Allergies - by Dr David Delvin

Have YOU got any allergies? I certainly have! And so do a huge chunk of the population.

Yes, allergies are incredibly common these days, and they seem to be increasing in incidence. No one knows why – though maybe it’s to do with the fact that we’re all exposed to so many chemicals and pollutants.

Anyway, in this article I’m going to gallop through the whole subject of allergies. Let’s begin by explaining what allergies AREN’T -- and what they ARE!

WHAT ALLERGIES AREN’T! Lots of people misunderstand the word ‘allergy.’

Often, they use it to mean ‘violent dislike’; or ‘phobia.’ For instance, I’ve heard patients say: ‘Doctor, I’m allergic to my son-in-law.’

This is impossible! You can’t be allergic to people. (However, as we’ll see in a minute, you can be allergic to certain people’s sexual secretions …)

Similarly, I’ve had patients tell me that they’re ‘allergic to thunderstorms’ or ‘allergic to flying.’ What they mean is that they have a great FEAR of these things – but they’re not actually allergic to them.

Similarly, people often think that if something doesn’t AGREE with them, then they must be allergic to it. For instance, quite a few of us get pain in the tummy if we take aspirin. But that’s simply an adverse reaction to that drug – not an allergy.

So what really are allergies? Well, an allergy is a crazy reaction by the body to something from outside it.

Our bodies have very good defence systems against foreign ‘agents,’ such as germs. We hit back at them by forming ANTIBODIES – which attack the germs and do them in.

Unfortunately, allergic people produce antibodies when they’re not needed. Some innocent bit of food or piece of clothing makes the body produce these stroppy antibodies – even though you have no use for them. And the antibodies then produce distressing symptoms in your nose or skin or lungs or elsewhere.

It’s rather as if you had a Home Guard composed of drunken layabouts who keep firing off their guns at innocent passers by!

The battle between your antibodies and the foreign substance often releases chemical called ‘histamine,’ which causes inflammation, redness, swelling and itching. And that’s why the ANTI-histamine group of drugs – which counter the effects of histamine – are often so useful in allergies.

SKIN ALLERGIES When this violent collision between antibodies and some foreign agent happens in your skin, the main possible results are:

  • Urticaria
  • Eczema

URTICARIA is often called ‘nettle rash’ in the UK – because it looks very like what happens to anybody when they touch nettle leaves. In the USA and Canada, it’s more often known as ‘hives.’

What happens is that you get some raised, bumpy, itchy patches on your skin. If you’re fair-skinned, these patches will look white – and they’ll be surrounded by a red area. If your skin is dark, then the patches will be varying shades of brown.

Common causes of acute urticaria are latex gloves, various plants, and hairs from cats, dogs and horses. Foods such as nuts, shellfish, strawberries and dairy products may also trigger attacks. Medications such as penicillin and blood pressure-lowering drugs can do the same thing. So may insect bites or stings.

Treatment is up to your GP or dermatologist, but usually involves giving anti-histamines – to counter the effect of all that histamine which has been released into the skin.

ECZEMA There are several types of eczema, but the one that is most closely connected with allergy is called ‘atopic eczema.’

This common condition affects many babies and toddlers, and tends to run in families. One good thing about it is that it tends to get better with age.

It is often very difficult to find out what is causing the allergy, but common provoking factors include dairy products (especially cow’s milk in young kiddies), eggs and the droppings of tiny mites which live in house dust (yuk!).

Treatment involves trying to avoid provoking factors (IF you can identify them), use of emollients on the skin, application of steroid creams or ointments —in as low a dose as possible – and giving the afore-mentioned anti-histamines.

FOOD ALLERGIES This is still quite a contentious subject, and I’m afraid that if you are an adult with a food allergy you may find it hard to get some GPs to take you seriously. (There is no such problem with INFANT food allergies, since everybody now accepts that they occur widely.)

About one in five of the population claim to have food allergies, but experts maintain that the true figure is nearer one in 100. It is difficult to know who’s right!

Part of the problem is that the symptoms of food allergy can often be pretty vague; they include ‘wind,’ constipation, rashes, itching, puffiness of the face, abdominal pain and discomfort, and diarrhoea.

Among the many foods which can provoke an allergic reaction are: egg white, cow’s milk, soya, wheat, fish, nuts, fruits, vegetables and – very commonly – shellfish.

The most important part of treatment is to find out WHICH foods are causing your problems – and then to eliminate them from your diet. Regrettably, finding the cause may be difficult – especially as we have so few allergy clinics.

Medications prescribed by doctors haven’t really been a great success in food allergy, but there is a drug called sodium cromoglycate which sometimes helps.

