Showing posts with label allergies. Show all posts
Showing posts with label allergies. Show all posts

Climate change is making us sneeze

Allergy sufferers are having a rough time of it this spring. If you're among them, and if you think it's getting worse, you're right–and climate change is at least partly to blame.

Admittedly, warming climate has far more severe consequences, such as the eventual flooding of entire coastal cities. On a personal level, though, pollen allergies make people pretty miserable. (I write this as a lifelong sufferer myself.) When springtime comes and trees burst into buds, some of us shut all the windows and huddle inside.

I hadn't thought that climate change would affect the pollen season until I read a newly published study in a journal called The Lancet Planetary Health. (Aside: yes, there really is a journal with that name, a specialty journal created two years ago by the venerable publishers of The Lancet.)

The new study, by USDA scientist Lewis Ziska and colleagues from 15 other countries, looked at airborne pollen data from 17 locations, spanning the entire globe, and stretching back an average of 26 years. The news isn't good for allergy sufferers:
"Overall, the long-term data indicate significant increases in both pollen loads and pollen season duration over time."
In other words, it's a double whammy: we getting more pollen than ever before, and the allergy season last longer. Okay, not that much longer, only an average of one day. But if you have hay fever, every day is one too many.

To be fair, not every location experienced a significant increase in pollen. Here are the 12 (of 17) that did:
  • Amiens, France
  • Brussels, Belgium
  • Geneva, Switzerland
  • Kevo, Finland
  • Krakow, Poland
  • Minneapolis, USA
  • Moscow, Russia
  • Papillion, USA
  • Reykjavik, Iceland
  • Thessaloniki, Greece
  • Turku, Finland
  • Winnipeg, Canada
Perhaps not coincidentally, the pollen season this spring is making headlines in the U.S. As the NY Times reported this week, "extreme" pollen has blanketed the middle of North Carolina this week. It's so bad that the air has taken on a yellowish tinge, as shown in this unaltered photo, one of several taken by photographer Jeremy Gilchrist and shared last week on social media.
A yellow haze caused by pollen over Durham, North Carolina
in April 2019. Photo credit: Jeremy Gilchrist via Facebook.

According to Ziska et al.'s study, more pollen-filled springs are the new normal. Their projections indicate that pollen seasons will continue to get longer in the future, and that the amount of pollen in the air will also increase during the spring and again in the fall, when ragweed pollen is at its peak.

What can you do about spring allergies? I wrote about this last year: for some people, over-the-counter antihistamines help, although they only treat the symptoms. Allergy shots can provide long-term relief, if you have the time to go through the months-long regimen. Other than these options, the best you can do is stay inside and wait for pollen season to end. You can always catch up on your reading of The Lancet Planetary Health.

Sniffle. It's allergy season again. Do those shots work?

Ah, spring is in the air. The flowers are blooming and the trees are bursting into leaf.

For many of us, this time of year means one thing: allergies. The price of going outside for any length of time is sneezing and itchy eyes that last for many hours, even after we return indoors. Rather than going out and enjoying the warm air and colorful vegetation, we close the doors and windows and stock up on antihistamines and eye drops. Studies show that 20–40% of people in the U.S. have allergies.

Your local pharmacy has shelf after shelf of allergy treatments, ranging from mildly effective (Zyrtec and its equivalents) to laughably ineffective (anything homeopathic). But even the best pills have side effects, and they only serve to suppress the symptoms. As one study put it:
"Patients struggle to alleviate their misery, frequently self-adjusting their treatment regimen of over-the-counter and prescription medications because of lack of efficacy, deterioration of efficacy, lack of 24-hour relief, and bothersome side effects."
Isn't there a way to tell your body to just stop it already? After all, pollen is not a pathogen. Our misery is caused by our own immune system's over-reaction: it ramps up in response to the foreign particles (pollen) in our eyes and airways and creates a histamine reaction, which is simply not necessary.

None of the over-the-counter pills prevent this reaction, but they can dampen it–hence the term "antihistamine." However, what if there were a way to tell your body to simply chill out and ignore the pollen?

Well, maybe. You can get allergy shots. This is a surprisingly simple procedure: your doctor takes a small, diluted amount of the allergen (pollen, cat dander, etc.) and injects it into your arm. Over the course of many months, your doctor will very gradually increase the amount being injected. You have to go for the shots every week, and continue them for several years.

The question is, do they work? The answer is a qualified yes.

NIH and the Agency for Healthcare Research and Quality (AHRQ) have put together a long explainer of the evidence for and against allergy shots, which you can find at PubMed Health. The NIH study looked at 74 clinical studies of allergy shots. To save you some time, I'll cut to the chase: the evidence is quite good that shots work. Or, as the AHRQ study put it,
"we found high grade evidence that subcutaneous immunotherapy reduces rhinitis/rhinoconjunctivitis symptoms."
This might seem like pseudoscience, but it's not: what's happening is that your immune system is being de-sensitized to the allergen. It doesn't work for everyone, but in many people, this gradual de-sensitization trains their immune system not to react so badly. It's not necessarily permanent, either: after stopping the shots, allergies might re-appear after a few years.

