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For people with allergies, it's time to get out the handkerchief. Here comes spring.

The arrival of spring means that pollen from trees will be flying through the air.And when trees pollinate, there is a noticeable rise in the number of people experiencing allergy problems.

More than 20 million Americans suffer from the sneezing, runny nose, itching and nasal congestion caused by pollen. Most people with allergies have multiple sensitivities.

About 20 percent of the population have a genetic ability to make allergic antibodies when they come in contact with an allergen, usually a foreign substance like pollen, or mold or dust mites.

Airborne allergens come in contact with mucous membranes such as those lining the respiratory tract or eyes.

The allergen reacts with allergic antibodies on specialized cells, called mast cells, which contain granules filled with more than 20 allergy-related chemicals. These chemicals are released and produce the allergic reaction.

If a person is having symptoms, the first thing to decide is whether they result from a cold or an allergy.

A "cold" that lingers is probably an allergy. The common cold usually disappears within about a week. And if you have a fever, it is not due to an allergy.

Multiple sneezes, often as many as eight in a row, are often a sign of allergy.

What is commonly called "hay fever" has nothing to do with hay and no fever occurs. It is often an allergic reaction to ragweed pollen that occurs in the late summer and continues until the frost.

The most sensitive test for measuring allergic reactions is the skin test. In this procedure, the skin is scratched, pricked, or injected with allergenic extract. Within minutes, an allergic person will develop an itchy, swollen pink reaction at the test site.

In recent years a blood test known as the RAST test has also been used to identify allergens.

Avoidance is the ideal treatment for allergies. A powerful air conditioner or air filter can reduce the pollen count in a room to zero.

A prescription nasal spray called cromolyn, marketed as Nasalcrom, also can relieve many allergic reactions.

Steroid nasal sprays are also very effective. Because the dosage is low and the steroids act only locally in the nose, they can be used for extended periods.

Oral medications such as antihistamines, alone or in combination with decongestants, may also be effective.

In the last few years, non-sedating antihistamines such as ter-fenadine, astemizole and loratadine (Claritin) have been available. They manage most allergic symptoms without making the patient groggy as other antihistamines do, but the first two cannot be taken in combination with certain antibiotics and anti-fungal drugs.

Another treatment option would be allergy shots in which increasing quantities of the allergen extracts are injected under the skin.