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Do you feel "sick" at springtime every year? Does being near a car make you want to scratch your eyes and clear your throat? Do you get short of breath or "feel tight" walking into a dusty or moldy room? Allergies and asthma affect many Americans. About 35 million suf-fer from asthma, and about 25 million suffer from hay fever.

Then there are those unfortunate enough to suffer from both. Asthma can announce itself with chest tightness, coughing, wheez-ing and shortness of breath. Deaths from asthma are on the rise. Air pollution, poor access to health care, Incorrect use of or non-compliance with medications, as well as lifestyle and dietary changes are being blamed.

If You Have Asthma, These Tips May Help:
1. Identify culprit allergens that trigger symptoms so that exposure can be eliminated, or at least minimized.
2. When exercising, choose an environment where the air is warm and moist. For example swimming is generally better tolerated than sports where the air is cold and dry, such as running. Also, warming up beforehand is desirable.
3. Use a scarf to cover your mouth so that the air you breathe in is warmer and more humidified.
4. Quit smoking! Even passive fumes from someone else can worsen your asthma. Not only is smoking an irritant that can cause symptoms, but tobacco will also compromise the immune system's ability to fight infection.
5. Since infections - especially those in the upper-respiratory tract - can bring on an asthma attack, try to avoid them, and get your flu vaccine annually.
6. Learn to relax and breathe properly during an attack, Consider different modalities to help cope with stress, since sudden changes in emotions are known to precipitate asthma.

Statistics show that asthma is increasing, especially in the inner cities, and indoor allergens such as cockroaches, pet dander, cigarette smoke and dust mites are believed to play a role. If your asthma is triggered or worsened by allergies, identifying responsible allergens may be difficult. -Seeing your allergist may be helpful, since any action to be initiated depends on the allergens responsible.

If You Have Allergies, Consider These Suggestions:
If pollen is the culprit, keep your windows closed and the air-conditioning on to keep pollen out. If animal dander offends, avoid exposure or keep pets outdoors (or at least off the bed!). If molds make you react, reduce indoor humidity-repair water leaks and discard moldy sources. If dust or dust mites are the problem, encase mattress and pillows with allergy-proof plastic cov-ers, wash all bedding in very hot water (at least 1300F) and replace upholstery with wipeable furniture.

Dust mites are microscopic creatures that eat flakes of human skin. They attach to fiber on furniture, mattresses, bedcovers and carpet, Vinyl, linoleum, tile and hardwood are easier to keep clean than wall-to-wall carpeting. If you love your carpeting, consider removing it at least from the bed-room, where you spend most of your time. But if you must keep carpeting, vacuuming once or, better yet, twice a week with a vacuum that has special double filter bags along with utilizing a HEPA (high-efficiency particulate air) filter in the room can decrease approximately 99 percent of dust and other allergenic particles. Also, although all carpeting contains dust mites, loose-pile shaggy rugs are worse than short, tight-pile carpeting,

Allergies or hay fever can be seasonal or perennial. Although some people have problems only during certain times of the year (seasonal), two-thirds of allergy suf-ferers have problems all year long (peren-nial). Symptoms can include nasal congestion, sneezing, a runny nose, itchy eyes and even itchiness of the ears and throat. Nasal congestion can result in mouth breathing, snoring, loss of taste or smell, and "allergic shiners," or dark circles under the eyes.

Medications
Both asthma and allergies are caused by hyperactive Immune systems reacting inappropriately and overzeal-ously to harmless "allergens" such as pollen, dust mites, mold or animal dander. The bodies of allergic, or atopic, people react to these allergens as if they were dangerous parasites, making allergic 1gE antibodies and releasing other chemicals such as histamines and leukotrienes that cause inflammation. Medications such as antihistamines anti-leukotrienes and corticosteroids that are helpful in combating allergies and asthma target these chemicals and mediators.

Most allergy sufferers desperate for relief will run to the nearest pharmacy for an over-the-counter solution. Once there, they are greeted by numerous pills, nose sprays and eyedrops, However, these nonprescription med-ications should be used with caution. The majority of over-the-counter pills consist of either an antihistamine or a decongestant, or a combination of both. These products generally contain the older, sedating antihistamines, which, while extremely effective at relieving seasonal allergy symptoms, can also cause tremendous sedation and impaired judgment. Studies show that sedative antihistamines can impair one's driving as much as alcohol! These older over-the-counter antihistamines can also have increased anti-cholinergic side effects, including dry mouth and difficulty with urination in men with prostate problems.

The new, second-generation antihistamines fexofena-dine, cetirizine, loratadine, desloratadine and azelastine all offer much-needed relief with significantly less sedation and anticholinergic properties, Most importantly, since allergies can actually trigger or worsen asthma symptoms, treating allergies aggres-sively can significantly decrease asthma problems.

Both allergies and asthma have an early phase and a late phase. Late phase is treated with anti-inflammatory medications. Some-including corticosteroids, mast cell stabilizers and leukotriene inhibitors-are helpful for both allergies and asthma. The leukotriene inhibitors montelukast sodium and zafirlukast come in a pill that can be taken orally, The corticosteroids fluticasone propionate, triamcinolone acetonide, flunisolide, beclomethasone dipropionate and budesonide, can be applied both in the nose via a nasal spray or inhaled into the lungs with "pump" or metered-dose-inhaler, The mast cell stabilizer cromolyn can also be used in both the nose and the lungs.

Medications also often used in asthma include: albuterol, levalbuterol, salmeterol, pirbuterol, formoterol furmarate and theophylline. These medications are not anti-inflammatory but are used to bronchodilate, or open up, the narrow airways of asthmatics.

If you have asthma, it is especially important that you see your doctor so that a treatment regimen based on the severity and frequency of your symptoms can be developed especially for you. Some drugs are designed to be used regularly as "maintenance"; others are to be used only as needed, or as "rescue therapy."

Also available is immunotherapy, or allergy shots, Allergy shots work by making your body tolerant to allergens so that the immune cells no longer react inappropriately to pollen or dust mites, for example. This is achieved by injecting increasingly larger doses of allergens over time. Many studies show that allergy shots can reduce asthma symptoms and may even decrease the need for other asthma medica-tions. Since each individual is allergic to different allergens, allergy shots must be individualized. Your allergist can do the proper testing to identify what your allergies are.

Working with your doctor, understanding and avoiding what triggers your symptoms, and know-ing how and when to use your medications can help you be at your personal best.

Dr. Lee-Wong is the associate chief of the Department of Clinical Immunology and Allergy at Beth Israel Medical Center and an assis-tant professor of medicine and pediatrics at Albert Einstein College of Medicine, both in New York City.

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