You’re running around getting ready for Christmas or Hanukkah or Kwanzaa or Ramadan – or just a generic holiday party.

You shop. You cook. You get the candles from the bottom drawer, the decorations from the basement. If Christmas is your tradition, you probably get a tree, too, all fragrant and piney.You certainly don’t need something else to worry about – like holiday allergies.

Sorry about that.

While people typically associate allergies with the pollen that causes wheezing and sneezing in spring and summer, many of America’s 50 million allergy sufferers are actually miserable all year long because of allergies to mold, dust mites, pet dander, and in some places cockroaches and their droppings.

On top of those perennial miseries, some poor souls find their allergies or asthma get worse during the holidays.

For instance:

• The sap of Christmas trees contains terpenes (compounds that are also found in turpentine), which contribute to the lovely scent but can also be strong irritants to the nasal passages of susceptible people, says Dr. Ira Finegold, director of the allergy section at Roosevelt-St. Luke’s Medical Center in New York and past president of the American College of Allergy, Asthma and Immunology. Some trees may also carry mold.

• If you have food allergies – the big culprits are peanuts, tree nuts like walnuts and pecans, shellfish, fish, eggs, milk, wheat, and soy – you have to be careful year-round.

The trouble is, says Anne Munoz-Furlong, founder of the Food Allergy Network in Fairfax, Va., food is central to most holiday gatherings and cooks get extra-creative at the holidays.

This means you have to be extra-vigilant about piecrusts that may contain hidden nuts. Ditto for imported chocolates (with uninformative labels) and eggnog fluffed up with raw egg white, which is even more allergenic than cooked egg white.

• Smoke, from Hanukkah candles, cozy fireplaces, and after-dinner cigars or cigarettes, can also be an irritant to people with asthma and other respiratory problems.

• So can dust and mold on ornaments, especially if you store them in dusty, moldy places like a basement.

• And of course, perfume or after-shave may seem the perfect gift, until the recipient runs gasping from the room.

While some allergies have such a dramatic onset they’re impossible to miss, others can be difficult to diagnose, especially in the winter when you’re more likely to attribute sneezing and runny noses to colds.

But if your “cold” lasts more than a week or so – especially if your nasal discharge is clear and you have no fever – you may have allergies.

Dust mites are a major culprit. Even if you keep your own home scrupulously clean, when you visit other people over the holidays who aren’t as vigilant you may get an allergy flareup.

The mites reside in bedding, pillow cases, bedclothes, and feed off tiny particles of human skin that have been shed, says Dr. Robert K. Bush, chairman of the indoor allergen committee of the American Academy of Allergy, Asthma and Immunology. Dust mites also thrive in carpets, says Bush, a professor of medicine at the University of Wisconsin in Madison.

Animal dander – shed from a pet’s skin, saliva, and urine – is another problem you may have under control in your own pet-free home, but not when you go visiting.

HEPA (or high-efficiency particulate arrestor) machines may help clean the air of some allergens, but they’re not cheap ($200) and you shouldn’t expect the host or hostess to buy one when you visit. They are also “of limited utility,” because some allergens like dust mites settle to the ground and don’t circulate much in the air, says Bush of Wisconsin.

What can help, if perennial or holiday allergies get to you, is to see an allergist – now, before the holidays arrive. At the very least, he or she may be able to help identify the problem and prescribe medications that can help. Claritin, Allegra or Zyrtec are a few of the many available. Over-the-counter medications such as Nasalcrom may help, too. And if you start soon enough, you may also get a series of desensitization injections.

For severe allergies, ask your doctor about a prescription for an EpiPen (pre-measured epinephrine) and carry it with you, especially to holiday parties.

Remember: Allergies are no joke. Airborne allergens and irritants can lead to serious inflammation of the bronchial tubes and sinuses (the cavities around the eyes and nose). Once the sinuses are blocked, mucus can’t drain properly and drips into the lower respiratory tract, causing bronchitis and asthma. Asthma kills 5,000 people a year.

Food allergies are no joke either. About 5 million Americans have them and an estimated 100 to 125 die every year, typically from a reaction called anaphylactic shock, in which blood pressure falls, you lose consciousness, and may develop hives, wheezing, vomiting and diarrhea, and severe shortness of breath. The flip side of all this is that there’s lots you can do to minimize allergies. And at least so far, there’s no evidence that anybody is allergic to reindeer. Or mistletoe.

Avoiding holiday allergies

• Christmas trees, wreaths, boughs – keep your distance if they’re a problem. Consider getting an artificial tree instead.

• Wash off dusty, moldy ornaments, too.

• If you have food allergies and get invited to parties and potluck dinners, take a dish you know is safe and be first in the buffet line. Take a hearty portion, then don’t go back – by then, the serving utensil may have been used on another dish that could trigger your allergies. Or eat before you go.

