Hay Fever, Seasonal Allergic Rhinitis, or What You Will

Doc Gumshoe checks in on the sniffles

By Michael Jorrin, "Doc Gumshoe", August 25, 2014

[ed. note: Michael Jorrin, who I like to call “Doc Gumshoe,” is a longtime medical writer (not a doctor) who shares his non-investing thoughts with us once or twice a month. His words and thoughts are his own. My eyes are red this time of year, so I read this one with interest.]

Just about everybody has sneezing fits from time to time, sometimes accompanied by watery, itchy eyes and other mildly annoying afflictions. And who can get through a season without an occasional stuffed-up nose? Many people regard these symptoms as normal responses to the presence of stuff in the environment to which they are allergic, whatever that means. And lots of people, when that time of year rolls around when whatever they are allergic to – grass and tree pollens, ragweed, goldenrod – is on the upswing, resort to over-the-counter antihistamines to keep the sneezing fits under some sort of control.

If that’s all there was to it, Doc Gumshoe would not be composing this epistle. But, as it happens, seasonal allergic rhinitis is more than a normal vexation, to be weathered with a packet of OTC pills and a big wad of Kleenex. Here are some tidbits of data:

  • Based on a number of different surveys, around 80 million persons in the US have at least 7 days per year of seasonal allergic rhinitis symptoms.
  • A 23,000 person sample found that more than 8% had physician-diagnosed allergic rhinitis.
  • Children and young people have a higher prevalence of allergic rhinitis.
  • Other surveys report that the economic burden of allergic rhinitis (combining seasonal with perennial) comes to $3.4 billion, a good part of which is accounted for by those OTC medications.
  • Absenteeism caused by allergic rhinitis is estimated to cost employers in the US about $250 million per year, and as many as a third of employees missed at least one day of work due to allergic rhinitis.
  • It is estimated that about 3.5 million work days per year are lost because of allergic rhinitis, as well as about 2 million school days.
  • Also, more than 80% of persons surveyed report that when they are affected by allergic rhinitis symptoms they are about one quarter less effective.
  • And finally, some employees surveyed report being affected by allergic symptoms about 70 days per year.

Beyond concluding that hay fever, or allergic rhinitis (whether perennial or seasonal) is definitely more than a trivial bother, I don’t want to make too much of those numbers. Experts like to put numbers to things, but what I want to stress is that allergic rhinitis is common, consequential, and costly.

Seasonal versus perennial allergic rhinitis

The difference between these is the particular allergic trigger. People with seasonal allergic rhinitis (SAR) are allergic to tree pollens, which are prevalent in early to late spring, or also possibly to grass pollens, prevalent in late spring through summer, or also possibly to various weeds (ragweed et al), prevalent in late summer to early fall, or also possibly to outdoor mold spores (late summer until winter).

People with perennial allergic rhinitis (PAR) can be allergic to indoor molds, house dust mites, cockroaches, and some animals, especially cats. As it happens, as more of our population lives in urban environments, PAR is gaining on SAR in prevalence.

Another factor in allergic rhinitis, whether seasonal or perennial, is a vexing phenomenon called “priming.” The way it works is this: a person is initially exposed to a high enough dose of a particular allergic trigger to set off an allergic reaction. It usually takes a fairly high initial concentration of the allergen to trigger the allergic reaction, but once that has taken place, the person is primed, and subsequent exposures to very small concentrations of that allergen may be enough to trigger another allergic reaction. Thus, when ragweed season sets in, the person may go for several days before feeling any of the usual symptoms, but once the first bout of “hay fever” takes place, the symptoms will persist, triggered daily by much smaller amounts of the ragweed pollen, because the person has become primed, or hypersensitive to that particular allergen. The amounts of allergen that can trigger subsequent symptoms may be as small as one one-hundredth as the original trigger.

Also, and perhaps of even greater consequence, once primed, the person can develop sensitivity to other triggers in the environment – not necessarily allergens of any kind – and those triggers can also res