What is allergy?

In allergic individuals the body starts producing increasing amounts of an antibody called ‘immunoglobulin E (lge)’ in response to exposure to common harmless environmental substances that it recognizes as ‘allergens’ (antigens). Allergens can be inhaled (pollens, dust, moulds, fungi, animal dander), eaten (egg white, milk, nuts, shrimps, fish, wheat or rice), injected (bee stings or drugs) or they can come into contact with the skin or eyes (dust, pollens, animal dander, moulds).

Allergy can manifest itself in many different forms:

  1. Allergic Rhinitis – An inflammation of the mucous membranes of the nose resulting from exposure to an inhaled allergic trigger. Common symptoms include bouts of sneezing, runny nose, stuffy nose and itchy nose.
  2. Asthma – An inflammation of the lower airways presenting with difficulty to breathe. Key symptoms include coughing, shortness of breath, wheezing and tightness of chest.
  3. Atopic Dermatitis – Sometimes called “the itch that rashes”, atopic dermatitis is a red, inflamed rash most often seen on arms, legs, ankles or neck. Atopic dermatitis often start in the first year of life. Between 80 and 90% of children who have atopic dermatitis show signs before the age of 7.
  4. Conjunctivitis – An inflammation of the whites of the eyes and the inner eyelid surfaces. It manifests as redness, tearing, stinging and watery discharge from the eye.
  5.  Anaphylaxis- A life threating allergic reaction, usually present as a medical emergency manifesting as obstruction of the upper airways, difficulty in breathing, wheezing and a sudden fall in blood pressure (shock). It occurs due to a reaction to the sting of bees and also drugs like penicillin.
  6. Food allergy – Several food items like egg white, milk, peanuts, shrimps, wheat and rice are capable of inducing allergy in select patients. It manifests as itching of the throat, vomiting, abdominal pain and diarrhea.
  7. Occupational allergy – Allergy that is caused by exposure to a product in the workplace. It can affect many target organs like the lungs, nose, eyes, and skin. Certain metals and latex are among the allergens that can cause
  8. occupationally allergy.

Is there a cure for allergy?

True cure is possible only when we can prevent the body from producing increased amounts of immunoglobulin E to the common environment allergens (e.g. pollens, dust mites), in other words preventing the body from mistaking something harmless for something harmful. However, allergies are terrible and to a large extent the symptoms can be suppressed with currently available medications.

Your doctor is the best person to advice you on ways to make your life as an allergy sufferer more manageable and thus improve your quality of life.

Is it a cold or nasal allergy?

Since the symptoms of nasal allergy are similar to those of common cold, sometimes it may difficult to distinguish between the two. Answering these questions might help you differentiate them.

Do you have a fever?

A fever may be present with a cold but never with allergies alone.

Do your eyes and nose itch?

In nasal allergies you may have itchy eyes and nose. In colds you don’t.

Do your symptoms last for more than 7 to 10 days?

Cold symptoms usually last for less than 7-10 days. Symptoms of nasal allergy can last for weeks or months.

Do your nasal symptoms appear to be seasonal?

If you have nasal symptoms at the same time every year, then actually you have nasal allergy.

What is allergic rhinitis?

In Allergic Rhinitis the inside of your nose gets swollen and inflamed. As a result, you may experience nasal allergy symptoms, such as sneezing, congestion (stuffy nose), runny and itchy nose.

Common symptoms of Allergic Rhinitis are:

  • Sneezing (usually sudden & strong)
  • Runny & itch nose
  • Red, watery & itchy eyes
  • Breathing through mouth

In addition, conditions such as Asthma, Nasal Polyps (small growth of tissues in the nasal cavity), Sinusitis (infection of sinuses), Otitis Media (infection of middle ear) and difficulty in breathing may also be associated with rhinitis.

If you sneeze and have a runny nose or nasal congestion only at certain times of the year, you probably have seasonal allergic rhinitis (your triggers are outdoor substance such as: tree, weed or grass pollens, outdoor mold and spores), but if you suffer from nasal allergy symptoms all year long you probably have perennial allergic rhinitis.

What causes Allergic Rhinitis?

If you have nasal allergies, immune cells in your nasal lining overreact to certain “allergic triggers” that you breathe in through air. Substances that cause an allergic response are called Allergens. These include seasonal nasal allergy triggers such as pollen and year round nasal allergy triggers such as dust mites, animal dander and mold spores.

How Nasal Allergies are treated

  1. Environmental controls: which are ways of avoiding your triggers. The most effective way to manage nasal allergies is to avoid the allergens and irritants that trigger your nasal allergy symptoms.
  1. Appropriate medication: Taking tablets and nasal sprays. The type of medication recommended by your doctor will depend on the severity and frequency of your nasal allergy symptoms, your lifestyle and your medical history. The main class of medications are:
  2. Antihistamine tablets – Effective but can cause drowsiness.
  3. Decongestant tablets – may also be helpful in reducing symptoms such as nasal congestion, but should not be used for long periods.
  4. Nasal corticosteroid sprays – very effective and safe.