• Don’t cave in to pressure to sample a tiny bite unless you’re sure it contains no allergy-triggering ingredients.

• Keep an EpiPen with you.

• Use smokeless and unscented candles if regular candles are irritating. Don’t insist on a fire if anyone in the room has asthma, emphysema or other respiratory problems.

• See an allergist if over-the-counter remedies don’t help.

For more information, contact:

• 1-800-842-7777 begin_of_the_skype_highlighting              1-800-842-7777      end_of_the_skype_highlighting, the American College of Allergy, Asthma and Immunology. Ask for a new brochure called “You can have a life without allergies.” On the web, it’s http://allergy.mcg.edu

• 1-877-9-ACHOOO begin_of_the_skype_highlighting              1-877-9-ACHOOO      end_of_the_skype_highlighting (1-877-922-4666 begin_of_the_skype_highlighting              1-877-922-4666      end_of_the_skype_highlighting), the National Allergy Bureau, run by the American Academy of Allergy, Asthma and Immunology. Ask for a brochure called “Because Allergies Last All Year Long.” On the web, www.aaaai.org/nab

Max Collins, now 8 and a second grader in Burlington, was a baby when a tiny taste of peanut butter nearly killed him.

No sooner had his mom, Lisa, now 32, spread a smidgeon on Max’s lips than he began vomiting and screaming. Huge hives sprouted on his skin. “It was almost simultaneous,” Lisa says. “I never knew foods could cause something life-threatening.”She rushed him to the nearest emergency room, where health workers, suspecting a potentially fatal allergy attack, pumped him full of epinephrine and Benadryl. Max survived, and hasn’t been near a peanut since – no small feat given that peanuts can lurk in any number of unsuspected places, from bakery-bought cakes to a restaurant meal cooked in a pan that has traces of peanut from a previous recipe.

Food allergies, once dismissed as rare or insignificant, are getting new respect. In response to requests from people with peanut allergies, the federal Department of Transportation told 10 major airlines in August that they must provide peanut-free “buffer zones” if a passenger with an allergy requests it. (Under pressure from peanut producers, however, the agency has been re-examining that policy.)

School systems, too, are grappling with ways to balance the needs of allergic kids with the rights of others to their p-b-and-j’s. Instead of bans – which can arouse antagonism without guaranteeing safety – many schools now offer peanut-free cafeteria tables, no-sharing policies for lunches or candy bars that may contain traces of peanuts, and instructions for teachers on handling allergy emergencies.

Still, food allergies – the big ones are to peanuts, tree nuts like walnuts and pecans, shellfish, fish, eggs, milk, wheat, and soy – pose a delicate problem.

On the one hand, the mere notion of killer food strikes some as ludicrous, though 100 to 125 people die every year from allergies to food – mainly peanuts – estimates Dr. Hugh Sampson, director of the Jaffe Food Allergy Institute at New York’s Mt. Sinai School of Medicine. He is also medical director for the Food Allergy Network in Fairfax, Va., a nonprofit education group.

Government statistics count only 88 deaths from food allergies between 1979 and 1995, but both sets of numbers are considered soft.

On the other hand, many people who think they have a food allergy – 25 percent of adults, according to one survey – do not, says Anne Munoz-Furlong, founder of the Food Allergy Network.

In reality, only 1 to 2 percent of people truly have a food allergy, she says. But that’s more than 5 million Americans and the number – hard data are scarce – appears to be growing, especially for allergies to peanuts, which are actually in the legume, not the nut family.

Despite the lack of solid data, many pediatricians and allergists believe peanut allergies are on the rise.

“The problem has doubled or tripled since I have been in practice for the last 15 years,” says Dr. John Saryan, an allergist at the Lahey Clinic in Burlington who thinks peanut consumption by nursing mothers may be partly to blame.

There’s no proof that the three proteins in peanuts that trigger allergies cross the placenta to the fetus during pregnancy. But there is evidence that peanut allergens are present in breast milk.

When a baby nurses, his immune system begins making a type of antibody called IgE to peanut allergens in breast milk. When an allergy-prone child is then exposed later in life to a larger dose of allergens – in a peanut butter sandwich, for instance – the allergens combine with his antibodies, triggering release of histamine and other chemicals from mast cells that line the respiratory and digestive tracts and the skin.

This leads to hives, vomiting, and swelling of the bronchial tubes as fluids seep out of blood vessels. The end result can be life-threatening anaphylactic shock – characterized by severe breathing problems and a drop in blood pressure.

Allergic reactions are especially dangerous in children who have asthma, says Dr. Dean Metcalfe, chief of the laboratory of allergic diseases at the National Institute of Allergy and Infectious Diseases, part of the National Institutes of Health.

In most cases, it takes ingestion of a peanut product to produce a reaction, not merely touching it or inhaling peanut dust. (Peanut oils are considered safe, by the way, as long as they are made by acid extraction and heat distillation, as most commercial products are.)

