Seasonal allergies: tips and remedies

While this time of year usually brings cheerful weather and the growth of beautiful plants, millions of people will be gearing up once again to do battle with a problem that recurs every year. Itchy eyes, repetitive sneezing, a permanently runny nose - the symptoms of seasonal allergies.

In the US, around 7.8% of people aged 18 and above are estimated to have hay fever.

For many people, the emergence of marauding ticks at this time of year is the least of their worries. The real struggle for these people is with seasonal allergies, also referred to as hay fever or allergic rhinitis.

If these common symptoms seem to develop for weeks and months on end at the same time each year, it is likely that you could be affected by seasonal allergies. The condition affects many in the US; in 2010, around 11.1 million visits to physicians' offices led to a primary diagnosis of hay fever.

Thankfully, despite how infuriating and disruptive seasonal allergies can be, there are many steps that can be taken to lessen their impact. In this Spotlight, we take a look at what seasonal allergies are and what the best strategies are for handling them.

What causes such allergies?

People develop allergies when their body's immune system reacts to a substance as though it is a threat like an infection, producing antibodies to fight it. These substances are referred to as allergens.

The next time that the body encounters the allergen, it produces more antibodies in anticipation, releasing histamine and chemical mediators in the body that lead to an allergic reaction. It is these chemicals that typically cause symptoms in the nose, throat, eyes and other areas of the body.

Jan Batten, a British Lung Foundation (BLF) Helpline nurse, explained to Medical News Today that as the summer months approach, certain allergies begin to cause more problems, such as allergies to flower pollen, grass pollen, tree molds and fungi. The drier days around this time of year help the allergens to remain in the atmosphere for longer.

"Summer allergies start to pick up around May and those affected will usually get itchy and runny eyes, a runny nose and inflamed, swollen sinuses. Breathing through your nose can be difficult too, and you might have a cough," she explained.

The American College of Allergy, Asthma & Immunology (ACAAI) report that allergies are the sixth leading cause of chronic illness in the US. According to the American Academy of Allergy, Asthma & Immunology (AAAAI), around 7.8% of people aged 18 and above have hay fever. Worldwide, the condition affects 10-30% of the population.

Most people with hay fever understand that their symptoms are set off by pollen, the fine powder released from flowering plants in order to reproduce. Pollens are spread by the wind and can be inhaled or land in the eyes or on the skin.

The most common trigger of seasonal allergies is pollen, though they can also be triggered by grasses and mold. Dealing with seasonal allergies, however, is not merely a matter of knowing when these airborne allergens are most prevalent and trying to avoid them. There are a few added complications to keep you on your toes.

Avoiding triggers - be aware of what sets you off

"People focus on the highs and lows of pollen counts," says Dr. James Sublett, president of ACAAI. "What they don't realize is that a high total pollen count doesn't always mean you will have allergy symptoms. The pollen from the plant you are allergic to may not be high. The key is to know what you're allergic to, and how to treat your particular symptoms."

Different kinds of pollen are prevalent at different times of the year, as well as varying from location to location. Between January and April, pollen is typically released from trees including pine, ash, birch, elm and poplar. During the summer months, grass pollens dominate, and in the fall, weed pollen is most prevalent.

People can determine whether they have an allergy or not by consulting their primary care physician and undergoing allergy testing. Dr. Andrew S. Kim, an allergist from the Allergy & Asthma Centers in Fairfax and Fredericksburg, VA, told MNT that sometimes people confuse having allergies with the flu or common cold.

Pollen is the cause of most seasonal allergies and is produced by flowers, trees, grasses and weeds alike.

"Allergies may share some similarities with sneezing and sniffling but the length of time is a big difference. Allergy symptoms usually last for weeks and months and patients typically complain of itchy nose, throat and eyes as well," he said.

"Allergy patients usually do not have fever. They do have dry cough and clear nasal drainage versus infectious cough which is characterized by yellow, or greenish nasal drainage. Some people may have asthma symptoms, such as cough, wheeze and chest tightness."

Once an individual knows that they have a seasonal allergy and is aware of what triggers it, they are in a much better position to avoid debilitating allergic reactions. Keeping track of pollen forecasts is a good place to start. It is good to remember that these change by the hour, and can be boosted when it is warm, dry and windy.

To reduce the chances of an allergic reaction, it is recommended that you stay inside when pollen counts are at their highest. These usually peak around the morning hours and maintain high levels during the afternoon.

If you do need to go outside, there are a number of steps that can be taken to reduce the chances of coming into contact with allergens. Wearing wraparound sunglasses offers protection to the eyes, and applying a small amount of petroleum jelly to the insides of the nostrils can prevent some allergens from reaching the sensitive lining of the nose.

Delegating outdoor chores to people that do not have seasonal allergies is a sensible approach. If there is no escaping lawn mowing or weed pulling, however, wear an NIOSH-rated (National Institute for Occupational Safety and Health) 95 filter mask to keep allergens out.

Laundry should not be hung to dry outside, despite the conditions being perfect for it. Pollen can stick to sheets and towels and be brought into the home - normally a haven from pollens. In fact, when tackling seasonal allergies, ensuring that your home is your castle is a great strategy.

Minimizing the risk indoors

It is impossible to remove all allergens from the air inside the home, but there are certainly steps that can help reduce levels of exposure. Keeping the windows shut is a simple strategy that should be one of the first to be adopted.

Shutting the windows might be the last thing on your mind when temperatures start to rise. To stay cool without the threat of pollen looming large, use air conditioning in the house and car. It is preferable that high-efficiency air filters are used and that units follow regular maintenance schedules.

Whenever you venture outside, there is the chance that you will bring pollen back inside with you on your clothes and hair. For this reason, people should wash their hair and clothes more regularly during periods when the pollen count is high.

If you are drying clothes indoors and keeping the windows closed, you may need to use a dehumidifier to keep the indoor air dry. Keeping the air dry indoors helps prevent the growth of other allergens such as molds.

Keeping the home clean with a vacuum cleaner that has a high-efficiency particulate air filter and using a damp duster to stop pollens moving about the home also helps to clean up any allergens that are present, reducing the chances of them getting onto and into the body.

"Simple changes like wearing wraparound sunglasses, washing your clothes and hair more regularly, keeping your home clean, avoiding open, grassy spaces where possible and keeping your windows shut can help lessen the effect of summer allergies," Jan Batten told.

All of these measures are relatively simple to take and can go a long way toward protecting the body from seasonal allergies. However, as stated before, it is nigh-on impossible to completely avoid exposure to allergens. Particularly for people who experience severe reactions to pollen, the best route to ease symptoms is often a medical one.

Medicine and other treatment

People tend to have unique allergic responses, so the treatment that works best for each individual will vary accordingly. While some people will be able to cope with seasonal allergies with over-the-counter medication and being careful about their exposure to allergens, others may require personal treatment plans drawn up by specially trained allergists.

Oral antihistamines are a form of nonprescription medication that alleviate many of the symptoms of seasonal allergies.

There is a wide range of nonprescription medication available for people who have seasonal allergies. Oral antihistamines relieve symptoms such as sneezing, itching and runny noses. Decongestants relieve nasal stuffiness and come in both oral and nasal form. Some medications contain a combination of the two.

