There are many ways that people can get sensitized to allergens, from pollen to pollution to food allergies in children with things like milk, eggs, peanuts, fish or shellfish. Although the process of sensitization from our environment is not fully understood, there has been some interesting research recently and scientists generally agree it is safest to be exposed to these food groups – and other allergens and microbes - while we are young, rather than later.
For example the LEAP (Learning Early About Peanut Allergy) study in the US found that introduction of peanut products into the diets of infants at high risk of developing peanut allergy was safe and led to an 81% reduction in the subsequent development of the allergy.
Other scientists previously hypothesised that peanut allergy – the body recognising peanut protein as foreign or dangerous by the immune system of the skin - was carried in the body’s immune pathway from breast milk, before the child is even developed.
The thing to remember is that food allergies and allergies generally are a growing concern worldwide. So we all need to understand them better.
To find a benefit of this magnitude in the prevention of peanut allergy was unprecedented and it caught the attention of scientists.
Germs and sensitivity
Over the years researchers have been looking at why allergic reactions are more prevalent in the first child in the family and just why they are growing at such a rate.
The importance of the peanut research is that has helped to shine the light on the whole science of atopy or atopic syndrome, where someone is characterized by a tendency to be “hyperallergic”.
The science is leading in the direction of the so-called ‘hygiene hypothesis’, the idea that reduced exposure to microbes in modern life is linked to chronic inflammatory diseases like asthma, atopic dermatitis and hay fever. It is thought that the concept may also apply to other diseases such as Type 1 diabetes, multiple sclerosis as well as some types of depression and cancer.
Essentially now that we have reduced microbial exposure to the bugs or “old friends” that used to cause cholera, typhoid and so on – through improved sanitation – our immune systems have developed in an unintended way. However there is also a genetic element.
Asthma and eczema: genes or environment?
A person with atopy typically experiences one or more out of: eczema (atopic dermatitis), allergic rhinitis (hay fever) or allergic asthma. Some patients with atopy display what is referred to as the “allergic triad” of symptoms, meaning they have all three of the conditions.
Patients with atopy also have a tendency to have food allergies, allergic conjunctivitis, and other symptoms characterized by their hyperallergic state. For example, eosinophilic esophagitis - the inflammatory condition of the esophagus- is found to be associated with atopic allergy, although the precise food allergen is still unknown.
Dr Glennis Scadding is a consultant allergist and rhinologist at London’s Royal National Throat, Nose and Ear Hospital and consultant to Dr Matt. She is also President of the UK Semiochemistry Network, which is pioneering research into smell and the chemical sense of smell as an indicator of other things in the body.
Dr Scadding says she believes much more needs to be done in the NHS to raise awareness and re-educate patients on the whole subject of allergies.
Atopic syndrome can be fatal for those who experience serious allergic reactions, such as anaphylaxis, brought on by reactions to food or environment.
Atopy also shows a strong hereditary element. One study indicates the risk of developing atopic dermatitis or eczema (3%) or atopy in general (7%) increases by a factor of two with each first-degree family member already suffering from atopy.
As Dr Scadding says: “Immune systems by default are adaptive pathways. Sometimes the adaptive system is unable to distinguish between foreign molecules, unless it has been stimulated by microbes – and a combination of microbes - on the way. The effects of this may be hay fever, asthma or any other allergies.”
The way our immune system works in a perfect world is that antibody responses are driven by either B cells or T cells that secret proteins causing the foreign body or antigen to inactivate, thus protecting the body. However the way these receptors acquire immunity – sending “stranger” or “danger” signals – doesn’t always work.
Dr Scadding says that in addition to the body reacting to a combination of microbes, there is some evidence that stress and certain types of pollution also have an effect on sensitization.
Treatments and avoiding exposure
Avoiding the allergens and irritants that affect us as individuals is the first place to start with controlling asthma or other allergies, for example looking at types of pollen, household dust and dust mites, certain foods, or chemical/physical irritants.
Dry skin is a common feature of patients with atopic eczema and it can exacerbate atopic eczema. So it’s best to avoid dry skin and anti-oil skin products which can be too strong.
Allergy testing can help get to the root cause of any allergy. It works by subjecting your body to a small dose of the suspected allergens and then measuring for raised levels of a molecule called immunoglobulin E (IgE).
Skin patch testing is an allergy test commonly-used to determine if a patient is allergic to a particular topical substance (such as cosmetics, metals, cleaning materials, types of foods, dust, pollen or other environmental materials). It can also take the form of a skin-prick test.
Use a non-sedative antihistamine
When using antihistamines, such as the readily available hay fever treatments, Dr Scadding says it is always best to go for a non-sedative one, because of the risk of complications with more severe rhinitis.
For eczema, topical steroids control the itching and the rash that accompany atopic dermatitis. Side-effects of topical steroid use are plentiful, and the patient is advised to use topical steroids in moderation and only as needed.
For hay fever, one example of the non-sedative antihistamines is Telfast, as recommended by Dr Matt, containing fexofenadine. Hay fever is easily dismissed, but it is becoming more serious, a sign of rhinitis that affects work performance and sleep with sufferers often waking up in the night and feeling unwell in the morning.
“People tend to go to the antihistamines,” says Dr Scadding. “People buy them but they need to be educated on what not to do.”
The intra-nasal cortisoidal sprays such as Nasonex are very safe for treating hay fever, even in children.
“But they should be used even before the symptoms develop and they should use it every day as the protection is better,” adds Dr Scadding.
What is new and highly effective, she says, are the new combined antihistamine nasal sprays such as Dymista, combining corticosteroid and antihistamine in one.
There is another even more cutting-edge therapy – immunology – which promises to bring about a complete cure for allergic reactions. This is a more serious treatment requiring a series of up to seven injection that acts by interfering with the T cells. Currently it brings relief for one to two years and the injections have to be done in a clinic setting.
“The great thing about immunology is that it can cure in some patients,” says Dr Scadding. “It helps prevent the slide from chronic rhinitis into asthma…Immunology also helps the patient develop resistance to other allergies.
“But we should be doing much more in the treatment of allergies, particularly for children, in those areas the NHS is currently not funding.”
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