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THANK YOU!
Thanking all of you for your support and following my blogs for this year’s World Allergy Week
Hoping for a better world free of allergies!
World Allergy Week 2019: Immunotherapy : Modifying Allergic Disorders
We have have started the discussion for treatment of allergic disorders in the previous post.
Allergy testing has been discussed . Once the type and cause of allergy has been determined, what should be the treatment for the same.
The primary treatment of allergy is to avoid the cause of allergy
In case of food allergies, this is quite possible
Maintain a diary for food.
- On avoiding a certain food for a week and re-introducing it, we can see whether it is the cause of allergy. If it is so, symptoms will show within half an hour.
- Certain foods can be avoided, otherwise lessened
- The patient should have a bracelet or carry a card informing of the food, allergies, in case they are causing severe reactions
In case of environmental allergens, environmental control is important
However, it is very difficult to control allergens such as pollen and dust mites due to travel, changing environment and obvious other reasons.
Symptomatic medication is effective only as long as the patient is taking it. Symptoms of allergy recur once the medication is stopped
Immunomodulators like Anti IgE therapy helps in severe cases of allergy, Monoclonal antibodies like Omalizumab, etc. Your allergy specialist will guide you on these medicines.
The other therapy of allergy is immunotherapy
- Immunotherapy is the only therapy which can modify the outcome of allergic diseases
- It’s effect is long lasting .
- It improves immunity and reduces the incidence of other allergies.
What is immunotherapy?
By immunotherapy we administer the problematic allergen in gradually increasing quantities. This reduces the sensitivity of the immune system to the allergen and the body gets adapted to it.
- It is completely natural.
- It is a biological product
- No pharmaceutical, steroidal or alternative medicine preparation is used
What are the types of immunotherapy?
There are 2 types of immunotherapy: subcutaneous and sublingual
Subcutaneous immunotherapy:
In this form of immunotherapy injections are administered below the skin
- It is said to be more effective than sublingual immunotherapy
- However, it requires multiple hospital visits for administration
- It is painful as multiple injections are required over a long period of time
- separate injections are required for separate allergens
- 30 minutes observation is advisable because of the risk of anaphylaxis. However, hypoallergenic allergoid preparations are available too
- It is best administered in a hospital with proper resuscitation facilities and an ICU backup
Sublingual immunotherapy:
In this particular therapy drops are administered below the tongue on an empty stomach, wait for a few minutes, then swallow. Do not eat or drink anything for an hour after doing so
- It is safe, and can be taken at home.
- Repeated hospital visits are not required
- It is as effective as subcutaneous immunotherapy.
- The drops are administered from twice weekly to daily dose as per the requirement of the patient.
What are the allergens chosen for immunotherapy?
Immunotherapy has to be effective. Each and every allergen tested positive does not require immunotherapy. so the allergen which has
- The strongest positive reaction
- Proven allergenicity
- Prevalence in the environment
- Clinical correlation with the patient’s history
Therapy of a single allergen is preferable than mixing of allergens.
What is the duration of immunotherapy?
Immunotherapy should be administered for 3-5 years for maximum efficacy
It’s effect lasts from 10-15 years or longer.
Your allergy specialist will be helpful in guiding you for what therapy is best for you!
World Allergy Week 2019: Emphasizing the importance of Allergy Testing
Allergies have not been given much importance in the past few years. The incidence of allergic disorders have gone up since then.
Till now medication used to be prescribed for allergies, and the patient used to be better as long as the course of medication was on, only to return when symptoms of allergies recurred after the course was over. The patients were explained that there was no solution for allergies but to continue with the medication and avoid dust, etc. Of late the importance of identifying and controlling allergens has been emphasized.
Why is diagnosis and treatment of allergic disorders so important?
- Allergies have found to be a major cause of morbidity and absence from work
- They compromise the Quality of Living due to their uncomfortable symptoms
- Activities are restricted due to allergic disorders, such as trekking in grasslands, etc.
- Job changes are required due to severe allergies
- Allergies can cause life-threatening disorders like Anaphylaxis!
The Allergic March: Allergies should be treated from early childhood.
- It starts with skin rashes and atopic dermatitis at an early age.
- If not treated properly it leads to sneezing which in turn leads to
- Asthma and other disorders like
- allergic conjunctivitis and
- Eosinophilic esophagitis
How to diagnose allergies?
Symptoms like sneezing, itching, runny nose, skin rashes etc. Worse after contact with things which are known to cause allergy. Even stomach upset and digestive disorders could be due to allergies.
