Allergy Information

What is Allergy?

Allergy is an adverse immune reaction to an allergen (or protein) in our environment, which is normally harmless to the non-allergic person. Or simply put it is hypersensitivity to foreign substances which are normally harmless but which produce a violent reaction in the allergy sufferer.

Allergy develops after repeated exposure to the causative allergen. Sensitization takes place on initial exposure (a process that may take up to 6 weeks to develop) and no adverse reaction appears to occur during this sensitization. On repeated allergen exposure, the full-blown allergic reaction will occur some time later.

During initial exposure (sensitization), Antibodies (IgE) are produced by our white blood cells and on re-exposure these IgE antibodies bind the allergen and attach to Mast Cells, which release Histamine. Histamine triggers the beginning of the Allergic Reaction, which may manifest with anything from a mild itch of the skin, Wheeze, anaphylaxis and to death. Late phase reactions also may follow 6 to 24 hours later with Inflammation and tissue swelling.

Symptoms of Allergy:

It may present as mild itching of the skin, wheeze or even progress to full-blown reaction and death
The most common of these problems is hay fever or allergic rhinitis in which the patient suffers from nasal congestion, running nose, sneezing, nose and eye itching and a post nasal drip. Patients also complain of loss of smell, loss of taste and nasal bleeding.
Typical allergic reactions are hay fever, asthma, allergic cold, recurrent sinusitis digestive disturbances, conjunctivitis, urticaria, eczema, allergy to Medication such as Penicillin.
Almost any substance can cause allergy in an individual. Common allergens include house dust, pollen, certain foods, especially milk, wheat and eggs, pollens, moulds, cosmetics and certain food additives.
Exposure to house dust, a major cause of year long suffering, intensifies as people head indoors for winter. Symptoms of an allergy to house dust are often mistaken for colds as they include running nose, nasal congestion, itchy and watery eyes.
House dust has been suspected as an allergen for many centuries, but was formerly seen as a simple substance. Today, its complexity is recognized – a conglomeration of living and non-living material including fabric fibers, animal dander, food particles and insect remains.
“Mattresses contain the highest concentration of dust mites, whose primary food source is flakes off human skin. The tiny creatures are also found in pillows, clothing, carpeting and upholstered furniture.”
Most people cannot control the dust conditions where they work or spend their daytime hours, but to a large extent everyone can eliminate dust from their bedroom. This is the single most important and effective step in treatment but it can become a costly exercise.
When symptoms suggest an allergy to dust mites, it will be less expensive to see an allergist for testing for the specific allergen than to entirely refurbish the bedroom on the suspicion that dust is at fault.

Who gets Allergy?

Only a small proportion of the population exposed to an allergen will develop an allergic reaction. Some families trend to develop allergic sensitization because of genetical transmission.

Why did I become Allergic?

The cause of allergy seems to be an entangled web of 3 factors – genetic predisposition, environmental triggers and locally found protein allergens.
Your genetic background plays a major role – family history of allergies is highly significant, smaller families with fewer children favour the development of allergy. Males are more likely to develop allergies than females, and prenatal maternal diet and smoking seem to play a role. Obesity also seems to be a risk factor for developing allergies.

The home environment in the first year of life is very important. Parental cigarette smoking triggers allergy, Infant diet and early introduction of allergenic foods may play a role. Air Pollution has been implicated; early use of day-care institutions, early use of broad spectrum antibiotics and birth just before the spring pollen season all seem to promote allergic sensitization. Living near a farm especially livestock farming seem to prevent allergies developing. This highlights the “hygiene theory”, whereby children living the so-called “clean western lifestyle” are at greater risk for developing allergy. Recent studies suggest that heavy exposure to dog and cat allergens in the home may actually prevent allergies developing in infants (they suggest having two or more pets in the home!)
And finally, modest exposure to the local aeroallergens and allergenic foods in conjunction with the other factors leads to sensitization in early life and clinical allergy then develops. Evidence now exists for very high allergen exposure during early life having a “protective” effect (for example to cats and dogs). However, minimal exposure during the first year of life is still the recommended “rule of thumb” for allergy prevention.

The Allergic March.

The Allergic March is the term used to describe the chronological progression of one clinical manifestation of allergy to the next. Early life allergy under the age of 3 years usually involves eczema and food allergy, this usually resolves as asthma develops in the middle childhood years. As asthma begins to stabilize, allergic rhinitis becomes a common manifestation of allergy in the adolescent years. Asthma often returns at about the age of 40 just as Hay fever is settling down.

Pseudo-allergic Reactions

Reactions to food additives such as Colouring agents, Preservatives and Flavorings are not IgE mediated, their mechanism is largely unknown.