Two types of immunotherapy are available to those who require relief from severe symptoms. These are allergy shots and tablets, and they are provided and prescribed by allergists. Allergy testing will need to be carried out first to determine precisely what allergens trigger symptoms.

Allergy shots consist of injecting a patient with diluted extracts of an allergen. Increasing doses are administered until a maintenance dose is established. This process helps the body to build up a form of resistance to the allergen and reduces the severity of symptoms.

Tablets can currently be used to treat allergies to grass and ragweed pollens. Beginning at least 3 months before the relevant pollen season begins, patients take one tablet daily, with the treatment continuing for as long as 3 years.

Dr. Kim told MNT that one of the best ways to reduce the influence of seasonal allergies is to start taking medication - such as topical nasal steroids - about a week before the beginning of the allergy season:

"Don't wait until symptoms kick in and you're already feeling bad before taking allergy medication. Instead, prepare by taking medications just before the season starts to minimize the symptoms of seasonal allergies."

A number of alternative treatments are also available, including natural remedies that feature extracts of butterbur and spirulina. It is recommended that any use of alternative treatments is discussed with a physician first, as some remedies may not be entirely safe for use.

There are many options for alleviating seasonal allergies

Allergies can be worrying, especially for people who are otherwise healthy and unused to experiencing sudden debilitating symptoms. If left unchecked, seasonal allergies can often turn an otherwise enjoyable time of year for many into misery.

Thankfully, there are many routes available for people with seasonal allergies to alleviate their symptoms. As ever, if there are any concerns or worries, it is best to speak with a health care professional who will be able to offer advice, provide treatment or refer on to a specialist.

Although there is no cure at present for seasonal allergies, the multiple options for treatment should hopefully provide some relief until winter rolls around again and we can shiver together, happy in the fact that pollen has gone for another year.

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Scientists 'incredibly excited' by asthma treatment breakthrough

A breakthrough study has uncovered a potential root cause of asthma and a drug that reversed symptoms in lab tests. The finding brings hope to the 300 million asthma sufferers worldwide who are plagued by debilitating bouts of coughing, wheezing, shortness of breath and tightness in the chest.

While the breakthrough will be welcomed by all asthma sufferers, it will particularly excite the 1 in 12 patients who do not respond to current treatments.

The study - led by Cardiff University in the UK - reveals for the first time that the calcium-sensing receptor (CaSR) plays a key role in causing the airway disease.

The team used human airway tissue from asthmatic and nonasthmatic people and lab mice with asthma to reach their findings.

In the journal Science Translational Medicine, they describe how manipulating CaSR with an existing class of drugs known as calcilytics reversed all symptoms.

Calcilytics block the calcium-sensing receptor and were originally developed for the treatment of osteoporosis - a condition that makes bones more likely to break - also referred to as "brittle bone disease."

One of the crucial study results is that the symptoms the drug reversed include airway narrowing, airway twitchiness and inflammation - all of which make breathing more difficult.

Daniela Riccardi, principal investigator and a professor in Cardiff's School of Biosciences, describes their findings as "incredibly exciting," because for the first time they have linked airway inflammation - which can be triggered for example by cigarette smoke and car fumes - with airway twitchiness. She adds:

"Our paper shows how these triggers release chemicals that activate CaSR in airway tissue and drive asthma symptoms like airway twitchiness, inflammation, and narrowing. Using calcilytics, nebulized directly into the lungs, we show that it is possible to deactivate CaSR and prevent all of these symptoms."

While the finding is likely to be welcomed by all asthma sufferers, it will particularly excite the 1 in 12 patients who do not respond to current treatments and who account for around 90% of health care costs associated with the disease.

Could be treating asthma patients in 5 years - huge implications for other airway diseases

Calcilytics were first developed about 15 years ago for the treatment of osteoporosis, but while they proved safe and well tolerated in trials, results have been disappointing in patients with osteoporosis.

However, the fact they have already been developed and tested gives researchers the unique opportunity to repurpose them and hugely reduce the time it usually takes to bring a new drug to market.

Once funding is secured, the team hopes to be testing the drugs on humans within the next 2 years. Prof. Riccardi concludes:

"If we can prove that calcilytics are safe when administered directly to the lung in people, then in 5 years we could be in a position to treat patients and potentially stop asthma from happening in the first place."

The researchers believe their findings about the role of CaSR in airway tissue could have important implications for other respiratory conditions such as chronic obstructive pulmonary disease (COPD), chronic bronchitis. There are currently no cure for these diseases, which predictions suggest will be the third biggest killers worldwide by 2020.

In the following video, Prof. Riccardi and colleagues talk about their findings and a patient with asthma describes her excitement about the potential implications.

Asthma UK, the Cardiff Partnership Fund and the Biotechnology and Biological Sciences Research Council (BBSRC) helped finance the study.

Last month, Medical News Today learned of another important study that uncovered new clues about overproduction of mucus in asthma and COPD in the behavior of ion channels - membrane-sited proteins that help regulate the flow of charged particles in and out of cells.

The researchers, from Washington University School of Medicine in St. Louis, believe their findings will lead to treatments for a range of diseases including asthma, COPD, cystic fibrosis and even certain cancers.

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Antibiotic No Better For Coughs, Uncomplicated Chest Infections Than No Medication

Amoxicillin, the antibiotic doctors often prescribe for persistent coughs caused by uncomplicated chest infections such as bronchitis, is no more effective at easing symptoms than no medication at all, even in older patients. This was the finding of the largest randomised placebo controlled trial of antibiotics for lower respiratory tract infections (LRTI) done to date.

The study, which was led by the University of Southampton in the UK, is from the GRACE (Genomics to Combat Resistance against Antibiotics in Community-acquired LRTI in Europe) consortium and was funded by the European Community's Sixth Framework Programme.

A paper on the findings appears in the 19 December online issue of The Lancet Infectious Diseases.

First author Paul Little, Professor of Primary Care Research at Southampton, says in a statement:

"Patients given amoxicillin don't recover much quicker or have significantly fewer symptoms."

In fact, he adds, using amoxicillin to treat patients with respiratory infections who don't have pneumonia could not only be ineffective, but might actually harm them.

"Overuse of antibiotics, which is dominated by primary care prescribing, particularly when they are ineffective, can lead to side effects such as diarrhea, rash, vomiting and the development of resistance," he explains.

The European Centre for Disease Prevention and Control (ECDC) recently put out a statement saying that antibiotic resistance remains a major threat to public health around the world, and for the large part, the cause is misuse of antibiotics.

Chest infections, also known as lower respiratory tract infections (LRTI), are one of the most common acute illnesses treated in primary care settings in developed countries.

There is a lot of controversy about whether LRTI, especially in older people, should be treated with antibiotics, especially since viruses are thought to cause most of them, and previous studies have shown inconsistent results.

A recent study presented at CHEST 2012, the annual meeting of the American College of Chest Physicians, also suggests antibiotics are not successful in treating cough due to the common cold in children.

