needed as they work within a few minutes for approximately twelve hours. Azelastine eye drops and nasal sprays are easy to use and well-tolerated.
Get well soon! Your editorial staff

Tips from experts – today:

This is how you clean the house correctly:
simply sweep the allergens away!

The best method to prevent allergies is to avoid contact with allergens, but this is often easier said than done. Allergens are in the air everywhere. However, here are a few tips for reducing the allergen load in your house.

1. During periods of high pollen load, air your house only after a rain shower.
2. Use materials on floors and furniture that can be cleaned with water.
3. Mop or wipe floor and furniture surfaces regularly and painstakingly.
4. Clean all cupboards regularly.
5. Wash your curtains, duvets and other bedclothes frequently.
6. After taking a walk, wash your hair before going to bed.
7. Do not take off any clothes that you have worn outdoors in your bedroom at night, and wash them frequently.
8. Get dressed for bed in the bathroom-this also contributes to avoidance of an excessively high pollen concentration in the bedroom.
9. Sleep with the windows closed at night.
10. Avoid taking walks in dry and windy weather.