Food Allergy:

Allergic reaction to foods varies from person to person. One particular food when allergic to somebody, you may not have the same type of allergic reaction. Allergy is there in genes.
Food allergic reactions may vary from immediate itching or swelling of the lips and/or tongue, to hives, coughing and wheezing. These reactions usually happen within a few minutes after eating the food, sometimes up to an hour. Sometimes food allergies may cause stomach cramping and diarrhoea hours later.

Food allergies can be life-threatening, especially if one is allergic to shellfish or peanuts. You know the icon of martial arts Bruce lee died of some food allergy, a form of shellfish used by Chinese for headache caused the death of the real hero.
Unfortunately, there are no safe and effective forms of allergy treatment for food allergy at this point of time. The only treatment is to avoid them.

What is “food intolerance”?

You must be careful to differentiate between “food allergy” and “food intolerance.” Per example, people have gastrointestinal symptoms upon eating milk products that means they are having lactose intolerance which is causing the symptoms. Other examples of food intolerance include a runny nose from eating spicy foods or headaches from drinking wine.

Environmental Allergy:

Your home, workplace, school or outside environment may contain substances that can cause an allergic reaction. These environmental allergens are

• Dust.
• Dust Mites.
• Animal dander (mostly cats, dogs).
• mould spores or pollen.

Pollen allergies usually occur in certain seasons when more concentration of pollen exists in the environment, and is called seasonal allergy. Other substances cause allergy problems all the year called perennial allergy.

Allergy treatment becomes harder as the true allergy to dust mites, mold or pollen is superimposed on the non-allergic effects of the pollution, ozone and humidity. That means you should pay equal attention to avoid dust mites that you are allergic to, and to avoid non-allergic triggers (e.g. cigarette smoke, perfume, etc.) and to seek medical help.

Drug Allergy:

Drug allergy is also a common allergic reaction that many people experience to prescription and over-the-counter medicines. Adverse allergic drug reactions present with body rashes, itching, swelling and wheeze.
Adverse drug reactions can be divided into three groups:
Not related to the drug at all: these are but coincidental and related to factors other than the drug. Rashes, headache or nausea are associated with the disease and not the medication.
Side effects: these are caused due to taking excess dose or due to interactions between other medicines taken at the same time.

Less common and unpredictable reactions: allergic reactions that involve the immune system that may be either immediate or delayed.

Drugs which cause allergies:

• Allergic drug reactions may vary from minor rashes to severe anaphylactic reactions. Common
• medications causing allergies.
• Antibiotics – penicillin, cephalosporins, sulphonamides, tetracycline, chloramphenicol, quinolones.
• Aspirin and anti-inflammatory drugs.
• heart and blood pressure drugs – ACE inhibitors, quinidine, amiodarone, methyldopa.
• aspirin-related drugs – diclofenac, ibuprofen, naproxen, indomethacin.
• radio-contrast fluids given intravenously during x-ray.
• anaesthetic drugs – muscle relaxing drugs, thiopentone, halothane.
• morphine-type opiate family – morphine, pethidine and codeine.
• cancer chemotherapy drugs – cisplatin, cyclophosphamide, methotrexate.
• antiseptic solutions – chlorhexidine, iodine.
• vaccines such as tetanus toxoid and diphtheria vaccine.
• preservatives and colourings in medication such as sulphites, benzoates, parabens and tartrazine.
• Anti-epileptic, anti-tuberculosis medication, heparin, insulin, enzymes and latex.

Why Drug allergy testing is difficult:

To confirm a drug allergy, initially intradermal skin testing has to be performed followed by a specific Drug Challenge test in a hospital setup. This procedure is very time consuming and expensive and may trigger a more severe allergic reaction and lead to more complications.

What are Drug Allergy Symptoms:

Most drug allergic reactions occur rapidly and may cause body rashes, itching or swelling. Sometimes a severe life-threatening drug allergic reaction may occur causing fever, joint pains and generalised skin blistering with peeling. It may occasionally progress to life threatening anaphylaxis and even death. Delayed reactions can occur later after 2 weeks after the drug exposure with generalised skin rash and swelling and damage to vital organs such as the kidneys, liver and blood cells.

Drug allergy treatment:

Stop the implicated drug immediately, followed by strong antihistamine medication and then consult your doctor or nearby physician immediately.
Prevention of drug allergies
If you are allergic to a group of drugs like penicillin or aspirin, then all other members of that group should be avoided. Use the alternative medications. And always inform your doctor when you meet him for any heath problem purpose.

Anaphylaxis:

Anaphylaxis or anaphylactic shock is a sudden catastrophic allergic reaction that usually occurs within minutes of exposure to the offending allergen and involves the whole body. Insect stings, shellfish, nuts and medication are common causes of this type of severe allergic reaction.
The first documented evidence of anaphylaxis was in 2641 BC, when King Menes of Egypt died from a Wasp sting.
About 1 in 1000 people attending Emergency of hospitals are because of some form of anaphylactic reaction. The number of new such cases seems to be rapidly increasing day by day possibly because of changes in our life style, diet and environment. Nut Anaphylaxis was first documented only 20 years ago.