For this latest GRACE study, the researchers recruited 2,061 adults attending primary care practices with straightforward mild chest infections. The practices were located in 12 European countries: England, Wales, Netherlands, Belgium, Germany, Sweden, France, Italy, Spain, Poland, Slovenia, and Slovakia.

The participants were randomly assigned to be prescribed either amoxicillin or a placebo, to be taken three times a day for seven days.

The prescribing general practitioners (GPs) assessed their patients' symptoms at the start of the study period, and the patients also filled in diaries of their daily symptoms.

When they analyzed this data, the researchers found there was little difference in how severe the symptoms were or how long they lasted for, between the amoxicillin and placebo groups.

Even in those aged 60 and over with no other illnesses, antibiotics seemed to offer little benefit over placebo.

Patients in the antibiotic group reported significantly more side effects, including rash, nausea and diarrhea.

The researchers did conclude, however, that while most people seem to get better on their own, there is a small number of patients who do benefit from antibiotics, and "the challenge remains to identify these individuals," says Little.

In an accompanying commentary, Philipp Schuetz, from the University of Basel in Switzerland, notes:

"Little and colleagues have generated convincing data that should encourage physicians in primary care to refrain from antibiotic treatment in low-risk patients in whom pneumonia is not suspected."

However, the question remains, he says, of whether this "one-size-fits-all approach can be further improved".

He suggests perhaps one way to avoid the "toxic effects and costs" of antibiotics and "the development of resistance in the other patients", is to test for "specific blood biomarkers of bacterial infection", so as to "identify the few individuals who will benefit from antibiotics despite the apparent absence of pneumonia".

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Electronic Cigarettes Harm The Lungs

Electronic cigarettes, seen by many as a healthy alternative to tobacco smoking, do cause damage to the lungs, scientists from the University of Athens, Greece, explained at the European Respiratory Society's Annual Congress 2012, Vienna, on Sunday. Electronic cigarettes, also called e-cigarettes have also been marketed as effective smoking cessation devices.

Professor Christina Gratziou and team set out to determine what the short-term effects of smoking with e-cigarettes might be on different individuals, including those with no known health problems, as well as existing smokers with and without lung conditions.

They carried out experiments on 32 volunteers; of whom 8 were lifetime non-smokers and 24 were current regular smokers. Some of them had healthy lungs, while others lived with asthma or COPD (chronic obstructive pulmonary disease).
br> They were asked to use an electronic cigarette for 10 minutes, inhaling the vapors into their lungs. A spirometry test, as well as some others diagnostic procedures were used to measure their airway resistance. Airway resistance is used in respiratory physiology to measure the resistance of the respiratory tract to airflow coming in during inspiration (inhalation) and going out during expiration (exhalation).

They found that using an e-cigarette caused an instant increase in airway resistance that lasted for 10 minutes in the majority of the participants. Below are some of their findings:

• Non-smokers - even among lifetimes non-smokers, using an e-cigarette for ten minutes raised their airway resistance to 206% from 182% (mean average); the researchers described this as a "significant increase".


• Current regular smokers - among existing regular smokers, the spirometry tests revealed a significant rise in airway resistance to 220%, from 176% after using one e-cigarette for ten minutes.


• COPD and Asthma patients experienced no significant increase in airway resistance from using one e-cigarette for ten minutes.

Professor Christina Gratziou, who is Chair of the European Respiratory Society Tobacco Control Committee, said:

"We do not yet know whether unapproved nicotine delivery products, such as e-cigarettes, are safer than normal cigarettes, despite marketing claims that they are less harmful. This research helps us to understand how these products could be potentially harmful.

"We found an immediate rise in airway resistance in our group of participants, which suggests e-cigarettes can cause immediate harm after smoking the device. More research is needed to understand whether this harm also has lasting effects in the long-term. "The ERS recommends following effective smoking cessation treatment guidelines based on clinical evidence which do not advocate the use of such products."

What are electronic cigarettes (e-cigarettes)?

Electronic cigarettes, also known as vaporizer cigarettes and e-cigarettes, are devices that people use, often instead of tobacco cigarettes, that release doses of water vapor that may or may not include nicotine. E-cigarettes are powered by a small battery.

Manufacturers, distributors and marketers of electronic cigarettes say that they are an effective and healthier alternative to tobacco smoking, because the user does not inhale harmful tobacco smoke, which contains over 4,000 toxic chemicals.

Regular e-cigarette users say that the device offers them a similar sensation to tobacco-cigarette smoking. However, as there is no combustion involved - there is no smoke.

Electronic cigarettes are long tube-like devices that either look like tobacco cigarettes or biros (ballpoint pens). Most of them have replaceable cartridges; some are throwaway ones.

The user places the device between his lips and sucks in, this action activates a heating element that immediately vaporizes a liquid solution. The vapor is inhaled. Learning how to use an e-cigarettes, especially for a regular tobacco-smoker, is straightforward because the action is virtually identical to what is done when you smoke a tobacco cigarette.

A typical electronic cigarette has the following components:

• The mouthpiece - the replaceable cartridge is placed here. The user sucks or inhales from the mouthpiece.


• The atomizer - a heating element which vaporizes the liquid solution. The vapors are inhaled. In most devices, the atomizer needs to be replaced every three to six months.


• The battery - this is usually a rechargeable lithium-ion rechargeable battery. The battery is the power-source for the heating element. There is also some electronic circuitry in the device, such as the airflow sensor, a timed cutoff switch to prevent overheating, and a colored LED (light emitting diode) to indicate the device has been activated.

Electronic cigarettes are becoming increasingly popular, especially in Western Europe. It is estimated that many tens of millions of people worldwide are regular users.

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Indoor Laundry Drying Could Be Bad For Your Health

A combination of prolonged wet weather and reducing use of tumble dryers as a way to cut fuel bills, may encourage people to dry more clothes indoors, for instance on drying frames or by draping on radiators. But according to researchers in Scotland, this could pose health risks by increasing moisture that encourages moulds and dust mites, which is bad for people prone to asthma.

Also, while the intention may be to save energy and cost, that is not necessarily the result, say the researchers, from the Mackintosh Environmental Architecture Research Unit (MEARU) at The Glasgow School of Art, working with Strathclyde and Caledonian universities, because in order to dry off the 2 litres that the average load of washing releases into the air, people often turn up the heating.

The three-year research project, titled "Environmental Assessment of Domestic laundering", was funded by the Engineering and Physical Sciences Research Council (EPSRC). A report and press statement were released on 2 November.

Report co-author, Colin Porteous, a professor at MEARU, says:

"Because of increased awareness of the energy consumption of tumble dryers many people are choosing to dry clothes passively within their home."

"This results not only in a severe energy penalty, because of increased heating demand, but also a potential health risk due to higher moisture levels," he adds.

Researchers suggest a strong correlation between drying laundry indoors and increased spore growth, which can exacerbate symptoms for sufferers of asthma, hay fever and other allergies.

The researchers examined the laundry habits of residents in a wide demographic mix living in social housing in the West of Scotland, and also carried out a detailed analysis of air quality and energy consumption.