But for some, even airborne exposure can be a problem, says Mike Hanson, a 43-year-old lawyer from Hingham whose son Dan, now 7, once reacted to the “airborne smell” of peanuts at a hotel. And that, he says, makes plane trips terrifying. “When 300 people open bags of peanuts at the same time, you can smell it. You are trapped. There’s no fresh air, no way out.”

Allergist Sampson agrees, saying some people have had such severe reactions after other passengers opened bags of peanuts that planes had to make emergency landings.

The allergens clearly linger in airplane ventilation systems, says Dr. John Yunginger, an allergist and pediatrician at the Mayo Clinic, whose data were used by the federal government. What’s not clear from his data, though, is whether enough peanut particles linger in the air to make people sick.

For some people, living with a food allergy is simply a nuisance. “Oh, I almost died several times,” says Paul Kelley, 63, a physicist and director of the electro-optics technology center at Tufts University who is severely allergic to peanuts.

When he visited China, where peanuts are used extensively in cooking, Kelley had a friend write him a sign to flash in restaurants saying, “Do not feed this white monkey peanuts.” But basically, he says, “I guess I’m oblivious.”

Not Lisa Collins. To protect her son, Max, she reads every label on every food product. She takes him only to restaurants with standardized menus, like McDonald’s. She talks to school staff to make sure other kids don’t give him peanut butter sandwiches or candy bars.

And when Max goes to birthday parties, he takes along something to eat rather than birthday cakes from a bakery, which could contain peanut allergens if mixing bowls and other utensils were previously used for foods containing peanuts.

Lisa also makes sure that wherever Max goes, there’s an adult with an EpiPen nearby, to give him an injection of epinephrine if he develops a reaction to unwittingly ingested peanuts.

“The threat is always with us,” she says, “but the more aware people are, the safer Max is.”

Some tips for averting perils in food allergies

Any food can potentially cause anaphylactic shock, a potentially life-threatening reaction. The most common culprits are peanuts, tree nuts, shellfish, fish, eggs, and milk.

• Milk and eggs cause the most common food allergies in children, but unlike with many other allergies, people often outgrow them as they get older. Not so with peanut allergies.

• Labels on food products are supposed to say whether the product contains allergy-triggering substances, but the labeling process is not foolproof. Labels do not have to say whether the food was processed in a vat also used for peanut products, which means cross-contamination is a slight possibility. In September, the Pillsbury Co. recalled some cookie dough products because the packages may have contained walnuts not listed on the label. Other companies have recalled products because labels failed to list peanuts, eggs, milk, pecans, hazelnuts or almonds.

• If your school-age child has a food allergy, request a meeting with the principal, school nurse, cafeteria personnel, and teacher to make sure they know how to handle an emergency.

• Use role-playing to teach your child ways to avoid contact with food allergens in the cafeteria or to resist peer pressure to try a new food.

• Send a spoil-proof lunch to be kept at school in case your child loses or forgets his allergy-safe lunch one day. This can include a can of tuna, crackers, canned fruit, and fruit juice.

• If you or your child has a severe food allergy, carry an EpiPen (pre-measured epinephrine) and a written emergency plan. School-age children and adults may also want to wear a bracelet describing the allergy.

• If you have a family history of asthma, hay fever or eczema, avoid peanuts if you are pregnant or nursing, and don’t let your child eat peanut products before age 3. (After that, a child’s maturing immune system may be less sensitive to peanut allergens.)

• Remember: As little as 1/20 of a peanut can cause a fatal reaction in someone who is highly allergic.

For more information on food allergies, call the Food Allergy Network, 1-800-929-4040 begin_of_the_skype_highlighting              1-800-929-4040      end_of_the_skype_highlighting or try the Net, at www.foodallergy.org.

Just when you thought there was nothing left to blame on El Nino comes this: We’re in for an unusually early – and perhaps long and nasty – allergy season this year.

Granted, everybody always thinks whatever allergy season they’re suffering through is the worst ever, but this year, it really will be bad – and in some places, already is – because El Nino created perfect growing conditions for trees and molds – a mild winter in the Northeast, rains in the South and North.”We’re in for a mega-season,” says Dr. Donald Pulver, an allergist in Rochester, N.Y., echoing a warning from the National Allergy Bureau, a program of the American Academy of Allergy Asthma & Immunology. And this is on top of a winter that – because there was no killing frost in many places – provided no respite for those allergic to molds.

“We’re seeing tree pollen in the air already, three to four weeks early,” says Dr. Julian Melamed of Allergy and Asthma Specialists in Chelmsford.

Because of the “priming effect” – once airways are inflamed by allergy-causing substances, it takes less and less exposure to cause further misery – the key is to begin taking medications now, before things get too far ahead of you, adds Dr. Frank Twarog, a Harvard allergist.

Allergies – also known as hay fever and allergic rhinitis – mean the body is making an excessive immune response to specific triggers, or allergens, in the environment.

