Spring is the time of year for seasonal allergies. The annual renewal of plant life brings along with it the onslaught of pollen—the heavy coat of yellow on our vehicles is as predictable as the uptick of patients in our chair with itchy, watery eyes.
Articles about seasonal allergies and allergic conjunctivitis are also just as predictable this time of year, but how about we skip the standard talk about the different types of allergic conjunctivitis, the pathogenesis, and myriad treatments, and take a different approach? Let’s hear the thoughts and wisdom from an allergy specialist, a physician who has spent his entire career focusing on systemic allergies and their effects, before this allergy season starts.
Andrew M. Brown, MD, is an allergist and immunologist with 47 years of experience and practices in otolaryngology, allergy, and immunology, and has been in practice in Gadsden, AL for the last 40 years. He graciously took time from his extremely busy practice, the largest allergy practice in the area, to talk with me. I started with the question: What would you like to tell an in-the-trenches optometrist about allergy?
Remember that allergic disease changes. “The running joke in our profession is that allergists earn their reputation in the spring and lose it in the fall when another set of allergens erupt,” said Dr. Brown.
He advised optometrists to avoid thinking of allergy as a straightforward static condition, like a railroad track. “Think of it as a winding, curving road,” he said. “You may think you have the patient’s condition under control, then something in his environment changes.
Keeping the patient’s environment—big and small—in mind is key to discovering the offending allergen. “In our area we have a lot of lakes, so I see a lot of allergies to molds,” said Dr. Brown. “There is a lot of agriculture in our area, and I see a lot of pesticide allergies. A new cat moves next door, a new plant blooms, or something presents that the patient is sensitive to, and her symptoms return. You can also look at the prevailing weather patterns. Again, here in our area the winds blow from southwest to northeast. I’ll start seeing tree pollens from the gulf coast initially before I see allergies from the tree pollens in our region.”
He reminded us that allergy is the body’s way of building up a defense against an assault. “One great example you hear about all the time is about a patient who moves to the desert southwest,” he said. “Lo and behold, his allergies clear up. He loves it. Then the tumbleweed blooms, the patient develops a sensitivity, and his allergies return. The patient’s own natural sensitivity is the problem. An allergy is the body’s way of letting it know what’s coming.”
Allergies can sometimes come on quite quickly. Food allergies are good example. Advise patients with food allergies to carry an Epi-Pen.