What is Allergy?
Allergy is an abnormal over-reaction of the body’s natural immune mechanism to substances that are normally not harmful to the human body.
Practically any substance can become an allergen, or allergy – causing nuisance. House dust, pollens, moulds, foods or even a pet (things that most people consider harmless) can make the allergic person too ill to function normally, forcing him or her to miss work, school and other important activities. These allergic reactions can provoke symptoms ranging from itchy, watery eyes of hay fever, breathing difficulties of asthma, itchy inflamed skin with hives and eczema, or the dangerous fall in blood pressure and breathing problems following a severe reaction after food allergies and insect stings (anaphylaxis). The substances provoking the reaction may have been ingested, injected, inhaled or merely have come into contact with the skin or mucous membranes (e.g. eyes). Even though your allergy symptoms are not serious or life threatening, in some cases allergies can make your life miserable.
Although most allergies make their first appearance before the age of 20, they can develop in any person at any age, and are virtually never outgrown. While specific allergies are not inherited, your chances of having an allergy are greatly increased if members of your family are allergic. The course and presentation of Allergic disease is variable and is age dependant and one allergy may manifest itself as a different symptom at a later age e.g. Atopic eczema in children usually manifests as asthma or other respiratory allergies at an older age.
Current Trends of Increase:
The incidence of Allergy is increasing at an alarming rate throughout the world. In the World Allergy Forum held at the end of the last Millennium, the statistics revealed that up to fifty percent of the World's teenagers were already suffering from airway allergies ie. allergic rhinitis and asthma. If these statistics were extrapolated, an expected seventy to eighty percent of teenagers will be afflicted by airway allergy by the end of this decade with increasing morbidity and mortality. Even though asthma is the commonest cause of death in childhood and the second commonest emergency hospital admission, the warning sirens seem to be silent.
These allergic conditions affect all ages in all countries, with signs and symptoms changing according to the ages of the sufferer. In fact recent research shows that allergic disease actually starts while the subject is still in utero (before birth), therefore avoidance measures can be taken even before the potential sufferer is born.
Even though all the signs point to a potential health catastrophe occurring, very little was being done by health organizations worldwide to highlight this problem, and even less was being done by us here in Malaysia. Recently the World Health Organization (W.H.O) has acknowledged this potential plague, and has formed the World Allergy Organization (W.A.O). There has been an increase in awareness in Europe, USA, Australia and in some parts of Asia like Thailand, Singapore, Indonesia, Philippines, China and Japan.
It is our turn now to help combat the potential plague of this Millennium.
This is why MSAI was formed three years ago.
What causes Allergy?
Allergy is caused by a combination of genetic and environmental influences. In fact the genes for a lot of major allergies have already been recently isolated - thereby paving the way for gene-therapy at a later date.
Our environmental influences in this more polluted world of urbanized living have also been a major cause for the dramatic increase in the allergy problem. The number of environmental toxins such as smoke, chemicals, fumes, perfumes or even physical agents like sunlight, humidity, heat, cold and haze have all contributed to the sharp increase in allergy-related illnesses.
Food allergy is on the rise because of the increased variety of foods ingested, the increased number of food additives and preservatives being used, insecticide usage and our new friend or foe – genetically modified foods! Basically, it is even more becoming harder to know how fresh our food is and whether or not it contains genes of another food we may be allergic to.
How do Allergies Manifest themselves?
Allergic disease is usually described according to the sites where they manifest their physical effects maximally. Allergy is a multi-organ disease and this is why almost every specialilty in medicine encounters it – but we must learn to understand that it is actually the same disease throughout the body.
Here are some “target organ” examples of allergic disease.
Hay Fever and “Sinusitis” = causing itchiness, sneezing, runny nose or blocked nose.
itchiness, pain and sometimes deafness.
irritation and cough
Asthma = cough, difficulty in breathing and wheezing
Conjunctivitis = itchiness, tearing, redness and swollen eyes
Eczema, Contact Dermatitis and Urticaria = itchiness rashes and swelling
Cramps, vomiting and diarrhoea
All of the above due to exposure to chemicals and materials. Latex allergy can also fall into this category
e.g. Penicillin = anaphylaxis
SLE, Thyroiditis and many other ones being postulated.
