Peanuts, shellfish or dairy can kill you: know the allergies, triggers, treatments and preventive measures

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Allergies
Image Credit: Seyyed de la Llata, Senior Designer

Dust allergy, mite allergy, food allergy, drug allergy…the list is endless, but do not take allergies lightly, because some can kill you.

Severe allergy cases are on the rise lately, said Dr Saied Al Habash, Consultant Otolaryngology, Medcare Hospital, Sharjah. Patients with Samter’s Triad, a chronic condition defined by asthma, sinus inflammation with recurring nasal polyps, can have severe reactions if they take pain killers, leading to even death, explained Dr Saied.

According to the American Academy of Allergy, Asthma and Immunology, about 9 per cent of adults with asthma and 30 per cent of adults with both asthma and nasal polyps also have Samter’s Triad.

A brief look at some people in UAE who overcame allergies:

Grade XI student with hives in UAE

A Grade XI student came to Dubai-based ENT specialist Dr Arijit Audhya with severe itching and hives all over his body.

The student was suffering for nearly six months and went through episodes of vomiting and loose stools too, making it almost impossible for him to attend classes or concentrate on studies.

The patient underwent detailed examinations, including blood tests to rule out infections and hormonal dysfunctions, urine and stool tests.

The boy also underwent a food allergy test. Finally, it was found out that the boy was allergic to peanuts, which he consumed in copious amounts, including chocolates that contain peanuts.

Dr Arijit from Aster Clinic, Al Khail Mall, Al Quoz, Dubai, treated the root cause of the illness, which resulted in the patient’s complete recovery.

Sneezing security guard in UAE

A young security guard at a mall in the UAE approached Dr Arijit complaining of excessive sneezing, runny nose, nasal blockage, itching of the nose and eyes.

He has been suffering from these issues for 11 years. The quality of his life deteriorated, and affected his ability to do his job.

Dr Arijit initially controlled the acute symptoms of the patient with medications and advised maintenance drugs. The security guard is now symptom-free but does constant follow-up checks.

Breathing difficulty and night cough for girl, 9

A 9-year-old schoolgirl approached Dr Arjit with severe breathing difficulty and coughing at night. Aggravating the girl’s troubles were severe episodes of tightness in the chest and wheezing.

Dubai-based ENT specialist Dr Arijit Audhya

The girl was unable to play and have quality time with her friends and family because of her condition. Her parents were also worried about her inability to attend studies regularly due to the illness.

After a detailed investigation, Dr Arjit started treating the patient. The parents were advised to remove pets and carpets from the house and to clean air conditioner ducts regularly.

After two years of treatment, the child is in control of her life and doing well.

The common thread in all three patients

The common factor in all the three cases were a family history of allergy, and they were young, said the Dubai-based ENT specialist. “Allergy is a disorder of the young and symptoms tend to become less intense when people grow older. Allergic rhinitis if treated properly can decrease the chances of developing asthma.”

Allergy symptoms

Dr Saied Al Habash

“Your allergy symptoms depend on how you’re exposed, through the air: your skin, food, or through an insect sting. If you’ve got a nasal allergy (one that’s triggered by something you inhale), common symptoms include: Itchy, runny nose, watery eyes, sneezing, feeling tired or ill,” said Dr Saied Al Habash.

Different ways of detecting allergies

There are different methods of detecting allergies. Once the allergic case is established, then the causative allergen can be detected by various investigations.

The treatment focuses on two parts.

First, avoidance of the possible cause

  1. Foods that are specifically allergenic for the patient
  2. Pets, mostly cats (one of the most allergenic animals), and birds
  3. Carpets and old unused cloth
  4. Regular vacuuming of beds and pillows and washing clothes in warm water before use
  5. Pest control, specifically for cockroaches (one of the highly allergenic insects)
  6. Keep house and washrooms damp-free to reduce chances of mould growth

Second is medication

Medications mostly comprise of long-term use of anti-allergics, mast-cell stabilisers and inhalation corticosteroids. Most people fear side-effects from the long-term use of these medications, but on the contrary, these medicines are extremely safe for long-term use and seldom cause any serious side-effects, said the Dubai-based ENT specialist Dr Arjit.

New generation of medications

Several new generation medications, known as immunotherapy or allergy vaccine or allergy shots, are very effective against some specific allergens. These treatments are long-term and need expert supervision, Dr Arjit said.

Allergy is a chronic disorder that affects the health and quality of life of the patient. Proper investigations and treatment can control it. Understanding the illness and proper guidance from an expert can change the life of the sufferer, Dr Arjit said.

What are allergies?

Allergies are fairly common: it is thought to affect more than 1 in 4 people at some point in their lives.

