Living with allergies
Posted on 20 September 2016
Allergies have been around since ancient times. They have changed surprisingly little over thousands of years and continue to affect millions of lives.
That was then…
Ancient civilisations were afflicted by allergies just like we are today. They didn’t call them by the names we use, but the causes and symptoms have not shifted over the centuries.
In the Islamic world, ‘rose fever’ affected many and was thought to be a common cold contracted from smelling roses in spring, a lot like the hay fever of today.
The ancient Chinese used a medicinal preparation from the ephedra shrub for asthma-like symptoms and the knowledge was passed on to the Greeks. In Greek and Roman times, demons and magic were blamed for asthma, but Hippocrates saw that environmental factors caused respiratory problems. Pliny the Elder found pollen to be the big culprit. His ‘cures’ for asthma included mixing the ephedra remedy with red wine – or eating fox liver soaked in red wine!
The Egyptian Ebers Papyrus is a medical encyclopaedia that mentions a foulness’ which sounds a lot like asthma, complete with instructions for a basic device that resembles the inhalers of today.
… and this is now
Allergies are still with us. We now know that an allergy means our immune system is incorrectly identifying allergens as threats and mounting aggressive attacks on them, for which our bodies pay a price.
Dr Gary Middleton, a general practitioner at Mediclinic Tzaneen, explains. ‘Allergies can cause a spectrum of reactions from minor niggles to life-threatening symptoms. You could have only a mild itch, whereas other cases could lead to full-scale anaphylactic shock.’
An allergy is different to a sensitivity or an intolerance. Symptoms of sensitivity can take hours or days to show, whereas an intolerance is not an immune response – it means your body can’t process something.
The causes differ from person to person, but three factors stand out:
• genetics – when a child develops an allergy, there’s a strong chance that a parent or grandparent had it too as a youngster
• breast-feeding – breast-fed babies have fewer allergies
• environment – pollutants in your immediate environment can play a role in allergies.
Dr Middleton says, ‘For example, we see that there’s an increase in middle-ear infections
(otitis media) in children who are exposed to second-hand cigarette smoke.’
Doctors have coined the phrase ‘allergic march’ to refer to three conditions – allergic rhinitis, asthma, and atopic dermatitis – that are strongly linked. The link between them hasn’t been determined with certainty, but patients who develop the first condition will often develop at least one, or both, of the others.
Misdiagnosed hay fever
A sneezing attack is often assumed to be due to hay fever, especially in spring. But it can be a different allergy – something that has been introduced by a third party. Perhaps a colleague owns a cat and there are a few catw hairs on their clothes when they come to work. Or your child might be exposed to something at school and bring it home. Even if you think it’s just hay fever, it’s worth consulting a doctor.
Five most common allergies in SA
Asthma can develop from other sources, but an allergic reaction remains one of the major causes. Doctors tend to use aggressive treatments on children with rhinitis because of the known link with asthma.
‘Asthma is an extension of the allergy into the lungs and it causes the secretion of mucous,’ says Dr Middleton. ‘The airways in the lungs are surrounded by circular muscles that go into spasm. This causes the chest to close up so the person struggles to breathe. Typically this manifests with coughing – often at night or in cooler temperatures.’
Some of the culprits that bring on asthma are:
• pre-existing rhinitis
• pollutants from the environment
• cold air
• Nasal sprays that deliver antihistamine medication, similar to those used for treating rhinitis, can be used for mild asthma.
• Inhalers are needed in more serious cases. They can be loaded with treatments that include steroids to prevent histamine action and bronchodilators to reverse chest spasms. Your doctor will prescribe the most appropriate one.
2. Eczema (Atopic Dermatitis)
Eczema is an inflammation of the skin that causes dryness, cracks and red blotches. It can be very itchy. For children it is especially difficult because scratching makes it worse and if the skin is broken there’s a risk of secondary infection. Luckily, many children outgrow eczema.
The root cause is unknown, but a genetic predisposition is thought to play a role. People who get eczema have often had hay fever or asthma in the past.
• Moisture replacement is the first line of treatment because the skin is so dry. Apply liberal amounts of unperfumed moisturisers (emollients) as often as needed.
• Topical steroids like cortisone can be used in more serious cases. Creams that contain topical steroids typically don’t cause the systemic problems of oral steroids and are generally safe for long-term use.
3. Hay fever
We call it ‘hay fever’ even though it’s not a fever and has nothing to do with hay. Dr Middleton explains, ‘When a person inhales a substance they’re allergic to – an allergen – the body reacts by releasing allergic substances and mediators such as histamine. The effects of histamine are swelling, itching and increased secretion of mucous. That’s why you get itchy eyes, a watery nose and congestion. It’s not an infection – your body is simply overreacting to allergens.’
Some of the common allergens that can result in hay fever are:
• cat hair or saliva
• Remove the allergen that is causing the reaction. In some cases this can be difficult, for example, if it’s the family dog or cat; or nearly impossible in the case of environmental allergens like pollen.
• Antihistamines are the first line of treatment for hay fever. They are usually taken daily as a syrup or tablets. Older incarnations of antihistamines were notorious for causing drowsiness, but nowadays the medications are longer-acting and don’t make you sleepy.
• Steroids are a very effective treatment. Dr Middleton says, ‘Whereas an antihistamine blocks the action of a histamine that’s already been released, but via a longer pathway, steroids block histamines from being released in the first place, which is why they work so well.’
4. Hives (urticaria)
This is an acute, violent allergic reaction. ‘I recently treated a child who had a been stung on the toe by a bee,’ says Dr Middleton. ‘His whole body was covered in hives. They look like welts: red, swollen and itchy.’
Sometimes the cause is obvious, for example bee stings, but the allergen can be hard to identify and it’s complicated by the fact that there are non-allergic causes too.
Antihistamines and systemic steroids (in severe cases) work best. Treatments are sometimes administered intravenously, which can offer dramatic, fast-acting relief.
5. Contact dermatitis
Like eczema, contact dermatitis is an allergic reaction that causes inflammation of the skin. A burning, itchy rash can disappear within hours or take weeks to heal.
Direct contact with an allergen is usually the cause, but the specific substance differs from person to person.
• chemicals in household cleaners
• certain types of fabric
• Allergen avoidance is the only way. So when you know what the allergen is, take it out of the equation. For example, you may need to stop using a particular deodorant.
• Moisture replacement for as long as the outbreak lasts. You could even cover or wrap the area after applying moisturiser to keep it from drying.
• Steroids in extremely serious cases, but they are prescribed only for short-term use to bring the reaction under control.