Seasonal Susceptibility: Worst allergens not always the obvious ones

New Orleans, La. — Spring is a season that spawns so much beauty: colorful flowers in bloom, trees adorned with leaves.

It is also a time of the year that awakens a world of misery for many people.

"Hello, how are you today?" asked David Schneider, M.D., of one of his patients.

He specializes in allergy and immunology, practicing in Metairie and Hammond.

"Like my ears, they itch," his patient tells him.

The mild, humid climate in this area is like a shot of adrenaline for grasses, ragweed, trees and other allergens.

"Dust mites cause indoor symptoms, pollens cause outdoor symptoms and the symptoms are year-round, and then whatever little gap is left is covered by mold spores and those are a big problem," said Dr. Prem Kumar, chief of allergy and immunology at the LSU Health Sciences Center.

Those are some of the more common allergens. Still, there are other, hidden dangers relating to allergic responses. They come without warning and often with no related medical history.

"They told me another half an hour and my lungs could have closed up on themselves," said Sagar Wadgaonkar.

His nightmare, which unfolded along St. Charles Avenue, caught him completely off guard within minutes.

"I was running one day and like I'd done many, many times before I had a shrimp po-boy for lunch that day. I had been eating shellfish my entire life," he said.

But suddenly his body was under attack. "My eyes were... you couldn't even see my pupils anymore. I was so puffed up around them, my entire body had puffed up. I had rash just all over. Someone said I looked like I was 250 pounds," he said.

Fortunately, Touro Hospital was not far away. "They were pumping me with all sorts of steroids and epinephrine and I could feel myself deflating, it was quite an experience," he continued.

The surprising diagnosis was exercise-induced food allergy.  "Of course my reaction, like most people's reaction, is that sounds ridiculous," Wadgaonkar said.

"It's actually an anaphylactic reaction that can occur, so an unlucky person eats the wrong food, within two hours of heavy exercise could develop an anaphylactic reaction," said Dr. Schneider.

Anaphylactic shock involves an extreme allergic response caused by food allergy, insect stings, and medications. Symptoms include hives, lip, face, tongue, throat swelling, vomiting, diarrhea, cramping and a dramatic drop in blood pressure.

"The classic example started with celery.  People who ate celery and exercised got into trouble, because one of the allergen primes in the other one triggers, and this is particularly true in patients who happen to have underlying asthma," said Dr. Kumar.

During exercise, body temperature rises and other physiological changes occur. But even when exercise is not a part of the equation, allergies often do not operate in isolation.

"Allergies cross the fence because there are shared proteins… I guess nature's little practical joke is to connect things.  An interesting example is someone who's allergic to latex... here they are, they have trouble with bananas and kiwis and chestnuts and papaya, avocado," said Dr. Schneider.

It is known as cross-reactivity and it causes oral allergy syndrome.

"Someone who's got ragweed allergy often has an itchy mouth when they are enjoying cantaloupe, watermelon, honeydew, and bananas because there's a cross-reaction of allergens between the foods and that pollen," said Dr. Schneider.

Food allergies, in general, are growing. The National Institutes of Health says the prevalence of food allergy increased by 18 percent between 1997 and 2007.

At the LSU clinic in the Garden District, Jane Hall was seeking answers to why she was experiencing lip swelling.

"I didn't know what to think, I had no idea what was going on.  But it was very painful the first time it happened. I looked like I had collagen injections," she said.

While Dr. Kumar has not totally ruled out skin care products as a cause for Hall's lip swelling, he leans strongly toward something else. "Once a person has hay fever and has swelling of the lips and tingling around the mouth and redness around the face area, lips area, then that's potentially oral allergy syndrome," Kumar said.

Turns out, Hall had eaten honeydew.  "When you start talking about ragweed, then you start talking about melon as being a cross-reactive allergen," Dr. Kumar stated.

"I had no idea that, that had any correlation with anything. I thought that a ragweed was a ragweed, and a melon was a melon," Hall responded.

When an allergic reaction happens, an individual's immune system is overreacting, mistaking certain substances as an enemy.

"[It's] perceiving that the allergen is harmful, but in reality if the body would just ignore the ragweed it would be fine," said Dr. Schneider.

"If you put all these together -- skin allergies, respiratory allergies, asthma, food allergies --you're talking about more than half the population suffering from some kind of allergy or the other," said Dr. Kumar.

Taming allergens remains a tall order.  "Since 1911, we have the same three rules, you either avoid it, you medicate it to mask the symptoms, and lastly there are allergy shots or de-sensitization to get your body tolerant to the things you're exposed to," Schneider said.

When it comes to allergy injections, Dr. Kumar tells his patients to be cautious.  "If they get allergy shots during pollen season and they exercise the same day, they can get into trouble with either asthma exacerbation or they can get into trouble with anaphylaxis, so they are strictly warned by me not to exercise the day they get their allergy shot," he said.

Doctors emphasize that allergic reactions, whatever the cause, can potentially be deadly.

"It's important to have access to the antidote. Basically adrenaline or epinephrine are the medicines that one uses to reverse the severe, systemic reactions allowing you to have time to get to the emergency room," said Dr. Schneider.

Those rescue drugs come in the form of syringes prescribed to patients.

"So quickly your world could potentially change like that... it affects everything," said Wadgaonkar.

And even though food alone did not cause his horrifying attack, he is swearing off shellfish.  "I can't, it's too scary to me," he said.

The National Institute of Allergy and Infectious Diseases, part of the National Institutes of Health, recommends avoiding eating a couple of hours before exercising.  It lists alcohol, shellfish, tomatoes, cheese and celery as common causes of exercise-induced food allergy reactions.