What’s making us sneeze and wheeze?
Chico’s high pollen and mold counts are part of the reason so many of us struggle with allergies and asthma—but only part of it
A lifelong struggle with allergies started for Charles when he was a child living in the high desert of Southern California during the 1970s.
“Weeds were everywhere, and I could barely breathe—hay fever, asthma, the works,” he says. “So I was totally drugged up on all these antihistamine medications, and none of the prescriptions seemed to help. I was like a total zombie.”
After receiving cortisone shots, a temporary remedy that doctors said could increase the risk of osteoporosis and glaucoma if used too long, Charles took a comprehensive allergy test. It consisted of injecting numerous kinds of allergens into his skin and seeing how he reacted. Then doctors mixed a serum extract of selected allergens to be administered slowly over a period of several years on the premise that his body would develop immunity over time. Doctors know the process as immunotherapy; patients often refer to it as “those $&#! allergy shots.”
And so young Charles began going to the doctor twice a week for the first period of time, then once a week, then every other week and so on—until he had received hundreds of shots over four years.
“Within a year and a half, my symptoms dropped off—it totally worked,” Charles said. “Of course you have to keep taking the shots for years to develop what they call a ‘memory’ for your immune system.”
But, as fate would have it, not long after Charles conquered his high-desert allergies, he decided to move—to Chico. If he thought the desert was a hotbed of allergens, he hadn’t seen anything yet. When it comes to allergens and other respiratory irritants, the fecund agricultural community of Chico and its surrounding Sacramento Valley are the Mother Lode, a virtual stew of natural and unnatural pollutants, from pollens and molds to automobile emissions. All of us who live here regularly breathe in air that is filled with unhealthful particles. Allergies sufferers simply react to them more readily than others do.
For the first few years Charles was fine. What he didn’t know was that it was just a matter of time before his immune system would succumb to Chico’s many diverse pollinators. When it did succumb, poor Charles didn’t know what hit him.
“Chico is classified as a transport corridor,” says Gail Williams, a planner with the Air Quality Management District who helps monitor local pollutants, mostly from stationary pollution sources such as industry, open burnings and manufacturing.
Williams explains that ocean air comes though the Carquinez Strait, where the Delta merges with San Francisco Bay, and goes either north or south, carrying with it much of the Bay Area’s smog. When the air travels north, up the Sacramento Valley, it merges with polluted air from Sacramento, and it doesn’t stop moving until it gets to Redding and hits the mountains. During the summer, Chico has a significant number of weather inversions that trap those pollutants in the atmosphere.
“So on really hot days in the summer when we have a south wind, we’ve basically got a big cooking stew here,” she says. “And until weather comes through, we’re stuck with it.”
Williams says this means that Chico has roughly five to 10 seriously harmful days of the year, mostly in the summer, when we exceed the state standard for safe air quality. “What we’re looking at is summertime ozone problems [hydrocarbons and nitrogen oxide emissions forming in the presence of sunlight to create ground level ozone, or smog] and wintertime PM-10 [particulate matter] problems.”
While these conditions are harmful for everyone, they can really spell real trouble for local allergy and asthma sufferers, who may already be experiencing respiratory complications.
They may be allergic, for example, to molds, which are present locally year-round, tending to reach their highest peaks in the spring and fall, with the lowest levels coming during the winter months. But it hardly ever freezes in Chico, so the molds and other leftover allergens aren’t cleaned out well.
Grass pollen is also present much of the year, from March to October, while tree pollens are from February to June and weed pollens from June to October. If you’re someone who is sensitive to these things, Chico is a tough town to live in.
In fact, local doctors speculate that as many as one in four Chicoans suffers some form of reaction to airborne allergens. Nationally, as many as 40 to 50 million people have allergies, and more than 4 million days a year are lost at school and work in the United States just because of allergy problems.
This is good news for drug companies and others who treat allergies, but not for anyone else. And it’s a growing problem, one that scientists point out is on the increase in all modern industrial societies. With it come a number of different viewpoints on how to handle allergies and the health issues that come with bad air.
Dr. Gary Incaudo, an allergy specialist with a busy Chico practice, knows the local allergy scene well.
I meet with him at his office, which is a typical medical establishment with bright white interiors and that pervasive, alcohol-tinged smell of sterilization. The atmosphere is bustling, with patients coming and going and a good number of nurses taking care of business. Incaudo shares the space with Dr. L. Gretchen Wooding; their names appear above a tagline: “specialists in nose and sinus diseases.”
It’s no wonder the place is hopping like a juke joint on Saturday night. This spring, as Incaudo notes, has been an especially tough allergy season.
“In this area we have high pollen and mold counts because we are agricultural and we’re a fertile valley basin with a temperate climate,” he explains. “The worst conditions are when we have a wet winter and a dry spring with wind—you get plenty of tree pollens blowing around.”
