LUCY SCHULTZE

Ongoing research at the University of Mississippi Medical Center (UMC) may establish a more important reason for controlling allergies than just keeping watery eyes and runny noses at bay.

Researchers are working now to establish a link between allergy and other more serious inflammatory problems, particularly cardiovascular disease. It's possible that allergy can also be linked to a patient's risk for diabetes and even some forms of cancer, said Dr. Gailen Marshall, director of clinical immunology and allergy at UMC.

"Of course, no one is going to die from hay fever," he said. "But if you can treat someone for allergies as a child and diminish their risk of cardiovascular disease as an adult, that's a big deal."

Marshall, who joined UMC from the University of Texas Medical School at Houston two-and-a-half years ago, has focused on Mississippi's high-risk populations while working with colleagues to build the medical center's division of clinical immunology.

A host of factors make Mississippi a hotbed for allergy and asthma, from socioeconomics to obesity to the ubiquitous presence of one of the worst allergy culprits: cockroaches.

"In the South, from a mansion to a ghetto, it's not a matter of whether anyone is going to have (cockroaches)." Marshall said. "It's how many."
On the flip side, the relatively clean environment that's become standard in modern America has likely contributed to rising incidence of allergy across the country.

Back in 1970, only about one among every 10 people suffered from some sort of allergic disease, Marshall said. By 1995, that figure was closer to one in three, and by 2015, it could include half the population.
Since genes simply don't evolve fast enough to account for such a rapid rise in the incidence of allergy, environmental factors must play a role as well, Marshall said.

"Some of this is related to the idea that we in Western culture are a very squeaky-clean society," he said. "We have a well-honed immune system that doesn't have enough to do, and so it gets into trouble."

Recent research at UMC has also focused on exploring the link between psychological stress and risk for allergy and asthma. Studies are finding a higher incidence among a group of Hurricane Katrina survivors, who've faced both the physiological effects of persistent stress and the environmental effects caused by the storm.

"They're living now in trailers, and many of them lived in tents for a period of time," Marshall said. "The fall of 2005 was a big allergy season, and these people were literally outside with no AC for months."

Ideally, of course, controlling those environmental factors and avoiding allergy triggers is the best defense. Yet recent studies also underscore the effectiveness of allergy shots in reducing patients' symptoms and need for allergy medication.

"If someone uses a nose spray or a simple inhaler and it works for them, then allergy shots are not for them," Marshall said. "But if they have a bad illness and you're trying to control that illness, then allergy shots work very well, as done by an allergist. It's not just something that anyone can do; it takes particular expertise."

Because the available treatments for allergy are so effective, it's possible to reign in a patient's trouble with them while also heading off more troubles down the road.

"It's recently been shown that children who have a very strong family history with asthma but who only yet have hay fever, are at as high as 60 percent risk to develop asthma themselves," Marshall said. "But with allergy shots, you can diminish that risk substantially."

As both allergy and asthma grow increasingly more common, the urgency to halt the "allergic march" from mild to serious conditions is underscored by the potential link between those conditions and cardiovascular disease, diabetes and some forms of cancer.

Even if that hypothesis doesn't prove true, Marshall said, the early and aggressive treatment of allergy should be a priority merely for the sake of a person's quality of life.

But if, in fact, allergy is an early signal that a patient's body tends to overreact to something that should be harmless, then it can certainly no longer be viewed as trivial.

"In our view, early intervention for allergic disease is likely in the long run to prove helpful in either lessening or maybe even preventing some of these other diseases that plague Mississippians," Marshall said.

"If, by keeping inflammation in control, we can have an impact on cardiovascular disease, then 20 years from now we'll be very much ahead of the curve and can hopefully make a significant impact on this state."

April 2007