About 50 million of us are allergic to something – either seasonal, outdoor things like trees and grasses, or year-round indoor things like mold, dust or cats. Or both.

In the spring, the big culprit is pollen – a packet of sperm that trees and grasses release into the air to be carried to female organs in the same plant or one nearby to form a seed.

Depending on your genetic makeup, pollen from a particular kind of tree, say a birch, may cause an immune reaction – release of a type of antibody called IgE. This antibody sits on the surface of mast cells – immune system cells that line the nose, throat, gastrointestinal tract, and skin.

The next time this pollen enters your system, it combines with these antibodies, causing the mast cells to release histamine and 44 other chemicals that can trigger an allergic reaction. These chemicals make blood vessels dilate and leak proteins into tissues, causing swelling – the stuffy noses of allergy sufferers – or hives on the skin.

Usually, this is just annoying. But allergies also can cause asthma, an inflammation of the bronchial tubes, and sinusitis, an inflammation of the sinus cavities around the eyes and nose.

If the sinuses are blocked, mucus cannot drain properly, which means that viruses or bacteria lurking there can thrive. Infected mucus then drips into the lower respiratory tract, triggering bronchitis and asthma.

So what can you do? Plenty.

Basic preventive measures include staying indoors when pollen counts – and air pollutants – are high. Close the windows and turn on air conditioners at home and in the car. If you exercise outdoors, do it at dawn when plants are covered with dew, after a rain, or at dusk, when pollen has fallen to the ground.

You can also use a HEPA (high-efficiency particulate arrestor) air cleaning filter – roughly $ 200. A dehumidifier may help combat mold allergies, too. The goal, says Pulver, is to keep indoor humidity at between 35 and 45 percent, which means you also have to get rid of any carpeting that’s been wet for more than 48 hours.

A growing array of medications can help, too, especially if you start using them now.

If your allergies are mild, over-the-counter antihistamines like Benadryl or Chlor-trimeton (or their cheaper, generic equivalents) may do the trick, though they can make you groggy. Newer antihistamines, like the nasal spray Astelin and pills like Allegra, Claritin or Zyrtec, don’t cause grogginess, except possibly for Zyrtec. But you can only get them by prescription.

A better solution, many allergists say, is one of the anti-inflammatory nasal sprays that act by a different mechanism.

Nasalcrom, now available over the counter, is a nonsteroidal drug that helps some people. Another nonsteroidal spray, which works by decreasing nasal mucus, is Atrovent, available by prescription. A different formulation of the drug is used to control asthma.

But often, allergy sufferers need the stronger stuff – prescription steroid sprays like Nasonex, Flonase, Nasacort, Nasacort AQ, Rhinocort, Nasarel or Vancenase AQ/DS. It may take 24 hours to a week for the steroid drugs to kick in, but once they do, they control allergies well if you use them faithfully.

If you have asthma, it’s especially important to treat allergies so smaller problems don’t become bigger ones, says Dr. Marshall Plaut, chief of the allergic mechanisms section at the National Institute of Allergy and Infectious Diseases.

For asthma, which kills 5,000 people a year, the mainstays of prevention and treatment are inhaled steroids such as Vanceril DS, Flovent, Aerobid, Azmacort, and the just-approved Pulmicort to dampen down the inflammatory response in airways.

These drugs must be taken regularly – not just during an attack – to allow delicate airways in the lungs to heal. Non-steroid inhaled drugs such as Intal and Tilade also help, by incapacitating mast cells.

And for some people with asthma, bronchodilators may help.

Short-acting “rescue” bronchodilators, such as Proventil, Ventolin, Alupent, Maxair, and Tornalate work by boosting the stress hormone adrenalin, which opens airways.

These are available only by prescription and should not be used regularly because they raise the risk of cardiac arrhythmias and stroke. If you use them more than three times a week, it’s a sign your asthma may be out of control and you should see your doctor again.

And be especially careful with Primatene Mist, a short-acting bronchodilator available over the counter. It provides relief fast – in little as 15 seconds – but is often overused.

A long-acting bronchodilator called Serevent can control nighttime and exercise-induced asthma by keeping muscles around airways relaxed, but it’s best used with inhaled steroids.

Increasingly, allergists are also prescribing a new class of drugs called anti-leukotrienes – Accolate, Zyflo and Singulair. These drugs block leukotrienes, substances that, like histamines, are released during inflammation.

If all this seems a bit overwhelming, take heart. It’s well worth the trip to the doctor and the pharmacy to keep allergies and asthma under control. Whatever El Nino may do out there, there’s no point in suffering if you don’t have to. Judy Foreman is a member of the Globe staff. Her E-mail address, via the Internet is: foreman, (AT SIGN SYMBOL)globe.com

1.  For pollen data

For more information on pollen counts nationwide and tips for dealing with allergies, you can try:

• 1-800-9-POLLEN begin_of_the_skype_highlighting              1-800-9-POLLEN      end_of_the_skype_highlighting (765536).

