The Senior Scene

Every year, when the buds begin to sprout on the flowering pear tree outside my office, people soon show up inside my office with runny noses and itchy eyes. That’s how I know allergy season has arrived in the South Sound.

With our mild winter this year, the pollen season arrived earlier than usual, which likely means we’ll have a long and difficult allergy season ahead.

The tree pollen counts are going to be high, and they’ve already started. Our area has some of the highest pollen counts in the United States, especially for alder trees and grasses.

In the Pacific Northwest’s temperate climate, tree pollen is most prevalent from February to April, grass pollen from May to July, then weed pollen in August and September.

With pollen allergies, every microclimate can be different, so symptoms can vary depending on where you live in the Pacific Northwest. Within a city, like Tacoma, pollen counts are generally lower because there’s less vegetation. In rural areas of east Pierce County, pollen counts can be as much as 100 times higher than in the cities, due to the increased vegetation.

With allergy season well under way, here are some of the common questions I hear at Mary Bridge Children’s Hospital and Health Center:

Can children outgrow allergies?

We believe that most people don’t grow out of allergies, but rather, they grow into them. Over the past few years, I’ve noticed that allergies tend to be increasing in both children and adults. Children usually start having problems with pollen allergies between ages of 5 to 10, and then their symptoms escalate every year with re-exposure to the pollen until they plateau in their late-teen years or early adulthood.

What can I do to help my child who has seasonal allergies?

Avoiding pollen is the best way to avoid pollen allergies, but staying indoors all the time is not practical as part of a normal childhood. Before your child goes outside, consider these tips to minimize exposure:

•  Allergies tend to be worse in theh middle of the day, so play outside during the morning or evening to provide less exposure to pollen.

•  Wear glasses and a hat to keep pollen off the face and eyes.

•  If a child starts to experience a reaction while playing at a park, find a water fountain and wash their hands and face. It also helps to wash after play time outdoors.

•  Don’t dry their sheets outdoors in the pollen season, as they’ll accumulate pollen.

•  When they sleep at night, keep their head away from any open windows.

What are some treatments?

Taking a simple antihistamine before outdoor activity can help. Generic, over-the-counter antihistamines are very good and can cost a penny or less per dose. Don’t be afraid to avoid the expensive name brands.

A saltwater nasal wash or a neti pot can be effective at reducing nasal secretions and congestion, and saline doesn’t have any side effects.

Eye symptoms are primarily related to congestion. Any decongestant for the nose can also reduce eye symptoms, without the need for eye drops, which can sting and be hard to put in your child’s eyes.

If those steps don’t work, a whole host of other medications are available by prescription. They include  intranasal steroid sprays, antihistamine (as a nasal spray or taken by mouth), eye drops and Cromolyn, which is available by prescription or as over-the-counter nasal spray or drops.

What are allergy shots, and what do they involve?

Subcutaneous immunotherapy, known as allergy shots, is quite useful for children and adults, and has a high incidence of control or cure for allergies. Treatment, however, requires multiple injections over a long period of time, usually five years.

On the horizon is oral allergy immunotherapy, which can be taken by mouth and is widely used in Europe, but not yet approved or available in the United States. This is not to be confused with the currently available sublingual drops, which are unreliable.

How do I know whether I should try simple over-the-counter medication, or do I need allergy shots?

Generally, allergies can be managed with simple medications and avoidance if:

• Symptoms are mild and don’t limit attendance at school or work.

• They don’t interfere with your ability to sleep at night.

•  They don’t interfere with your daytime activities.

If your life is impaired by allergies, it may be time to consider allergy immunotherapy. Visit a board-certified allergy/immunology specialist for an evaluation and appropriate treatment.

 

Dr. Lawrence Larson, who wrote this article,

is a board-certified allergy/immunology specialist at MultiCare Mary Bridge Children’s Hospital and Health Center and Pediatrics Northwest.

The two major forms of diabetes are type 1, also known as insulin-dependent diabetes mellitus (IDDM) or juvenile-onset diabetes, and type 2, also called non-insulin-dependent diabetes mellitus (NIDDM) or maturity-onset diabetes. Both types share one feature: Elevated blood sugar (glucose) levels due to absolute or relative insufficiencies of insulin, a hormone produced by the pancreas. Insulin is a key regulator of the body’s metabolism.

In type 1 diabetes, the pancreas does not produce insulin. Onset is usually in childhood or adolescence. Type 1 diabetes is considered an autoimmune disorder. Individuals with type 1 diabetes need to take insulin. Dietary control is very important. Treatment focuses on balancing insulin intake with food intake and energy expenditure from physical exertion.

Type 2 is the most common form of diabetes, accounting for 90 to 95 percent of cases. In type 2, the body does not respond normally to insulin, a condition known as insulin resistance. Patients with type 2 diabetes are either diet-controlled or may have to take medications and/or insulin injections.

Patients whose blood glucose levels are higher than normal, but are not yet high enough to be classified as diabetes, are considered to have pre-diabetes. It is very important that people with pre-diabetes control their weight to stop or delay the progression to diabetes.

Obesity is common in individuals with type 2 diabetes, and this condition appears to be related to insulin resistance. The primary dietary goals for overweight patients with type 2 diabetes are weight loss and weight maintenance. With regular exercise and diet modification programs, many people with type 2 can minimize or even avoid medications. Weight loss medications or bariatric surgery may be appropriate for some people.

For people who have diabetes, the treatment goals for a diabetes diet include:

1. Achieving near-normal blood glucose levels to prevent eye, kidney and nerve complications from diabetes.

2. Aiming for healthy lipid (cholesterol and triglyceride) levels and controlling blood pressure to protect the heart.

3. Achieving reasonable weight, which is usually defined as what is achievable and sustainable and helps achieve normal blood glucose levels.

Even modest weight loss can improve insulin resistance, which is the main problem in patients with pre-diabetes or diabetes and are overweight or obese. Physical activity, even without weight loss, is very important.

Individuals with pre-diabetes or diabetes should consult their primary-care physician or a registered dietitian who is knowledgeable about diabetes nutrition. There is no such thing as a single diabetes diet.

Dr. Wajahat Kahn wrote this article. He specializes in family medicine at the Franciscan Medical Clinic in Gig Harbor. The clinic is part of Franciscan Health System, which includes St. Joseph Medical Center in Tacoma, St. Francis Hospital in Federal Way, St. Anthony Hospital in Gig Harbor, St. Clare Hospital in Lakewood and St. Elizabeth Hospital in Enumclaw.