Anaphylaxis causes:

Though one cannot find the exact cause of anaphylaxis, we know that the most common cause of anaphylaxis is from food allergens like nuts, peanuts, eggs, milk, fish and shellfish. These foods account for 90% of cases of food induced anaphylaxis. Peanuts and tree nuts like Almonds, Walnuts are most likely to provoke a severe allergic reaction. Sometimes drugs such as penicillin, codeine and aspirin may cause anaphylaxis. Medicines like muscle relaxants, antibiotics, x-ray contrast medium and injectable medications including anaesthetic agents may also cause this reaction.
Some people will have so severe reaction that even eating small amount of that particular allergic food can cause anaphylactic shock.
Exercise Induced Anaphylaxis occurs when exercising shortly after ingesting the allergic foods like wheat, apple, hazelnut, squid or chicken.

Anaphylaxis symptoms:

Anaphylaxis is an emergency condition and should be treated as an emergency as the symptoms of breathlessness and shock develop so rapidly that if you not treat it on time, it may lead to disaster. Emergency treatment consists of an injection of adrenaline or epinephrine, which raises blood pressure instantly, relieves breathlessness by reducing swelling of soft tissues in the throat. the affected people normally recover very quickly once the adrenaline is given. They should also be given immediately a dose of antihistamine and a short course of steroid tablets to prevent the recurrence of the reaction (biphasic response).

If you are a known anaphylactic person, be sure that having Adrenaline Injector all the time with you 24×7. In future and use it immediately whenever required as delay puts you at risk of collapse and death. Although people carry adrenalin auto injector, the common cause of death is failure to use it. So be ready with full information and knowledge about it and be daring enough to use it with a trained practice of self-administration. Always take antihistamines like levocetrizines and monitor the situation for a few minutes before taking adrenaline as milder symptoms usually resolve over the next few minutes. And later seek for doctor’s help at any emergency care of a hospital for at least 4 hours for observation.

What can you do at an Anaphylaxis Emergency:

If the person is conscious and having mild symptoms of breathing difficulty, help him to get medications.
If the person is shocked with low blood pressure, they should be kept lying flat with their legs rose.
If the person is unconscious, check their airways and breathing and kept them in the recovery position left or right turning. Check for asthma inhaler, if there, administer it. Check for a preloaded adrenaline syringe; inject it into the muscle of the thigh. And call emergency helpline for ambulance.

Asthma:

Asthma is a chronic inflammatory disease that makes your airways (bronchial tubes) particularly sensitive to irritants or allergens. During an asthma episode, an individual might experience shortness of breath or wheezing or tightening in the chest or cough leading to difficulty for the asthma patient to move the breathing air in and out of the lungs.
Asthma affects people of all ages and is closely related to allergy. However, it is commonly seen in children and reoccurred again in elderly.
Triggers of Asthma

What actually triggers asthma can vary greatly from person to person. Commonly allergens, but may also be such other environmental factors as:

• Air pollution.
• Dust mites.
• Tobacco smoke.
• Strong odours.
• Wood smoke.
• Pets.
• Mold.
• Weather changes.
• Stress or illness.
• Emergency Treatment.
• See anaphylaxis.

Diagnosing Allergy

Allergy Diagnosis and Tests

Our Allergy super speciality clinic offers comprehensive allergy management to help in the diagnosis and treatment of allergy problems
The ideal way to manage an allergy is to avoid the substances that cause the allergic symptoms. It is, therefore, very important to first identify the substances (allergens) causing the allergic reaction.

The patient’s description of their allergy and careful questioning by the doctor goes 90% of the way to a correct diagnosis. This is usually followed by a brief examination of the relevant organs such as nose, eyes, lungs, glands and skin. Allergy tests are done to confirm the suspected allergy detected from the history.
Once diagnosed, you need to understand nature, causes and the implications of the allergy which will make future allergy control much more successful. A follow-up consultation is helpful as it provides an opportunity to discuss problems associated with the allergy and to reinforce the need for treatment.

Specific Allergy related Immunoglobulin E (IgE) is the antibody found in our blood and tissues which mediates allergy. Allergy sufferers have raised levels of IgE and it can be measured in the blood by RAST tests and also with Skin Prick Tests.

What allergy confirmatory tests are available to us:

We can perform Skin Prick tests for common Inhalant and Food allergens or measure Total IgE in the blood. Over 450 individual RAST tests are available. We can measure another allergy cell, the eosinophil in the blood, in the sputum and also in nasal samples.