They concluded indoor drying of laundry poses environmental, economic and health problems, and the tendency in the UK toward building smaller, more airtight homes, only serves to make things worse.

In ill-ventilated rooms, putting clothes on radiators to dry can account for up to a third of the moisture in the air, and creates ideal conditions for mould spores to grow and dust mites to thrive. Both these conditions are known triggers of asthma.

The researchers also point out that indoor drying of clothes that contain fabric conditioner is likely to increase the amount of cancer-causing chemicals in the air.

Indoor laundry drying also leads to increased use of energy, as radiators are often turned up to help the drying process, and/or windows are opened. This just worsens fuel poverty, already a major issue in the West of Scotland, say the researchers.

The team recommends people dry their laundry outdoors whenever possible, or use energy-efficient, condensing tumble dryers. If you have to dry your clothes indoors, then place them by a south facing window (the message is for people in the UK), using natural light and heat. An even better method is to place the clothes on a south-facing balcony, if you have one.

They also suggest, when creating new housing stock, planners and builders should make sure the designs cater for ways of drying laundry that do not contribute to poor air quality. The researchers have published a design guide with suggestions like: upgrading balconies and sunspaces, ensuring new homes have a drying space with its own heating and ventilation, communal laundry and drying facilities, and installing energy-efficient appliances.

The team is now discussing its findings with social housing authorities, with a view to their proposals being adopted as Housing Associations upgrade existing stock and build new homes.

However they argue more sweeping changes are necessary, including updating the Building Regulations so they apply to all new housing. Such a move would have many benefits, says Porteous:

"Our research gives strong justification for the changes both in terms of health and wellbeing, and associated economic impacts. It is our hope that current statutory and advisory standards will be modified to take them on board ensuring a healthy and economically sustainable living environment."

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Antibiotic No Better For Coughs, Uncomplicated Chest Infections Than No Medication

Amoxicillin, the antibiotic doctors often prescribe for persistent coughs caused by uncomplicated chest infections such as bronchitis, is no more effective at easing symptoms than no medication at all, even in older patients. This was the finding of the largest randomised placebo controlled trial of antibiotics for lower respiratory tract infections (LRTI) done to date.

The study, which was led by the University of Southampton in the UK, is from the GRACE (Genomics to Combat Resistance against Antibiotics in Community-acquired LRTI in Europe) consortium and was funded by the European Community's Sixth Framework Programme.

A paper on the findings appears in the 19 December online issue of The Lancet Infectious Diseases.

First author Paul Little, Professor of Primary Care Research at Southampton, says in a statement:

"Patients given amoxicillin don't recover much quicker or have significantly fewer symptoms."

In fact, he adds, using amoxicillin to treat patients with respiratory infections who don't have pneumonia could not only be ineffective, but might actually harm them.

"Overuse of antibiotics, which is dominated by primary care prescribing, particularly when they are ineffective, can lead to side effects such as diarrhea, rash, vomiting and the development of resistance," he explains.

The European Centre for Disease Prevention and Control (ECDC) recently put out a statement saying that antibiotic resistance remains a major threat to public health around the world, and for the large part, the cause is misuse of antibiotics.

Chest infections, also known as lower respiratory tract infections (LRTI), are one of the most common acute illnesses treated in primary care settings in developed countries.

There is a lot of controversy about whether LRTI, especially in older people, should be treated with antibiotics, especially since viruses are thought to cause most of them, and previous studies have shown inconsistent results.

A recent study presented at CHEST 2012, the annual meeting of the American College of Chest Physicians, also suggests antibiotics are not successful in treating cough due to the common cold in children.

For this latest GRACE study, the researchers recruited 2,061 adults attending primary care practices with straightforward mild chest infections. The practices were located in 12 European countries: England, Wales, Netherlands, Belgium, Germany, Sweden, France, Italy, Spain, Poland, Slovenia, and Slovakia.

The participants were randomly assigned to be prescribed either amoxicillin or a placebo, to be taken three times a day for seven days.

The prescribing general practitioners (GPs) assessed their patients' symptoms at the start of the study period, and the patients also filled in diaries of their daily symptoms.

When they analyzed this data, the researchers found there was little difference in how severe the symptoms were or how long they lasted for, between the amoxicillin and placebo groups.

Even in those aged 60 and over with no other illnesses, antibiotics seemed to offer little benefit over placebo.

Patients in the antibiotic group reported significantly more side effects, including rash, nausea and diarrhea.

The researchers did conclude, however, that while most people seem to get better on their own, there is a small number of patients who do benefit from antibiotics, and "the challenge remains to identify these individuals," says Little.

In an accompanying commentary, Philipp Schuetz, from the University of Basel in Switzerland, notes:

"Little and colleagues have generated convincing data that should encourage physicians in primary care to refrain from antibiotic treatment in low-risk patients in whom pneumonia is not suspected."

However, the question remains, he says, of whether this "one-size-fits-all approach can be further improved".

He suggests perhaps one way to avoid the "toxic effects and costs" of antibiotics and "the development of resistance in the other patients", is to test for "specific blood biomarkers of bacterial infection", so as to "identify the few individuals who will benefit from antibiotics despite the apparent absence of pneumonia".

Written by Catharine Paddock PhD

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New Respiratory Coronavirus Claims Second Victim

Another person with a severe acute respiratory infection (SARI) caused by a novel coronavirus 2012 has died, the World Health Organization (WHO) announced on Friday. The second victim, like the first, died in Saudi Arabia.

The announcement follows enhanced surveillance in Saudi Arabia and Qatar that has identified 4 new cases (3 in Saudi Arabia, 1 in Qatar), including the second death, the United Nations health agency reports.

Human coronoviruses are so called because of the crown-like projections on their surfaces. First identified in the 1960s, they are a large family of viruses that cause illnesses in animals and humans.

The illnesses they cause include respiratory infections such as the common cold and SARS (severe acute respiratory syndrome). In 2002, an oubreak of SARS spread from Hong Kong around the world, killing around 800 people.

However, according to information published on the WHO website at the end of September, the new coronavirus is genetically quite distinct from SARS.

The WHO says globally, the total of lab-confirmed cases of novel coronavirus 2012 notified to them is now 6, with 4 of them (including 2 deaths) linked to Saudi Arabia and 2 to Qatar (one reported from the UK and the other from Germany).

Two of the recently confirmed cases in Saudi Arabia are "epidemiologically linked" and from the same family and household. One person died and the other has since recovered, says the WHO.

Two other family members have also been tested: so far one is negative and the result of the other is not yet available.

According to the UK's Health Protection Agency (HPA), the newly reported case from Qatar, was lab-confirmed by them in November. The patient was initially treated in Qatar in October, but then transferred to Germany, and has now been discharged.

The WHO is now reviewing these new developments to see if there is a need to revise the interim case definition it published at the end of September, and any guidance relating to it.

The UN agency says in the meantime:

"Investigations are ongoing in areas of epidemiology, clinical management, and virology, to look into the likely source of infection, the route of exposure, and the possibility of human-to-human transmission of the virus. Close contacts of the recently confirmed cases are being identified and followed up."

