Come close, little ones, and hear our bedtime tale . . .

Once upon a time, there was a woman. In the fall, she loved to go outside and feel the wind. In the winter, she loved to go outside and play in the snow. And in the spring, she would go outside, but her throat would itch, her eyes would get puffy, her nose would run, her sinuses would clog, and she'd get nasal drip. So she locked herself up in her house, and never came out again. The moral of the story: hay fever bites.

Living with hay fever can be extremely difficult - when you're having trouble doing something as simple as breathing, you know that you're in for a long spring and summer. Yet most of us don't live anywhere near a farm . . . so where does the hay fever come from?

It has often been noted (by people who like to note things) that hay fever is not a fever at all, nor does it have anything to do with hay. Hay fever, a.k.a. rose fever, is medically designated as "allergic rhinitis," a seasonal allergy and an inheritable disease in which the victim's immune system unpleasantly overreacts to the presence of pollen. We say "overreact" because the pollen isn't harmful - your body just thinks it is. Your immune system deals with pollen much the way the National Guard was called upon to deal with pot-smoking hippies back in '68. It fights the pollen as though it was a threat to national security, and the nasty symptoms of hay fever are a by-product of that fight.

But fear the fever no more, for in this SYW, we'll give you some top tips for overcoming your allergies, so that you will no longer be held prisoner by your nasal passages.

1. LEARN ABOUT THE DISEASE

Every year it's the same thing: spring prances into town and the trees go into a reproductive frenzy. The sneezin' season has begun, and your life becomes a hell of mucus, tears, irritability and depression. Face it - you have allergies. What can you do to manage the unpleasant side effects of this annual vegetable orgy?

First of all, you have to know exactly what you're dealing with. Consider these facts:

  • 26 million Americans suffer from chronic seasonal allergies, according to the National Center for Health Statistics.

  • 40 million more have milder symptoms, but symptoms nonetheless.

  • Hay fever costs hundreds of millions of dollars each year in medicine, doctors' bills, and lost work productivity.

  • Hay fever can develop at any stage in life, and once you have it, it probably isn't going to go away.

  • Your sensitivity to the allergen (the substance causing the allergy - in this case, pollen) may go dormant for a time, but it will, in most cases, eventually return, and may worsen.

  • Those who react to only one particular kind of pollen may become sensitive to others over time, or to different types of allergens like mold and dust.

So what makes hay fever different from a cold? Generally, allergic rhinitis can be distinguished from a cold or flu by the absence of fever and muscle aches. Also, a cold will go away in a week to ten days, whereas allergy symptoms will linger for as long as the allergen is present, sometimes for months. The usual symptoms of hay fever are:

  • Sneezing
  • Runny nose
  • Nasal congestion
  • Watery, itchy eyes
  • Itchy throat
  • Circles under the eyes
  • Irritability
  • You smell bad (That is, your power to detect scents has weakened.)

Now when we say "allergies," you have to understand that we're not talking about ALL allergies. It's possible to be allergic to a vast array of things: pollen, mold, dust mites, bee stings, latex, animal proteins, nuts, chemicals, milk, penicillin, dander, ex-wives, Eskimos, etc. Furthermore, people with a sensitivity to one thing are more likely to be sensitive to others, and many people have tons of allergies that run the gamut. Hay fever just happens to be the most common allergy out there, a general reaction to pollen and mold spores that makes the sufferer feel icky. There are ways to protect yourself, though, as you will soon see.

2. PROTECT YOURSELF FROM POLLEN

As much fun as taking medicine and visiting doctors may be, the most effective treatment for hay fever is to keep the distance between you and the offending particles. How can you possibly avoid something like pollen and mold spores? It's not that tough if you take our advice:

  • Find out what the peak pollen season is for your region. Different plants thrive in different various parts of the country, so you need to know what's happening in your neighborhood. This chart shows when and where trees, grasses, and weeds do their thing. If you know when to expect the onslaught, you'll be prepared. Generally, trees peak first, then grasses, then weed season starts in late summer to early fall.