In simple terms, an allergy is the body’s reaction to the environment, especially a particular food or substance. More to it, allergies are the immune system’s response to “allergens” — a foreign substance that’s not typically harmful to your body.

In other words, allergies are caused by an immune reaction to something around you. Often, this includes dust or pollen. Such allergens cause the body to release histamine, just as it would with a cold, which causes nasal congestion, sneezing and coughing.

Here’s the good news about allergies: most allergic reactions are mild — which means they can be largely kept under control. The bad news: severe reactions may occasionally occur, and can be deadly, though such incidents tend to be uncommon.

While allergies are particularly common in children — some allergies go away as a child gets older — adults can also develop allergies to things they were not previously allergic to.

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Many allergies could stay for life.

Common allergy triggers include airborne allergens, such as pollen, animal dander, dust mites and mould. Certain foods, particularly peanuts, tree nuts, wheat, soy, fish, shellfish, eggs and milk. Insect stings, such as from a bee or wasp.

My struggles with skin and food allergies
Image Credit: Vijith Pulikkal, Assistant Product Manager

Are allergies genetic?

Allergies tend to be inherited, but are not contagious. They cannot be passed from one person to another. However, the tendency to develop allergies is usually hereditary, say experts. This means: children can inherit the allergic tendencies of their parents.

In the 2015 study “Genetics of Allergic Diseases” in Immunology and Allergy Clinics of North America journal, for example, researchers pointed to “significant associations” for nearly 100 asthma genes/loci.

Researchers have also established that some families may be more likely to be affected by allergic conditions than others. Therefore, children born into these families often have a higher risk of developing an allergic condition.

This tendency to develop allergic conditions is thought to have a genetic link known as “atopic”.

However, it doesn’t mean that just because you, your spouse or one of your children may have allergies doesn’t mean that all of your kids will definitely get them.

Allergy tests
Image Credit: Seyyed de la Llata, Senior Designer

Difference between food allergy and food intolerance

A physical reaction to certain foods causes the same signs and symptoms as a food allergy, but they are not the same.

A food allergy causes an immune system reaction that hits many organs in the body and can cause a range of symptoms. An allergic food reaction can be severe or life-threatening. In contrast, food intolerance symptoms are generally less serious and often limited to digestive problems.

People with food intolerance can still eat small amounts of the offending food without much trouble. For example, if you have lactose intolerance, you may be able to drink lactose-free milk or take lactase enzyme pills (Lactaid) to aid digestion.

Causes of food intolerance:

It is the absence of an enzyme needed to fully digest a food. Lactose intolerance is a common example.

Irritable bowel syndrome. This chronic condition can cause cramping, constipation and diarrhoea.

Sensitivity to food additives. For example, sulfites used to preserve dried fruit, canned goods and wine can trigger asthma attacks in sensitive people.

Recurring stress or psychological factors. Sometimes the mere thought of food may make you sick. The reason is not fully understood.

Coeliac disease: Coeliac disease has some features of a true food allergy because it involves the immune system. Symptoms often include gastrointestinal issues as well as those unrelated to the digestive system, such as joint pain and headaches. However, people with coeliac disease are not at risk of anaphylaxis. This chronic digestive condition is triggered by eating gluten, a protein found in wheat and other grains.

Food allergy

In the case of a food allergy, there is a risk of a life-threatening allergic reaction (anaphylaxis). It’s important to recognise a severe allergic reaction and know what to do if one occurs.

Seek medical help

If you react to eating a particular food, see your doctor to find out whether you have a food intolerance or a food allergy.

Common symptoms of a skin allergy

Rashes and hives (a rash with raised red patches). Your skin may be red, itchy, or swollen.

How allergies are treated

The best option is to identify the substances you are allergic to and stay away from those. And if you come into contact with them, there are treatments available to relieve the symptoms. Also available is allergen immunotherapy in which you are given allergy shots to decrease the sensitivity to allergens, which in many cases offers relief to allergy symptoms.

An allergy is the result of an exaggerated immune response towards perceived threats from agents that are usually harmless. When your body comes into contact with these allergens, it makes histamine. Histamine is a chemical released in the body when the immune system sees a threat and is defending against a potential ‘enemy’. This organic nitrogenous compound — C5H9N3 — is secreted by the white blood cells into the bloodstream as part of the local immune response. Its role, in simple terms, is to help the body get rid of the allergen. In most people and cases the reactions are mild but when it goes out of control you get allergy symptoms that need to be treated.

