E-News - issue 3/2009

Dear Reader,

This year, summer has offered up all kinds of weather conditions, from prickly heat and mugginess to rainy and cold days. Indeed, from a weather-perspective it seemed like anything was possible. As an allergy sufferer, you are all too aware of what the wind can bring, and if it carries pollen you unfortunately suffer the consequences! And it is still not over.

Now, we are entering the season of wild herbs when numerous antigens are released into the air. A lot of people suffering from wild herb allergies have to deal with cross over reactions. These individuals suffer not only from the effects of pollen exposure, but also have to abstain from certain fruit and vegetables. In this issue we introduce you to white Chenopodia, a wild herb that releases very potent allergens.

In addition, allergy testing is an important subject in this issue. Here we discuss the different types of tests on offer and what results you can expect.

We also answer two important questions sent to us by readers focusing on the frustration that may arise if allergies impair your life. Finally, our expert's advice deals with the difference between a cold and allergic rhinitis.

Have much fun reading!

Your Azelastine-News team

Ragweed, Chenopodia and Plantain: It's a "wild time" for allergy sufferers

Some allergy sufferers are affected by pollen in spring. But there are many others who have to deal with typical allergic symptoms during the entire year. After the pollens of early blooming plants, like trees, have gone, the middle blowers, such as grains and grasses, have their turn at disturbing the immune system. And now, in late summer, wild herbs have their peak season, so people suffering from allergic rhinitis face "wild times" in the coming weeks and months! In addition, patients with wild-herb allergies bear the risk of cross reactions with vegetables. Therefore, it is crucial that individuals with allergic rhinitis have an anti-histamine to hand.

Wild herbs are plants, with little agricultural or horticultural value. The most important group of wild herbs causing allergic reactions is the Compositae. About 20,000 species belong to this group. A very famous member is Ragweed, and the impor-tance of Ragweed as an allergen is growing in Europe. Rag-weed pollen contains 14 antigens which can induce allergic symptoms. Still, not every person with rhinitis experiences symptoms caused by the same antigen.

In late summer and autumn, there are several other wild herb pollens in the air. One of these is the so-called Reinfarn-class, to which mugwort and sage belong. These plants often cause allergies. In addition, dandelion-related plants disperse a broad range of antigens. Ornamental plants such as aster, goldenrod, chrysanthemums and dahlia belong to this group. The southern and central European family of Chenopodia also carry highly allergenic pollens.

Herbal allergies can be very unpleasant, because antigens of different families are very similar to each other. This means that cross reactions frequently occur. These cross reactions not only occur between wild herbs, but many vegetables, such as celery and tomatoes bear the same risks.

To diagnose the exact cause of an allergy is very difficult as far as wild herbs are concerned. At the moment about 90 extracts of wild herbs are available for immunological testing. However, Mother Nature has many more antigens in her arsenal. Nevertheless, it is important to track antigens. The best way to minimize allergic symptoms is to avoid pollen, which is not always possible, and not to eat certain foods.

A runny nose, watery and itching eyes very often are unavoidable. In this case, it is necessary to have a good medication to hand. Anti-histamines, for example, are very useful, as well as nasal sprays and asthma medications especially if contact with antigens is unexpected. Sprays with a very fast onset of action, such as sprays containing Azelastine, are advantageous. This modern anti-histamine can be used just when needed. It relieves all symptoms quickly (within 15 minutes) and reliably and its effects lasts for about 12 hours. So, you don't need to "go wild" just because the herbs do!

Pollen meets food:

Cross reaction cannot be excluded!

A hearty bite into a fresh apple - that's what fruit lovers fancy in late summer. But some people cannot enjoy this simple pleasure at all, for as soon as the fruit has been eaten, their tongue starts to tickle, their respiratory tract narrows and itching follows. It happens all of a sudden. Very often the apple itself is not the main reason for the allergic reaction. Symptoms are the result of a pollen allergy.

Pollen allergies against early blooming plants such as birch, elder and hazel often cause cross reactions with foods. More than half of all persons that are allergic to pollen cannot eat nuts or uncooked fruits such as apples, pears, peaches, plums, cherries and almonds.

