ENGLISH ESSAY

ALLERGY

CREATED BY :
PUTRI AYU FIRDELLA (11-099)

MEDICAL FACULTY
BAITURRAHMAH UNIVERSITY
PADANG
2013

ALLERGY
Definition about Allergies
Allergy refers to the exaggerated reaction by our immune system in
response to bodily contact with certain foreign substances. Exaggerated
because these foreign substances are generally regarded by the body as
something that is not dangerous and no response occurs in people who are
not allergic. The bodies of the people who are allergic to recognize foreign
material and part of the immune system is activated. Allergic substances
called "allergens". Examples of allergens include pollens, dust mites, molds,
and foods. To understand the language of allergy it is important to remember
that allergens are substances that are foreign to the body and can cause an
allergic reaction in certain people.
When allergens come in contact with the body, he causes the immune
system to develop an allergic reaction in people who are allergic to it. When
you react to allergens that do not fit are generally harmless to other people,
you have an allergic reaction and can be referred to as allergic or atopic. By
karananya, the people who tend to get called allergic or atopic allergies.
Austrian pediatrician named Clemens Pirquet (1874-1929) first used
the term allergy. He referred to both Immunity Lucrative and Dangerous as
Allergic Hypersensitivity. The word allergy comes from the Greek words
"allos," meaning different or changed and "ergos," meaning work or action.
Allergy broadly referred to as "reaction to change". The word allergy was first
used in 1905 to describe the adverse reactions of children who are given
repeated injections of horse serum to fight infection. The following year, the
term allergy was proposed to explain the reactivity change is not expected
this.
Allergy Facts
An estimated 50 million Americans are affected by allergic conditions.
The cost of allergies in America is more than U.S. $ 10 billion annually.
Allergic rhinitis (nasal allergies) affects about 35 million Americans, 6
million of whom are children.
Asthma affects 15 million Americans, 5 million of whom are children.
The rate of asthma cases doubled over the last 20 years.
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Types of allergen
Allergens that may be life threatening in allergic individuals are usually
harmless in the non-allergic. Common allergens include:
house dust mites
mould
grass and tree pollen
pet hair
Mould may be fungal spores present in damp areas. Pet skin flakes and
hair from cat, dogs or hamsters may be allergenic.

Food allergens
Food allergens include:

nuts
fruits
cow's milk
hen eggs
wheat
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 seafood
soya
gluten etc.

Skin allergens
Skin allergens or contact allergen include:

latex

nickel

rubber

preservatives

dyes like hair dyes etc.

Other allergens

Allergies might be caused due to Wasp and bee stings and also due to
drugs especially antibiotics like penicillin or other drugs like aspirin and
anaesthetics.
Classification of allergies
Types of allergy are classified to denote cause, severity and possible
management and prevention. These include :
Type I hypersensitivity
This is also known as immediate or anaphylactic-type reactions. This may be
caused due to pollen, foods and drugs and insect stings .
Type II hypersensitivity
This involves specific antibodies called the Immunoglobulin G (IgG) and
IgM. There is binding to and destroying the cell the antibody is bound on.
This type of reaction is seen after an organ transplant when the body refuses
to see the transplanted organ as its own.

Type III hypersensitivity

This is an Immune complex-mediated reaction. The immune complex is the

bound form of an antibody and an antigen. This leads to a cascade of
reactions in the body which goes on to destroy local tissues. Examples of this

condition
include glomerulonephritis and
(lupus, SLE ).

systemic lupus erythematous

Type IV hypersensitivity

Delayed or cell-mediated reactions are mediated by special immune cells

called the T-cell lymphocytes. The T cells take from a few hours to a few days
to mount an allergic response. Examples include contact dermatitises such
as poison ivy rashes.
Causes of Allergies
Allergies are when the immune system over reacts to everyday proteins
and relatively harmless substances like pollen, animal dander, dust, dust
mites, foods and some commonly used drugs. The exact cause of allergies is
not known. It is unclear why some people are prone to certain allergies to an
extent that the condition may be life threatening while others are seemingly
unaffected by such allergens.
Atopy
Sometimes allergic tendencies run in families. This is called atopy. The
exact genetic cause for atopy is still unclear, however, there seems to be a
rise of atopic cases over the past four decades.
Causes of the rise in atopic cases
It is not known why this rising trend occurs. Some researchers believe the
rise in pollution, and addition of newer chemicals and allergens into the
environment, is adding to the rise of cases of atopy. On the other hand, some
believe that increased upbringing in a cleaner and more germ free
environment could be responsible for a relatively under exposed immune
system. This may be leading to over reactivity of the immune system when
exposed to common proteins and substances in the environment.
There is evidence that better armaments against infectious diseases,
and better prevention of infections by increased cleanliness, could be a
reason for increased risk of allergies. Some believe global warming also has
an impact and changing patterns of natural vegetation and pollen production
could be the reason for rising trends of allergies.
How does the immune system develop?