Various tests are available for diagnosis of allergies
- Total IgE test: This is done fairly commonly but is not required. In countries with infection such as worm infestation this would be high. It does not predict the intensity of allergy
- RAST: It is not very reliable. various labs offering diagnostic tests on these basis should be approached with caution.
- Immunocap: this is the most reliable blood test for allergies in patients where skin prick testing is not possible
- Skin prick test This is the gold standard for allergy testing . It is simple, safe and very efficient in diagnosing allergies and prescribing immunotherapy.
- Oral food challenge test
- Provocation tests such as Asthma and nasal challenge test
How is the skin prick test done for allergies?
- Drops are placed according to serial number at 3 cm distance on the skin
- Pricking is done through the drops through the topmost layer of the skin. It is very light, painless and there is absolutely no bleeding and scarring
- After 20 minutes the reading is done. In case of allergies there will be a bump at the site of pricking. The bigger the bump, more severe the allergies.
- It is extremely safe, comfortable and can be done on an outpatient basis in routine hospital set up
- There are absolutely minimal risks and complications for the procedure
Allergy tests can be done for everybody starting from 2 years of age
Allergy tests should not be done in
- Patients known to have high risk of anaphylactic shock.
- Severe rashes or skin disorders-there would be no place on the skin
- Pregnancy
- Acute fever
- Immunocompromised patients
- Patients with dermographism-the interpretation of the result needs some special skills
Consult your allergy specialist in case you need to get an allergy test done.
Allergy tests are good markers for initiation of allergen immunotherapy.
World Allergy Week 2019: Focus on Controlling Environmental Allergens
In addition to other factors, our environment contributes a lot to allergies. We should be aware of what things can be controlled in our environment.
Pigeons:
There is a huge controversy regarding pigeons in metros. Pigeons are fed for religious purposes. this creates a lot of problems
- Pigeons clustering create a nuisance. The metro railway strictly instructs pigeons should not be fed near metro lines
- Their droppings and feathers can cause severe allergies, especially for asthmatic patients. The droppings on window ledges, etc can cause media for harboring fungi like aspergillus which themselves cause allergies. They are harmful for asthmatic patients
- Pigeons roost in skyscrapers and old buildings. They build nests on top AC units, window ledges, etc. Their nests are messy and unhygienic
- Pigeons harbour organisms which can cause chronic lung diseases
Tips to avoid pigeons:
- Install pigeon netting on windows and in balconies to restrict their entry
- Put barbed wire or glass shards to discourage pigeons from roosting in certain areas
- And first and foremost, discourage feeding of pigeons in residential and community areas.
Cockroaches:
Cockroaches are a huge menace for allergies.
- Cockroaches multiply quickly. They reside in crevices, in drains, in the kitchen, etc.
- Cockroaches love to hide in tight places. If a few cockroaches are visible outside, large numbers of them are hidden in your home.
- Cockroach dust, urine and feces are highly allergenic. Cockroaches spread a lot of diseases.
Tips to prevent cockroaches:
- Keep your kitchen and surroundings clean. Store groceries in properly closed containers.Spilled food and food particles attract cockroaches.
- Do a proper pest control.However cockroach allergens will be persistent for upto 6 months in the environment after that
- Get drains, etc cleaned regularly
Petrol and diesel fumes:
In the modern age it is difficult to escape from petrol and diesel fumes. They are highly irritant and aggravate existing allergies.To minimize this
- Do PUC and servicing of your vehicles regularly
- Car pooling and public transport reduce the incidence of petrol burning
Industrial and occupational pollutants:
- These vary from industry to industry. Cotton mills, textiles, etc cause chronic lung diseases due to fibres and fungus harboured on them
Cigarette Smoke:
- This is one of the most dangerous pollutant in our environment
- Smoking injures the delicate lining of the lungs and air passages
- Carbon particles and toxic chemicals get lodged inside our lungs
- Passive smoking is more harmful than active smoking. Your loved ones are suffering worse than you are !
Solution: Stop the habit!
Smoking is a major risk factor for early onset asthma and various lung diseases
Pollution inside your home:
Our homes are not spared from pollutants too:
- Deo spray: Reduce the use of room sprays and aerosols. They can trigger allergic attacks
- Insect repellant: Overnight plug ins and mosquito coils should be avoided, as the toxic fumes are released throughout the night. The insecticides are highly toxic and should be used with caution
- agarbattis: The smoke from incense sticks can cause trouble
- dust mites: They are discussed in detail in my previous blogs. Basic protective measures should be used to reduce them. https://nucareallergy.com/2018/07/19/dust-mites-tiny-but-troublesome
- Pets: Handling of pets should be minimized if you are allergic to them. Don’t allow them into the bedroom.https://nucareallergy.com/2018/08/31/should-fluffy-be-given-a-new-home-how-to-deal-with-pet-allergies
- Fungus or Molds: Proper measures should be taken place to minimize household fungi. https://nucareallergy.com/2018/08/26/latest-blog
Thus we can see that we are exposed to a variety of allergens in the security of our home!