Take your prescribed nasal allergy medication

Makes sure you follow your doctor’s exact directions when it comes to taking your nasal allergy medication. This includes:

  • Taking the right amount of medication.
  • Taking the medication at the right time, and as often as you’re supposed to.
  • Continuing to take the medication for as long as your doctor directs.

Keep in touch with your doctor

Your nasal allergy care and planning should always begin with your doctor. He or she has the expertise to develop the best plan of care for you and your nasal allergies. So, it is essential to keep talking/meeting with your doctor on a regular basis.

Allergic rhinitis is an inflammation of the mucous membrane of the nose.

  1. It occurs an allergen (an allergy-producing substance, such as house dust mite or pollen) causes the body to defend itself by producing antibodies.
  2. When the allergen and the antibody combine, the body responds by releasing certain chemical substances like histamine, leukotrienes and prostaglandins in the nose.
  3. As a result you may experience nasal symptoms like sneezing, congestion, itchy and runny nose, and itchy and watery eyes.

Our immune cells in nasal mucosa overreact to certain “allergic triggers” that you breathe in through air. Nasal allergies can have a disruptive impact on your life.

What are the things in your environment that can cause allergic rhinitis?

Some of those common allergens that are trigger factors for allergic rhinitis and asthma are:

  • House dust mites
  • Pollens (tree, weeds and grass)
  • Moulds
  • Animal dander (cat, dog, horse, rabbit)

Triggers of seasonal allergic rhinitis are usually tree, grass or weed pollen, in this type of rhinitis, symptoms occur during the pollen season although in tropical climate allergenic pollens may cause symptoms throughout the year.

The factors that aggravate allergic rhinitis?

There are genetic factors that predispose to the development of allergic rhinitis, exposure to certain environmental factors or occupational pollutants can contribute significantly to the risk of developing the disease.

Indoor factors:

  • Tobacco smoke
  • Nitrogen dioxide from gas-fired ranges and ovens
  • Kerosene combustion and wood smoke
  • Formaldehyde used in building material
  • Indoor environment – modern changes in housing standards like tightly sealed buildings, wall to wall carpeting and central heating are optimal environment for allergens like dust mites to survive.

Outdoor factors:

  • Diesel exhaust particles from motor vehicles emissions
  • Nitric oxide
  • Ozone
  • Sulphur dioxide release from coal combustion
  • Carbon monoxide

Occupational Pollutants

  • Di-isocynates used in spray painting
  • Hexachlorplatinates – intermediates in refining of platinum

Co-morbidities of allergic rhinitis

Asthma

Asthma and allergic rhinitis often co-exist, with up to 40% of rhinitis patients suffering from asthma.

Otitis Media

Ear disease that occurs due to inflammation and swelling of the eustachian tubes that connect the inside of the ear to the nose. The earliest signs are usually ear fullness and pain.

Sinusitis

Inflammation of the sinuses that occurs due to viral, bacterial or allergic triggers. Common symptoms comprise pain in the forehead, teeth or face, coughing and thick, dark yellow or greenish nasal discharge.

What are allergy tests?

There are two types of allergy tests. One is a test done with blood samples collected from the patient, and the other skin testing.

Skin prick test

This is the most commonly used allergy test that measures allergen specific lgE attached to most cells in the skin. The skin prick test is quit safe and patient of almost any age group can be tested. However, in some elderly patients the skin may not be capable of reacting and therefore the skin test is of no value.

Positive Reaction

A positive reaction is depicted by a wheat and flare reaction. Basically, the skin becomes itchy within a few minutes and then becomes red and swollen with a ‘wheal’ in the centre and a ‘flare’ surrounding it.

Negative Reaction

A negative response to a skin prick test usually indicates that the patient is not sensitive to that allergen.

Blood test

The blood test measures the amount of allergen-specific lgE antibodies in the blood. The test is carried out using a small sample of blood, which is usually taken from a vein in the arm.

Positive Test

The results of blood tests to measure serum specific lgE are expressed in grades from class 0-6, where increasing classes indicate increasing sensitivity to the causative allergen.

  • Class 0: Negative
  • Class 1: Low
  • Class 2: Moderate
  • Class 3: High
  • Class 4-6: Extremely high

Treatment strategy for allergic rhinitis?