• On the web, try www.aaaai.org (the American Academy of Allergy Asthma and Immunology)

2.  Telling symptoms

It can be hard to determine if you’ve got a cold, allergies or sinusitis. Colds get better by themselves, but allergies and sinusitis persist and often need medical treatment. Here are the distinguishing symptoms. Symptom Sinusitis Allergy Cold Facial pressure/pain Yes Sometimes Sometimes

• Duration of illness More than 10-14 days Varies Less than 10 days

• Nasal discharge Thick, yellow-green Clear, thin, watery Thick and whitish or thin and watery

• Fever Sometimes No Sometimes

• Headache Yes Sometimes Sometimes

• Pain in upper teeth Sometimes No No Bad breath Sometimes No No

• Coughing Yes Sometimes Yes

• Nasal congestion Yes Sometimes Yes

Sneezing No Sometimes Yes SOURCE: American Academy of Otolaryngology.  Globe staff chart

Lise C. Borel, now 42, had been happily practicing dentistry for 10 years when she began noticing welts on her neck whenever she touched herself after removing her latex gloves.

Several weeks later, she suddenly found she couldn’t breathe within three minutes of donning her gloves.”I turned incredibly red. I was feeling very odd,” she recalls. A partner recognized that she was having a severe allergic reaction, gave her oxygen and a shot of antihistamine.

She revived and went to an allergist, who told her to use an inhaler and antihistamines and to keep an “EpiPen” handy to give herself adrenalin shots if it happened again.

It did, repeatedly, until even minimal contact with latex would send Borel into potentially fatal anaphylactic shock.

Her troubles are severe, but even less dramatic reactions to latex have become a growing problem, and not just among health care workers.

Natural rubber latex, made from the rubber tree Hevea brasiliensis, is used in 40,000 products – including 300 medical items – from anesthesia masks to automobile tires, balloons to blood pressure cuffs, condoms to catheters to diaphragms.

Although latex has been around for 50 years, concern about allergic reactions to the plant proteins in this natural, milky substance didn’t surface until 1979, with the first published report of a reaction to latex gloves in England.

Then in 1987, with fear of AIDS soaring, the US Centers for Disease Control recommended “universal precautions” for all health workers – using masks and gloves all the time to lessen the risk of infection. In 1992, the Occupational Safety and Health Administration stepped in, requiring employers to provide gloves and take other measures to protect employees against blood-borne organisms.

Although no one said latex was the only way to protect against disease, it quickly became the top choice. Before 1987, Americans used two billion pairs of gloves a year for medical purposes, says Thomas Tillotson, a New Hampshire glove manufacturer. Today, the figure is up to nine billion pairs,says Tillotson, who heads the latex task force of the Health Industry Manufacturers Association.

In addition to greater use of latex, some manufacturers may have changed the way they process the natural rubber, leaving more allergy-producing proteins in the finished goods, says Dr. Edward Petsonk, chief of the clinical section at the National Institute for Occupational Safety and Health.

And many of the gloves are now made overseas, where it’s tougher for American customers to monitor manufacturing, although gloves labelled for surgical or patient exam use are spot checked by the Food and Drug Administration.

Latex products have undoubtedly saved some lives, but they began threatening others. In 1989, the FDA investigated reports of patients going into shock during barium enemas. In all, 16 people died from allergies to latex in enema tips, which were taken off the market seven years ago.

Suspicions deepened in the early 1990s when nine children at a Milwaukee hospital went into shock after anesthesia had begun but before the first surgical incision was made. The culprit was the latex in anesthesia equipment and intravenous catheters.

Today, the FDA has tallied at least 1,700 cases of latex allergic reactions and 17 deaths. But Borel, who quit dentistry to run a support group called Elastic, Inc., says this understates the problem, based on data she obtained through a Freedom of Information Act request.

Indeed, half of people with spina bifida, a congential defect of the spinal canal, or with congenital urinary problems, have allergies attributed to the numerous medical procedures they must undergo that involve latex products, according to the American Academy of Allergy, Asthma & Immunology.

There are also more than 100 latex lawsuits in state and federal courts. The federal cases are now consolidated into a multi-district litigation in Philadelphia, says Jami Oliver, a lawyer with Clark, Perdue, Roberts & Scott in Columbus, Ohio.

Other studies estimate that 1-to-6 six percent of the general population and 8-to-12 percent of health care workers have been “sensitized” to latex, says Dr. Marshall Plout, chief of the allergic mechanisms section at the National Institute of Allergy and Infectious Diseases.

Sensitization means the body has antibodies to latex proteins, notes Dr. B. Lauren Charous, chairman of the latex allergy committee of the American College of Allergy, Asthma and Immunology.A fullblown allergic response often affects the skin and other organs, producing hives, swelling, asthma and, in extreme cases, anaphylatic shock.

