Prevention And Treatment Of Hay Fever
( Originally Published 1936 )
August fifteenth is the date, but whoever is interested had better be getting ready for it now. The opening of the American hay fever season is usually prompt and according to schedule.
The number of people in the United States who are affected can only be determined by guess work or calculation, but it is probably not fewer than one in ten. In the Mississippi Valley, including the valleys of the Ohio and Missouri, the home of the ragweed, it must be higher than that. The ragweed in these regions is extremely abundant, and it gives more people hay fever in a more virulent form than any other plant. The Mississippi Valley, then, its favorite habitat, is the plague spot of the world for hay fever.
Something like 12 to 20 million people, therefore, are more or less incapacitated during the last two weeks of August and all of September from this disease, in the United States alone, every year. The amount of their incapacity ranges from mild discomfort to complete prostration. For most of them there is a considerable economic loss.
In view of such a situation, methods of control of the disease are extremely important. Methods of treatment are practically useless. Of methods of prevention there are three with any possibilities of success.
First, is the vaccine treatment, using a solution of the ragweed pollen for the vaccine. To be successful the treatment must be begun early. Most practitioners who have handled such cases believe the injections should be begun six to twelve weeks before the attack is expected. In some cases the treatment is completely successful. In others there is no benefit obtained whatever.
The second method is the use of pollen filters in the bedroom. If economically feasible also in the room inhabited in the daytime—office or house. These filters fit into any window. If the room is otherwise kept closed they act efficiently in practically every case. Their cost is no more than the charge ordinarily made for a course of vaccines. Employers who have many employes with hay fever would probably profit by installing such filters in their offices.
The third method of prevention is the destruction of ragweed plants early in the season. If city departments of health in neigh-boring cities would agree among themselves to cut all weeds in vacant lots, along fences and railroad tracks, from July 1 to August 15, it would undoubtedly mitigate this nuisance considerably.
How AIR FILTERS ARE USED TO HELP HAY FEVER VICTIMS
For several seasons I have been advocating the use of air filters in the bedrooms of patients during the hay fever season. While there was a great deal of favorable testimony in favor of this, it is only this year that a careful scientific study of the results are at hand.
This study was made at the University of Illinois College of Medicine. A ward was equipped with air filtering apparatus, and patients with various complaints were admitted. Some of these patients had plain hay fever. Some hay fever with asthma. Some had asthma made worse in the hay fever season (they were sensitive to pollen, but also to other things).
Pollen counts made in the room proved that the machines would reduce the amount of pollen from that prevailing in the outside air—three to four hundred (pollen grains per square centimeter)—to less than 10 on some days and always less than 20. So we may be sure that the causative factor of hay fever is largely removed.
Of the uncomplicated hay fever patients over 83 per cent were relieved in 3 hours or less. The relief in most instances was complete. Only 7 per cent reported no relief.
In the hay fever and asthma cases combined there was even more relief than in the simple hay fever cases, and it occurred in 1 hours.
In the third group—asthma made worse in the hay fever season—the improvement was less striking.
These results seem to me to indicate a practical method of treatment during the hay fever season. The amount of relief is far greater than that following the use of vaccines or any other method. And in the long run less expensive.
The machines employed are arranged in windows so that all the air entering the room is driven by a fan through a filter which removes the pollen grains. It would not be difficult for an ingenious jack-of-all trades around any household to construct one. The filter used is either lint or filter paper. These filters undoubtedly remove the pollen grains. The only source of error is that the machine may leak and allow pollen to sift into the room. The room must be closed and may become stuffy, but a fan can be employed to remedy this.
Hay fever patients almost invariably say that if their nights are comfortable they can stand the days. On those hot, dry days in the middle of the season when the pollen is very heavy, the attack acquired during the day cannot be expected to wear off for several hours even in air conditioned rooms.
START EARLY TO WARD OFF HAY FEVER BY VACCINATION
The first week in July is nearly the last call for those who wish to try to ward off hay fever this year by means of individual vaccination.
