Community Corner

The Season of Flowers and Misery: Q&A with Allergy Specialist

Dr. Kenneth Lien, Chief of Allergy at Kaiser Permanente in Hayward, answers questions about seasonal (sniff!) allergies.

The rainy season is finally winding down. The hills are green. Trees and flowers are in bloom. And millions of people around the Bay Area and across the country are miserable.

Spring means allergy season, and experts say pollen is flying through local airspace in copious amounts this year. If you’re both an allergy sufferer and an outdoor lover, like me, opting to stay indoors in order to spare your nasal passages is torture.

Pollen allergies are something of a mystery to me, since I only picked them up a few years ago. So I found an expert who could answer some of my questions, and hopefully some of yours, about the who, what, when, where and why of seasonal allergies.

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Dr. Kenneth Lien is Chief of Allergy at Kaiser Permanente in Hayward. Here’s what he had to say. (Questions and answers have been condensed and edited for clarity.)

Patch: People often use the term “hay fever” or just “allergies” for the kind of seasonal allergies a lot of people get in the spring. What’s the correct term and what are the symptoms? 

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KL: Allergic rhinitis is the correct term. It means an allergic inflammation of the nose. People use hay fever because a lot of people suffer from allergies during grass season.

The symptoms often times mimic colds: nasal congestion, runny nose, post-nasal drip, coughing, sore throat, fatigue, swollen, red eyes.

When you have allergies, it’s more than just the nose that’s involved, it’s kind of like a whole body reaction.

Patch: Is it a false reaction? Because pollen doesn’t really harm us, right?

KL: Basically it’s an immune response. A person will make antibodies to things he or she is exposed to. Pollen behaves like a foreign body, and when it gets into the nasal mucosa or conjunctive area of the eye, your body has cells there that are basically trying to fight off this foreign invasion of pollen.

Patch: Why do some people develop allergies while others don’t? And why do some people seem to develop allergies all of a sudden?

KL: Basically, a lot of it is hereditary. You inherit the genetic profile to develop allergies; you inherit a mutation in the chromosome. And if exposed to pollen, you become sensitized; you develop antibodies and have an allergic reaction, usually locally.

It usually takes a few years before allergies start to blossom (in a person).

There are many theories on why allergies have gotten worse over the last few decades. There’s the hygiene hypothesis, which is the idea that our environments have gotten so sterile that the body’s immune system is no longer used to fight off bacteria; for example, from the soil. So now the body switches to fighting off pollen.

Another theory is that pollution is actually a factor in driving allergies. Diesel particles have been found in the lab to stimulate your body to produce antibodies, regardless of the pollen count in those areas.

A lot of people from India and other places where the air pollution is worse come here and say, "Why are my allergies worse here?"

In polluted areas, your body makes antibodies. And when your body is later exposed to pollens, those antibodies start reacting to the pollens. I think that has more credibility than the hygiene hypothesis.

If you grew up in L.A. in the 1980s and 1990s (when pollution levels were higher than they are today) and never had allergies, and then come to the Bay Area, a blood test could show that you make high levels of antibodies (presumably because of exposure to pollution).

Patch: What is producing the most allergy-provoking pollen this spring in the Bay Area?

KL: Mostly trees: oak, juniper, cypress, mulberry. The strong rain we’ve had has pushed back allergy season. It seems like it will be a very bad year because of the rain and wind.

In the Bay Area, not only tree season, but grass season, is bad. That peaks in early May and generally lasts until early July. Fourth of July weekend is usually the unofficial end of allergy season.

Patch: Flowers don’t cause allergies?

KL: Flowers are usually not a problem because they are insect-pollinated. So their pollen tends to be sticky and viscous. It doesn’t travel on the wind and get into your nose.

A lot of people think flowers bother them, but it’s probably the fragrance, not the pollen, that can cause a reaction in nose.

Patch: How widespread is the reach of allergy-provoking pollen? Can people living in neighboring towns have different levels of allergic reactions?

KL: The pollen count changes in different neighborhoods depending on the dominance of trees. But the wind can also carry pollen from 50 miles up to 150 miles away.

At the Hayward clinic, we see a lot of people with olive tree allergies. There used to be an olive cannery in the South Bay and now there are lots of olive trees around Fremont. Patients as far north as Oakland may have allergies to olive trees.

Patch: So it varies around the Bay?

KL: Yes. In the North Bay, there are more cypress, mountain cedar and juniper allergies. In Pleasanton, there are more grass allergies.

Patch: What’s the best source for finding out what kind of pollen is in the air on a given day?

KL: There are a few sites in the Bay Area where they measure pollen in the air. There are two stations in San Jose, one in Pleasanton and one in Roseville.

You can look up the pollen counts from those stations on the website of the American Academy of Allergy, Asthma and Immunology: http://pollen.aaaai.org/nab/.

You can also punch in your zip code on pollen.com and get a four-day allergy forecast.

Patch: How can I find out what exactly I’m allergic to?

KL: You can have a skin test done. It’s the most sensitive test to find out what you’re allergic to. We actually scratch the skin with the protein extracts of different things we’re testing for, and if it makes a little bit of swelling, that’s how we know.

Patch: What treatments do you recommend to your patients? And are there any negative effects of using the standard pharmaceutical allergy treatments long term?

KL: The mainstay for treatment is a nasal steroid spray. They are prescription only, not yet available over the counter. They’re mainly used to reduce inflammation in the nose. The safety profile is excellent for nasal steroids. They have been found to be safe with long-term use.

The second thing is antihistamines. Many of them are over the counter now. If your symptoms are just mild and generalized, an antihistamine by mouth would be a great first-line agent.

If your nose if completely blocked, a nasal steroid is better.

You can also get allergy shots. It’s a way of fooling your immune system or actually building tolerance to an allergen. We give weekly injections of higher and higher doses of protein extracts of pollens or whatever you’re allergic to.

Patch: For how long do you have to get the shots?

KL: Weekly during the build-up phase, which lasts six to nine months. Then a monthly shot for three to five years. The shots can help you for up to 10 years after that.

There’s also an oral equivalent of an allergy shot that’s being studied right now. The results look promising.

Patch: What about non-pharmaceutical treatments?

KL: You can use a sinus rinse. A good homemade recipe is 8 ounces of warm water, ¼ teaspoon of sea salt or kosher salt and a pinch of baking soda. The neti pot (a small pot with a spout used to flush out the nasal passages) is popular.

It’s very safe to use two to three times a day.

Patch: What other practical tips can you give for reducing exposure to pollen?

KL: Windows should stay closed throughout allergy season. If you’re allergic to trees blooming in the spring, you should keep windows closed starting in March. If you’re allergic to grass and weeds, keep them closed in summer and fall.

If you need to open them, do it late in the afternoon because the pollen count is usually down then. Also, try to re-circulate the air in your car (as opposed to pulling in outside air). 


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