Allergies: a long standing infirmity but still part of the ‘New Normal’

Allergies are becoming more frequent in many countries around the world. According to the Allergy, Asthma and Immunology Association of Thailand, the rate of Thai children with allergies is as high as 30% and about 20% with adults. At present, there are 3-4 more times more people suffering from allergies than there were 10 years ago.

Admissions into hospitals for anaphylaxis have doubled in the past few years and were several times higher in children under five years old within the same period. The trend shows that nowadays children are susceptible to allergies faster than adults.

Causes of allergies

Allergies are reactions caused by the immune system in most people as it responds to harmful environmental substances. It happens because of the body’s response to a range of different environmental reactions, such as pollution (PM2.5), food, pollen, dust mites, animals, insect stings, medicines and many more causes.

An allergy can affect any part of the body. Allergic rhinitis, for example, affects the eyes and nose, while eczema affects the skin. According to some studies, food allergies normally affect the gut, skin, airways, lungs and sometimes the entire body through the blood vessels. With slightly different underlying factors but still closely related to allergy, conditions like asthma affect the lungs and oesophagus. It's not clear why this happens, but most people affected have a family history of allergies or have closely related conditions, especially asthma or eczema.

Common allergens

According to the National Health Service (NHS) of the UK, the more common allergens include:

  • grass and tree pollen – common cause of allergic rhinitis
  • animal dander, tiny flakes of skin or hair
  • insect bites and stings
  • medicines – including ibuprofen, aspirin and certain antibiotics
  • latex – gloves and condoms
  • mould – small particles released into the air that can be inhaled breathe in
  • household chemicals – detergents and hair colourings
  • dust mites
  • food – particularly nuts, fruit, shellfish, eggs and cows' milk

These allergens are in general harmless to people who are not allergic to them.

Allergic reactions

Although most reactions are of mild to moderate severity which can be treated with antihistamines, some can have dire consequences and require immediate medical attention. The most severe allergic reactions are known as anaphylaxis. People with known severe allergies should have a contingency plan which normally includes an adrenaline auto-injector in cases of severe reactions. Common symptoms of an allergic reaction include:

  • runny or blocked nose, sneezing and an itchy (allergic rhinitis)
  • itchy, red, watering eyes (conjunctivitis)
  • dry, red and cracked skin
  • wheezing, chest tightness, shortness of breath
  • abdominal discomfort, nausea, vomiting or diarrhoea
  • itchiness, red rash (hives)
  • face, tongue, eyes or face swelling

The symptoms may be different depending on one’s allergies and the type of contact.

Severe allergic reaction (Anaphylaxis)

At times, an allergy can cause severe allergic reaction, called anaphylaxis or anaphylactic shock, which can be life threatening. This affects the whole body and usually develops within minutes of exposure to something you're allergic to.

Signs of anaphylaxis include any of the symptoms above, as well as:

  • difficulty breathing
  • swelling of the throat and mouth
  • dizziness
  • confusion
  • blueish-lips and skin
  • lost consciousness
  • cold and clammy sensations

It should be noted that Anaphylaxis is a Medical Emergency that requires immediate treatment.

Diagnosis

One should be immediately refer to healthcare professionals if one suspects an allergy. Inform them of the symptoms, when and how often they occur plus if anything seems to have triggered the reaction. If your allergy is more severe or if unsure of the root cause, you may have to do the following tests:

Skin prick testing

Skin prick testing is a common allergy test. This involves putting a drop of liquid onto your forearm that contains a substance you may be allergic to. The skin under the drop will then be gently pricked. If you are allergic to the substance, an itchy, red bump will appear.

Blood tests

A blood test may be done either on its own or together with the skin prick tests to help diagnose allergies. Blood sample is analysed for specific antibodies produced by your immune system in response to an allergen.

Patch tests

Patch tests are used to investigate contact dermatitis, which can be caused by being exposed to an allergen. The suspected allergen is introduce to your skin for 48 hours and monitored for a reaction.

Elimination diet

For food allergy, you may be advised to avoid eating a particular food to see if your symptoms improve. You may then be asked to eat the food again after a few weeks to check if you have another reaction. This must be done under medical supervision.

Challenge testing

A test called a food challenge may also be used to diagnose a food allergy. You will be given the food you think you're allergic to in gradually increasing amounts to see how you react under close supervision at a medical premises. This test has a higher risk as severe reaction can occur, but is the most accurate way to diagnose food allergies.