Prompted by the growing concern, the occupational safety institute last month issued an alert urging employers and workers to switch to non-latex gloves for activities, like food handling, that do not involve contact with infectious materials.

When latex is a must, NIOSH recommended powder-free, lower-protein latex products. The powder, used to make gloves easier to put on, can latch onto latex proteins and aerosolize them.

Some hospitals, including Brigham and Women’s in Boston, have now gone latex-safe. But avoiding latex completely – the only real protection for people who are allergic – requires enormous commitment and vigilance, for both institutions and individuals.

If you are allergic, you have to avoid not only the latex in everything from balloons to condoms, but often bananas, kiwis, avocados and chestnuts as well, because proteins in these fruits and vegetables are similar to those in latex.

But it’s avoiding the products themselves that is hardest.

When one 39-year old banker from a Boston suburb discovered she was allergic to the condoms she and her husband used, she felt “overwhelmed, because of the extent of lifestyle changes.

“Many things are not labelled,” she adds, although the FDA is now considering requiring a warning on all latex products.

“It’s a nightmare,” says Rosemarie Pinheiro, a 33-year old Norton manicurist who got hives from her son’s toys. “I have to avoid everything with latex – that’s basically everything.”

And some health care workers, like Borel and Taunton nurse Maureen Iannoni, 41, have had to give up their jobs to survive.

Iannoni can no longer work in a hospital and uses non-latex products when she sees patients in their homes. The prospect of surgery was terrifying, because the hospital had to use a special protocol so she would not come in contact with latex.

Borel’s war with latex has been even tougher, she recalled recently from a hospital bed near her home in West Chester, Penn., where she was being treated for heart damage caused by asthma, which has plagued her since her first allergy attack.

After that first reaction, she went on vacation, she says. “I just felt wonderful. I felt my problems were done.” But on her first day back at work, she went into shock. Her office mates called 911 and the paramedics rushed to her aid, whipping on latex gloves and spewing powder everywhere.

She wound up in the hospital, but then went back to work and avoided using latex.  But she went into shock again because her co-workers were still using powdered gloves.

While she stayed home, her partners then “de-latexed” the office, deep-cleaning carpets and scouring the ventilation system. Borel returned, went into shock again and spent a week in intensive care. That was the end of her dentistry career.

Today, things are changing, slowly. Tillotson, of the industry task force, estimates that non-powdered, reduced-latex gloves now comprise 25 to 30 percent of the market.

And although some medical centers like the Mayo Clinic in Minnesota have found that switching to latex-safe alternatives can save money, others find that costs go up. When allergist Dr. Donald Accetta of Taunton, head of the Massachusetts Allergy Society, made the switch, “the price doubled,” he says.

Still, there is a growing array of nonlatex products available. Some gloves for patient exams are now made of vinyl or PVC (polyvinyl chloride), nitrile or other synthetics, including synthetic rubber.

For surgical gloves, which must stretch, synthetic neoprene is also an option, as are some synthetic rubber gloves. The US Department of Agriculture is also exploring natural latex from a plant called guayule (pronounced “why-YOU-lee”) that grows in the southwest and seems not to trigger the same allergies as the traditional latex.

The FDA says that for protecting intact skin, both natural rubber latex and non-latex gloves are effective.

For condoms, which must protect more delicate mucous membranes, the CDC still recommends latex, noting that the AIDS virus can get through the pores of animal skin condoms.

For people allergic to latex, the FDA has approved condoms made from synthetics like polyurethane and Tactylon. Lab studies show these materials block viruses, but studies in people have not yet been completed.

Says Borel: “Don’t use latex if something else will do. If and when you do need latex gloves, use the kind that’s powder-free, with low latex proteins.”

LATEX REACTIONS CAN VARY

Latex allergy sometimes causes only a poison-ivy like rash 12-to-36 hours after contact. This reaction is not life-threatening.

Life-threatening reactions usually occur in people who are already sensitized to latex proteins. With the next exposure, these people may develop itching, redness, swelling, sneezing and wheezing, trouble breathing and anaphylactic shock, a marked drop in blood pressure.

The greatest danger often occurs when latex proteins are inhaled or come in contact with mucous membranes in the lips, nose, rectum or vagina, or during surgery.

For more information on latex allergies, you may call:

• Allergy and Asthma Foundation of America, New England Chapter, 617-965-7771 begin_of_the_skype_highlighting              617-965-7771      end_of_the_skype_highlighting or 800-7-ASTHMA begin_of_the_skype_highlighting              800-7-ASTHMA      end_of_the_skype_highlighting (1-800-727-8462 begin_of_the_skype_highlighting              1-800-727-8462      end_of_the_skype_highlighting).

• Latex Allergy News, 860-482-6869 begin_of_the_skype_highlighting              860-482-6869      end_of_the_skype_highlighting.