The allergic reactions caused by histamine include itchy skin, watery eyes, runny nose and breathing difficulty. Most of the minor symptoms are treated with antihistamines and steroids. As the name suggests, antihistamines help treat symptoms caused by histamines in the affected area. Antihistamines are available as tablets, capsules, liquid solutions, nasal sprays, eye drops, lotions and creams, which are used depending on the affected area.

It is best to seek medical care even in the case of mild allergies and do not try to self-medicate.

However, in case of serious allergy attacks involving anaphylaxis one may not get enough time to get proper medical care and the symptoms are too severe and sudden and it can progress into anaphylaxis in no time. If anaphylactic shock isn’t treated immediately, it can be fatal.

The first-line treatment for anaphylaxis is Epinephrine and it should be administered immediately. It is available in auto-injectors, in pre-measured doses and it is advised people with severe allergy reactions carry with it themselves always. In adults, it is administered intra-muscularly in the mid-outer thigh.

Using the auto-injector immediately can keep anaphylaxis from worsening and could save your life.

What can trigger allergies?

Harmless substances known as allergens can provoke an overreaction from the human immune system, resulting in allergies. These allergens can be anything: pollen, food, medicines, latex (rubber), perfumes, gold, well, almost anything. It can be different things for different people. So the best way to prevent allergies is to steer clear of allergens.

Here are some of the allergens:

Food: One in every 20 people is at risk of developing a food allergy. Peanuts and shellfish (shrimp, lobster, scallops, squid, crayfish) can wreak havoc, and they can be fatal for some people. Most people with peanut allergies tend to be allergic to other nuts (tree nuts) as well. Other common food allergens may include eggs, milk and milk products, fish, wheat and soy. Some less known food allergies can be reactions to mustard seeds, aniseed, linseed, sesame seed, peach, kiwi fruit, passion fruit, banana, avocado, celery, garlic, and chamomile. Even food colouring can be the cause of allergies.

Medicines: Any drug can cause an allergic reaction. Some medicines that can set off allergies include antibiotics (penicillin among others), pain-relievers or anti-inflammatory medicines (aspirin, ibuprofen and naproxen sodium), chemotherapy drugs (for treating cancer), medications for autoimmune diseases(rheumatoid, arthritis, etc.).

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Pollen: When flowers bloom in spring and summer, pollen from grass, weeds, shrubs and trees float around in the air. And this could spark an allergic reaction in some people. Among trees, oak, ash, elm, birch, maple, alder, hazel, hickory, pecan, mountain cedar, evergreen juniper, cedar, cypress, and sequoia can cause allergies. Kentucky bluegrass, Johnson, Bermuda, redtop, orchard grass, sweet vernal, perennial rye, and salt grass are some of the grass types that could trigger allergy symptoms. People with pollen allergies should keep out of areas with weeds like ragweed, sagebrush, lamb’s quarters, goosefoot, Russian thistle, and English plantain.

Moulds: Moulds are tiny fungi with spores that float around the air. They are primarily found in damp areas such as basements and bathrooms in buildings, and piles of leaves or grass and mulch provide good growth conditions outdoors.

Gold and nickel: Allergic to gold? Yes, skin contact with gold produces an allergic reaction in some people. The Healthline quoted a study that found that 9.5 per cent positive for gold allergy in a sample of 4,101 people. And it need not be gold in itself that’s triggering the reaction; it could well from other metals like nickel which is added to gold for making jewellery.

Dust mites: Dust mites are common allergens that live in pillows, mattresses, upholstered furniture and carpets. They feed on dead skin shed by people and thrive in warm, humid conditions. Many people with dust mite allergy also experience signs of asthma, such as wheezing and difficulty breathing, a Mayo Clinic report said.

Dander and cockroaches: Dander is microscopic flecks of skin shed by cats, dogs and even birds, and they can trigger allergies. The reaction stems from the proteins from oil glands in an animal’s skin or saliva. Cockroaches too are a source of allergens. Their saliva, faeces and body parts can spark both asthma and allergies.

Insect sting: Insects that cause allergic reactions include various bees, fire ants, yellow jackets, hornets, and wasps. For most people, there will be redness and swelling at the site of an insect bite, but for others, insect venom can trigger a more severe reaction. Sometimes, it could be life-threatening.

Latex: Latex allergy is a reaction to some proteins in latex rubber used to make gloves, condoms and other things. It’s a mild reaction that manifests as itchy red skin, rash or hives. Some may develop a runny nose, itchy eyes, sore throat or sneezing. It’s not generally life-threatening.

Perfumes and beauty products: More than 5,000 fragrances are used in perfumes, soaps, shampoos, lipstick and cosmetics; eight of them have been proved to cause allergic skin reactions, according to On Health.com. But they do not lead to anaphylactic shock, a life-threatening condition. Balsam of Peru, found in deodorants, baby powder, sunscreen, suntan lotion, shampoo and perfumes, can be allergic to some people.

