Come spring, Washington is both a nature lover's showcase and a pollen-choked crucible that sends allergy suffers scrambling for cover.
However, seeking relief indoors might be wishful thinking.
The Environmental Protection Agency has declared the air two to five times as polluted indoors than out, and placed it among the top five environmental risks to public health. The problem: Homes populated by mites, molds, bacteria, dander and volatile organic compounds, creating a hostile environment for the sensitive.
According to the EPA, since 1980, the biggest increase in asthma cases has been in children under 5. In 2000 alone, nearly 2 million emergency room visits and half a million hospitalizations were linked to asthma, at a cost of nearly $2 billion and 14 million missed school days.
Not that it's so great outside. In February, the Asthma and Allergy Foundation of America proclaimed Washington the fifth "most challenging place to live" for people with asthma, jumping 45 spots since last year. In the pollen-laden months of April and May, the land of cherry blossoms and manicured lawns seems practically designed to jump-start an allergist's practice.
When symptoms hit, instead of blindly buying allergy-relief products, the American Lung Association recommends several steps: Consult a medical specialist, know your triggers and symptoms, control the source, ventilate, and filter the air.
Controlling the source is key. "The best thing you can do to improve your indoor air quality is to put some elbow grease into it," said Angel Waldron, a spokeswoman for the American Asthma and Allergy Foundation of America. "Remove the source of allergens you are sensitive to: pets, carpet, fluffy furniture, stuffed toys and window treatments."
Relief may mean trading delicate designer labels for utilitarian fabrics that can withstand repeated laundering. "We recommend keeping surfaces inside the home clean and uncluttered, sweeping and mopping frequently, and washing bedroom linens in hot water weekly," Waldron said.
Robert Moffitt, a spokesman for the American Lung Association's Health House Program, echoed Waldron. Homes become breeding grounds for allergies, he said, by trapping pollutants inside. Adequate ventilation relieves the problem while also controlling moisture.
"So many indoor air issues are moisture related, such as mold," he said. "Dust mites and cockroaches are really the leading indoor allergens and asthma triggers, and they both like moist, humid homes."
Air conditioners and dehumidifiers can keep interior relative humidity at or below the association's target 50 percent maximum. "A huge amount of water enters the air just from taking showers or cooking," Moffitt said.
Running exhaust fans can make a huge difference.
A common mistake, Moffitt said, is turning down air conditioning in warm weather when no one is home. The motivation may be frugality, but the result is a critical increase in humidity and temperature, turning the home into a petri dish for bacteria and mold.
Carpeting can bedevil sensitive respiratory systems, said Albert Tompkins, an allergist with Allergy Care Centers, a medical practice with offices around the region. The culprit, household dust, is often more than a nuisance. "Dust is a mixture of dust mites, dead insect parts and fabric from clothing, upholstered furniture and carpeting," he said. "Dust-mite sensitivity is the leading cause of childhood asthma."
Tompkins urged prompt identification of irritating allergens and proper medical treatment, before children develop stubborn respiratory disease.
While some people spend a lot of money on high-end filtration devices, such technology does little to control dust mites or pollens, said Peyton Eggleston, a pediatric allergist at Johns Hopkins Children's Center. "Large particles like dust mites cling to and contaminate fabrics and bedding," he said. "You can't clean them from the air very well. That's why it's important to wash bedding" and put dust mite-proof covers on mattresses, pillows and quilts.
But didn't two 2003 reports in the New England Journal of Medicine cast doubt on encasing bedding?
Eggleston said the studies showed that you can't resort to encasement alone. "If you use mattress covers and then put a dust mite-contaminated blanket or quilt back on the bed, it doesn't do any good," he said.
In some cases, Eggleston said, lasting relief requires saying goodbye to pets. Referring to a study he co-authored, he said, "In animal allergens, what [we] showed is that if you keep the dog or cat in the house, you can't reduce [the allergens] enough."
Tompkins agreed. "It's not the hair of the pet, it's the dander and saliva that cause the allergic reactions." Frequent bathing may make a dog smell good, but does nothing to his sinus-clogging dander.
Moffitt cited another problem: attached garages. He warned against warming up a vehicle inside a garage, even with the garage door wide open. Nor should you store pesticides, paints or gasoline in the garage. "If it's inside your garage, it's going to get inside your house," he said.
Mechanically cleaning the air is sometimes essential, Eggleston and Moffitt said. The trick is finding the right system, using it correctly and not thinking it a one-step cure-all.
That's how Rockville resident Kari Keaton approached the problem. After moving her family to a nearly carpetless house and encasing the bedding of her sensitive son, Keaton still saw him suffer. At the suggestion of Johns Hopkins pediatric allergist Robert Wood, she bought a $450 HealthMate portable HEPA (high efficiency particulate air) cleaner.
"That air cleaner made all the difference in the world," she said.
Without the technology, she said, "they would probably be on more medicines." The downside: the air cleaners are noisy.
Gary Warren, who has a high-efficiency central air filter system at his Laurel home, said it cut household dust 80 to 90 percent. Since moving to another house, today he relies on prescription medications and four Ionic Breeze Quadra portable air cleaners, purchased for about $800 total.
In an industry dedicated to clearing the air, the Sharper Image Ionic Breeze Quadra units have generated controversy, after Consumer Reports slammed the devices in February 2002 and October 2003 reviews. The testers found "almost no measurable reduction in airborne particles," despite advertising to the contrary. In November 2004, a U.S. District Court dismissed a lawsuit filed by Sharper Image Corp., effectively siding with Consumer Reports. The Sharper Image, meanwhile, still sells the machines.
Consumer Reports' Mark Connelly, director of appliances and home environment, endorsed the American Lung Association's systematic approach of identifying triggers, controlling sources, and ventilating and filtering the air. Buying an air filter should be part of a comprehensive approach, he said.
According to the May 2005 issue of Consumer Reports, "ionizer" air cleaners, such as the Breeze Quadra, work poorly and generate varying amounts of ozone, a known lung irritant. Consumer Reports said that another type of air cleaner -- "ozone generators" -- produce dangerously high ozone levels. The product testers also noted that not all ionizers create high levels of ozone and that an ionizer model manufactured by Friedrich Air Conditioning Co. removes pollutants well.
"Ozone is a known lung irritant and prime ingredient of smog," Connelly said. "It really does nothing to just replace one type of pollution for another."
Moffitt recommended a whole-house filtration solution. "A higher-end air filter is the one easy and relatively cheap thing most people can do to greatly improve the air quality in their home," he said. His recommendation: high-efficiency pleated filters shaped like an accordion and carrying an electrostatic charge.
To work well, air cleaners must move large volumes of air, something central air conditioners rarely do in cool weather. No problem, Moffitt said. "If you turn your [air conditioning system] blower fan on," he said, "you've got an automatic ventilation and filtration system." He noted that the operating cost is far less than "several of those ionic breeze machines seen on TV."
Sal Hakim, owner of the Allergy & Asthma Store in Gaithersburg, said customers speak glowingly about portable HEPA-based air cleaners and vacuum cleaners made by Miele Inc. and Electrolux Group. Hakim, an environmental physiologist, demonstrated products with a laser particle monitor that measures emissions.
"A good unit can make a whole world of difference, he said." Leaky vacuum cleaners are a case study in garbage in, garbage out.
Noting the impending explosion of pollen, he said, "Business is good."