So if you're looking out your window at the beautiful spring weather with a box of tissues by your side, maybe you have a way out. Talk to your doctor or visit the AAAAI site to find an allergy specialist. Don't expect miracles or a quick fix, but allergy shots are the best we've got, for now.


Allergy sufferers beware! These eyedrops are a scam.

Spring allergy season is upon us, and plants are bursting into leaf and bloom, spreading pollen everywhere. For some of us, this otherwise beautiful season is a time to stock up on antihistamines and tissues, and we try our best to stay indoors.

When pollen causes red, itchy eyes, we look for eyedrops to provide some relief. The American Academy of Allergy, Asthma, and Immunology and has a list of eyedrops here that includes products such as Zaditor®, Alaway®, and others. These eyedrops contain real medicine that can soothe itchy eyes and reduce your allergy symptoms.

So I was in the pharmacy section of my local grocery store, Giant, looking for eye relief, but they were sold out of Zaditor. Right next to the empty slot, though, I saw a row of other eyedrops from a company called Similisan®, and I took the picture shown here.
Homeopathic eye drops at Giant Foods in Baltimore.
Looks legitimate, right? Each box has a cross on it (apparently intended to resemble the logo of the Red Cross), and they are in the pharmacy section. I picked up the box labeled "Allergy Eye Relief" to take a closer look, though, and saw the word "homeopathic" near the bottom of the box.

Uh oh. It turns out that these products are little more than very, very expensive bottles of sterile water. For $9.99 you get 10 ml of water that contains several extracts–in vanishingly small amounts–for which there is no evidence whatsoever that they have any effect on allergies. Similisan's allergy relief bottle contains:

  • Honeybee
  • Eyebright (a plant)
  • Sabadilla lily (another plant)

Yes, that's right: they grind up honeybees and put them in the eyedrops. The (wacky) idea is that because bee stings cause allergic reactions, a tiny bit of ground-up bee in solution will prevent those reactions. This flawed principle is the basis for all of homeopathy, which has stuck around for 200 years despite the complete absence of evidence that it works.

As I've written before, homeopathic drugs get a free pass on regulation, thanks to Congress. Homeopaths will tell you that their drugs are regulated by the FDA (they often make this claim in the comments on my articles - just watch), but they're not. All the FDA can do is check to see if the products contain the ingredients listed on the label. Unlike real drugs, though, the FDA does not and cannot require that these "drugs" have any effect whatsoever.

I don't think I need to say more about ground-up bees, but what about those other two ingredients? Eyebright is a plant that has "little or no evidence of efficacy" for eye infections. Its use dates back to the ancient Greeks, and has an interesting history:
"Eyebright was used as early as Theophrastus and Dioscorides, who prescribed infusions for topical application in the treatment of eye infections. This in large part was due to the similarity of the “bloodshot” petals to irritated eyes."
That's right: the flower petals look like irritated eyes, and this was enough to get the early Greeks to try them out as a treatment. Needless to say, the physical appearance of a plant has nothing to do with its efficacy as a medicine. (But try telling that to a homeopath.)

Sabadilla, the third ingredient, is a plant extract used as an insecticide, with an active ingredient called veratrine. As Laura Pottorff from Colorado State University explains, "its dust can be highly irritating to the eyes." Therein lies the homeopath's motivation for using sabadilla in eyedrops: homeopaths believe that a substance that irritates the eyes will somehow soothe the eyes if it is sufficiently diluted.

Similisan claims that their 3 homeopathic eyedrops will relieve itching, burning, watering, and redness in your eyes. The box just says it's "manufactured according to homeopathic principles," but doesn't explain that it hasn't been shown to be effective. You have to go to their website to discover that
"The uses of our products are in compliance with official Homeopathic Compendia. They were not the subject of approved applications reviewed by the Food and Drug Administration prior to marketing." 
In other words, they've never presented any evidence that these things actually work.

One can only hope that the sabadilla in Similisan's eye drops is sufficiently diluted; if not, you're putting insecticide in your eyes. The package says that all three ingredients are at 6X dilution, which in homeopathic jargon means 1 part in 1 million. The problem is that homeopathic substances have no real standards, so we don't know how much of the active ingredients were in the original mixture before dilution.

I was curious to see if Whole Foods Market sold the same stuff, and not surprisingly they do, in their special section devoted to homeopathy. (I've written about WFM and their love affair with homeopathy before.) The only difference is that Similisan costs more at Whole Foods, $11.99 to $14.99 depending on which flavor you buy (check out the photo below).

Homeopathic eye drops at Whole Foods Market. How much
money do you want to waste on a tiny water bottle?
Homeopathic eye drops are nothing more than really, really expensive water. At $10 for 10 ml, that works out to $1000 per liter. Similisan proudly states that it's sold at a wide variety of U.S. retailers and pharmacies, including CVS, Kroger, Publix, RiteAid, Safeway, Target, Walgreens, Walmart, and Wegmans. Seems like they're doing quite a good business selling their $1000/liter water.

Consumers beware: the eyedrops you're looking at, even in the Pharmacy section of the store, might be expensive, ineffective make-believe medicine. Make sure to read the package closely; the fake medicine is sometimes right next to the real stuff, and the packaging is designed to fool you.