When a baby is born the immune system develops based on

the genetics and environment. It either becomes predominantly TH2 or
TH1. The former makes the individual allergy prone; whereas the latter
makes the individual non-allergy prone.
TH cells are T helper cells or lymphocytes that fight invading microbes
and organisms.TH1 immunity works in defending against bacteria
and viruses and protects against allergies . TH2 immunity on the other hand
fights parasite infections and makes an individual prone to allergies.

Allergies and TH2 immunity

Children with a family of allergic individuals are more likely to switch on
TH2 immunity. This leads to increased amounts of allergy-related
immunoglobulin E or Ig E in the blood. The IgE goes on to attach with an
allergen or a foreign protein and triggers an allergic reaction.
For example, when a pollen particle is inhaled it attaches to the IgE that is
present in the nasal mucosal membranes. This complex molecule of
IgE/pollen further attaches to the mast cells and this Releases naturally
occurring defence chemicals that include:

histamine and serotonin

proteoglycans
serine protease
leukotriene C4 etc.

Histamine and other allergic chemicals lead to itching, sneezing, runny

nose and eyes etc.
Who is at risk of developing allergies?
Those at risk of developing allergies include atopic individuals who
have a family member (usually a parent or a sibling) with a known allergic
tendency. Children who have no allergic family members have a 12% risk of
developing allergies and those with one parent and two parents with
allergies have a 20% and 40% risk of allergies respectively. If both parents
have the same allergic condition like hay fever, asthma or eczema the child's
risk of the same allergic condition rises to about 70%.

Other risk factors for developing allergies include:

Sex - men are found to be more prone to allergies than women. The
cause of this is unknown.
Smoking - children who belong to families where parents or family
members smoke are at greater risk of allergies
Childbirth - babies born by caesarean section are found to have higher
allergic tendencies. The cause is unknown.
Environmental conditions - children who belong to smaller families with
just one or two children or who are overweight or obese are at a
greater risk.
Frequency of antibiotics - children who have frequent courses of
antibiotics are at a greater risk of developing allergies.
It is speculated that this could be a two-way association. Children
with allergies like asthma often get frequent respiratory tract infections and
may need frequent courses of antibiotics.
Exposure to allergens - children who are exposed to very low amounts
of dust mites, pollens, certain food items and pets and animals often
have an increased likelihood of allergies.
Symptoms and Signs
Body parts that tend to react to allergies include the eyes, nose, lungs,
skin, and stomach. Although a variety of allergic diseases can arise different,
they all come from responses / excessive immune reaction to foreign
substances in sensitive people. The following brief descriptions will present
an overview of allergic disorders are common.
Allergy Rhinitis

Allergic rhinitis ("hay fever") is the most common of the allergic

diseases and refers to seasonal nasal symptoms caused by pollen. Yearround allergic rhinitis or perennial allergic rhinitis (perennial) usually caused
by allergens in the house / room, such as mites (dust mites), animal dander,
or molds. It can also be caused by pollen. The symptoms are from
inflammation of the tissue that lines the inside of the nose (coatings or
mucous membranes) after allergens are inhaled. Adjacent areas, such as the
ears, sinuses, and throat can also be involved.
The symptoms most commonly include:

Nose runny
nose congestion
Sneezing
Nose itchy
Ear-ear and throat who itchy
Post nasal drip

In 1819, an English physician, John Bostock, first described hay fever by

detailing the nasal symptoms of seasonal itself, which he called "summer
catarrh". The condition is called hay fever because it is expected to be
caused by "new hay".
Asthma

Asthma is a breathing problem that comes from the inflammation and

spasm (spasm) of the airways of the lungs (bronchial tubes). Inflammation
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causes narrowing of the airways, which limits the flow of air into and out of
the lungs. Asthma is most often, but not always, associated with allergies.
Symptom-common symptoms including:

Shortness of Breath
wheezing (Wheezing)
Cough
Shortness Chest

Allergy Eyes

Allergy eyes (allergic conjunctivitis) is an inflammation of the tissue

layers (membranes) that cover the surface of the eyeball and the under
surface of the eyelid. Inflammation occurs as a result of allergic reactions
and may be able to produce the following symptoms:
Redness below the eyelid and eye its entirety
Mata-eye who watery and itchy
swelling from membrane-membrane

Diagnosis of Allergies
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Allergies come in variety for types and forms and diagnosis is often
important in order to avoid the possible allergy causing substances that
trigger allergic reactions that may be life threatening. Diagnosis is primarily
based on history and certain laboratory tests.

