Mold Levels 20 Times Higher

This year's levels of pollen and mold are straining resources and filling clinics.

by Victoria Stagg Elliott, AMNews

When a person calls the allergy clinic at the University of Mississippi Medical Center in Jackson, it may be months before the patient sees an allergist. If the patient gets an appointment, it will be in a special clinic where only acute symptoms will be treated. The reason? This year's allergy season has stretched the center's resources to the limit, creating a three-month backlog.

"We have just been overwhelmed this spring," said Richard D. deShazo, MD, chief of allergy at the center. "We're seeing people acutely, getting them sorted out for the summer and then bringing them back this winter for a more exhaustive work-up."

Pollen and mold counts in many U.S. areas are higher than ever. Allergists around the country have been besieged by people who have usually done well on immunotherapy or prescription antihistamines only to have them fail this year. New patients also are flooding offices.

"Everyone's breaking through," said Jordan Fink, MD, professor of medicine and pediatrics in the allergy-immunology division of the Medical College of Wisconsin in Milwaukee. "Everyone who is on antihistamines is having trouble. We have to put them on stronger antihistamines and nasal steroids. Even the patients who have been on immunotherapy for a long time and have been well are breaking through."

His practice is double-booking patients. In addition to prescription antihistamines and other medications for allergies, physicians in his practice are also prescribing numerous antibiotics because allergic rhinitis makes people more susceptible to sinus and ear infections. Asthma is becoming a bigger issue because this severe allergy season is aggravating those who are already asthmatic and making those who aren't more susceptible to the respiratory disorder.

"This year is probably the worst year in two decades," said James D. Wolfe, MD, an allergist with Allergy and Asthma Associates of Northern California in San Jose. "I have patients who say they can't go to work. They can't go outside, and they can't function. These are people who could always function before."

Weather gets the blame

Most credit this onslaught of pollen and mold to a long, dry winter followed by a quick, damp spring -- particularly in the Northeast, where some areas are reporting pollen levels four times higher than last year and mold levels 20 times higher.

"The trees remained dormant later and, as a result, all trees pollinated simultaneously, causing a single intense season," said Jay Portnoy, MD, chair of the National Allergy Bureau, a national network of pollen- and mold-counting stations. "The grass season also has been intense because of lots of rainfall and favorable weather conditions."

Some areas of the country, particularly California, have been experiencing a drought, meaning that the rains that provide some relief to those with allergies just haven't happened.

"Because we have no rain and because the pollen counts stay at a high level day after day after day, patients are very miserable," Dr. Wolfe said. "Because so many are coming into the office, we're working early in the morning, into the early evening and through the lunch hour -- five, six, seven days a week -- to attempt to provide time for patients."

Those researching climate change are hesitant to say that this one bad allergy season is a possible result of global warming, but some say there is evidence pointing in that direction. Several studies have shown that the high carbon dioxide levels associated with the higher-than-average temperatures that many areas are experiencing double the amount of pollen in the air. Exposure to ground-level ozone -- smog -- also can make people more sensitive to allergens. In addition, spring has been arriving on average a week earlier and winter a week later, making the allergy season longer. Seasons also are changing suddenly from winter conditions to summer.

"This is one of the costs associated with our current energy policy," said Paul R. Epstein, MD, MPH, associate director of the Harvard Medical School Center for Health and the Global Environment in Boston. "And they're mounting in terms of public health."

Many worry that the possibility of increasingly severe allergy seasons will strain the U.S. health care system with greater demands for allergy medications, more office visits to have them prescribed and a higher number of hospitalizations for allergy-related asthma attacks.

Publicly funded health organizations say this season has been particularly tough, and the insurance industry has reacted with a push to move the most commonly prescribed, nonsedating antihistamines to over-the-counter status.

Shifting the cost of medication

A Food and Drug Administration advisory panel endorsed the move last month. Statements from WellPoint Health Networks Inc., the company that first petitioned the FDA in 1998, say the move was intended to empower allergy patients, but it is widely believed to be an attempt to shift the cost of the drugs -- currently retailing at $60 to $70 a month -- from insurers to consumers. Experts estimate that the move would save WellPoint $45 million a year.

The shift is being resisted by the manufacturers and some medical groups. Physicians have mixed feelings about how the shift would affect people's access to the medications, although several believe that increased availability would reduce the use of the currently available OTC allergy drugs, which all cause drowsiness and increase the risk of auto crashes.

But there is concern about the possibility of misuse if these drugs become OTC medications. Studies have shown that the drugs already are prescribed to people who do not really have allergies but asthma, upper-respiratory infections or nonallergic rhinitis. The drugs are most effective if they are taken at the beginning of the season before a person becomes ill.

"As an allergist, I want to be available to advise my patients properly," said Dr. Portnoy. "OTC status will tend to encourage self-treatment without proper counseling."