  • Keep a diary. An allergy sufferer might be sensitive to one particular kind of tree pollen, to every kind of weed pollen, to all kinds of pollen, or to pollen, mold, mites, dust, perfume, cats, dogs, fish, and midgets. Every individual is unique, and allergic sensitivities can change. Keep track of when, where, and how you are suffering, in order to help you and your allergist identify the specific characteristics of your condition. The more information you have, the easier it will be to avoid and to treat reactions.

  • Watch pollen forecasts. In this wonderful civilization of ours, there are people who count the amount of pollen in the air in cities across the United States and attempt to predict what the count will be over the next few days. These are incredibly interesting people who are fun to talk to at parties. We suggest, however, that you visit pollen.com and plug in your zip code. You'll get a pollen count analysis of your neighborhood, and they'll even send you free e-mail alerts. Will the fun ever cease?

  • Don't go out during the worst times. Unfortunately, most of us lead busy lives and the condition of our nasal organ must take a backseat to more important things - like life, for example. Still, it might occasionally be helpful to know that plants are busiest churning out the bad stuff between 5 and 10 a.m. and just before dusk. So try to wait until after 10 a.m. before you go jogging. Also, be aware that pollen concentrations are higher on warm, windy days (the heat stimulates production and the breeze spreads it around). Wet, cloudy days are better, as the moisture washes pollen out of the air.

  • Keep the windows of your home and car shut. Make use of air conditioning, and change the filters regularly.

  • When you come inside on a high-pollen-count day, you're probably covered in invisible pollen, so change your clothes, and if you're having a really bad day, maybe take a shower and wash your hair. Same goes for your pet.

  • Keep your grass cut short - this reduces pollination. But don't do it yourself, since mowing stirs up whatever is there already. Pay a kid $2 to mow your lawn so he can develop his own allergy ailments.

  • Don't line-dry sheets or clothes outdoors.

  • Avoid travel in "the country" during peak pollen season and at harvest time.

  • Tips for gardeners: Your hobby brings you into close contact with the enemy. Consider wearing a mask, and do your work in the mid-afternoon when concentrations are lowest. When you're planning a garden, be aware of what the good and bad plants are. A good rule of thumb is that the more colorful the flower, the better. Brightly colored flowers are insect-pollinated rather than wind-pollinated; their heavier pollen is less likely to find it's way up your schnoz. Check out this chart for an allergy sufferer's list of good and bad garden plants.

3. TAKE THE RIGHT DRUGS

Avoiding pollen completely isn't easy, but we don't want you to revert to a Howard Hughes-esque lifestyle. Your second line of defense is medication. The unpleasant symptoms of hay fever are the result of a chemical reaction in your body, mainly the release of histamine as a by-product of your immune system response, and researchers have come up with a variety of drugs to counteract these symptoms.

Get an allergist

Rather than loading up on over-the-counter sprays and pills, you should probably take the trouble to see an allergist. Your allergist can take into consideration your individual needs, and provide you with prescriptions for drugs less likely to cause drowsiness than over-the-counter remedies. To find an allergist near you, go to the directory at the American Academy of Allergy, Asthma, and Immunology. Tell him or her as much as possible about the nature of your hay fever (what you react to, when you react, and what your symptoms are), and ask lots of questions about your options for treatment.

Antihistamine pills

These are a tricky set of drugs. Histamine is a natural substance that your brain needs to function properly, so antihistamines block this functioning. That's why over-the-counter boxes of antihistamines often read, "do use while operating heavy machinery." The stuff makes you completely loopy.

The latest generation of antihistamines has improved a lot. They are less likely to cause drowsiness and there is less of a risk of dangerous side effects. If there are no conflicts with other medications you happen to be taking (or with other medical conditions from which you may be suffering) your doctor will set you up with Allegra (fexofenadine), Claritin (loratadine), or a similar antihistamine that will help you feel better.