History of Allergy Symptoms

Diagnosis begins with a detailed history of the symptoms of allergies,

possible triggers as felt by the patient and duration and severity of the
symptoms. Symptoms of allergies after intake of certain foods, inhalation of
dust or mites or animal hair and in certain seasons when there is profusion of
pollen in the environment are significant. History of contact with latex, nickel
plating etc. in patients with contact dermatitis or skin allergies is significant.

Diagnosis of Food Allergies

For detection of food allergies questions are asked, these include:

onset time from intake of the suspected food and reaction

persistent association with a particular food
amount of this potentially allergenic food
anyone else who took the food getting ill
if any benefits were derived from allergy medicines

Patient is asked to maintain a diet diary and regular elimination of

suspected foods is done to detect the suspected allergen in food.

History of Allergies in Family

The physician enquires about history of allergies in any of the family

members. First degree relatives like parents, siblings who suffer from
allergies is a significant finding. This type of propensity for allergies is termed
atopy and often runs in the family. It is determined both by genes as well as
environment.
Other history like growing up in a home with smokers, male children,
obese and overweight children, children from small families and those on
frequent antibiotics are also relevant in diagnosis of allergies.

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Skin Prick Test

This is the first test to be done to look for a potential allergen leading to
the allergic reaction. In this test the skin usually on the inner side of the
forearm or over the back is cleaned. The skin is pricked with a tiny amount of
the suspected allergen from a battery of allergens available in the
laboratory. Each of the different allergen sites are marked with codes.
In case a person is allergic to a certain allergen, there is a skin reaction
around the site of injection. The skin around the prick quickly turns itchy, red
and swollen. Since the amount of the allergen is very tiny there is a very rare
risk of a more severe allergic reaction. It is safe in all age groups including
babies. Skin prick tests are not performed in patients with eczema and those
who are on medications like antihistaminics which may mitigate the allergic
reaction to the tested allergens.

Blood Test

Blood tests (radio-allergosorbent tests RAST) are performed to measure

the amount of antibodies like Immunoglobulin E or IgE. These are antibodies
that are produced in response to a suspected allergen. The results of the IgE
are usually provided as a number between 0 and 6 with 0 indicating no
sensitivity or propensity to allergies and 6 indicating highest sensitivity.
These tests are used when a rare allergen is suspected that may lead to
future life threatening attacks of allergic reactions or anaphylactic reactions.

Patch Test

This is a test that is used to find the allergen that is causing

skin allergies or contact dermatitis or eczema. In this a small amount of the
suspected allergen is put on metal discs. These discs are taped to the skin
and left for 48 hours. After removal the skin reaction is noted. Patch test is
usually conducted by a dermatologist or a skin disease specialist.

Oral Food Challenge

This is performed to detect a specific food allergy. This is a very

dangerous test and needs to be performed under supervision. An oral food
challenge is the final method healthcare professionals use to diagnose food
allergy.

Mast Cell Tryptase Levels Assessment

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The serum level of -tryptase can be used to diagnose anaphylaxis and

mast cell activation. Tryptase levels peak at 45 - 60 minutes and may remain
and may remain elevated for up to 24 hours.

CAST testing (cellular antigen stimulation test)

This is done to test for allergies to food additives and colors. These are
not mediated by IgE.
Treatment of Allergies

Allergy medications

These drugs cannot cure the allergy but can prevent common symptoms
of allergy like a runny nose and eyes, itching, sneezing etc. A Primary Drug
Class used in Allergies Are Antihistamines. These antihistamines act by
blocking the action of the chemical histamine that the mast cells release in
response to an allergen. This histamine is responsible for the symptoms of
allergy like itching, sneezing, narrowing or constriction of the airways etc.
Antihistaminics may be taken as pills, gels, liquids, eye drops or nasal
sprays. The eye drops are used in allergic conjunctivitis and the nasal sprays
are used to reduce the swelling and watering of nasal mucus membranes in
allergic rhinitis . These agents, especially if taken as pills, often lead to
increased drowsiness as a part of their side effects.

Decongestants

These are medications that are used to relieve a blocked nose that occurs
in dust or animal allergy or in hay fever. They are available as pills, nasal
sprays and also as liquids. They lose efficacy over long term use and lead to
side effects like drying of the nasal mucosa and drowsiness etc.

Steroid sprays

Steroids are drugs that modify the immune system. These steroid nasal
sprays like Beclomethasone, Budesonide and Fluticasone act on the nasal
lining and airways to reduce inflammation and congestion and reduce
allergies.