Pollen allergy
Pollen allergy, or hay fever is more common in the warm spring and summer months
It is common in European countries during hay making time.
Due to Birch and pine tree pollen, it is fairly common in Canada and the united states
Due to warm climate following global warming, and longer summers the amount of pollen has increased in the air, increasing the incidence of hay fever
Information on pollen allergy are in my previous blogs.
https://nucareallergy.com/2018/07/26/am-i-allergic-to-pollen-in-the-city
World Allergy Week 2019:Dermatitis and Skin Disorders. Skin allergy patch testing.
With the ongoing cold and dry weather, skin disorders are coming up. With uncontrolled use of cosmetics, allergies to cosmetic products are on the rise too.
Patch testing is done for cosmetic products such as PPD and metals like nickel, chromium and various other chemicals.
TYPES OF DERMATITIS:
Contact Dermatitis: Contact dermatitis is when an outside allergen comes in contact with your skin and causes allergic and/or irritant response. Irritation to external chemicals is more common.
Sometimes the skin can become red and angry due to hypereactivity
A systemic response like extreme redness of skin, especially on the buttocks can be seen.
Contact Urticaria: When you get a typical wheal and flare reaction to an external allergen. In extreme cases you can get an anaphylactic shock.
Irritant Contact Dermatitis
The skin will look glazed, parched or scalded, with a sharply circumscribed margin. Once you remove the external irritating agent, healing will start.
Atopic dermatitis:
- There is a family history of atopy or allergic diseases
- It’s common in early childhood due to food allergies. The child may grow out of most of them or develop allergic rhinitis,asthma or allergic conjunctivitis later on.
- It is characterized by dry, scaly and itchy lesions, in early childhood and babies this is a rash on the face, back of joints
- In adolescents and young adults it is more common in the folds of the elbow and knee joints, armpit, groin, etc.
- It can be treated by avoiding the allergen, allergy skin prick tests to identify the cause. Local emollient creams help.
- Immunotherapy will help control the disease, prevent development of other allergies and prevent progress to further complications.
Seborrheic Dermatitis: It is common in areas like the scalp, face and chest. It is related to sebum or the greasy substance produced by the sebaceous glands in the skin.
- It is common in cold weather, and can be triggered by stress
- It is seen in infants, healthy young people, but can be common in people with Parkinson’s or HIV infection.
- It is not related to diet.
- It is caused because of a yeast like fungus in the skin.
Symptoms:
- Reddish areas covered with greasy looking white or reddish skin scales.
- In the scalp: It could result in mild flakes leading to dandruff, or a redder, scalier weeping rash. Cradle cap in infants could be due to seborrheic dermatitis
- On the face: It affects the inner part of the eyebrows, the crease on the side of the nose, and the cheeks. Eyelids can become red, sensitive and inflamed.(blepharitiS)
- Ears: the skin behind the ear can show reddish scaly lesions. the ear canal and Pinna too. It can lead to Otitis externa.
- Chest : Front of the chest.
- Folds: Elbow, armpit, knee, groin. In children the nappy area is affected.
Treatment: Treatment with seborrheic dermatitis has to be continued. Once you stop the treatment the lesions tend to recur
On the scalp:
- Remove dense scales with olive oil.
- Shampoos containing Zinc, selenium sulphide, or ketoconazole can be used. They should be kept for 10-15 minutes before rinsing them off.
- Sometimes a strong steroidal cream will help.
Over the body: Mild steroidal and antifungal creams will help.
Ear canal: Antifungal creams used in the ear canal and antifungal/steroidal ear drops.
- Application of olive oil can prevent, itching dryness and scaly lesions.
Regular use of a moisturizer or anti-fungal cream, shampoo, body lotion will help in control.
PSORIASIS: Dry silvery white scales like mica. On removal they leave a white patch with punctate bleeding.
Causes of Contact Dermatitis:
- Detergents are a very common cause of irritant contact dermatitis due to their strong caustic nature and they easily erode the skin barrier.
- Cosmetics, eye shadows cause allergy too.
- Transfer of nail polish to the eye and face
- Benzalkonium chloride, a preservative in medicated eye and ear drops is one of the common causes. Thimerosal and neomycin sulphate are other ones.