The first step in the treatment strategy for your allergy is to avoid the allergen. The following steps should be taken in order to control your allergies:

  1. Allergen Avoidance
  2. Medication
  3. Immunotherapy(allergy vaccines or allergy shots)
  4. Surgery

You cannot prevent the development of allergy, but you can prevent an allergic reaction with these most effective methods:

  1. Allergen Avoidance

Pollens and outdoor avoidance

  • Stay indoors during the midday and afternoon when the pollen count is high.
  • Use air conditioning, if possible.
  • Keep windows closed during seasons when pollen and mould counts are highest.
  • Avoid sources of moulds (wet leaves, garden debris).
  • Use face masks and sunglasses when moving out during the pollen season.

House Dust Mites

  • Encase your matters and pillow in a mite impermeable encasing.
  • Avoid sleeping or lying on upholstered furniture.
  • Wash your bed covers, clothes, and stuffed toys once a week in hot water.
  • Remove carpets.
  • Use mask while dusting.

Animal Dander

  • Remove the animal from the house
  • Keep the pets out of bedroom at all times
  • Wash the pet weekly.
  • Avoid visits to friends or relatives with pets.
  • Avoid products made of feathers, like pillows and quilts.

Cockroach Allergen & Indoor Moulds

  • Use insect sprays but have someone else spray when you are outside the home.
  • Air out the house for a few hours after spraying.
  • Use cockroach traps.
  • Keep bathrooms, kitchens, and basement clean & well aired.
  1. Medications

Antihistamines –

These are effective in reducing nasal symptoms of itching, sneezing, and runny nose but are not vary effective for reducing nasal congestion. Older antihistamines can cause side effects that include drowsiness, dizziness, and blurred vision etc. However, most of the newer antihistamines are devoid of these side effects.

Decongestants –

Can give quick but short-term relief for nasal congestion. Many decongestants promote histamine release and this can cause a “rebound” effect that ultimately makes nose even more congested tan before. Therefore, topical decongestants should not be used for more than 10 days at a stretch.
Topical Nasal Steroids –

It helps to reduce inflammation in the nose. By treating the underlying cause of nasal allergy, nasal steroids provide relief from sneezing, runny nose, stuffy nose and nasal itching. Occasionally, topical steroids can cause a nose bleed, some throat irritation or cough. Often correct administration of the nasal spray not exceeding prescribed doses may prevent these side effects.

How to use nasal sprays:

  1. Blow your nose gently to clear your nostrils.
  2. Shake the medicine container gently.
  3. The first time the device is used, prime the pump while pointing the nasal applicator away from you.
  4. Keep your head upright.
  5. Press a finger against the side of your nose to close one nostril.
  6. With your mouth closed, insert the tip of the pump or inhaler into the open nostril while keeping the bottle upright.
  7. Sniff through the nostril while quickly & firmly pressing down on the pump release the spray.
  8. The spray should be administrated upward into the nasal cavity & not against the walls of the nostrils.
  9. Hold your breath for a few seconds & then breathe out through your mouth.
  10. Repeat this procedure for the nostril only if directed to do so.
  11. Immunotherapy

Allergen immunotherapy, or allergy vaccines also known as ‘allergy shots’, may be recommended for persons who don’t respond well to treatment with medications, experience side-effects from medications or have long term allergen exposure that is unavoidable. It consist of injections of a diluted allergen extract, administered frequently in increasing doses until a maintenance dose is reached. This helps the body build a kind of tolerance to the causative allergen, reduces the intensity of symptoms caused by allergen exposure, and can also prevent development of new allergies.

Surgery

Surgery is indicated in select cases of severe nasal blockage which do not improve with medication or immunotherapy.

Special considerations in children

Allergic rhinitis is the most common chronic condition worldwide in children under 18 years of age. In addition to causing nasal symptoms, nasal allergies can disturb your child’s sleep, school performance and overall mood. Along with your child’s doctor, you play major role in lessening the burden of allergy symptoms in your child. Basically, the drugs used in the treatment of allergic rhinitis for children are similar to those for adults except that the doses are different.

Dispelling some myths about nasal allergies
1.   Moving is a good way to cure allergies

You may think that seasonal nasal allergies will disappear if you move to a different climate. While the place you move to may not have tree, weed or grass that you are allergic to, it may have other types of pollen mould. You may develop a sensitivity to these other pollens and moulds in time.

2.   Allergies are all in your head

Allergies are a real medical condition that affects the immune system. Emotional stress may worsen symptoms, but allergies are not caused by emotions.

3.   Short-haired pets are better than long haired pets

If you are allergic to cats or dogs, you are allergic to the saliva, urine or dander and not the hair. The best way to relieve symptoms is to keep the pet out of your environment.
4.   Allergies are harmless

Allergies are a serious problem and should be treated that way. If left untreated, nasal allergies can lead to other serious fatal complications like asthma