Many Spink County residents have been extra stuffy, sniffly, and itchy lately. This may soon get worse. Dr. Thomas Luzier predicted a “spectacular” ragweed season. Luzier, an allergist based in Aberdeen, used to take his own pollen counts each year. “August 1^st, you can almost set your watch by it. Ragweed would start, and it would continue until hard frost.”

Local Bob Brugger said that he hasn’t noticed a worsening of his allergies. When they do act up, he “can’t breathe so good,” and he gets stuffy and itchy. His allergies are significant enough that he takes over-the-counter medication, as well as prescription medication. On top of that, he gets a shot from his primary care doctor every 3 months. This is “so I don’t suffer.” 

If ragweed pollen hasn’t exploded yet, what’s been going on? Luzier said “There’s a lot going on. Just before the Fourth of July, grass pollen is kind of as high as it gets, then it kind of fritters off.” There’s more to worry about, however. He continued “But all the other things that people are allergic to, like tree pollen and molds, kind of gin up your immune system. And then if you throw in a little Canadian smoke and that kind of thing, it makes it even more intense. Right now we really are at a little dip in what’s happening with pollen, but we are not with mold because we had all that rain. They’re trying to get the hay down and can’t get it down. So that’s primarily what’s in the air when the wind’s blowing.”

Ragweed pollen, no changes made

Luzier said that soon pollen from kochia, Russian thistle, tumbleweed, ragweed, and sagebrush will be in the air. This followed the data from his years of pollen counts. He said “It was always tree pollen early in the spring, and then grass pollen would occur from about May 15^th to July 4^th. Then there was a little dip, but it was primarily molds and that sort of thing.” At about the first of August, ragweed would take over.

Ragweed pollen tended to peak around the time of the county fair, when people were out and about. Youth participating in FFA events could be especially prone. “The kids are out and they’re grooming their animals, which is of course picking the pollen up. If they’re not allergic to the animal itself, they’re allergic to the pollen in that’s in the air.” He used to have a busy booth at the Brown County Fair.

Allergy woes extended past the animal barns. “And then we’re haying right now. For those people that are in haying, it’s like giant lawn mowing that gets a lot of mold up into the air.” Luzier said.

Mold is “everywhere, all the time, and gets highest at harvest.” he said. The mold lives with the grass, so when grass gets mowed, mold gets into the air. Mold, dust, and pollen bring about hay fever. Symptoms of hay fever affect the upper respiratory system. They include nasal congestion or a runny nose; post-nasal drip; and sinus pressure. Other symptoms can include itchy, watery, red eyes; headaches; and discoloration and puffiness around the eyes. Hay fever is a type of allergic reaction. Other general allergy symptoms include itchiness, as in skin, throat, or ears; shortness of breath; as well as rash or hives.

Luzier gave an overview on the allergic response in the body. “What happens is, that pollen or mold or cat or dog or dust mite comes into your nose. You have cells in your nose that are called antigen-presenting cells. They take anything that’s foreign, and they go ‘Oh, that’s foreign. That’s not you. We need to dispose of that.’”

He explained that either a white blood cell will dissolve the antigen, or an antigen-presenting cell will send a message to the B-cells to make antibodies. The next time that antigen is encountered, the antibodies react. Luzier said that one must be sensitized. “That’s why you don’t ever get a bad reaction on the first bee sting.” The body has to encounter it more than once. An antibody that is involved in allergic reactions is called IgG. The allergic reaction is the body’s mechanism to get rid of the invaders.

According to Luzier, about 20% of people suffer from allergies. Also, it affects grown-ups more than kids. He said “It’s more of an adult process, because the number of exposures you get gives you a bigger opportunity to be sensitized.” Pregnancy can change a person’s allergies. “When women have babies, the placenta tells the system to downregulate. When the baby is born, the woman’s immune system boots back up again. Sometimes it boots up allergic when it wasn’t before, and sometimes they’re allergic and when it boots back up again, they’re not allergic.” he said.

There’s also a strong familial link for having allergies. “If your mom is allergic, you have about a 70% chance of being allergic also. If your dad’s allergic, you have about a 30% chance.” Luzier said. “And if your mom and dad are allergic, you should have chosen your parents more carefully.” he added with a laugh.

Allergy severity can run the gamut from barely noticeable to miserable. It’s possible to have mild allergy and feel no symptoms. Luzier cited a study done at the University of Kansas. Students were skin-tested for allergies. Many had no symptoms, but tested positive on the skin tests. When the students were re-tested a couple of years later, they had symptoms of those allergies. “The skin test kind of anticipated the allergy. You have people out there who don’t have any symptoms this year, but might have symptoms next year.” he said.

