TORONTO — As ragweed season begins and you reach for an antihistamine to help relieve a runny nose and itchy, watery eyes, you might want to shed one of those tears for the allergy-afflicted souls who take part in drug trials long before the pills get to market.
At Kingston General Hospital, Dr. James Day heads an allergy unit where two or three major studies are conducted each year to test pills and other allergy products for pharmaceutical companies.
Drugmakers from around the globe come to Kingston, Ont., to make use of a database of about 3,500 allergy sufferers and the hospital's "environmental exposure unit" - a large room where conditions are controlled and researchers can deliver pollen into the air so that the symptoms of study participants can be recorded.
The former cafeteria can seat about 160 people, who read, use their laptops, watch movies and eat meals while a study is underway, amid pollen levels that might approximate those found on a heavy pollen day in late August.
"We can determine exactly the amount of ragweed pollen at any given time and know how much to deliver, which is about 3,500 grains per cubic metre," Day said from Kingston.
"There's hardly any medication used in the allergic field that we haven't tested. We compare one medication against another, or if it's a new medication, we test against placebo to see whether it is effective and to what degree it is effective."
But pity the folks who get the placebo or a medication that isn't effective. Sometimes, a study will extend over a period of 12 hours, so there can be dozens of people sneezing and experiencing other active symptoms.
"They get pretty miserable," Day conceded, while praising them for their "tremendous" contribution that provides researchers with remarkable results.
"Through the excellence of our participants ... they can determine not only differences in medication but differences in doses of medication, through this process, by the way that they indicate their symptoms. It's really quite amazing."
Jeff Adams, 46, is an allergy sufferer who has taken part in numerous trials over the past seven years or so. The studies are "double-blind" - the participant and the doctors don't know what kind of pill any individual is getting. Still, Adams said there have been "many times" when he's been able to figure out that he received a placebo.
"It's basically just a really long day of the sneezing or the runny nose, blowing your nose all the time," said the Kingston resident.
"We fill out symptom cards, diary cards, every half-hour, just explaining the level of our symptoms."
Each person is supplied with a box of tissues, and everyone gets paid.
"Money-wise, it's good," he said, explaining that he's receiving anywhere from $350 to $1,000 per study, depending on how much time is involved.
While pollen from grasses and trees are a problem for him in the spring, Adams said he feels symptoms that become heavier and more consistent when ragweed season begins in mid-August.
Day calls it an "inauspicious" plant that thrives under the wet conditions that Ontario and Quebec experienced in July.
The plant begins pollinating in mid-August and will continue to do so until the first frost.
Dr. Richard Weber, chair of the American Academy of Allergy, Asthma and Immunology, said allergists in the eastern and midwestern states, and the eastern middle part of Canada, see lots of problems with late summer ragweed hay fever - and he adds that global climate change could be making things worse.
"Ragweed, for allergists, well we don't want to say it's the motherlode, but it's certainly a very important aero-allergen," he said from Denver, where he's a professor of medicine at National Jewish Health and the University of Colorado.
"We know that it carries long distances, we know that the pollen grains themselves are loaded with some very strong allergenic proteins, and they rapidly elute out of the pollen grains," he said.
"And it's a pretty common sensitization in allergic people. So it's probably always been considered one of the bigger allergy hitters in North America."
In a paper published this month in the Journal of Allergy and Clinical Immunology, Weber said there's evidence that climate change will have an impact on the ragweed plant.
"The impact is ... that increased temperature and CO2 result in a more brisk growth of the plant," he said.
"So that there is more above ground, what's called biomass, which is basically the size of the weed. They're bigger, they pollinate earlier, so they start releasing pollen quicker, and there are more pollen grains that are released."
"It kind of gets a leg up because it's developing a little bit faster than perhaps some other weeds."
People allergic to ragweed can expect that they'll be suffering earlier and longer, he said.
"Whatever has worked for them before hopefully will continue to work. Whether that's taking just over-the-counter antihistamines, or whether that's talking to their physicians and getting nasal steroid sprays, which are the most effective thing for treating hay fever, or some eye drops as well if necessary."
"They may have to be a little more religious in how they use their medications."
Day said some people opt to take immunotherapy shots, which are highly effective but inconvenient because the treatment involves going for a needle on a monthly basis for a year. The therapy involves stimulating the immune system with gradually increasing doses of the substances to which a person is allergic.
In Europe, instead of shots, allergy sufferers can have sublingual therapy, in which concentrations of the allergen are placed under the tongue. Weber said it will likely be a few more years before the Food and Drug Administration approves it for the United States.
Adams said he just uses antihistamines when he needs them during ragweed season. As for his contribution to the science of finding new treatments, he does it because he enjoys watching how the research is done.
"I find it to be very interesting, the whole process of it, sort of being the guinea pig," he said
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