Most physicians who give this treatment like to start it about a month in advance. The fall type of hay fever seldom arrives later than August 15. Therefore, early July is the time to think seriously of it if you are going to do it.
It is true that in some cases it is possible to begin the treatment later, and even after the season has actually started. But these late starts are not as successful in many cases. Smaller doses of the extracts have to be used, and they involve more danger of disagreeable reactions.
The results of this preventive treatment have become better and better during the last few years. Ten years ago, about 25 per cent of patients were relieved of their hay fever attacks. Now, in the hands of the average physician who makes no specialty of the treatment, from 7 to 45 per cent of patients get relief, and in the hands of experts 65 to 75 per cent are relieved.
The difference between the expert's works and the average man's is, that the expert takes more trouble. People who are sensitive to hay fever have a general constitutional condition which is known as "allergy" or hypersensitiveness, and most of them are hypersensitive to more than one substance. Those who are hypersensitive to the plant pollens which cause hay fever, may show no sensitiveness to other substances until the hay fever season arrives. Then certain foods increase their discomfort—foods which during the rest of the year they can eat without anticipating any disagreeable consequences.
For instance,- I know a patient who cannot eat cantaloupe during the hay fever season without having a rash, and without increasing the turgescence of the nose and the itching of the eyes. I know other patients who cannot eat tomatoes during the season on account of the same symptoms.
The expert tests patients for these extra pollen sensitizations and vaccinates against them also. Hence his better results.
The expert also, in stubborn cases, advises using perennial treatment. That is to say, he treats the patient all the year around. After the hay fever season is over the treatment is given once every two weeks until July, and then twice weekly. By this means the results are improved about 50 per cent.
The treatments consist in the hypodermic injections of extracts of the pollens and other substances to which the patient is sensitive. Beginning with very small doses, they are gradually increased at intervals of several days, until by the time the hay fever season sets, in they are taking sufficiently large doses to produce immunity. Enough immunity so that the presence of the pollen in the air will not bother them when it appears.
How TO PREVENT HAY FEVER OR GAIN RELIEF THEREFROM
If you know from past experience that you are going to have hay fever, you have one of five choices in the way of management.
One, of course, is to lay in a good supply of handkerchiefs and just bear it.
Second is to attempt to prevent the attack by the use of vaccines of the pollens which are responsible. In order to do this you should engage the services of a physician early in the season, about June. He determines what pollen you are susceptible to. He does this by making solutions of the various pollens and injecting or scratching them into the skin. The skin will react with a red, raised wheal to the one which causes the hay fever. Vaccines cf this pollen are then made and given hypodermically for several weeks before the advent of the hay fever season. This is the simplest form of the vaccine treatment; in certain complicated cases more extended—for instance, all year round—treatment must be undertaken.
Third is to take a vacation through the entire hay fever season, and remove yourself to a climate where the scourge rageth not. This course is, naturally, open to very few people.
Fourth is the use of air filters or air-conditioned rooms. A filter placed in a window can be constructed so that it will remove all the pollen grains which come into the room. This, used in a bedroom, will give relief, according to experiments, in about 98 per cent of cases. The same thing put in an office window will assure both day and night relief, with only slight possibilities of discomfort while outdoors.
The cost of these filters ranges from $34 up, so that they are really cheaper than a vacation or many other forms of treatment.
Fifth, if none of these things can be arranged, a great deal of relief will come from using certain substances in the eye and in the nose to keep down the irritation. Ordinary saturated boracic acid solution makes a good eye wash, and can be used freely also as a douche for the nose. Many people get relief from a preparation called "estivin," which is dropped in the eyes. Other remedies used in the same way are ephedrine, adrenalin and neosynephrin. When dropped in the eye, these solutions get to the nose through the lacrymal duct, and usually give relief to both places, although there is no reason why they should not be used both in the eye and nose.