Chris Flowers loves the outdoors, and loves animals. Yet for years she’d dread the change of seasons or regular trips to see her sisters and their dogs, because she’d get sick, often for a week or more, at a time. “I had horrible sinus infections several times a year, and I would just prepare to be sick every time I’d visit my sisters,” she recalls. Chris, who edits and produces this newsletter, knows a lot about allergies and their effects. Like the 60 million Americans who suffer from allergies, she was affected significantly.

During spring and fall, when seasonal allergies would strike, for example, “I can remember being sick for a week-and-a half at home,” she says. “It affected everything. I couldn’t even think. And that would happen 2-3 times a year! Who would want to be sick at home for a week that often?” Chris is not alone. The National Institutes of Health estimates that patients with allergic rhinitis, a common health problem, are sick up to two months a year and miss an average of nearly four days of work. The Asthma and Allergy Foundation of America pegs the annual cost of allergies at $14.5 billion, with more than $12 billion of that in direct medical/medicine costs, including 17 million outpatient physician visits, nearly half of these for seasonal allergies. Frustrated and incapacitated so regularly by her allergies, Chris went to see her UI Otolaryngology colleague, Stephanie Joe, M.D. Dr. Joe, Director of the Nasal & Sinus Center and Co-Director of the Skull Base program, is an expert on nasal and sinus problems, including allergies.

“We look for the path of allergies” in a patient’s history, Dr. Joe said, describing an almost forensic process of tracking the allergy sources and symptoms. In Chris’ case, that meant looking at the exposure to her sister’s dogs (and the airplane rides surrounding those visits), among other factors. “What is the patient around, and what is the patient exposed to?” she notes, in summarizing her approach. “We usually treat first with medication and avoidance measures,” she said. “When that doesn’t work, we do allergy and skin testing, looking for the common pollens and problems in the area” into account. In Chris’ case, like many other patients Dr. Joe sees, “the seasonal factors (like ragweed) exacerbated the year-round ones (like the dogs, dust and mold).” “When Chris told me about the dogs, we tested for that, because animal sensitivity is very common.” This is accomplished with skin testing, injecting the skin with allergens, potential sources of allergy symptoms to look for a reaction. Then she gave Chris immunotherapy, “allergy shots” to “prime the immune system to start blocking antibodies that will stop the reactions” that lead to the allergy symptoms (in Flowers’ case, dogs, cats, and some trees were among the most significant contributors to her problems).

“I started seeing results within the first year, but after a few years of regular treatments, I don’t get the allergic reactions anymore,” she said. “I don’t get the standard colds I used to get every fall and winter. I don’t get sick. In fact, I’ve just been waiting to get sick!” Chris’ case and results are typical, Dr. Joe noted. In Chris’ case, it took about five years of treatment in all to alleviate the symptoms and build her immunity so she didn’t need allergy shots anymore. “It was convenient,” she said. “The appointments were at UI Health, and I never waited more than 10 minutes.” Having seen thousands of patients over the years, Dr. Joe knows that “a lot of people just live with allergies” and try to manage them with over-the-counter medications, with mixed results. “Patients like Chris come to me when it affects their daily life, their quality of life, and overall function, including work.” Allergies are debilitating to many, she adds, even when self-care works. Over-the-counter remedies may relieve some symptoms, but in the case of Chris and millions of others, the side effects, like sleep problems, can be comparable to the allergies themselves. And other conditions commonly associated with allergy symptoms can only be noticed by a skilled professional.

“Forty percent of allergy sufferers have or can develop asthma” if untreated, Dr. Joe added, so seeing a doctor for allergy symptoms can help in ways well beyond acute care. “We tell patients about the risks of asthma and other symptoms like laryngitis and sinusitis, if they show signs of lower airway problems, we send them to our Internal Medicine colleagues quickly.” With ragweed season approaching, fall allergies are near for many patients. Even the first frost, the sign of cold weather and an end to outdoor allergies, can give way to exacerbations of indoor allergies like animals and dust that arise when cold weather keeps people more homebound, Dr. Joe adds. Seasonal climate changes – a warm late-winter or wet spring, for example – can exacerbate the start of outdoor allergy season, giving many allergy sufferers little relief. For the primary-care physicians who send patients her way, Dr. Joe advises keeping patients off antibiotics unless infection symptoms are present. “Patients can get a false sense of security with antibiotics, but antibiotics don’t necessarily relieve the symptoms,” she notes.

From Chris’s point of view, the change is astounding. Bring on the dogs, she says. “I’m ecstatic – now I can go to my sisters, visit with their families and the threedogs knowing that I can play with them and be fine. I might need a little nasal spray, but that’s it,” she says. Dr. Stephanie Joe specializes in difficult nasal and sinus problems. Her surgical specialty involves a minimally invasive approach that avoids skin cuts on the nose and face. Through endoscopic techniques, the use of telescopes and cameras through the nose, she can take care of nasal polyps and sinusitis. She has expertise in dealing with patients who have cerebrospinal fluid leaks and sinus tumors. She also deals with tough cases when a person has had previous sinus surgery.