The international agency says there is a need for more studies to better understand the virus, and encourages all members of the UN to continue their surveillance of severe acute respiratory infections (SARI).

It is likely the virus is present in more than just two countries, says the WHO, and it suggests patients with unexplained pneumonias should be tested for the new coronavirus, even if they have not been travelling to the two affected countries or are otherwise associated with them.

"In addition, any clusters of SARI or SARI in health care workers should be thoroughly investigated regardless of where in the world they occur," it urges.

More information from the WHO on coronavirus infections.

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Promising New Drug Target For Inflammatory Lung Diseases

The naturally occurring cytokine interleukin-18, or IL-18, plays a key role in inflammation and has been implicated in serious inflammatory diseases for which the prognosis is poor and there are currently limited treatment options. Therapies targeting IL-18 could prove effective against inflammatory diseases of the lung including bronchial asthma and chronic obstructive pulmonary disease (COPD), as described in a review article published in Journal of Interferon & Cytokine Research, a peer-reviewed publication from Mary Ann Liebert, Inc., publishers. The article is available free online at the Journal of Interferon & Cytokine Research website. (http://www.liebertpub.com/jir)

Tomotaka Kawayama and coauthors from Kurume University School of Medicine, Fukuoka, Japan, University of Ryukyus, Okinawa, Japan, and Frederick National Laboratory for Cancer Research, Frederick, MD, review the growing evidence to support the important role IL-18 has in inflammation and how it may help to initiate and worsen inflammatory disorders such as arthritis, dermatitis and inflammatory diseases of the bowel and immune system. In the article "Interleukin-18 in Pulmonary Inflammatory Diseases" (http://online.liebertpub.com/doi/full/10.1089/jir.2012.0029) they describe the potential benefits of therapies aimed at blocking the activity of IL-18 to treat inflammatory lung disease.

"This review provides an interesting and thorough summary of the biology and potential application of IL-18 in the setting of inflammatory pulmonary disease," says Co-Editor-in-Chief Thomas A. Hamilton, PhD, Chairman, Department of Immunology, Cleveland Clinic Foundation.

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Child's Allergy Risk Higher If Parent Of Same Sex Has It

Researchers have discovered an interesting fact about the genetic basis of childhood allergic diseases: a child is more likely to have a particular allergy if his or her same-sex parent has it.

So for example, a girl's chance of having asthma is higher if her mother has it, and a boy's is higher if his father has it.

And the same appears to be true of eczema and other childhood allergies.

This is the conclusion of a study by Professor Hasan Arshad, a consultant in allergy and immunology at Southampton General Hospital, and colleagues, that is published in the August issue of The Journal of Allergy and Clinical Immunology.

What The Researchers Did

For the study, the researchers used data from the Isle of Wight (IOW) Birth Cohort Study, which collected information on just under 1,500 children that were followed up to the age of 18. During that time, the children were examined at age 1, 2, 4, 10 and 18.

The Isle of Wight, which lies off the South coast of England, is ideal for carrying out long-term prospective epidemiological studies because it has a stable resident population, so most of the participants did not move away during the course of the study, and were thus available for follow-up.

Arshad was one of the initiators of the The IOW cohort study, which was set up with the aim of prospectively studying a whole population (about 130,000 people live on the IOW) for the development of asthma and allergic diseases and identify any relevant genetic and environmental risk factors.

The data on the cohort contains detailed information on heredity and environmental exposures, collected from birth and updated at each follow-up, where detailed questionnaires were completed with the parents for each child, about asthma and any other allergies, for example eczema and rhinitis.

At ages 4, 10, and 18, the children also underwent skin prick tests to 14 common food and airborne allergens.

Other examinations included spirometry and bronchial provocation tests, and collected blood samples to measure Immunoglobulin E (IgE) at ages 10 and 18. IgE is an antibody that is often screened for in testing for allergies.

The parents also underwent assessments. For example, shortly after the children in the cohort were born, the researchers found out whether his or her parents had allergies, and the mother's IgE level was also measured.

What They Found

When they analyzed the results the researchers found that maternal asthma was tied to asthma in girls but not to boys, and paternal asthma was linked to asthma in boys but not to girls.

They found the same pattern for eczema: if a child's mother had eczema, then the chances of the child having it was higher if it was a girl but not a boy, and if the father had it, the chance was higher for his son but not his daughter.

Similar patterns were found for other allergies, as the authors explain:

"Similar trends were observed when the effect of maternal and paternal allergic disease was assessed for childhood atopy and when maternal total IgE levels were related to total IgE levels in children at ages 10 and 18 years."

Possible Implications

The authors suggest the findings may change the way childhood allergies are assessed and prevented. For instance, in diagnosis, it may be useful to find out the allergy history of the mother in girl patients and of the father in boy patients.

The study may also open new avenues for studying sex-dependent effects in hereditary diseases, with the prospect one day of finding ways to prevent them.

The National Institutes of Health in the US funded the study.

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Diet May Help Prevent Allergies And Asthma

A recent publication from the Global Allergy and Asthma European Network (GA2LEN) (1) provides new insights into the role that diet may play in the development of allergies, especially in children. The work suggests that the significant changes in European diets over the past 20-40 years may have contributed to the increased incidence of allergic diseases in both children and adults seen over this period. Members of the nutrition work package responsible for the report consider that its findings are just the beginning of GA2LEN's potential role in greater understanding of this complex area.

The prevalence of allergic diseases has increased dramatically over the past few decades, especially in children. One child in three is allergic today and one in two people in Europe are likely to be suffering from at least one allergy by 2015. It is generally agreed that a combination of heredity and environmental factors is responsible for the development of the allergy and asthma. However, the evolution of these diseases has been far too rapid for genetics to be the sole explanation. Among the wide range of environmental factors under discussion, changes in the European diet in the last 20-40 years are considered to be a possible explanation. Indeed, the way in which children are fed early in life may have a direct effect on the subsequent development of asthma and allergies, according to a recent publication from the Global Allergy and Asthma European Network (GA2LEN). (1)

In a paper entitled "Nutrition and allergic disease", published this year in Clinical and Experimental Allergy Reviews, 12 European experts working together in the GA2LEN nutrition work package present the evidence and define fertile topics for future research. (2) The work package team is led by Professor Philip C Calder, Institute of Human Nutrition, University of Southampton. (3)

Key findings: breastfeeding, early diet and probiotics

The three main areas producing key findings are breastfeeding, intake of certain nutrients, and probiotics. (4)

Exclusive breastfeeding, that is providing the infant with no other liquid or food other than breast milk, is believed to be effective in reducing subsequent development of allergies. It appears that exclusive breastfeeding for four months helps protect the child from cow's milk protein allergy until 18 months, reduces the likelihood of dermatitis (skin allergy) until three years, and reduces the risk of recurrent wheeze (or asthma) until six years' of age. However, the longer term effects of breast feeding on allergic outcomes are not known and require investigation.

The protective effect of four months of exclusive breastfeeding is important for all children but it is especially valuable for those at high risk of developing allergies. Children are at high risk of developing allergies if one or both parents are affected by allergic disease. If it is not possible for the high-risk child to be breastfed, hypoallergenic formula combined with avoidance of solid foods for 4-6 months offers an alternative source of protection. The studies show that hypoallergenic formula helps prevent cows' milk protein allergy developing before the age of five years and offers protection against atopic dermatitis (eczema or other skin allergy) until the age of four years.


