Fight Sneezing Without Snoozing

For the more than 35 million hay fever sufferers in the U.S., spring is the cruelest season of all. Warm breezes blow tree and grass pollen every which way, making it a time of sneezing, wheezing, and dripping noses.

The good news is that even after the Food & Drug Administration announced plans to try and remove one old standby--the nonsedating antihistamine Seldane--from the market because of rare but potentially dangerous side effects, a bevy of other drugs remains to help most allergy victims. In fact, says Dr. Michael Welch, an allergist in San Diego, "there are more options available this year than ever before."

Hay fever (allergic rhinitis) is by far the most common allergy. When a sufferer inhales pollen, grass, dust, or mold, his or her immune system gears up for a hostile invasion. The defense takes the form of a chemical cascade that results in the release of histamine and other substances which cause inflammation of the nose, eyes, and throat.

A decade ago, the only option for hay fever sufferers was to use antihistamines that turned most people into zombies. When the nonsedating Seldane hit the market in the early 1980s, it quickly became a top-selling drug. Now, there are several similar drugs on the market with very few differences between them, says Dr. Andrea J. Apter, the allergy specialist at the University of Connecticut Health Center in Farmington, Conn. Apter contends that Seldane remains safe for most people, although there is a slight risk of serious heart problems if people take it with erythromycin, a common antibiotic, or with anti-fungal medications. Hoechst Marion Roussel, which manufactures Seldane, won approval last year to sell Allegra, a drug that appears to be as effective as Seldane without the side effects.

In addition to antihistamine pills, doctors are increasingly prescribing new-fangled nasal sprays. Steroid sprays work by preventing an immune response to allergens such as pollen or dust. There are now nearly half a dozen on the market, including Glaxo's Flonase and Schering-Plough's Vancenase. Since these sprays require two to four days to take effect, Welch advises patients seeking quick relief to try a prescription antihistamine nasal spray that can stop sneezing and relieve nasal itchiness within minutes.

For the many patients whose major symptoms are itchy, burning, or weepy eyes, doctors now have several kinds of prescription drops in hand. Some solutions contain antihistamines, others the drug chromolin. A new entry to the market contains both drugs.

Probably the most controversial area of treatment is immunotherapy or allergy shots. Doctors disagree sharply over whether or how well it works and how often such shots should be prescribed. Only about 25% of all allergy sufferers actually need immunotherapy, says Welch.

PILLOW FLIGHT. Before getting shots, Dr. B. Robert Feldman, an allergy specialist at Columbia Presbyterian Medical Center in Manhattan, recommends getting rid of environmental triggers like a down pillow or family cat. If these steps don't help, medication might. But if a patient has battled serious allergies for years despite drug therapy, immunotherapy may be necessary.

Treatment involves giving a person gradually larger amounts of the allergy-inducing substance over a period of three to five years. That helps the immune system get used to allergens. The risk is that too much dust or mold can set off a serious allergic reaction called anaphylaxis. Some companies are working on shots that use just one key part of an allergen instead of the whole molecule. Studies are also being conducted on oral and nasally administered immunotherapy.

In years to come, allergy medication will evolve even further. One promising class of drugs approved last year for treating asthma--called leukotriene inhibitors--blocks inflammation. Studies are being done to determine their effectiveness in treating allergies. Boston-based ImmuLogic is testing a cat dander vaccine that could prevent feline allergies. A vaccine for ragweed is also in the works. Indeed, for the millions of hankie hoarders, these developments are nothing to sneeze at.

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