Ragweed also cross reacts
People suffering from a Ragweed allergy very often have to deal with a pollen associated food allergy, which is a special kind of food allergy. Many persons with allergies against Ragweed suffer from cross allergies against bell pepper, tomato and celery, chilli and spicy pepper, and these cross reactions are very unpleasant, because pepper is used everywhere and on everything.

Grasses don't trigger allergies so much
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.

What is the solution to the problem of cross reaction?
Most allergy sufferers instinctively know the answer to this question. Allergy symptoms don't occur, or are less severe, if the antigens don't come into contact with the mucous membranes. However, it is nearly impossible to avoid all kinds of fruits and vegetables. Fortunately, it is not necessary to avoid these foods. Following the consumption of fresh foods, symptoms most frequently occur if pollens have changed the immune system at the same time. This means that if you suffer from an allergy against early blossoming plants, you are in most cases able to enjoy an apple in autumn. In addition, many food allergens are destroyed by heat So simply cooking fresh foods is a practicable way to avoid allergies. Uncooked vegetarian foods remain a problem though.

Trial and error
Cross reactions develop in different ways and differ from individual to individual. Scientific forecasts are impossible. Therefore, you have to find out for yourself by trial and error, if a cross reaction occurs or not! One thing which certainly does help is to avoid allergens if at all possible and to treat symptoms very early. Having your main allergy under control is the best you can do.

To relieve allergic symptoms, allergy sufferers should choose a therapy that acts very quickly and reliably right where allergic symptoms occur. Azelastine is an agent which reduces sneezing, itching and watery eyes, as well as a runny or a congested nose within fifteen minutes after use. Azelastine should be applied when symptoms arise, and used just when needed. It works for about twelve hours. Azelastine is well-tolerated when used throughout the year, and is very effective.

Profile: White Chenopodium (Chenopodium album)

Family: Chenopodiaceae
Home: worldwide

White Chenopodium is a perennial plant, which can grow to three metres in height. The plant is deep-seated with roots burrowed deep in the earth. It is nutritionally undemanding, growing as the primary settler on scree and on roads, in fields and in gardens. Chenopodium pollens are spread on the wind, a common method of allergenic plants, and also carried by animals. A large plant produces about one and a half million pollen particles.

Chenopodium's original home is the Himalayas. It was used as a cultivated plant centuries ago. Even today the plant is used to feed humans and animals in India and northern America. Chenopodium is also known as remedy against inflammations, flatulence, constipation as well as pain and skin diseases


However these benefits of Chenopodium are not available to the allergy sufferer as the plant belongs to the most allergenic of the wild herbs. The widespread distribution of Chenopodium is the basis of its allergenic burden.

Detective work: Looking for a needle in a haystack: allergy tests

A pollen allergy is a real scourge. What, with a runny nose watery eyes and constant respiratory trouble, it's no wonder that sufferers can feel miserable and have a low quality of life. Allergy symptoms are typical, but tracking allergy triggers is difficult. Allergy tests sometimes are not clear. At the beginning of the diagnosis a detailed talk with a specialised physician is necessary. Then, the search for antigens begins.

An allergy results when the immune system puts up a fight against harmless foreign agents. The body considers the agent as dangerous. Many defensive agents, such as antibodies, are formed. Some immune cells are stimulated to release histamine, which is responsible for the typical inflammation observable during allergic reactions. A second contact to the triggering agent or allergen accelerates the allergic reaction, and in this instance the immune system acts in a few seconds and the reaction can be more severe.

To find out which allergens stimulate the body's immune system, allergy tests are necessary. Generally, these fall into two categories, skin-tests and blood-tests. If the tests result in a vague idea of what might be the cause of allergic symptoms, a provocation test under the control of a physician can be used to substantiate a suspicion.

There are many different types of skin-test, and these are all different from each other. The Skin Prick test is the so called standard test. The physician applies allergens onto the skin of the forearm and then pricks the skin softly with a sterile needle. If the skin becomes flushed or swollen (often forming a hive or 'wheal') at the site of this 'prick', then the applied allergen is most likely a trigger of the patient's allergic reaction.