1.Skin Prick Testing:

This is one of the oldest allergy tests and is the cornerstone of primary allergy diagnosis. This test is still the most highly sensitive allergy test available. It tests for specific IgE antibodies to inhalants including House dust mite, pollen, cat and dog dander but can also be used to test for food, venom and drug allergy. A positive result is a typical raised wheal and red flare reaction on the skin. The results are immediately available. It is used to either diagnose or exclude a specific IgE mediated cause for the patient’s allergic symptoms.

How are the tests performed:

We use standardized glycerinated extracts of the various allergen extracts such as House dust mite, tree, grass and weed pollen and fungal spores. There is also a negative control (for reference).

The reactions are read after 15 to 20 minutes and a positive reaction should have at least 3mm of raised wheal. All oral antihistamines should be avoided for 2 – 3 days before hand, as they suppress skin reactivity. The kit has a six-month shelf life and should be stored in a refrigerator.

2) Allergy-confirming blood tests- RAST

There is the original old Total serum IgE blood test, which has been superseded by the newer multi-allergen screening tests. The inhalant allergy screen is called a UniCAP Phadiatop, There are over 450 individual RAST (Radio Allergo Sorbent Test) available for everything from sheep dander to sesame seeds. These are now called Unicap RAST tests and measure specific IgE in the serum to different food allergens. To simplify matters, there are various screening panels.

The advantages of this new test include improved accuracy, better safety and being less invasive.

Allergy Treatment

Allergy Prevention:

Allergy Management at MicroCare ENT Hospital and Research Institute is greatly helped with the identification of the cause for the allergic symptoms. Once the triggering allergen has been identified, we at MicroCare ENT Hospital advices to institute avoidance measures and try to remove the allergen from the environment. This will reduce symptoms. In addition, symptom control may be attained with the aid of anti-allergy medicines.

ENT Hospital, Hyderabad, India has become only ENT hospital in India to treat all three nose conditions under one roof i.e. nose allergies, nose sinus problems and nose cosmetic operations. MicroCare ENT Hospital is well equipped with all advanced ENT equipment to treat all ENT conditions.

Methods to control exposure to dust at home:

• Allergy team at MicroCare ENT Hospital advices the following measures to control the dust.
• Remove any rugs and carpets. For dust-sensitive people, bare hardwood or vinyl floors are preferable. If it is impossible to remove carpeting, a low pile is recommended
• Clean regularly. Most people spend a third of their lives in the bedroom; therefore, it is necessary to put on a dust mask and vacuum the room vigorously every day, and clean thoroughly every week. Throw rugs are better than carpeting, because they can be washed weekly in hot water. Products that kill mites are available and include benzyl benzoate to decrease the presence of the allergen in carpets.
• Keep humidity low. Avoid humidifiers, because dust mites multiply in a humid environment.
• Dust-proof the bedding. The bed should have mite-proof covers that completely encase the mattress and pillows. This is necessary even if the bedding is new.
• Discard any feather or down pillows or quilts. Hypoallergenic pillows and washable blankets are preferable.
• Eliminate other dust-catchers. If possible, remove all upholstered furniture, drapes, old books and newspapers, stuffed animals, even knickknacks. Use wooden or metal chairs, and lightweight fabric curtains.

Allergy Immunotherapy:

Desensitization Immunotherapy or Allergy Shots using allergen extracts is the only possible method for curing a specific allergy. MicroCare ENT Hospital & Research Institute is proud to be part of the world’s latest treatment of nose allergy.

Complementary Treatments:

Treatments commonly employed by complementary medical practitioners in allergy treatment.

Homeopathy:

Homeopathy was devised by Hahnemann in the last century and is based on the law of similar – like cures like. Homeopaths believe that any substance that produces symptoms similar to the symptoms under treatment would actually cure that same disease if taken in minute doses. Treatments are usually individualized for the specific patient and not the disease. The British Society for Allergy and Clinical Immunology (BSACI) recently issued a position statement in which it concluded that there is inadequate evidence for any benefit from homeopathy in treating allergic disorders.

Acupuncture:

Acupuncture is an ancient Chinese form of treatment that involves inserting tiny needles into specific meridians or areas of the body. It has been found to be particularly useful for pain relief and the practice has grown remarkably in recent years. Claims that the use of acupuncture is useful in treating allergies in general are not based on well-performed clinical trials. Some studies have shown a small but temporary improvement in wheezing when acupuncture was employed.

Auyrveda:

Many plants have therapeutic properties and one only has to remember that. Herbal remedies such as the Ma Huang plant (Ephedra sinica) which contains ephedrine has been used to treat asthma for 5000 years but there is very little evidence that herbal medicines in general confer any major benefit. In some cases they may even be hepatotoxic.
Dr. Vinnakota Sriprakash MS ENT, MicroCare ENT Hospital advocates allergy immunotherapy as it is the EVIDENCE BASED and the treatment given for the specific allergen known after the allergy test.

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