Dr. Shelly Sehgal and
Dr. Sachin Gupta
“It’s more important to know what person the disease has,
Than what disease a person has”
There you go sniffling, sneezing and feeling dizzy again!! It is your third (or fourth or fifth) cold of the season, and you are already in a fix- is something really wrong with you. Recurrent cold is one of the most frequent manifestations of seasonal allergy (hay fever). With the dropping temperatures, seasonal allergic response is a common sight in all age groups. Worldwide, the burden of allergic rhinitis is enormous, affecting about 10-25% of the population. In India, the reported incidence varies from 20-30%. Particularly alarming is the increasing prevalence of the disease in the younger age group i.e. 4-15 yrs. Therefore, knowledge about allergy and its manifestations is important to overcome the menace and welcome the local climatic change with open arms.
Allergy and allergens
The immune system acts as the guardian of our body from harmful environmental influences. The seasonal allergic response is the abnormal reaction of the immune system when exposed to external insults (like foreign particles or allergens). An allergen is any substance or antigen; most often inhaled or ingested that triggers an allergic reaction. When it enters the body and binds with antibody (protective response of immune system), a number of chemical mediators such as histamine are released, which lead to the watery eyes, runny nose, excessive sneezing and other tell-tale symptoms of an allergy attack. Many also experience exacerbation of seasonal asthma which appears as recurring episodes of cough, wheezing and difficulty breathing. Consequently, seasonal allergy can significantly impact quality of life by disrupting sleep and, thereby, affecting the learning ability at school and productivity at work. Allergic rhinitis is also associated with number of comorbid conditions such as asthma, sinusitis, otitis media, atopic dermatitis and nasal polyps. Recently, a scientific concept of “atopic march” has gained attention which postulates that onset of one disease can predict the occurrence of the other. The illness starts with allergic rash or food allergy eventually progresses to asthma and allergic rhinitis. Another concept of “early immune challenge” has also gained significant acceptance, wherein exposure to possible allergens at an early age may boost immunity. Henceforth, complex interactions of factors influencing environmental and genetic tendency may act as disease progenitors.
Different people with allergies have different triggers. Seasonal allergic rhinitis is most commonly caused by pollens of specific seasonal plants. Pollens from the grass, weeds and trees are responsible for allergic symptoms in a significant proportion of population The indoor allergens commonly comprise of house dust mites which are the microscopic bugs flourishing in mattresses and bedding. In addition, the mould or fungus thriving in damp, humid areas may serve as potent triggers of allergy. Animal fur, dander, saliva and urine are frequently problematic in case of animals. Several epidemiologic and multiple observational studies propose that deficiencies of vitamins A, D and E may be associated with development of asthma and allergic disorders. Exposing children to passive smoke, pollution and dust has also been known to increase the development of asthma and other chronic respiratory illnesses.
Symptoms of winter allergies
Evidence suggests that patients of different age groups experience different allergic symptoms out of the wide spectrum of allergic manifestations in their daily life. Winter allergy symptoms can easily be mistaken for a common cold. Typically, a common cold does not last for more than 10 days. Also flu or cold, are usually accompanied by a fever, aches and pains. Allergies on the other hand, last as long as the allergens causing them are present. Coughing, itchy and stuffy nose, runny nose, excessive sneezing, red watery eyes are the general symptoms. Some allergens can also trigger asthma, causing coughing, wheezing and shortness of breath. A comparatively harsh reaction is termed as anaphylaxis that may cause swelling of lips, tongue, or throat and can sometimes make breathing difficult. The initial clinical presentation which is stimulated by histamine is followed by additional sequence of events. The leukotrienes and cytokines attract and activate eosinophils and cause allergic inflammation, nasal blockage which eventually leads to deleterious effects like sleep disturbance, fatigue, poor concentration, and limitations in daily activities.
In J&K health-care centers are flooded with patients suffering from allergic reactions. Awareness of the problem of allergic rhinitis along with clinical acumen and detailed investigations are required to provide further precision to nature/sensitivity of allergen or the cause of allergy. By and large, treatment is primarily with second generation H1 -antihistamines and intranasal corticosteroid sprays targeted for mild to severe allergic response. First generation H1 -antihistamines are generally avoided as they cause impairment in the cognitive functions. Specific and individually designed immunotherapy is yet another alternative for the patients suffering from varied aspects of this disease but this is possible only after comprehensive assessment of the patient responses.
An allergy management plan is the solution for preventing and controlling allergic reactions. Work with your doctor to create your allergy management plan. General precautionary measures are:
Outdoor allergies: During peak pollen days (sunny and windy) try to stay indoors as much as possible and keep your windows at home, car closed and use air conditioning if possible. Take a shower after spending the day outside to remove pollen from your hair and skin. When outdoors, wear sunglasses/wide-brim hat to reduce pollen blowing into your eyes and avoid wearing strong perfumes or fragrances, as these can attract insects.
Indoor allergies: Home should be kept dry and well ventilated. If possible carpets and upholstered furniture should be removed, and surfaces should be regularly wiped with a damp, clean cloth – avoid dry dusting, as this can spread dust into the air. Regular washing/grooming of the pets and limit them to a particular area of the house.
Proper medications: Take your medications at the start of, or even before, the pollen season and tailor them in consultation with the physician, especially if your allergies tend to be severe. For long-term relief of allergy symptoms, immunotherapy is the viable alternative.
Population of J&K is highly diverse in genetic, ethnic, geographical and cultural aspects. Successful characterization of the factors distinguishing an “allergic individual” from the general population can be of great value for diagnostic purposes. Proper identification, prompt diagnosis and efficient treatment of allergy is crucial to prevent disease associated morbidity and comorbidities. The masses must not only be well-informed about the rising trends of the disease, but also about the serious complications, if it goes unnoticed. Efforts should be targeted towards a common goal of reducing the burden of allergic diseases, developing cost-effective innovative preventive strategies and a more integrated, holistic approach to treatment thereby improving the quality of life of patients.
(The authors are Assistant Professors in CUJ and ASCOMS respectively)