Treating anaphylactic shock

For treatment of anaphylactic shock patient needs to be admitted

immediately to the Emergency department as it could be life threatening.
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After ensuring that the normal airway and oxygenation is maintained the
patient is given adrenaline injections. To prevent inadvertent anaphylaxis ,
patients are advised to wear a medical information bracelet or another form
of identification that carries information about the risk of anaphylaxis.

Prevention of allergies
The main way to prevent an allergy is to avoid it. There are, however,
other techniques too including Leukotriene receptor antagonists, steroid
sprays and so forth.
Allergen avoidance
In as many cases as possible the potential allergen should be
avoided. This means avoiding the allergy triggering food items like nuts,
eggs, wheat, gluten, soya or milk etc. This also means avoiding outdoors
during the season of pollen dissemination in the environment, avoidance of
pets and animal dander and keeping the house clean and free of dust and
dust mites.
Common methods of allergen avoidance:

Avoidance of dust mites - These are tiny insects that breed in household
dust.To reduce them wood or hard vinyl floor coverings should be
preferred over woolly carpets. Cushions, soft toys and upholstery should
be cleaned regularly by washing or vacuuming. Allergy prone individuals
should use synthetic pillows and acrylic duvets rather that woollen
blankets and cotton or down pillows.
Preventing pet allergies - Flakes of dead skin from pets are a reason
for allergies. Pets should be avoided or should not be allowed within bed
rooms and living areas. Grooming and washing regularly also helps.
Preventing mould allergies - Fungal spores grow in damp and decaying
areas. Good and dry ventilation, dry and clean clothes storage in the
wardrobes and removal of damps from the house helps prevent allergies
from moulds.
Preventing food allergies - All manufacturers are instructed by law to
clearly label any foods that may be known allergens like wheat, gluten,
eggs, fish, milk, peanuts, nuts, soy beans, preservatives sulphur dioxide

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and sulphites etc. Persons with allergies are encouraged to inspect the
labels carefully before consuming any food.
Preventing pollen allergies - Pollen allergies typically affect people during
spring (for those allergic to tree pollen) and summer (for those allergic to
grass pollen).Patients are advised to check weather reports for the pollen
count and stay indoors if there are warnings of high pollen outside. Other
ways to prevent allergies

Other important measures for prevention of allergies include:

Exclusive breast feeding for the first four months of life.
Living with parents who do not smoke.
Exposure to good probiotic bacteria in the infant diet .
Inclusion of vitamins C and E, and omega-3 polyunsaturated oils in
diet.
Those living in farms and exposed to playing in dirt are also at a low
risk of allergies. Other ways to prevent allergies include leukotriene receptor
antagonists and immunotherapy and so forth.
Leukotriene receptor antagonists
Drugs
belonging
to this
class
include
Monteleukast and
Zafirleukast. These block theallergic reaction triggered by the chemicals
leukotrienes that are released during an allergy. They are used to
treat asthma . These agents do not relieve symptoms in an acute attack but
may prevent future attacks.
Immunotherapy or hyposensitisation
This acts by introducing the allergen to the susceptible individual
slowly in small doses. The body eventually becomes less sensitive to the
allergen. The allergen is usually injected under the skin of the upper
arm. The injections are spaced at intervals of a week or less with slowly
rising doses of the allergen. The injections at their peak disease are given
every few weeks for a year or two to blunt the sensitivity to the foreign
protein. This therapy is used in severe hay fever or pet allergies. This therapy
is performed under medical supervision.
Newer therapies to prevent allergies
Newer therapies in prevention of allergies include development
of DNA vaccines , Anti-IgE antibodies that bind to the Immunoglobulin E and

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inactivate it (eg Omalizumab) and modification of the binding sites of the

IgE.
Conclusion
The main way to prevent an allergy is to avoid it. There are, however,
other techniques too including Leukotriene receptor antagonists, steroid
sprays and so forth. Newer therapies in prevention of allergies include
development of DNA vaccines, Anti-IgE antibodies that bind to the
Immunoglobulin E and inactivate it (eg Omalizumab) and modification of the
binding sites of the IgE.

References

http://www.news-medical.net/health/Allergies-What-are-Allergies.aspx
http://www.news-medical.net/health/Causes-of-Allergies.aspx
http://www.news-medical.net/health/Different-Types-of-Allergies.aspx
http://www.news-medical.net/health/Treatment-and-Prevention-ofAllergies.aspx
http://www.nhs.uk/Conditions/Allergies/Pages/Treatment.aspx
http://www.bbc.co.uk/health/physical_health/conditions/in_depth/allergi
es/aboutallergies_what.shtml
http://www.csa.com/discoveryguides/allergy/review.pdf
http://www.niaid.nih.gov/topics/foodallergy/documents/foodallergy.pdf

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