- Chemicals such as lanolin, coconut oil, etc
- PPD, Balsam of Peru, Parabens, colophony and many others
- Nickel, chromium and cobalt in costume jewellery
- The above can also be responsible for rejection in orthopedic joint replacement surgeries.Once you have allergy in the skin to these chemicals, a systemic reaction can occur.
- Ultraviolet light as exposure to sun Rays can worsen the reaction.
Occupational contact dermatitis is common in the following groups:
- Food handlers like cooks and caterers
- Health care workers
- Persons involved in cleaning
- Cosmetology
- Painting
- Heavy mechanics and assembling of parts
- electronics
- Construction
- Agriculture, Forestry and Fishing
- Printing and Lithography
PATCH TESTING FOR ALLERGIES:
In patch testing, chemical allergens and drugs are applied directly on the skin. They are left for 3 to 7 days. If there is an irritating lesion, from a mild rash to a severe reaction and vesicles, the patch test is said to be positive.
- Readymade patches are available which can be applied to the skin.
- The patches can be customised by using paste and applying pre cut linen patches covered by micropore or hypoallergenic dressing tape.
Instructions for patch testing:
- The patient should not be on oral antihistaminic, anti allergic or steroidal medication for at least 3 days before the patch test.
- Topical application of corticosteroids and lotions to the skin should be avoided for 3 days prior
- The patches are applied to the back or upper arm. During the period of the patch test the patient cannot take a bath or apply water to the patches.
- The patient should not sweat otherwise the patches will come off. The patch test is typically done in cold weather, as summers can cause sweating.
Treatment of Contact Dermatitis
- Avoidance of the chemical e.g. using long handled cleaning tools like wet mops and vacuum cleaners.
- Substitution wherever possible with a less allergenic chemical
- Job rotation so that periods of exposure are less
- Protective gloves, face shields, aprons, uniforms, eye wear, etc
- Emollient creams
Please contact your doctor for expert diagnosis and prescription of medication
World Allergy Week 2019: Food Allergies
In the past few years, Food allergies have gained a lot of importance. Dietary changes, lifestyle diseases and environmental changes have contributed a lot to food allergies.
Food allergies play a major role in asthma in early childhood.
What are the most important foods that cause allergies?
Allergy is caused by allergy causing proteins in certain kinds of food.
The big 8 foods causing allergies are:
Why are food allergies so important?
First and foremost, food allergies can be life threatening!
- People can be so sensitive to food that even a whiff of the particular food can cause a fatal allergic reaction called anaphylaxis. Traces of the food in the dishes or spoons used to serve another food are known to cause such a fatal reaction
- This is the reason why peanuts are not served on airlines anymore
What is anaphylaxis?
Anaphylaxis is an extremely severe reaction of the body’s immune system in response to an allergy causing substance. It is extremely common with food allergies.
It’s symptoms are:
- Anxiety, a feeling that something is not right
- increased pulse rate
- swelling of the lips , tongue and face leading to swelling of the voice box
- choking, difficulty in breathing
- collapse
Anaphylaxis can happen in seconds. It needs immediate treatment.
- Preferably allergy causing patients should carry bracelets or cards stating their allergies
- They should inform the hotel or other staff or wherever they are having food about their allergies.
- Most important, Epi-pen injectors should be carried by the patient at all times.
How is Epi-pen administered?
It is to be given deep intramuscular on the outer part of the thigh. Instructions should be followed as provided by the packaging . Correct procedure and sufficient time should be given for the medication to enter the body.
If you are diagnosed with severe allergies, your health care provider will give you instructions and training on how to use the above device.
How do I know if me/ my child has a food allergy?
Symptoms develop immediately after ingesting the particular food. they are
- Nausea, vomiting ,diarrhea, bloating
- rashes and itching
- urticaria and swelling of the lips and face
- stuffy and runny nose
- Even fatal reactions can occur
Food allergies can be detected by
- Skin prick testing
- Oral food challenge test. This has a high risk of anaphylaxis and has to be done in a hospital setting.
- small quantities of food are administered in increasing strength every half hour till the patient shows a reaction to that particular food. various trials are done and a placebo can be used to differentiate sometimes.
How to treat food allergies?
Prevention is better than cure
- Once the particular food allergy has been identified, the patient has to avoid it completely.
- Immunotherapy consists of administering small doses of allergens in increasing quantity till your body gets used to the allergen.
