Happy Diwali!

Wishing you all a happy pollution free Diwali! Say no to firecrackers as they worsen asthma and allergy.

Take off Those Headphones!

Be careful.

Nowadays it,s common for everyone to be using headphones, even commuters, to listen to music, watch tiktok videos, but we don’t realise the hazards of them

Headphones, especially noise cancellation headphones make us unaware of our surroundings. They’re appropriate for sitting comfortably and safe in flights and on buses, trains,etc, but if you’re walking on the road you’re totally cut off. You don’t realize what is happening around you, especially while crossing the road. In the past few years, the incidence of road traffic accidents has tripled due to the use of headphones.

Headphones can cause sensorineural hearing loss. Don’t listen to loud volumes for long periods of time. Heed the permitted levels set by mobile phones

Take care of your ears!

Our ears are very important to us. We Listen with them. They help us in communicating with others, various sounds in the surroundings around us. Ears help us to hear when danger is approaching , so we can get to safety quickly, especially while crossing a busy road.

Nowadays ears are important to us with the onset of smartphones and music. We use our ears for relaxation and entertainment.

However, As much as people take care of their eyes, we do not bother about our ears. We listen to loud sounds in public or with headphones, we attempt to clean our ears on our own, put oil and various substances in the ears.

Common problems of the ears:

Image result for earwax stock images

Wax: Wax is formed naturally in the ear by glands similar to oil glands in the skin. It is a mechanism of protection from dirt, foreign bodies and pollutants.

Wax naturally comes out. It is not required to clean it on your own.

Sometimes wax accumulates in the ear canal and causes deafness, pain and sometimes dizziness. This is normal for some people who have a narrow or twisted ear canal. Sometimes the wax itself is hard. It’s just a tendency for wax to collect for some people. They should not attempt to clean it on their own as this could lead to complications but to consult their local ENT doctor

Fungus: In case of damp weather, or moisture or instillation of oil or ear drops or self medication, fungus grows in the ear. This fungus is similar to the mold found on stale bread and food.

It can cause pain, blocking of ear and discharge.

Fungus can be removed by your doctor by syringing or under the microscope. Sometimes you may need 2 or more visits to the doctor to clean up your ear as fungus tends to grow again.

Image result for insects in ear stock images

Insects: The ear canal is small. Sometimes small insects like ants, cockroaches, spiders, flies, etc can make their way into your ear . The humming of their wings and wriggling can be quite distressing

Cockroach and beetle legs have sharp spines which can scratch.

In that case don’t panic. Don’t pour oil or water or anything in your ear or attempt to pull them out. That can worsen the problem or cause injury.

If they are alive shine a torch light in the ear. Most insects are attracted by light and will come out easily

Maggots: In people with poor hygiene, terminally ill patients, sometimes flies enter the ear and lay eggs.

The maggots which hatch can cause pain and irritation. They can be removed by proper treatment

Consult your doctor immediately

Pus from the ear: This happens for people with colds, when the cold reaches the space behind the ears. With proper medicines it should clear up. Always consult your doctor, especially for small children

Image result for foreign bodies in ear stock images

Foreign bodies; This is common in small children, mentally retarded people, etc Common things are:

  • Seeds of fruits, like dry peas, peanut, tamarind seeds, wheat, riceetc
  • rubbers, pen, pencil, stones
  • small toys, thermacol, etc
  • Beads and decorative jewellery
  • The deadliest are small button cells of battery operated toys. The alkali in them can eat away tissue and bone and create a nasty situation.
  • Adults commonly have cotton, sticks, etc in their ears.

Sometimes inert non living foreign bodies can sit in the ear for years together without harm and are discovered incidentally

Image result for deafness stock images

Deafness: There are a lot of reasons for deafness. wax, colds, etc

Consult your doctor immediately if you have sudden loss of hearing. Medication helps in cases of nerve deafness.

Dizziness and Tinnitus: There are various reasons for this which your doctor will help you.

Image result for vertigo stock images

Here are some Do’s and don’ts about the ears:


  • Pour oil inside your ears. It’s a common traditional custom to put oil in your ears, one of grandma’s remedies. However, the oil will sit in a nook or corner in the ear canal and get infected with fungus, which takes a long time to treat.
  • Insert ear buds inside your ears. People use keys, matchsticks, hairpins which are equally bad. You can damage your ear drum, hearing mechanism and go deaf. You can get a nasty boil in the ear canal which is extremely painful. In diabetic patients with uncontrolled sugar this can spread to the skull bones and can be fatal. This condition is known as Skull Base Osteomyelitis, formerly Malignant Otitis Externa
  • Listen to loud noises for prolonged periods of time. Sounds around 120 decibels are known to damage the delicate structures in the inner ear and the nerves for hearing.
  • Be aware of your surroundings. While walking in public, on the road don’t keep your headphones on
Illustration of hearing, journey of the sound wave in the ear. The sound wave is captured by the auricle, penetrates in the auditory canal, vibrates the eardrum membrane, which in turn vibrates the ossicles, malleus, incus, stapes). The vibration of the stapes make the fenestra vestibuli membrane vibrate which causes hydraulic waves in the cochlea perilympha, blue), applying pressure on the endolymph inside the cochlea channel, moving the basilar membrane, pink), causing the hair cells to move against the tectorial membrane, producing a nerve impulse in the cochlea nerve fibers, yellow). This nerve impulse moves to the auditory nerve and carries the message to the auditory area of the brain, which analyses the data. (Photo by: BSIP/UIG via Getty Images)


  • Consult your doctor for earache, pus coming from the ear, hearing loss, foreign bodies, giddiness etc.
  • protect your ear from water especially in the rains
  • follow the instructions on use of medicines and follow up regularly

Monsoon woes! Allergies and respiratory illnesses

colds in monsoon
Cough. Closeup Of Beautiful Young Woman Caught Cold Or Flu Illness, Having Sore Throat And Coughing With Hand Near Mouth. Portrait Of Unhealthy Girl In Scarf Feeling Pain In Throat. High Resolution

Monsoon has been very harsh this year. Lot of flooding, Natural disasters, waterlogging, etc. And monsoon leads to diseases, especially vector borne diseases. Monsoon too contributes to the following:

  • Humidity and moisture encourages growth of fungus and dust mites in the house
  • Pollen allergies increase due to flowering of seasonal plants
  • pests like cockroaches and other insects thrive during this season

Diseases like allergies, viral fever, colds, stomach upsets are on the rise in this season.

To prevent progress of these diseases following precautions should be taken:

  • Avoid collection of water in old vessels, tyres, etc
  • Holes and potholes should be filled to prevent breeding of mosquitoes
  • Wear long sleeved clothes and cover yourself to prevent insect bites
  • Sleeping in a mosquito net is the best option
  • Don’t wear wet clothes. Keep a dry pair at your workplace if possible
  • In case of fever immediately contact your doctor
  • Dont eat street food. Avoid eating out as much as possible
  • Don’t travel in case of floods and waterlogging. Waters harbour leptospirosis

The views of the website are solely of the author. Please contact your doctor for further advice.

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.