Eczema, a common skin condition, isn’t quite an allergic reaction. “Atopic dermatitis is a different kind of inflammatory response.” Luzier said. He explained that people with eczema/atopic dermatitis may still show high levels of the IgG antibody. But this is because “With eczema, your skin’s just open to the environment.” A person can sensitize and develop an allergy via skin contact. “We call it an itch that rashes.” Eczema is generally treated topically, with prednisone, triamcinolone, or hydrocortisone.

How are seasonal allergies treated? “The most common way to do it is to treat with antihistamines.” Luzier said. Brand names include Allegra, Claritin, and Zyrtec. “Zyrtec is the strongest one. It makes people sleepy or crabby. Claritin is the weaker one. That’s why it doesn’t make ‘em quite as sleepy. And Allegra doesn’t go in your brain, so it does a nice job of not making you sleepy.” he said. Other medications are more localized. “If nasal congestion is the major thing, then you use Nasacort or Flonase because that’s like using prednisone, only just in your nose. It doesn’t have the side effects, because the dose is so much lower when you spray it directly in your nose.” he said. “If your eyes are still itchy, then you use an antihistamine for your eyes called Pataday. Then if all that doesn’t work, the you have one that’s called Singulair. Singulair works by a different mechanism.”

That may still not offer relief. “If all of that doesn’t work, then you do allergy shots. You are given a little bit of what you’re allergic to in increasing doses. It takes about 3 years of weekly shots to reverse your allergy, typically.” Luzier said. After that, shots are done twice a month, then monthly. “If you still do well, you’re finished. Usually, 80% of the time, your allergy does not come back.”  he added.

Luzier mentioned one more medication. “Then we have a weird one. We have a monoclonal antibody called Xolair, which will completely shut down your allergy. It’s so effective that if you have like a food allergy and you can’t eat peanuts because you’ll blow up like a pufferfish, this Xolair, when you take it weekly, will keep you from doing that.” This medication isn’t known to have a lot of side effects. Luzier said “When people ask me ‘What’s the side effect of the Xolair?’ I say ‘poverty.’” For the most part, allergy medications are affordable. Luzier said that allergy shots are often covered by insurance. “It’s just the hassle of having to get into a clinic to get a shot every week.”

Another condition Luzier treats is asthma. “About 70% of people with asthma, especially young people, have an allergic component that makes their airway reactive.” he said. But other things, such as cold air, viral infections and running could also do this. “There’s a whole lot of triggers for asthma. Asthma is reversible inflammation in your airway.” he said. This can be temporary. “That’s why we see people sucking on their albuterol inhalers, because it’s reversible, but the albuterol wears off in 4 hours. So you’re back to where you were.” Luzier had a two-pronged approach for treatment. “You use an inhaled steroid, just like we do in the nose, and that gives you a more permanent and better treatment for what’s in your airway. It’s just hard to get the steroid all the way down into your small airways. So we usually use both a long-acting albuterol, plus a steroid. That does a very good job of controlling peoples’ asthma.”

Luzier stated that any respiratory illness, including covid infections, could make an airway reactive. “You could get RSV (respiratory syncytial virus) and then have airway reactivity for a very long time, for years after you’ve had that infection.” Symptoms of airway reactivity could include wheezing during a cold, when exposed to cold air, or during exercise. “It happens a lot in children.” Luzier said. Asthma overall “is more common in boys than girls at a ratio of 3:1.” he said. The boys tend to out-grow it. “Until the boys go through puberty. Testosterone is excellent for asthma. Estrogen isn’t so good.”

The only way to avoid allergens would be “a bubble.” Luzier said “You could keep your windows closed, unless you want to just stay inside. But summer in South Dakota, who wants to stay inside?” Wearing separate clothes outside and inside would have limited use. “You’d have to cover your airway.” Luzier said. “I tell people who are mowing lawns to mask, but if you ever put a mask on when it’s 90 degrees out, that’s not fun.” he added.

With the summer warmth comes the pollen in the air. Luzier stated that each type of pollen looks a little different. Ragweed pollen looks like a mace, a medieval weapon.

Luzier had unpleasant predictions. “Ragweed this year is going to be spectacular. Because the crops got flooded out, the farmers aren’t going to be able to keep up with the weeds.”

He opted to specialize in Allergy/Immunology because “I could see that immunology was going to be a frontier, and I had allergies.” He had a ragweed allergy. It was cured by doing allergy shots.

For those who have not been cured, it will be an itchy, sneezy season. Luzier’s clinic has been “ridiculously” busy. Speaking of ragweed season, he said “It’s gonna be bad – bad for you, and good for me.”