A second major area of importance appears to be the components of the diet. For example, antioxidants in the diet, such as vitamin C, vitamin E and selenium coming mainly from fruit and vegetables, may have a protective effect. Furthermore, different fats found in milk, butter, vegetable oils and fish may have different effects on development of allergies and asthma. Although it is difficult to find clear-cut evidence, it appears that reducing sodium intake, increasing magnesium intake, eating apples and other fruit and vegetables, and avoiding margarine might help some asthmatics. However much of the research conducted to date has not been systematic in its approach and this makes the drawing of hard conclusions very difficult.

The role of probiotics and prebiotics in the diet is promising. Living organisms such as probiotics appear to protect against the development of allergies by producing changes in the bacteria in the gut that stimulate the immune system. A double blind, placebo-controlled study has recently shown that probiotics can help reduce the risk of atopic disease. This is an important area for future research.

Meeting the challenge

The review highlighted several areas in nutrition and diet that appear to be fruitful for future research in allergic disease, and therefore for future disease control. In particular, it has highlighted gaps in relation to specific effects of maternal and infant nutrition on allergy and asthma in later life. Patients, health professionals and policy makers alike would benefit from such research and from more large-scale studies on diet and allergy. Key focuses should be identification of dietary patterns or factors likely to be involved in altering risk of development of allergies and asthma, and developing the evidence base about whether supplementation with specific fats or probiotics could contribute both to the protection and treatment of allergic diseases. The studies required will need to be large and to be well planned, designed and executed. They are likely to require cross-country collaboration.

###

Notes:

1. GA2LEN - the Global Allergy and Asthma European Network is a "Network of Excellence" funded by the European Union 6th Research Framework Programme. It consists of 26 research centres spread throughout Europe, as well as the European Academy of Allergology and Clinical Immunology (EAACI) and the European Federation of Allergy and Airways Diseases Patients Associations (EFA).

2. The 72-page peer-reviewed paper entitled "Nutrition and allergic disease" is published in Clinical and Experimental Allergy Reviews 6: 117-188, 2006 Blackwell Publishing Ltd.

3. The article represents the work of Workpackage 2.1 of GA2LEN. Correspondence should be addressed to the workpackage leader, P. C. Calder, BSc, PhD, DPhil, Professor of Nutritional Immunology, Institute of Nutrition, University of Southampton, UK.

4. The full list of indicators comprises: Sodium and potassium, magnesium, lipids including fatty acids in milk, butter, vegetable oils and fish, antioxidants, including fruit and vegetable intake, flavonoids and flavonoid-rich foods, Vitamin C, Vitamin E, b-Carotene, Vitamin A, selenium, zinc and copper, and probiotics and prebiotics.

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What is Asthma? How Do You Get Asthma? How Long Does Asthma Last?

Asthma is a long-lasting (chronic) disease of the lungs and airways (bronchi) that affects 5 people in every 100. In children, this figure is higher and rising.

Asthma is characterised by attacks of breathlessness, tight chest, wheezing and coughing which are caused by the airways becoming narrowed and inflamed. Some people may have these symptoms all of the time and others may be normal between attacks.

How do you get asthma?

Asthma can arise at any age, but why some people have the disease and others don't is not known. People with asthma have airways that are more sensitive than normal.

• Doctors know, however, that asthma can sometimes run in families.


• Asthma attacks can be set off by many different things, these are called triggers. Examples include cold air, vigorous exercise and stress.


• These triggers may also include 'allergens'. These are present in the environment and contain chemicals that trigger allergic reactions.


• Allergens include, for example, pollen, animal danders, house dust, pollution, some foods, perfumes and cigarette smoke.


• Allergens cause the lining of the airways to become swollen and inflamed. It produces extra mucus and the muscles of the airways tighten. There is then less room for the air to pass in and out.


• Attacks may be more frequent or severe in people who have a chest infection.

How serious is asthma?

Asthma is not generally considered by doctors to be a serious illness in most people who have it, mainly due to the mildness of symptoms and the range of very effective medicines that control these symptoms and stop asthma worsening. Asthma does, however, have an effect on quality of life because attacks can be unpleasant and distressing and can restrict activity. Whilst most sufferers learn to live with and manage their condition, for some it can be disabling. In exceptional cases, asthma can be life-threatening, particularly if it is not treated adequately or promptly. For some of these, an attack is so severe that it results in death.

How long does asthma last?

Asthma attacks come and go, with wide variation in the symptoms at different times. Many people with asthma have problems only occasionally but others struggle with it every day. Modern medicines control and relieve symptoms and so attacks may only last a few hours or minutes, but without treatment this may go on for several days. Some children grow out of asthma and some people are only affected at different times of the year. However, the period of time during which people may have asthma attacks can last for many years or throughout life.

How is asthma treated?

Asthma is not so much "treated" as it is "controlled". As a chronic, long-term disease, there is no cure. However, there are tools and medicines to help you control asthma as well as benchmarks to gauge your progress.

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Asthma: Identifying Your Triggers

Asthma is a long-lasting (chronic) disease of the respiratory system . It causes inflammation in tubes that carry air to the lungs (bronchial tubes). The inflammation makes your bronchial tubes likely to overreact to certain triggers. An overreaction can lead to decreased lung function, sudden difficulty breathing, and other symptoms of an asthma attack.
If you avoid triggers, you can:

• Prevent some asthma attacks.
• Reduce the frequency and severity of some attacks.

You may not be able to avoid or even want to avoid all your asthma triggers. However, you can identify many things that trigger your symptoms by:

• Monitoring your lung function (peak expiratory flow). Your lungs will not work as well when you are around a trigger.
• Being tested for allergies. If you have allergies, the substances to which you are allergic can trigger symptoms.

An asthma trigger is a factor that can decrease lung function and lead to sudden difficulty breathing and other symptoms of an asthma attack. When you are around a trigger, you are at increased risk for an asthma attack. A severe attack may mean you have to go to the hospital.
Some triggers are substances you may be allergic to (allergens). These triggers may include:

• House dust mites.
• Cockroaches.
• Animal dander.
• Indoor mold.
• Pollen.

Other triggers are not allergens-they can cause asthma symptoms, but you are not allergic to them. These include:

• Cigarette smoke and air pollution.
• Upper respiratory infections such as colds, influenza (flu), and sinusitis.
• Exercise. Many people with asthma have symptoms when they exercise.
• Dry, cold air.
• Medicines, such as beta-blockers, aspirin, and other nonsteroidal anti-inflammatory drugs (NSAIDs).
• In adults, hormones, including those involved in pregnancy and menstrual periods. Your symptoms may change just before or during periods.
• Gastroesophageal reflux disease (GERD). Some experts debate whether GERD makes asthma worse. Studies have shown conflicting results as to whether GERD triggers asthma.