- Oral and sublingual immunotherapy is available for food, which is safer that subcutaneous immunotherapy. However, depending on the severity of the disease, therapy in food allergy carries a high risk of fatal reactions
- After success of immunotherapy, it is advised to continue the same food daily in small quantities to avoid relapse of the allergies
- Please conduct any immunotherapy only if advised under the strict guidance and supervision of your allergy specialist!
What is the difference between allergy and intolerance?
- Allergy is an overreaction of the immune system to a foreign protein
- Intolerance is the absence of enzymes required to digest the particular food, such as in lactose intolerance, or autoimmune disorder of the gut in gluten intolerance or coeliac disease.
- symptoms of intolerance are bloating, stomach upset, diarrhoea.
- intolerance can be treated by substitution of enzyme lactase, (sachets are available for this)in lactose intolerance and by totally avoiding gluten based products in coeliac disease.
World Allergy Week 2019: Allergic Rhinitis
Allergic rhinitis is a major disorder causing morbidity, disturbance in the quality of living and is a major reason for loss of days of work.
Symptoms of allergic rhinitis are
- sneezing
- running nose
- watering of eyes
- itching of eyes, ear and throat
- stuffiness of the nose
Allergic rhinitis can lead to breathing problems and asthma
Allergy symptoms can be controlled with medication. Consult your doctor for help.
What causes these allergies?
- Pollen: pollen allergies or hay fever are common, more in Europe and in the US, due to birch pollen. It is troublesome in the warm summer months when trees release their pollen in the air. Pollen is the mode of reproduction for plants and travels long distances in the air. Especially for plants with small flowers like grasses.
How to avoid pollen?
- Keep doors and windows closed especially early mornings and late evening when pollen counts are high
- wear a mask and full sleeve clothes while doing outside activities
- take a shower and put your clothes immediately for washing after spending a long time outdoors for work or games, etc, to remove pollen stuck to your body and clothes.
- get your allergy checked by allergy testing. Immunotherapy helps to control allergies
House Dust mites:
They are the most common cause of allergies
How to avoid dust mites:
- They are destroyed by heat, so wash bed-sheets, blankets, pillow covers in hot water at least twice a week and dry them in the sun
- Minimize dust in your house by removing soft furnishing like carpets, curtains, sofa covers, soft toys, etc. Or vacuum them regularly
- Immunotherapy helps in controlling dust mite allergies.
Fungi or Molds:
- They are the cause of allergy in warm and humid climates.
- Fungal spores become airborne and cause allergies
- They are found in air conditioning, on damp bathroom walls or walls where there is seepage of water or pipe leakage
- they can cause sinusitis and allergic asthma
Prevention of fungal allergy
- Basic cleanliness helps
- Servicing of AC vents regularly, cleaning the bathroom with bleach, treating water leakage, removal of junk in the home, etc
- Vaccines help
Pets:
- Animals like cats, dogs and even birds can cause allergies
- Cats are very common since they lick their fur and the saliva on it is highly allergenic
Prevention of pet allergies:
These are very difficult since the pet is a family member and minimizing contact with them is not possible. Vaccines help.
Cockroaches:
Cockroach dust causes a lot of allergy. Cockroaches like tight places so even if 1-2 are visible outside, most of them will be hidden in crevices.
Proper pest control should be done for allergy prevention
Minimize environmental pollution. These are irritants which worsen symptoms of allergy such as:
- Cigarette smoke
- petrol and diesel fumes
- industrial pollutants
- insect repellents and plug in liquids
Consult your doctor as soon as possible for allergic symptoms for immediate relief and further management
World allergy week April 7-13 2019
Hello. welcome to World Allergy Week 2019
Allergic disorders are increasing in the past 10 years, due to lifestyle changes, global warming, diet, etc. We need to address this problem and treat the diseases at a critical level
In The Upcoming days we will discuss various aspects of allergy
World hearing day March 3
March 3 is celebrated as international hearing day.
Take care of your hearing especially in children and the elderly.
- If your baby does not respond to sound, get the child checked early it is advisable to treat hearing problems before speech develops, since this improves chances of recovery
- Children with Ear pain, pus from the ear should be checked as soon as possible
- Elderly who can’t respond to sounds or listen to the TV in high volume need to get assessed immediately
- Take care of your ears.
- Avoid loud music
- Wear protective headphones while working in machinery with loud noise.
- Don’t try to clean your ears on your own. Don’t put any object like hair pin, sticks, keys in your ear
- In case of cold take proper precautions while flying.
- Don’t go swimming or diving with Ear problems
- Check with your ENT specialist before using any ear drops or medications. Certain medicines can damage your inner ear and excess use of ear drops can cause fungus and other complications
- Don’t blow your nose hard during colds