Chico also has a great diversity of non-indigenous plants all over the city, and many of these heavy pollinators combine with pollution that migrates up the valley from Sacramento for devastating effects, he says. The primary tree pollens are from oaks, as well as the highly allergenic walnut trees (the chief culprit that makes the time around Easter particularly rough) and olive trees, while almonds are benign.
Some people have planted mulberry trees for shade—these too are very allergenic, Incaudo says, as are cottonwoods, which are indigenous along the river. Chico has lot of grasses and weeds, and because farmers irrigate their orchards, they inadvertently foster grasses and weeds along the edges, maximizing pollen issues.
“But our mobile sources are hugely to blame as well,” Incaudo continues. “We can’t blame everything on agriculture. Car and truck emissions are a big part.”
People are not born with an allergy to a specific substance. Instead, each of us has the genetic predisposition (or capacity) to develop an allergy, and with repeated exposure it can become acquired.
Doctors say it’s largely a genetic thing: If both your parents have allergies, then you have about a 60-70 percent chance of being allergic to something. By the same token, the allergic probability for your offspring goes up to a whopping 90 percent.
Some alternative theories emanating from the health food industry hold that people can override genetics to a certain extent by being careful about their diets and lifestyles. But all parties agree that enhancing factors for allergies include such things as automobile and diesel fumes, indoor heating and indoor pollution.
Many specific allergies can be prevented in childhood if identified early enough and exposure is limited. The most common allergic diseases are hay fever, forms of asthma, eczema, hives and some forms of chronic “stuffy nose.” Any substances causing allergic reaction are known as allergens and are generally taken into the body via the nose and lungs (pollens, molds, house dust, animal dander, etc.), by mouth (foods, drinks, medications), or through the skin (woolen clothing, animals, rugs, plants, chemicals, injections). Closed houses that accumulate dust mites, mold or cigarette smoke can cause problems at home. People who have allergies year-round and try to fight them off each year with whatever new drugs have become available seem to accumulate susceptibility that can lead to more-serious diseases.
“The thing that really gripes me are those people who take Claritin for the last five years every day then say they are ‘just now starting to have asthma,'” Incaudo says. “It drives me crazy, because if I had seen that patient three to four years ago, I probably could have stopped it [through immunizations or avoidance]. Drugs don’t change the natural history, they just make you feel better.”
Donald Payne, a nutrition specialist at S&S Produce, is all for natural solutions. Payne has dedicated his life to alternative ways of dealing with allergies and the whole concept of health in general. A friendly guy who looks to be in his mid-40s, with a youthful complexion and white hair that gives him a sage-like look, Payne has been studying alternative medicine for 32 years, ever since he discovered he had a serious kidney disease.
“I walked into a health food store, and somebody handed me a book and said, ‘Change your diet and change your life. You don’t have to die of kidney disease.’ I thought, ‘Yeah sure, but who told you I had kidney disease?’ It turned out they were practicing Oriental medicine, and they looked at me and could see I was in bad shape. And the book they gave me helped save my life. … I treated the disease strictly with diet and herbs, and it went away fairly quickly and I’ve been fine ever since.”
Payne went on to study and practice Oriental medicine with an underground Chinese doctor who worked out of the back room of his laundry shop off Lincoln Avenue in Chicago. With four doctors and four laypeople, Payne studied acupuncture and alternative healing methods that led him into a long career in health foods.
Most people who come to S&S for medications do so because they want natural remedies that don’t have side effects. One of the big sellers this season for allergy sufferers is a $13.99 bottle of nettles—and Payne also points out a few small liquid dropper bottles that are composed strictly by region in accordance with local allergens.
“Of course, we don’t tell people to stop taking prescription drugs; that’s illegal. I’m not a doctor,” Payne is quick to say. “Maybe [drugs] are the only thing that works for them. However, there is quite a bit of evidence to point out that the homeopathic and herbal remedies are effective for the vast majority of people—the key is with less side effects.”
Payne says he thinks we need to incorporate our medicines more, using both alternative and traditional treatments in tandem, as is done in Europe. He believes that the most comprehensive approach would ideally work with all modalities of medicine and healing simultaneously for the benefit of the patient, or the person, as he says.
Allergies are a sign of imbalance, he says. They’re not natural: “Having an allergy to air-blown pollens of the trees is like having an allergy to your mother, because without those pollens there’s no life, no plant life, no animal life. We come from those simple organisms to create a complex system of life. … Actually, it’s our own toxic blood condition that makes it so we cannot handle the environment. When did we become so weak that we get sick just breathing the air?”
It’s obvious that Payne has passion for his approach and firmly believes we can still learn from the medicinal techniques of the past, particularly in Asian countries.
He also discounts the influence of heredity. “You are not your parents—genetics isn’t everything,” he argues. “No matter what they had, you are not subject unless you buy into it and create the same kind of life they did—the same biology, psychology and emotional situations.”