If the physician uses the intra cutaneous test, the allergens are injected into the skin. Non fluid allergens are rubbed on the skin of the forearm (rubbing test). Alternatively, an epicutaneous test can be used. In this instance the physician sticks some allergen containing skin plasters onto the skin of the forearm. If the scratch test is the method of choice, the doctor first scratches the skin and then drips some allergenic extract onto the scratched parts.

The results of skin tests are generally drug-sensitive. Anti-histamines, used for the treatment of allergies, influence the skin tests very much. They need to be removed from the daily drug plan before skin-testing. Some blood pressure regulating agents (e.g. beta-blockers and ACE inhibitors) as well as pain relievers (e.g. non steroidal anti-rheumatics, [NSAR]) increase the reaction of the immune system. This drug interference could therefore cause some allergens to be misleadingly suspected.

Blood tests
The problem of drug interactions rarely occurs using blood tests. With blood tests the amount of antibodies (immune globulins, IgE) is analysed (RAST-Test). These tests are useful to discover if an allergic reaction has happened or not. However, they do not offer an indication as to which allergen may be involved.

Provocation test
If blood tests prove an allergic reaction and a skin test indicates one or more possible triggers, a provocation test provides more profound evidence. Suspicious allergens are administered to the patient. Hay fever, for example, is provoked by administering grass pollen directly onto the nasal membranes. Other allergens can be inhaled or dropped into the eyes. If the mucous membranes swell and typical allergic reactions occur upon administration of a certain agent, the allergy trigger is confirmed.

What happens if you found the needle in the hay stack?
To avoid the antigen is the most important method to reduce allergic reactions. Allergen-avoidance, however, is not always possible. Hyposensitization, which makes the body unsusceptible towards antigens, is another option. But this process is not possible for all kinds of allergy. The fewer antigens that are involved as allergy triggers, the more successful this method is. The disadvantage of hyposensitisation is the length of time it takes to be effective. It takes about three years to succeed. Not surprisingly then, pollen allergies are usually treated with anti-histamines, which are very effective: Medications containing the active agent Azelastine can be used just when needed. The onset of action is extremely rapid, taking only ten to fifteen minutes. The fast relief from all symptoms lasts for up to twelve hours.

Frequent requests of allergy-stressed fellows

It seems like every second there is another antigen that upsets my life! A therapy that needs to be started two weeks before first symptoms arise is not, in my case, very convenient or helpful. What can I do?

If your immune system reacts to several allergens, the cromoglycate therapy you are currently using is not sufficient. You have to respond much faster and your therapy needs to be more flexible. Therefore, we advise taking anti-histamines, at least as an additional medication. Anti-histamines which are locally applied are reassuring because of their fast onset of action. Nasal sprays and eye drops containing the agent Azelastine are recommended. They relieve all of your symptoms within a few minutes because they act directly where the inflammation occurs. This medication is applied locally and does so you do not have to take a tablet. The duration of action is about twelve hours. Azelastine is well-tolerated throughout the year and is extremely effective at relieving symptoms. Try it and see for yourself!
Get well soon!
Your editorial staff

My allergy bothers me throughout the year. What can I do to combat the frustration of watery eyes and a runny nose?

Our advice to combat the frustration caused by the burden of ever-present allergic symptoms is three-fold. Firstly, you should equip yourself with an effective drug. The most suitable and most frequently prescribed medications are ant-histamines. For anti-histamines containing the agent Azelastine you need only take them as and when you need them - not prior to allergic symptoms as with other types of medication. Secondly, you should take a close look at your environment and try to minimise your allergen exposure. For example you could refit your car with a pollen filter. At home it may be helpful to have a humidifier or an air cleaner, you could remove carpets, which can harbour pollen and other allergens, or perhaps you could use an allergen-free mattress? Thirdly, visiting a self-help group and talking to others in a similar situation may help to alleviate your frustration. At these groups you may learn useful tips to alleviate your symptoms, and, during especially hard times when your symptoms are particularly bothersome, you may receive help and comfort from similarly affected people. It is worth a try!
Get well soon!
Your editorial staff

Expert's advice - today:
How to tell a cold from allergic rhinitis