• Elastic, Inc. 610-436-4801 begin_of_the_skype_highlighting              610-436-4801      end_of_the_skype_highlighting. (In Massachusetts, 508-824-4094 begin_of_the_skype_highlighting              508-824-4094      end_of_the_skype_highlighting.) Elastic (Education for Latex Allergy Support Team and Information Coalition – a independent nonprofit group.

• Alert (Allergy to Latex Education and Resource Team), 888-97-ALERT begin_of_the_skype_highlighting              888-97-ALERT      end_of_the_skype_highlighting or 888-972-5378 begin_of_the_skype_highlighting              888-972-5378      end_of_the_skype_highlighting. Alert accepts funding from manufacturers of low allergen, non-powdered latex products.

• For a copy of the latex alert by the National Institute for Occupational Safety and Health, call 800-35-NIOSH begin_of_the_skype_highlighting              800-35-NIOSH      end_of_the_skype_highlighting.

There may still be patches of snow smothering your crocuses, but believe it or not, springtime allergy season is only about 10 days away – and for some poor souls it’s already begun.

But you may be able to head off trouble before it starts.At least that’s the current thinking of allergy specialists, who say that if you’re among the 26 million Americans likely to get allergic rhinitis, or hay fever, consider calling your doctor now to start taking medications before symptoms get bad.

There’s also another reason to attack allergies before they attack you. The medications are getting better – and we’ll get to the newest ones in a minute.

Allergies, miserable as they can be, simply mean that “the body is making an inappropriate immune response” to specific triggers, or allergens, in the environment, says Dr. Marshall Plaut, chief of the allergic mechanisms section at the National Institute of Allergy and Infectious Diseases.

Altogether, about 50 million of us are allergic to something – either seasonal, outdoor things like trees and grasses, or year-round indoor things like mold, dust or cats. Or both.

In the spring, the big culprit is pollen – a packet of male genetic information that trees and grasses release into the air to be carried to female organs in the same plant or one nearby.

Right now, it’s pollen from elms, willows, poplars, and maples that is likely to cause the most grief. By May, it’ll be the oak, birches, and beeches. By June and July, grass pollen will be the culprit; and by Labor Day, ragweed.

Depending on your genetic makeup, pollen from a particular kind of tree, say a birch, may cause an immune reaction – release of a type of antibody called IgE. This antibody sits on the surface of mast cells – immune cells that line the nose, throat, gastrointestinal tract and skin.

The next time this pollen enters your system, it combines with these antibodies, causing the mast cells to release histamine and other chemicals that trigger an allergic reaction. These chemicals make blood vessels dilate and leak proteins into tissues, causing swelling – the stuffy noses of allergy sufferers – or hives on the skin.

Usually, this is just annoying. But allergies are also the leading cause of asthma, an inflammation of the bronchial tubes. Like colds, allergies can also trigger sinusitis, an inflammation of the sinus cavities around the eyes and nose.

The basic problem is that “allergies can swell your nose internally,” says Dr. Marvin Fried, chief of ear, nose and throat medicine at the Beth Israel Deaconess Medical Center and Brigham and Women’s Hospital.

Once the sinuses become blocked, mucus cannot drain properly, which means that any virus or bacterium can “set up shop in this nice warm environment,” he says. Infected mucus then drips into the lower respiratory tract, where it can cause bronchitis and asthma. It can also seep into the eye or brain, where, in rare cases, it can cause life-threatening infections.

So what can you do?

“Call the doctor now. Get a jump on the allergy season. If you wait until Memorial Day and you’re feeling miserable, you’ll need even more powerful medications,” says Dr. Julian Melamed of Allergy and Asthma Specialists in Chelmsford.

And if you’re discouraged because medications you’ve tried in the past haven’t worked or caused too many side effects, call anyway, because there are new products available this spring.

These include Astelin, a recently-approved antihistamine nasal spray that should not make you sleepy because it acts only in the nose, not throughout the body; Nasalcrom, an anti-inflammatory spray once available by prescription but now available over the counter; and Allegra, an antihistamine pill that does not cause drowsiness or heart rhythm disturbances, as its more famous, soon-to-be-banned cousin, Seldane, does.

The main preventive measure to start now, says Melamed, is an anti-inflammatory nasal spray. One choice is Nasalcrom, a safe drug that does not contain steroids but that is relatively weak and does not work for everybody.

You could also try one of the more powerful prescription corticosteroid sprays, such as Vancenase, Beconase, Flonase or Nasacort . These can be very effective, but can also cause nasal dryness and in large doses over many months can irritate the eyes. In children, they may intefere with growth, but only at high doses.

These medications, which keep down swelling in the nose by damping down the inflammatory response, usually take a number of days to begin working. So if your doctor agrees, you may want to start taking them soon so they will have kicked in by the time the trees and grasses start pollinating.