Allergies that can lead to death
Image Credit: Vijith Pulikkal, Assistant Product Manager

Medicines, reactions and allergies

The risks of buying over-the-counter medicines, herbal or otherwise, are that they are capable of triggering a drug allergy.

Most of the time, drug allergies are with certain specific medications.

The most common signs and symptoms of drug allergy are hives, rash or fever. A drug allergy may cause serious reactions, including a life-threatening condition that affects multiple body systems (anaphylaxis).

Medicine allergies happen when the body’s immune system mistakenly identifies a drug as a harmful substance. In response, the body will develop an antibody specific to that drug. It can happen at the first instance of taking medicine or at times after repeated intake of the same medicine.

A drug allergy is not the same as a drug side-effect, a known possible reaction listed on a drug label. A drug allergy is also different from drug toxicity caused by an overdose of medication.

Drug allergy signs and symptoms may include:

  1. Skin rash
  2. Hives
  3. Itching
  4. Fever
  5. Swelling
  6. Shortness of breath
  7. Wheezing
  8. Runny nose
  9. Itchy, watery eyes

Signs and symptoms of anaphylaxis include:

  • Tightening of the airways and throat, causing trouble breathing
  • Nausea or abdominal cramps
  • Vomiting or diarrhoea
  • Dizziness or lightheadedness
  • Weak, rapid pulse
  • Drop in blood pressure
  • Seizure
  • Loss of consciousness

Other conditions resulting from drug allergy

Serum sickness, which may cause fever, joint pain, rash, swelling and nausea

Drug-induced anaemia, a reduction in red blood cells, which can cause fatigue, irregular heartbeats, shortness of breath and other symptoms

Drug rash with eosinophilia and systemic symptoms (DRESS), which results in rash, high white blood cell count, general swelling, swollen lymph nodes and recurrence of dormant hepatitis infection

Inflammation in the kidneys (nephritis), which can cause fever, blood in the urine, general swelling, confusion and other symptoms

Allergy in children, and how they outgrow it

Allergies and asthma generally start in childhood and continue throughout life. Some children outgrow their allergies in the teens or when they become young adults. Some allergies cannot be cured and can be managed with good care and a healthy lifestyle.

Children can be allergic to pollen, pet dander, dust, and food. Some of these reactions manifest as skin rashes, nasal allergies and asthma. The US Centres for Disease Control and Prevention estimates that 8 per cent of children have a food allergy.

An itchy skin rash called atopic dermatitis is seen in 10 to 20 per cent of children, particularly during infancy. Hay fever or allergic rhinitis is found in about 50 per cent of children with atopic dermatitis. These children are allergic to pets, dust, and mould and are likely to develop pollen allergies later.

Asthma, which mainly stems from allergies, is the most common chronic disease in children. It occurs when airways in the lungs are inflamed or swollen, making breathing difficult. One in 4 children with allergic rhinitis will develop asthma, according to medical experts.

An egg allergy is common in children, but around 68 per cent of children will outgrow it by the time they’re 16, according to Healthline.

Cow’s milk is likely to produce an allergic reaction in babies and young children, especially if they have been exposed to it before they are six months old, Healthline says. But around 90 per cent of them will cease to be allergic to milk when they grow older. A report by Allergy Partners says that cow’s milk allergy solves in 42 per cent of children by age 8, 64 per cent by age 12, and 79 per cent by age 16. So egg and milk allergies are much less common in adults.

Peanut allergies are commonly found in around 4–8 per cent of children and 1–2 per cent of adults. This is an allergy that’s difficult to shake off since only around 15–22 per cent of children ceases to be allergic to peanuts when they become teenagers.

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A wheat allergy is an allergic response to one of the proteins found in wheat. It tends to affect children the most. Although, children with a wheat allergy often outgrow it when they reach 10 years of age.

Soy allergies, triggered by a protein in soybeans, affect around 0.4 per cent of children, mostly under three years of age. Around 70 per cent of children who are allergic to soy outgrow the allergy.

Fish and shellfish allergies tend to persist as children turn into adults. Nancy Ott, a paediatric allergy and immunisation specialist at Mayo Clinic in the US, says only a small number of children, just 4 to 5 per cent, will outgrow a fish or shellfish allergy.

A sesame allergy tends to show up early in life, and if the children haven’t outgrown it by the age of six, it is likely to remain throughout adulthood. The allergy persists in 80 per cent of the cases, a report by Anaphylaxis Campaign, a British charity, said.