Identifying asthma triggers helps you know what increases your asthma symptoms. If you avoid triggers, you may be able to:

• Avoid an asthma attack altogether.
• Reduce the length and severity of an asthma attack.

How to identify asthma triggers

1. Identify possible asthma triggers. A trigger is anything that can lead to an asthma attack. When you are around something that triggers your symptoms, keep track of it. This can help you find a pattern in what triggers your symptoms. Record triggers on a piece of paper or in your asthma diary.
2. Monitor your lung function. A trigger may not always cause symptoms. But it can still narrow your bronchial tubes, making your lungs work harder. To identify triggers that do not always cause immediate symptoms, measure your peak expiratory flow (PEF) throughout the day. PEF will drop when your bronchial tubes narrow, so your PEF will drop when you are near things that trigger symptoms. Measure your PEF when you are around the common irritants mentioned in the "What are asthma triggers?" section to see if they are triggers. Record your PEF in your asthma diary.
3. Be tested for allergies. Skin or blood testing may be used to diagnose allergies to certain substances. Skin testing involves pricking the skin on your back or arms with one or more small doses of specific allergens. The amount of swelling and redness at the sites where your skin was pricked are measured to identify allergens to which you react. If your PEF drops when you are near an allergen, consider being tested for this allergen.
4. Share your trigger record with your doctor. After you have found some things that may trigger your asthma, you and your doctor can devise a plan for how to deal with them.

Now that you have read this information, you are ready to start identifying your asthma triggers. Let your doctor know of any triggers you identify.
If you have questions about this information, take it with you when you visit your doctor.

Organization

Asthma and Allergy Foundation of America (AAFA)
1233 20th Street NW
Suite 402
Washington, DC  20036
Phone:	1-800-7-ASTHMA (1-800-727-8462)
Email:	info@aafa.org
Web Address:	www.aafa.org
The Asthma and Allergy Foundation of America (AAFA) provides information and support for people who have allergies or asthma. The AAFA has local chapters and support groups. And its Web site has online resources, such as fact sheets, brochures, and newsletters, both free and for purchase.

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Allergy Relief Tips Wherever You Go

Worst Allergy Cities in America for Spring Allergies

 

It’s a top ranking that Knoxville, Tenn., won’t be promoting any time soon: It’s No. 1 on the list of “most challenging” places to live if you have spring allergies. That’s according to the Asthma and Allergy Foundation of America’s 2010 ranking of 100 U.S. cities.
The city earned the dubious honor on the latest list of "The 100 Most Challenging Places to Live with Spring Allergies." Los Angeles, much maligned for its air pollution, ranked far better -- number 92 on the 2010 list. San Diego was 99, and Harrisburg, Pa., came in at number 100. (See full list at the end of this article)
What do the worst allergy cities have in common? What makes a city good for people with allergies?  Unfortunately, there are no easy answers. But allergy experts say there are key factors to look for.

How the 'Worst' Allergy Cities Are Computed

Unveiling the worst spring allergy cities in America has become an annual tradition. The lists are released by the Asthma and Allergy Foundation of America, in Washington, D.C., and many factors are plugged in to figure out which cities will get the dubious honor each year, says Mike Tringale, a spokesman for the foundation.
The foundation experts look at the most populated cities and take into account factors such as the region's pollen score (pollen count and other factors), along with the number of allergy medications prescribed and the number of board-certified allergists practicing there. Each city gets a score and then the list of 100 cities is drawn up.
More than half of the top 10 worst cities are Southern cities: Knoxville, Tenn.; Louisville, Ky., Chattanooga, Tenn.; Charlotte, N.C.; Greensboro, N.C.; and Jackson, Miss.
But Philadelphia; St Louis; Dayton, Ohio; and Wichita, Kan., are also in the top 10.

Why Are Some Cities Worse for Allergies Than Others?

"The fundamental issue with cities is the type of plant or grasses, trees or weeds that grow in the area," says Daniel Waggoner, MD, an allergist in Mystic, Conn., who is not affiliated with the list creation but is familiar with it.
Cities with an exceptionally high concentration of trees, grass, or weeds may have more pollen in the air, he says. Local environmental factors such as wind, humidity, typical temperatures -- and air pollution -- also play a role in allergies, notes Miguel Wolbert, MD, an allergist in Evansville, Ind. and a certified pollen counter.
What if you don't live in a major city? How can you tell if your region is especially bad for allergies? Here's what the experts have to say.

Allergy Risks by Geography

Near River Basins
"If you are around certain river basins, such as in Ohio or Mississippi, higher pollen counts occur due to high humidity levels," says Wolbert. Pollen thrives in high humidity, he says.

In the middle of Mississippi, everything sits, Wolbert says, so pollen is likely to be worse.
Plants around river basins vary in different parts of the country. For instance, in the lower Mississippi, ragweed and chenopods thrive, Wolbert says.
In the Mountains
In the mountains, there are fewer plants, Wolbert says, perhaps explaining why some mountainous states are absent from the list. "The higher the mountains, the fewer the plants,'' Wolbert says, resulting in less pollen overall.
And pollen from evergreens is typically heavy pollen, so it falls to the ground relatively quickly, he says. It poses less of an allergy problem simply because it is airborne for a shorter time.
Near the Coast

While some seaside towns made the list, in general a sea breeze helps reduce allergens, Leftwich says. The closer to the sea the better. "If you can afford to live in that first quarter mile from the beach, it's great. Pollens are not so much a problem there."
In coastal areas that are densely populated, however, the pollution can make allergies worse despite the sea breeze, Wolbert says. One exception: In Miami, he says the sea breeze is strong enough to reduce pollen-triggered allergies, despite the population.

Allergy Risks by Region of the U.S.

It's difficult to pick out one region of the country as "better" or "worse" for allergies, according to the experts. Why? Even within a region the trees, grasses, and weeds that typically provoke allergies can differ.
People's sensitivities are very different, too. For example, one person may be allergic to tree pollen. Another person may be allergic to grass pollen. Your allergies react to the plants that surround you, no matter the region of the country.  Nonetheless, here are allergy triggers to look for, region by region.
The Midwest
The Midwest, known for its ragweed pollen, has several cities on the list including Dayton, Ohio, and St. Louis. Some experts believe global warming is making the ragweed season longer, Wolbert says, so pollen may just get worse.
''Ragweed thrives with higher carbon dioxide,'' he says. So the more air pollution, the hardier ragweed becomes. "I think ragweed will continue to worsen every year," he says.
Global climate change also appears to increase ragweed – and allergic disease – according to recent studies in medical journals, including the Journal of Allergy and Clinical Immunology.
In the Midwest -- Illinois, Indiana, Ohio, Minnesota, Wisconsin, Michigan, Iowa, Missouri -- tree pollen season is roughly March to June. Trees that typically trigger allergies include elder, alder, birch, oak, elm, and hickory, Wolbert says.
Overlapping the tree pollen season, grasses start to pollinate in the summer, Wolbert says. Grasses that can provoke allergy symptoms include Bermuda, Timothy, fescue, rye, and orchard grass.
Weeds pollinate in the fall, says Wolbert. "Weed season is pretty uniform," he says. The Midwestern states are known for lamb's quarter weed, pigweed, Russian thistle, and others.

