Trying pollen seasons are becoming the norm in Western Pennsylvania.
In March, TribLive reported that allergy season is getting longer in Western Pennsylvania and around the world. Climate change is shortening the number of freeze-free days, leading to earlier blooming and increased vegetation.
Thankfully, there are new and in-development treatment options that could work in tandem with allergy shots.
While immunotherapy via “allergy shots” has trained patients’ immune systems to slowly calm down with a given allergen or allergens for years via prolonged controlled exposure, newer treatments in various stages of testing and use might offer solutions, too.
First, there’s one you might have missed if you haven’t seen an allergist in a while.
Since gaining regulatory approval in 2014, tablet-based immunotherapy — with FDA-approved tablets for grass, ragweed and dust mites — can be self-administered at home. Meanwhile, some allergists offer off-label immunotherapy tablets that they’ve mixed themselves, said AHN pediatric allergist and immunologist Russell Traister.
”I think there is some evidence that they probably work. I think we don’t have all the studies to tell us the ideal dosing for every allergen. I offer the FDA-approved ones,” Traister said. “But for example, there’s a grass pollen tablet, and if someone’s only allergic to grass, I offer that to them and say, ‘Maybe if you can’t do shots, maybe this tablet will be helpful.’ If you’re allergic to many things, just doing a grass tablet might not be that helpful.”
But not everyone has been quick to adopt them.
“I don’t use a lot of those in my practice, because the insurances don’t always cover and they’re not as effective as traditional shots,” said Dr. Thomas Mertz, DO, of Allergy and Asthma Associates of Pittsburgh in Harmar. “But those are an option.”
In other countries, biologic drugs — engineered antibodies derived from living systems — can offer shorter, though less durable, treatment than immunotherapy, targeting a single pathway rather than the entire immune system.
In the U.S., biologics are currently only approved for conditions like food allergies, asthma, eczema and hives. They have already been approved for use to inhibit seasonal plant-based allergies in Japan and other countries.
Mertz noted one issue he sees when recommending biologics for other conditions.
“The difference between the biologics and the shots is the shots are usually covered by insurance, and they’re usually pretty reasonable versus the biologics; we have to go through a process because they’re so expensive,” said Mertz. “They’re definitely effective, but the biggest downside would probably be the cost.”
Additionally, researchers are currently probing the viability of mRNA vaccines in rewiring the immune system to prevent reactions in the first place.
While too far out to speculate on specifically, Mertz indicated he’d welcome any approved tool to the toolkit.
“Sometimes not every person needs the same type of treatment, but if something else came out, then I think that it definitely would be incorporated,” said Mertz.
With the Pittsburgh at 23 overall on the Asthma and Allergy Foundation’s list of hardest places to live in the U.S. for those with pronounced seasonal allergies — due to factors including above-average pollen levels — Western Pennsylvanians who suffer the sneezing, reddened eye-itching, congested woes of seasonal allergies are having a rough go of it.
“Previously, you’d have set seasons. You’d have your spring come with (pollen from) trees, grasses in the summer and weeds in the fall, and there’d be a little bit of late green,” Mertz explained. “But the big thing is that pollination season has extended, so now you’re seeing a lot of overlap — more than one type of pollen at a time. That tends to make people have worsening symptoms, too.
“We’ve got a lot of moisture. We have poor air quality. Those combined tend to make for what we call a higher biomass of pollinators. So you have a greater amount of exposure.”
Factors key to allergy season in the region — trees like birch, oak, maple as well as grass like Kentucky, orchard, rye, Timothy and sweet vernal and weeds including ragweed, English plantain, cocklebur and pigweed — are thriving in those conditions to create an allergy climate that delivered pollen levels that fell under medium-high just three days during April and sit above that mark for the foreseeable future.
Both Mertz and Traister say seasons have generally been trending harsher.
“Unfortunately, over the last several years, the pollen counts have been increasing seemingly every year,” said Traister.
This year, both said the cold weather led to a relatively slower start to allergy season compared to the most recent years, but the overall trend is eye-opening.
And, for some, common allergy remedies like antihistamines can fall short when used in isolation since they only block the allergic response chemical histamine and don’t address the overactivity of the immune system that triggers allergic reactions to defend against outside substances.
“They might help, they just might not help enough. And so that just means that, basically, your allergies are so overwhelming that one pill of antihistamine is not enough to combat all the histamine that’s being released by your allergy cells from the allergen exposure,” Traister said. “There are usually a few weeks here in the spring when people are particularly miserable with the very high pollen counts. I’ll tell people that they can take an extra antihistamine … On the advice of a physician, it’s okay to take an extra one if you’re miserable, and sometimes that will give some extra relief to people.”
It’s all led to an uptick in patient numbers, said Traister.
“At some point, people reach their tolerance level, and it pushes them over the edge and their symptoms just sort of become overwhelming,” he said. “A lot more people are getting allergy shots because they’re miserable.”
Preventing flare-ups
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