He could go on and on—and, judging by the sales of herbal pills and home remedies at S&S, he often does.
Incaudo agrees that taking a natural approach to allegies is best. The path he recommends, however, is immunotherapy, building up the body’s own resistance to allergens. He says that although alternative medicines may be useful for some people, he doesn’t use them in his practice because they are generally not researched or quantified by the conventional medical establishment—unlike in Europe, where alternative, natural therapies are more scientifically accepted.
“Usually the ingredients are not quantified, and people have no idea what they are taking. I have nothing against it, but there’s not much science to it. What I know [about the prescribed drugs], I know I know.”
But Incaudo admits that all our drugs originally come from herbal remedies and many of them undoubtedly have solid biological activities (anti-inflammatories, for example). Some of the homeopathic remedies seem completely irrelevant to him, as he points to the example he often hears of patients who ask if they can take bee pollen for allergies.
“People who want to take honey or bee pollen, that just doesn’t make sense, because that pollen is non-allergenic. The stuff that causes most allergies is wind blown—bees don’t go to walnut trees—so you have to believe in some other mystical quality to think bee pollen would work.”
Remember Charles who moved to Chico back in the early ‘90s? Once here he had to undergo yet another lengthy regimen of shots—just like in his childhood.
“When I came to Chico I was OK for a year or two, then I started sneezing again really badly while walking on my way to work.”
A walker and biker who doesn’t use a car, Charles found himself in bad shape and was soon in Dr. Incaudo’s office scheduling a shot treatment.
Realizing the same therapy worked before, Charles kept a good attitude and forged onward after it was revealed that he was allergic to just about all the severe Chico tree pollens, from oak to the walnut and olive trees in the area—the many wind-blown pollens that one can see littering the air on an average spring day.
"[The shots] are not that painful, and your reaction really depends on what cocktail they’re using,” he explains.
Although some people can have a bad reaction to the therapy, especially when the level of the offending allergen is high outside and the body is already fighting it at the time of injection, the worst reaction Charles ever noticed was something like “a fair-sized lump, maybe some itchy palms or throat once.”
Doctors who administer the therapy often insist that patients hang around after the shots for 30 minutes or so to monitor any kind of reaction. They also call for avoidance of any strenuous activity or aerobic exercise for at least the first two hours after injections and preferably the entire day.
“That was the most difficult thing for me about the therapy, coordinating a ride afterwards, because I always rode my bike.”
That was seven years ago. Charles, now 32, completed his second go-around on the immunotherapy carousel last December. So far so good, as he points out, but this current spring season has been one of the worst he can remember, and he has noticed tiny flare-ups of his allergies—though not nearly as bad as they could have been.
“I’ve done the shots twice now, and I’m pretty much afraid to ever move again!” he laughs.
Although patients have to take the shots for five years or more, at a cost of around $500-$700 a year, and it’s not a hundred-percent-successful procedure, most people gain control over their allergies in a safe manner.
Many of the patients who see an allergy specialist—people with recurring allergies or with complications like sinus disease or asthma (the incidence of which, Incaudo points out, has quadrupled “amazingly” in the last 20 years)—don’t respond well to the usual medications.
“The first thing we do is identify the allergy and try to avoid it,” Incaudo says. “Things we see that get people the sickest are the grasses [which pollinate all year long], dust mites, mold and animal dander—those cause symptoms all year.”
The patients are highly active people with busy lives—and sometimes the immunotherapy can be a hindrance. Take Amber Johnsen, outgoing Associated Students president at Chico State University, who discovered she had allergy problems when she moved to Chico in high school.
“I started getting physically sick—really bad headaches, hay fever symptoms. I eventually caught mono because my immune system was so low,” she says.
Johnsen is currently three years into her immunotherapy with Dr. Incaudo, about halfway done, and it has helped rid her of most symptoms—even though she admits a couple of times when she neglected the treatment for a month or two.
“It can impede your progress, because it means you have to start back at a lower dose. They [doctors] gave me crap,” she jokes. “The main inconvenience for me was not having a car and the location of the office—but they do have good hours during the week, sometimes from 7 a.m. to 7 p.m.”
All the shots in the world still won’t change the fact that Chico has a pollution problem, characterized increasingly by more cars and more population growth. Although the town has its fair share of alternative transportation and many people bike, a newcomer may notice the tremendous number of stoplights and the general stop-and-go pace of traffic. Incaudo is known in city planning circles for his feelings about “traffic control being a total mess in this town.”
Incaudo says he and a group of local physicians, in conjunction with the Butte County Air Quality Management District and the American Lung Association, filed a report with the city about four years ago charging it with creating traffic chaos because Chico has about 75 percent more stop signs than required by engineering standards.
