By Udaya Sureshkumar

Mangaluru, Jul 17: The last week of June commemorates Allergy Week. But the question is - Why does something that everyone seems to have, warrant a week of dedicated awareness plan?

The simple answer is because of the sheer number of different allergies that are encountered and how resilient these allergies are. That being said, let's see what different kinds of allergies are encountered:

• Atopic dermatitis/ eczema
• Allergic conjunctivitis
• Allergic rhinitis
• Allergic Rhinosinusitis and nasal polyps
• Asthma and eosinophilic lung disorders
• Food allergy
• Drug allergy and Anaphylaxis

While we consider a runny nose, hay-fever, skin rashes and itching as the cardinal and only symptoms of allergy that are well known, the underlying issues can be quite varying.

So is being allergic bad for us?

In motto, we are all born with a certain type of immunity and pre-disposition. Depending on our genetic framework and exposures from childbirth to adulthood, we can have a certain kind of stronger response to certain things, essentially the protein molecules in them. Now it is not necessary that these are harmful substances - as seen in case of food allergy, pollen allergy - but the body sees this innocent visitor as a dangerous threat and launches an attack towards it leading to different symptoms.

So what is the spectrum of allergy disease?

In literature, we call this as 'atopic march'.

When the child is born, the earliest presentation might be 'excezma' - dry flaky skin/rashes with itching on the folds of arms or behind the ear, face of babies, children may have silvery patches on ankles, knees or elbows. Adults on the neck, eyelids or hands.

Early childhood (ages 2-5) is when food allergy starts, when the kid starts experimenting with different food types. The most common triggers being peanuts, cow milk and eggs. These can be food intolerance or food allergy. Food allergy which is ig-E mediated classically presents as itching in the back of the throat/mouth, swelling of lips and choking. These are the ones with significant anaphylaxis hazard and most of the patients come with blood tests consisting of 30 or more agents, half of which they are allergic to.

In real practice done by a professional allergy specialist, this doesn't hold true. We prefer to narrow down the history and exposure, and only test the food which the patient consumed and had a reaction to. This is again done by a prick-to-prick method where we ask the patient to bring the particular food from their home so we can replicate it exactly!

It might be surprising to know that most of the patients have allergy to the contamination in the food. For example, dust mites found in wheat flour might be the actual culprit rather than the ingredient.

Most patients have what we call food intolerance, which is basically indigestion, increased production of mucous, diarrhoea without any associated respiratory or skin manifestations. This can be resolved by frequent microdosing of the said ingredient, and is relatively harmless. So, it's time you stop restricting yourself from the food you love and let us decide if that's necessary!

In children, there are known types of food allergy in which the baby has failure to digest the food well, and passes stool with traces of blood. These need special and timely attention by a pediatrician so as to prevent complications. Most of it is seen after the introduction or cow milk or formula-based feed.

The Next Part of the Spectrum

The next part of the spectrum is the classical runny nose, sneezing and wheezing - predominantly nasorespiratory symptoms. This might be due to exposure to dust, pollen or seasonal variations in the same amount, increase in mould in place of work or residence, pet hair, etc.

These might need skin prick tests to pin down the exact trigger so that adequate avoidance measures can be taken. Usually adequate and well planned treatment helps. The use of nasal sprays and inhalers at the right time prevents progression to adult asthma - which is when these neglected patients have clinical asthma which when ignored the patient becomes dependent on daily inhalers.

In today's world, even these difficult to treat asthma has new developments where there are injectable biological therapies, which when chosen well and therapy curated (according to the individual patient as to which amongst the molecules would be effective like omalizumab, mepolizumab, benralizumab) has shown good response, with less side-effects, reduction in admissions and avoidance of oral steroids.

Not all patients need all these treatments. Sometimes the solutions are very simple. It's just the hesitancy and taboo related to the disease and for some, pure neglect by blaming the symptoms and calling it a common cold.

Also, patients tend to be more affected by common cold viruses as it is a known trigger increasing their suffering so regular treatment for the underlying allergic disease is a win-win situation!

Dr Udaya Sureshkumar, Consultant - Respiratory Medicine, Pulmonology & Allergy Specialist, KMC Hospital Mangalore