Possible reasons for increase

There are several reasons that come to mind when thinking of the possibilities as to why allergies are on the rise. The following theories are according to website Theconversation.com:

  • Decreased exposure to infections or microbes, or both, in early life could lead to an increased risk of allergy. This is commonly referred to as the hygiene hypothesis. Research shows that children who have close contact with pets or livestock and those who come from larger families are less likely to develop allergies.
  • Delayed introduction of allergenic foods, such as eggs and nuts, until later in childhood could also have an impact. Randomised trials for early life peanut consumption in a population at increased risk of developing peanut allergies demonstrated that exposure to nuts early in life is protective against developing the allergy. According to some studies, a child with a nut allergy only has a 20% chance of resolving it by the time of reaching adulthood.
  • Different food preparation methods can also have an impact on allergies and the degree to which they invoke an allergic response. For example, roasting peanuts, greatly increases allergy possibilities while boiling reduces it.
  • Altered gut bacterial species due to low-fibre diets and widespread antibiotic usage may alter the body’s immune function and create an allergy.

Treatments

Whether your allergy improves over time often depends on the type of allergy you have. While we have treatments for the symptoms of allergies, what we need to do as a preventive measure is to get to the root causes. The following some of the treatment pathways available:

  • Decongestants. Normally used as a short-term treatment for a blocked nose caused by an allergic reaction. They can be taken as tablets, capsules, nasal sprays or liquids. It is not recommended to use them for more than a week at a time, as symptoms may worsen when used long term.
  • Antihistamines. Antihistamines are the most common medicines for allergies. They can be used:
    • when the symptoms of an allergic reaction occur
    • prevention of allergic reactions. Antihistamines can be taken as tablets, capsules, creams, liquids, eye drops or nasal sprays, depending on which part of your body is affected by your allergy.
  • Lotions and creams
  • Over-the-counter creams and lotions can sometimes be treated with red and itchy skin caused by an allergic reaction:
    • calamine lotion to reduce itchiness
    • moisturising creams to keep the skin moist and act as a protection from allergens

Steroids

Steroid can assist in reducing inflammation caused by an allergic reaction.

Types available:

  • inhalers for asthma
  • tablets for hives
  • creams for contact dermatitis or eczema
  • nasal sprays and eye drops for an inflamed nose and eyes

Immunotherapy

Immunotherapy has become an option for patients with severe and persistent allergies even though they have tried the options mentioned above. The treatment involves being given occasional small doses of the allergen, either as an injection, or as drops or tablets under the tongue, over the course of several years. The injection can only be performed in a specialist clinic under the supervision of a doctor, as there's a small risk of a severe reaction. The drops or tablets can usually be taken at home. The aim of treatment is to help the body get used to the allergen to reduce the severity of the reaction.

Integrative medicine

Integrative Medicine has the potential to offer the best curative path in managing allergies and at the same time adjusting the body’s immune system. There are several treatments mythology through this pathway, as follows:

  • Diet therapy helps to reduce the inflammation of the body. In naturopathy medicine, natural nutrients are commonly used as part of the treatment protocol. For example, Omega fatty acid, curcumin extract from turmeric and cassumunar ginger extract, which works extremely well in restraining inflammation caused by allergies. These natural treatments also have less side effects than when treating with steroidal anti-inflammatories.
  • Checking of immunity through food intolerance test and refraining from foods that cause allergic reaction, stop allergies or symptoms without having to take antihistamines.
  • Reducing factors that affect the allergies, especially physical and mental stress. Stress will cause adrenal fatigue and stimulate inflammation in the body. Refrain from alcohol, smoking, and nightlife. Many people get better after adjusting their lifestyle.
  • Therapeutic vaccine that reduces allergies and stops the inflammation process naturally. This treatment is done by extracting anti-bodies from the patient to make these vaccines and reintroducing them back into the body in order to boost white blood cells for resistance.
  • Treatments for allergies are necessary. However, medications might not be the right answer. Emphasise more on treating the problems from the root causes with non-toxic medicaments, lifestyle adjustments and minimising any possible side effects is definitely the best option for the best possible curative path.


Author: Ezree Ebrahim, Head Business Development (Healthcare), Absolute Health Group. For Further information, please contact: ezree.ebrahim@akesisoncology.com

Series Editor: Christopher F. Bruton, Executive Director, Dataconsult Ltd, chris@dataconsult.co.th. Dataconsult’s Thailand Regional Forum provides seminars and extensive documentation to update business on future trends in Thailand and in the Mekong Region.