Living with allergies

How do you manage allergies? A life with any allergy is not easy, and a food allergy can be fatal in case of an anaphylactic shock (a severe reaction that includes the blockage of air passages in the lungs). So a prudent approach would help since the world is made for people without allergies.

Pet gander can be avoided by removing pets from the house, and dust mites can be eliminated by frequently laundering pillow covers and bedsheets, besides air the mattress and pillows. Allergen-free covers for mattresses and pillows are also available.

By staying indoors, you can stay away from pollen and dust. Keep the windows closed and use the air-conditioning at home or in the car. And don’t use fans since they can stir up dust particles.

The use of air purifiers with HEPA filters is a huge help. A HEPA (high-efficiency particulate air) filter can “theoretically remove at least 99.97 per cent of dust, pollen, mould, bacteria, and any airborne particles with a size of 0.3 microns”.

Avoid using rugs, carpets, window blinds, drapes and other materials that gather dust. Use a face mask or a cap as protection from pollen, when stepping out.

An epinephrine kit (EpiPen) could be a life-saver. So have some at home and carry a couple of them wherever you go. Learn to use them correctly.

While most allergies can be avoided by keeping out the allergens, food allergies are a minefield. Traces of peanut can lurk in cereals and breakfast food, and soy can remain hidden in flavourings or thickeners found in processed or frozen foods. So the best option is to read the labels. These days, it’s mandatory to list the contents of food on the label. That’s a huge help. But beware, not all allergens may be listed. So always carry home-cooked food.

How parents can help children with food allergies

Parents play a significant role in helping children cope with food allergies. The lure of eating out is very strong in children, so they have to be told about the consequences and how lethal it can be.

It has to be communicated to children’s friends so that they don’t share food. Even the school staff have to be informed about the allergy.

Parents should pack food for children wherever they go. At school and even at parties. One school student with a food allergy says that her mother even packs her snacks and a homemade cake when she goes for birthday parties. “My friends know of my allergy and are very accomodating, so they don’t insist on sharing food with me,” Fay [name changed] said.

And when cooking food at home, it’s better to make it from scratch rather than using packaged or frozen ingredients. Because you never know whether it contains allergen traces.

If the children are old enough, teach them to use epinephrine kits and keep a couple of kits in their bag. In the case of younger children, leave a couple of kits at school and ensure that the school staff know to use them properly.

WHY COELIAC DISEASE IS NOT AN ALLERGY

Do you have diarrhoea when you eat bread, cakes, cereals or pasta? Is it followed by abdominal pain, nausea, bloating of the stomach, flatulence, fatigue, or weight loss? All these symptoms could point to coeliac disease, an auto-immune response that damages the small intestine. They could be other symptoms as well, including anaemia.
People with coeliac disease cannot consume wheat, barley, or rye products because of gluten, a protein. But don’t confuse the coeliac disease with a gluten allergy or a wheat allergy, which are very different. Coeliac disease is not an allergy; it’s an immune reaction linked to the antibody IgA. An allergy is different and involves a separate branch of the immune system and may involve the antibody IgE. Since the coeliac disease can easily be confused with other disorders, leave the diagnosis to medical experts.
One in 100 people worldwide suffers from coeliac disease, which has no cure. It’s a hereditary disease, but people can develop it at any age. It can be managed with a strict gluten-free diet, which will help heal the intestine. Left untreated or unmanaged, the disease can lead to serious health issues and early death. One study said it is fatal for 10-30 per cent of people, and cancer is the most likely cause.
If the diet is not controlled, coeliac disease can result in malnutrition, weakening of the bones (osteoporosis), infertility and miscarriage, cause several types of cancer, lactose intolerance and nervous system issues (peripheral neuropathy). It also increases the risk of diabetes, heart failure, obesity, epilepsy and thyroid disease.

Glossary

Loci: In genetics, a locus (plural “loci”) is a specific, fixed position on a DNA chromosome (thread-like structure made up of DNA) where a particular gene or genetic marker is located. This is established through gene mapping, the method of pointing out the specific locus (or loci) responsible for producing a particular phenotype or biological trait.

Histamine: Histamine is a chemical created in the body which is released by white blood cells into the bloodstream when the immune system is defending against a potential allergen. This release can result in an allergic reaction from allergy triggers such as pollen and certain foods.

Histamine also regulates the physiological function in the gut and acts as a neurotransmitter for the brain, spinal cord, and uterus.

Once released from its granules, histamine produces many varied effects within the body, including the contraction of smooth muscle tissues of the lungs, uterus, and stomach; the dilation of blood vessels, which increases permeability and lowers blood pressure; the stimulation of gastric acid secretion in the stomach.



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