Sprays and drops

Antihistamine pills won't do everything, so it's often a good idea to combine your drug regime with one or more of the following. As always, ask your allergist which ones are right for you.

  • Nasal decongestant spray. Available over the counter, these shrink the blood vessels in your nose and cut down on the production of nasty mucus. Antihistamines won't do this, so a decongestant spray is a common helper.

  • Cromolyn sodium nasal spray. A preventative. Snort this to block allergens and prevent the allergic reaction from happening in the first place. Allergens can still get to you through other orifices (always wear underwear), but this will help.

  • Topical nasal steroids (corticosteroids). No, these don't have anything in common with the drugs that make bodybuilders huge and pimply. Nasal steroids simply reduce the number of histamine-producing cells in the nose. Less histamine = less misery. Another accompaniment to antihistamine pills.

You might also consider a couple of home remedies for good measure, such as the ol' steam inhalation trick Grandma used (hanging your towel-covered head over the kettle). Some allergists recommend herbal cure-alls such as echinacea. Just keep in mind as you explore the foggy panorama of alternative medicine that "natural" does not mean non-toxic. Mix herbs with meds at your own peril, and check EVERYTHING over with your allergist.

But let's say you don't go for all that New Age stuff, the drug store has just repossessed your car, and you're still a miserable, sniveling, dripping invalid. Isn't there anything else you can do? Yes: read step 4 and get shots.

4. GET ALLERGY SHOTS

Allergen immunotherapy, otherwise known as "allergy shots," is the last word in hay fever treatment. It's the closest thing to a "cure" there is. So why doesn't everybody do it? Because it consists of getting stuck with a needle hundreds of times over the course of several years. It can also be quite expensive (each shot costs about $25). A recent study in The New England Journal reported that grass-pollen allergy sufferers experienced "prolonged clinical benefits" for at least three years after their immunotherapy treatment ended. However, despite the established effectiveness of allergy shots, the time-consuming and prickly process of going through it all means that it is usually recommended only for those whose allergy symptoms are pretty bad, suffer from an especially long allergy season, and do not respond well to medication. Here's what you're in for:

  • What does immunotherapy involve?

    1. First you'll get an allergy test: they'll prick you and introduce a little bit of a variety of allergens under your skin to see what the reaction is like.

    2. You'll get a lovely little red bump on your skin when the reaction is allergic.

    3. If you have eczema or if you're on medication that might interfere with the results of skin test, they'll give you the RAST (radioallergosorbent blood test) instead.

    4. Once your particular allergens are identified, they'll begin to inoculate you against them. What that means is that small doses of the allergen are shot into your bloodstream, so that you body can slowly begin to develop a resistance to them.

    5. Over time, the dosages are increased as you become more and more desensitized to the allergen.

    6. Most patients experience a significant reduction in their hay fever within twelve months.

  • How long does it last? Treatment varies, but in general, you get a shot once a week for the first 30 weeks or so. They keep you in the doctor's office for at least 20 minutes following a shot to monitor you for a possible adverse reaction. After the initial period, you may get shots only once every 2 or 3 weeks, and towards the end, once a month. Treatment usually lasts a minimum of 2 years up to a maximum of 5 years. Immunotherapy works, but obviously the time and trouble involved means it's not for everyone. Once you start, it's very important that you continue with the treatment on a regular basis.

  • What are the possible side effects? The reason they keep you in the office after a shot is to watch for a possible allergic reaction to the shot. Rarely, a patient might experience an asthma attack or even anaphylactic shock. Other reactions might include wheezing, tightness in the chest, nausea, itchy eyes, watery nasal discharge, swelling in the throat, or dizziness. None of these reactions is particularly pleasant, and that's why the monitoring period is so important.

The important thing to realize is that you do have options. Armed with these helpful tips, the world you see through those bleary, itchy eyes won't seem quite so bleak. Now you can spend your time reading traumatic bedtime stories to children. But we must warn you: mental therapy is MUCH more expensive than immunotherapy . . .