“It’s a poor education of the public—the public perception that these stop signs are safety devices. They’re not. They’re for determining right of way and for reducing congestion. There is a whole science to it—and lots of other ways of mitigating traffic—but Chico has done it piecemeal just in order to placate the public.
“Our city councils for the last 15-20 years have been overriding the engineers. I understand that people want to limit traffic and slow down cars in their neighborhoods, but those people need to understand you’d have less cars out there if you get them off the road efficiently. Roundabouts or other measures that could create a smooth, uniform flow of traffic would be much better.”
E. C. Ross, Public Works director for the city of Chico, says that air quality in Chico had not reached the severity that would make it a recurring factor in future traffic planning.
“Dr. Incaudo is right that stop-and-go traffic does create more pollution,” Ross says. “But we do not evaluate the air quality. That’s the job of Air Quality Management. … We might be asked to mitigate the severity of a certain development by paving a dirt road, for example. But pollution is not a factor in the process.”
“The traffic issue would improve quality of life for the whole town,” Incaudo firmly states. “It would reduce air pollution, but unfortunately we still would get a lot of pollution from Sacramento. [Chico] is not that healthy of an area—it’s better than L.A. but not as good, obviously, as coastal regions.”
Many doctors believe that the more infections you get at an early age, the better your immune system seems to become as you grow older. Some also say that we are over-saturating our youths with immunizations that weaken their natural immune system.
“There’s something unique to Westernized society that we don’t see in a place like Africa,” Incaudo says. “We give antibiotics and immunizations so quickly at a young age that the immune system often doesn’t develop correctly—all of our efforts to deal with allergies have to do with a sort of see-saw balance.”
However, these beliefs are not totally recognized or accepted. Just recently, in late April, a new survey by Danish scientists found that early childhood infections such as measles, chicken pox and mumps might not protect youngsters from developing allergies. They found that, out of 889 Danish women, those who had measles in the first year of life had a higher risk of allergy than those who did not have the measles before the age of 7—puzzling new data for many scientists.
Today, the usual prescribed allergy drugs include Allegra, Claritin, Clarinex and Zyrtec, all of which are advertised as having the advantage of minimal side effects and long-acting results, though they are more expensive than your typical prescription. Even with health insurance, you’re looking at $20 bucks a month for a Zyrtec regimen—about $70 if you pay out-of-pocket.
There are numerous nasal steroid sprays, and Claritin is about to come on the market over the counter, which should produce a big boom in sales—though many doctors have already begun prescribing its successor, Clarinex. Other experimental treatments are currently showing promise on animals, including freezing the molecular process that triggers allergic reactions.
Right now, for those who have severe allergy problems, immunotherapy may be the only way to go (unless you’re willing to move from the area).
But some patients have a hard time getting in to see an allergy specialist even if they want to. That’s because HMOs generally outline treatment plans, or drug regimens, that a primary-care physician must first try before issuing a referral.
Lisa Mee-Stephenson, spokeswoman for Blue Cross Blue Shield, confirmed that referrals to specialists depend on the particular health plan. Members of HMOs are required to get a referral from a primary-care physician, while those using preferred-provider plans can self-refer (at greater cost).
In one local official’s words, “HMOs are dictating what doctors can do. … It’s not like the old days.”
In the meantime, air quality officials are trying to keep smog conditions from worsening, but it’s a tough fight as the area grows in population.
“When we look at emissions inventories and where the pollution is coming from, 70 percent comes from cars and trucks, so that’s what you have to target,” says Gail Williams. “We’ve already cut back and put all the available control on stationary sources—you don’t see stacks of black smoke in California. We just have more cars than many parts of the country.”
Williams points out that things have not gotten better with the rabid popularity of SUVs across California.
“SUVs are trucks, so they have truck emissions and don’t get the mileage that a passenger car gets. … They will be required to lower their emissions too—that’s already in the works.”
Interesting data in this regard has emerged since the reunification of East and West Germany, two countries that had essentially the same genetic pool. East Germans had high rates of bronchitis, poor health care and industrial pollution, yet after unification the incidence rate of allergies doubled over five years in the early ‘90s, an increase scientists attribute to an increasing number of cars and trucks, better health care and more immunizations brought from West Germany.
This doesn’t bode well for Chico. California’s Great Central Valley already has some of the worst air in the country (see sidebar), and it’s going to get worse. The valley, with its still-affordable housing, is the fastest-growing region in the state, and its population is expected to double, from its current 3 million to 6 million, by 2020.
In the end, we in Chico may have to face facts: We live in an area whose air quality is poor and getting worse for a number of reasons, some of which we can affect and others we cannot. As long as population increases and we keep buying bigger and more wasteful vehicles and driving everywhere, Dr. Incaudo and other allergy and air quality specialists should remain quite busy.
As he puts it, "Modern man has produced a quality of life with a price tag—increased incidence of allergy and asthma."