The West


In Washington, Oregon, and California, tree pollination is usually in full swing from February to June.  Trees that are native cause the most allergy problems, says Richard W. Honsinger, MD, an allergist in Los Alamos, N.M., and a clinical professor of medicine at the University of New Mexico School of Medicine.
For instance, in the Pacific Northwest, pollen from the native alder and birch trees can make people with allergies miserable, he says.
In California, oak and walnut trees can be problematic for those with allergies, he says. Pine trees don't deserve their bad reputation, he says. "People always think pine pollen causes problems because they see it." When they park their car under pines in the mountain, he says, the car can be covered with the pollen.
"But pine is a heavy pollen, it falls to the ground," he says."It is airborne, but it settles. It doesn't float in the air as long so it doesn't provoke as strong an allergy attack."
In the dryer states of Arizona and New Mexico, trees such as cedar, ash, and oak pollinate from about February to April, Honsinger says.
Grass pollination in the West is high in May and June, Honsinger says.  Bermuda grass, orchard, wheat grass, and fescue are common in the West. Honsinger says, "If you are allergic to one grass, you are often allergic to almost all," with one exception. People allergic to Bermuda grasses are often allergic only to those, he finds.
Weed season in the West can extend from spring or early summer through fall. Among the offenders: plantain weed. Ragweed is not so much a problem in the Pacific Northwest and northern California, but it can be in Arizona and New Mexico. Ragweed can grow throughout the U.S., according to the Asthma and Allergy Foundation of America.
The South

When it comes to allergies, Leftwich says, "Tennessee is where everything comes together," noting there are several different types of pollen flourishing there. His town, Nashville, Tenn., made No. 47 on the list.
Nashville has plenty of Southern state company on the worst cities for allergies list, and for reasons that make sense, Leftwich says. ''The longer the growing season, the worse it is for allergies," he says.
A second factor is rainfall. So people with allergies who live in a Southern city with a temperate climate, long growing season, and plenty of rain can expect to sneeze a lot.
In the south, tree pollen season is roughly February through May, with pollens from oak, cedar, and pecan trees the worst allergy triggers. Birch and hickory trees can also provoke allergies, Leftwich says.
"Grasses can be a problem in the South year round," he says. Commonly planted grasses include fescue, rye, and bluegrass. Never mind the type. Often, someone who is allergic to one of those will be allergic to all, he says.

Weed season kicks in around late summer and continues until a hard freeze, Leftwich says. The biggest culprit: ragweed.
The Northeast
In the Northeast -- states such as Maine, New York, Pennsylvania, Delaware, Connecticut, and others -- tree pollens begin in February or March, continuing through June or so, says Clifford Bassett, MD, an allergist in New York City.  Among the offenders: elm, hazelnut, maple, poplar, hackberry, and red cedar.
In May and June, grass pollens kick up. While some people are only allergic to Bermuda grass, most with allergies are allergic to all grasses.
Weed season begins in August and continues through the fall. Pollens from such weeds as English plantain, lamb's-quarter, and cocklebur provoke symptoms, Bassett says.

Putting the Worst Allergy Cities List Into Perspective

Waggoner and other allergists caution that the list of worst cities for springtime allergies may not be that scientific. "The worst city for one person is the best city for another person," Leftwich agrees. "It depends on what you are allergic to."
"Being allergic to one tree pollen doesn't mean you are allergic to another." The city that has the worst tree pollen count may not have the worst grass pollen count, he says. “It is a common misconception that pollens are pollens. They are not."
No scientific studies have thoroughly compared allergy risks in different cities, Leftwich says. Instead, we turn to the annual list almost for bragging rights.
So how can we use the annual list of worst allergy cities? Well, don't use the list to pick one place to live over another, allergy experts say. Instead, get allergy testing to be sure you know what triggers your allergies. And if you must move, find out whether your pollen triggers grow widely in the area and neighborhood you're considering.
What if you love your home, but you're in a bad allergy community?  Talk to your doctor. There are preventive treatments you can start before allergy season to help you stay home and healthy.

Complete List of 2010 Spring Allergy Capitals

1. Knoxville, Tenn.
2. Louisville, Ky.
3. Chattanooga, Tenn.
4. Dayton, Ohio
5. Charlotte, N.C.
6. Philadelphia, Pa.
7. Greensboro, N.C.
8. Jackson, Miss.
9. St. Louis
10. Wichita, Kan.
11. Madison, Wis.
12. Columbia, S.C.
13. Richmond, Va.
14. Providence, R.I. 
15. Birmingham, Ala.
16. Memphis, Tenn. 
17. Oklahoma City, Okla.
18. Baton Rouge, La.
19. Allentown, Pa.
20. New Orleans
21. New York
22. Syracuse, N.Y. 
23. Augusta, Ga. 
24. Little Rock, Ark.
25. McAllen, Texas
26. Columbus, Ohio 
27. Hartford, Conn. 
28. Greenville, S.C.
29. Rochester, N.Y. 
30. Springfield, Mass. 
31. Pittsburgh, Pa.
32. Scranton, Pa.
33. Tulsa, Okla. 
34. Omaha, Neb.

35.  Buffalo, N.Y.  
36. Des Moines, Iowa
37. Toledo, Ohio
38. Akron, Ohio  
39. Virginia Beach, Va.
40. Poughkeepsie, N.Y.   
41. Albany, N.Y. 
42. San Antonio
43. Washington, D.C.
44. Kansas City, Mo.
45. Tucson, Ariz. 
46. Portland, Maine
47. Nashville, Tenn. 
48. Baltimore
49. Cleveland, Ohio  
50. Indianapolis
51. Charleston, S.C.
52. Dallas
53. Youngstown, Ohio
54. Las Vegas
55. Jacksonville, Fla.
56. New Haven, Conn. 
57. Atlanta
58. Cincinnati, Ohio  
59. Detroit 
60. Grand Rapids, Mich.
61. Houston
62. El Paso, Texas
63. San Francisco
64. Modesto, Calif. 
65.  Lancaster, Pa.
66.  Milwaukee, Wis.
67. San Jose, Calif.
68. Boston
69.  Cape Coral, Fla.
70. Tampa, Fla. 
71. Raleigh, N.C.   
72. Lakeland, Fla. 
73. Bakersfield, Calif. 
74. Bridgeport, Conn.
75. Portland, Ore. 
76. Worcester, Mass. 
77. Orlando, Fla.
78. Austin, Texas
79. Albuquerque, N.M.
80.  Ogden, Utah
81. Phoenix, Ariz.  
82. Minneapolis 
83.  Chicago   
84. Riverside, Calif.  
85. Salt Lake City  
86. Stockton, Calif.  
87. Seattle
88. Sarasota, Fla. 
89. Sacramento, Calif.
90. Palm Bay, Fla.
91. Colorado Springs, Colo.
92. Los Angeles  
93. Denver 
94. Fresno, Calif. 
95. Oxnard, Calif.  
96. Miami  
97. Boise City, Idaho 
98. Daytona Beach, Fla. 
99. San Diego   
100. Harrisburg, Pa.

 

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