Attention Deficit Hyperactivity Disorder (ADHD) = Hyperactivity and Dsylexia in Children. Headaches (Migraine), Arthralgia and Fatigue
Allergies can present in many other unusual forms and a lot of time as a combination of signs and symptoms. It is up to your physician to be vigilant and to realise that allergic disease is a systemic disease with multi- factorial aetiology
(Allergens that are air borne/inhaled)
There are many allergens that are found in the air that we breathe. These vary according to the location, season, proximity with pets and of course environmental pollution such as forest fires etc.
Pollutants are not considered allergens as such but they help to worsen many allergy problems.
In Malaysia, our most common aeroallergens can be broken up into the outdoor variety and indoor variety.
Outdoors we have many different types of pollen, grasses, weeds, moulds and pollutants.
Indoors we are exposed to the house dust mites, cockroach and various animal dander (e.g. cat/dog dander). Even indoors we are not safe from various pollutants e.g. cigarette smoke.
(Though a puff of smoke may look innocuous, it contains around two thousand different substances, many hazardous to health.)
Avoidance measures are always paramount in the treatment of allergic diseases. However a lot of this exposure sometimes cannot be avoided and this is where the treatment of the allergic disease becomes necessary.
Because of the wide variety of foods in any Malaysians diet, it may be difficult to pin-point or limit the number of potentially offending foods. Always remember that our food contains various coloring and preservative agents, and that one food class may cross-react with another. As you can see, these food allergies can be tricky to diagnose.
Foods can cause many symptoms which range from severe acute allergic reactions with hives, rashes and generalized swelling, through eczema, diarrhoea, vomiting, tummy aches, asthma, blocked/ runny nose and sinusitis. Migraines are and can be largely due to food allergies.
In small children, it can also cause an accumulation of fluid in the middle ears (like other allergies) leading to reduced hearing and therefore learning disabilities. Many of these problems can cause considerable discomfort and therefore children often become quiet irritable and difficult. Like other allergies, symptoms occurring at night can disturb sleep patterns leading to a lethargic individual the next day – of course other organic causes must also be out ruled before blaming these symptoms purely to food or other allergies.
If crucial elements need to be eliminated e.g. milk, wheat etc, one must always ensure that these are adequately supplemented. Your allergist or physician will advice you accordingly.
Most of us have had adverse contact reactions at some stage in our lives.
Various materials, metallic, synthetic or even natural have been known to produce allergic reactions in our skin or even as a systemic reaction.
Examples of these materials would be like nickel, a metallic substance found in buttons, jewellery, watches, spectacle frames etc. Latex is another naturally producing material that is widely used in everyday domestic, industrial and medical applications.
These are only two of an endless list of potential allergy causing materials.
The symptoms could be mild like a contact dermatitis reaction to extremely severe leading to anaphylaxis and death.
Some materials are hidden and therefore their presence will go undetected until a reaction occurs.
It is possible to test for these allergies either by contact patch testing, skin prick tests and by RAST in-vitro blood tests.
Treatment is of course by avoidance, and various medical treatments in lessening the effects of the allergy.
One cannot assume however that contact allergies are only caused by contact. They are able to manifest their effects by the inhalation and ingested routes as well - e.g. someone with a severe nickel allergy is likely to react to mushrooms, asparagus, oysters, peanuts and a list of another 30+ foods.
Anaphylaxis is a severe allergic reaction – the extreme end of the allergic spectrum. Being a systemic disease, the whole body gets affected, usually within seconds or minutes of exposure to the allergen but sometimes only after a few hours.
Every type of allergen is capable of causing Anaphylaxis but foods, insect stings and drugs are the common culprits.
What are the symptoms?
Any or all of the following may be present:
- Swelling of the throat and mouth
- Difficulty in swallowing or speaking
- Difficulty in breathing – due to asthma or throat swelling
- Hives anywhere on the body, especially large hives
- Generalized flushing of the skin
- Abdominal cramps, nausea and vomiting
- Sudden feeling of weakness ( drop in blood pressure)
- Sense of impending doom, followed by collapse and unconsciousness.
If any of the above symptoms were to happen to you – rush to your nearest major hospital where full resuscitational facilities are available. Once better, contact your physician or allergist to prevent this from happening again – or you may not have a second chance.
Strict management plans are necessary:
- Wear a Medi-Alert bracelet
- Carry an adrenalin injection / inhaler (Epi-Pen / Medihaler Epi) -MSAI has recently got the government approval for these to be imported legally into Malaysia.
- Inform all family/ staff / and school staff about what to do if anaphylaxis occurs.
(MSAI will soon be carrying all appropriate training manuals / videos)
- Precautionary measures must be taken for allergen avoidance.