Antihistamines, which act through a different mechanism to block release of histamine, usually work faster than the anti-inflammatory drugs. Talk to your doctor about what antihistamine to use and when to start using it.

Traditionally, the over-the-counter formulations have worked well but also caused drowsiness. “In recent years, the big advance has been development of nonsedating antihistamines,” says Dr. Paul Chervinsky, president of the New England Research Center in Dartmouth, a private group that tests allergy drugs. But these drugs are available only by prescription.

The initial star in this category was Seldane, but in January, the US Food and Drug Administration announced its intention to withdraw approval of Seldane because it has contributed to cardiac arrhythmias in people who were also taking certain antibiotic or antifungal drugs.

Besides, the FDA reasoned, there is now a better alternative: Allegra, which was approved last summer and, like Seldane, is made by Hoechst Marion Roussel.

Other nonsedating antihistamines that may help are Claritin, the biggest seller, and Zyrtec, which can cause some drowsiness. There’s also Hismanal, which is still on the market but has been linked to the same cardiac problems as Seldane.

But you may have to fight for these drugs. Some cost-conscious managed care plans ask doctors not to precribe nonsedating antihistamines, which can cost roughly $ 60 a month.

In addition to antihistamines, which relieve runny noses, sneezing and watery eyes, decongestants like Sudafed can help with other symptoms, notably a stuffy nose, by constricting blood vessels. The oral decongestants can raise heart rate and blood pressure and contribute to insomnia, so you may want to avoid them at nighttime.

The decongestant sprays like Afrin and Neo-Synephrine cause fewer of these problems, but they can cause stuffiness to “rebound” if used for more than three days.

If all else fails, you may need allergy “shots,” a series of injections that can train your immune system not to overreact every time a speck of pollen comes along. But this treatment can take months to complete, so you probably can’t count on it for this year’s allergy season.

And if your allergies seem to be evolving into asthma or sinusitis, it’s all the more reason to call the doctor.

“In the middle of it, it’s hard to tell” whether you’ve got a cold, allergies or sinusitis, says Fried of Beth Israel. But the American Academy of Otolaryngology now offers some rules of thumb for sorting it out.

With allergies, for instance, the nasal discharge is usually clear, thin and watery. But it turns thick and yellow-green, or you develop a fever, bad breath, pain in your upper teeth and you feel quite sick for 10 to 14 days, you may have a bacterial sinus infection.

The usual treatment for that is a long – three to six weeks – course of antibiotics, though a recent study in the medical journal Lancet questions how effective such treatments are.

If sinusitis becomes a chronic problem, as it does for about 35 million Americans, you may also consider endoscopic surgery – in which doctors insert instruments through the nose to make holes for better drainage of sinus cavities.

The procedure is not without risk, says Fried, a pioneer in the method, because probing the sinuses brings surgical instruments close to the eyes and brain. But the safety of this procedure, now done 250,000 times a year, has improved considerably with imaging techniques that allow a surgeon to “see” exactly where the instruments are.

And if your allergies bring on significant coughing or trouble breathing, you may have asthma.

“Asthma is a major sequel of allergies,” says Melamed of Chelmsford. In fact, allergies are the most common cause of asthma, which, though treatable, kills 5,000 people a year.

The cornerstone of asthma treatment is still inhaled steroids to dampen down the inflammatory response, but two newly approved drugs – Accolate and Zyflo – may also help by blocking the chemical chain reaction that sets off the asthma response.

“If you have asthma, it’s even more important that you treat allergies,” says Plaut of the allergy institute. There is even some evidence that children who get allergy shots may be less likely to develop asthma later, though this is unproved.

The take-home message, he says, is that “while allergies cause a lot of discomfort and can cause significant illness, there are treatments that can improve your quality of life.”

Telling symptoms

It can be hard to determine if you’ve got a cold, allergies or sinusitis. Colds get better by themselves, but allergies and sinusitis persist and often need medical treatment. Here are the distinguishing symptoms.

Symptom Sinusitis Allergy Cold Facial pressure/pain YES Allergy Sometimes Cold Sometimes

Duration of illness Sinusitis More than 10-14 days Allergy Varies Cold Less than 10 days

Nasal discharge Sinusitis Thick, yellow-green Allergy Clear, thin, watery cold Thick and whitish or thin and watery

Fever Sinusitis Sometimes Allergy NO Cold Sometimes

Headache Sinusitis YES Allergy Sometimes Cold Sometimes

Pain in upper teeth Sinusitis Sometimes Allergy NO Cold NO

Bad breath Sinusitis Sometimes Allergy NO Cold NO

Coughing Sinusitis YES Allergy Sometimes Cold YES

Nasal congestion Sinusitis YES Allergy Sometimes Cold YES

Sneezing Sinusitis NO Allergy Sometimes Cold YES SOURCE: American Academy of Otolaryngology.