RHINITIS (INCLUDING HAY FEVER) Rhinitis means ‘inflammation of the nose’ -- and that implies the inside of the nose, not the outside! Symptoms are:

  • Itchy nose
  • Runny nose
  • Blocked nose
  • A feeling of congestion

That may not sound much, but actually it can be absolute misery – particularly if you’re trying to do something difficult -- like sit an exam in the hay fever season!

The main types of rhinitis are:

  • Hay fever – caused mainly by grass pollen in the UK, and by ragweed pollen in the USA;
  • Dust mite allergy;
  • Perennial (year-round) rhinitis – which can due to dust, tree pollens, pets, or almost any kind of protein material in the air.

People tend to think that medication must be the answer, but in fact the first thing to do is to try and PROTECT yourself from the allergen. So with hay fever, you should:

  • Stay in on days when the pollen count is high;
  • Wear a paper face-mask;
  • Wear wrap-round glasses;
  • Keep windows shut or curtained;
  • Keep CAR windows rolled up;
  • Stay away from fields;
  • If possible, go to the seaside – where pollen counts are generally lower.

MEDICATION Anti-histamine pills are very helpful; these days, most people go for the non-sedative ones. Mild steroid nose sprays (and nose drops) are jolly good, but MUST be used every day – some people make the bad mistake of just having a sniff when symptoms are bad.

A nasal spray containing the anti-inflammatory sodium croglycate is often helpful; again, it must be employed every day.

Injections against hay fever and rhinitis haven’t really fulfilled the hopes that people used to put in them, but are sometimes used at specialist allergy clinics – particularly in the USA. In Britain, the best-known one is Pollinex, which contains extracts of grass, rye or tree pollens.

*** A really good First Aid tip for days when allergy is really bad is to put a blob of Vaseline inside each nostril. This prevents most of the nasty allergens from getting in!

DRUG ALLERGIES Unfortunately, many of the pills and potions prescribed by us doctors do cause allergies. It’s great shame, but on the other hand most of these drugs are very valuable.

Over-the-counter tablets and creams can also cause similar allergies.

Common symptoms of drug allergy include very itchy rashes, or even blistering of the skin.

Drugs which commonly cause problems include:

  • Penicillin and some other antibiotics;
  • Vaccines;
  • Certain heart drugs – notably the kind called ‘ACE-inhibitors;’
  • Some anaesthetic drugs;
  • Anti-inflammatories, such as aspirin, ibuprofen and diclofenac;
  • Anti-convulsants (used for epilepsy).

Obviously, if you are allergic to a drug, you need to steer clear of it in the future. I recommend that people who have penicillin allergy should carry a card saying ‘NO PENICILLIN PLEASE’!

If a reaction occurs, anti-histamines are useful. In a really severe case, you may need adrenaline injections or steroids.

ANAPHYLAXIS This is a really SEVERE allergic reaction. The patient may collapse and become seriously ill. It requires immediate medical attention – preferably at an A & E Department.

Anaphylaxis (a k a ‘anaphylactic shock’) is most often caused by a food – such as peanuts, other nuts, shellfish and eggs. Medical injections can provoke it, as can insect stings.

Chief symptoms include swelling of the skin, mouth and throat – which may cause choking – and itching. The person may feel that she/he is about to die.

URGENT first aid administration of adrenaline may be life-saving, and families who have a child with a tendency to anaphylaxis should be issued with adrenaline-containing Anapens or Epipens.

ASTHMA Asthma is an enormous subject, and I only have room to deal with the ALLERGIC aspects of it here. It is basically a periodic narrowing of the little airways (tubes) which carry air into the lungs, and out again.

When these narrow down, breathing becomes difficult and the person wheezes. This can be very frightening.

The causes of asthma are very complex. Attacks can be triggered by chest infections, cigarette smoke, and stress. As far as ALLERGY is concerned, precipitating factors may include:

  • House dust mite droppings
  • Pollen
  • Mould spores
  • Hairs of pets

If you know what you’re allergic to, then steer clear of it. For example, children whose asthma is connected with dust will often benefit by going to live in a dust-free environment – perhaps by the sea.

As to drugs, anti-histamines are unfortunately not a lot of help in asthma, but other drugs certainly are. The two main groups of drugs used are:

  • RELIEVERS - These are medications that widen the airways during an attack;
  • PREVENTERS - These are drugs which you must take every day, in order to keep asthma attacks away. They’re mostly inhaled low-dose steroids.

There is also a newer group of anti-asthma drugs called ‘leukotriene antagonists.’ They include Singulair and Accolate, and they come in tablet or granule form. But ask your GP to tell you about the rare risk of serious side-effects.

EYE ALLERGIES These are extremely common, and often provoked by make –up or by contact lens preparations. They can also be caused by medications like eye drops or eye ointment.

Also, allergic eye reactions are often part and parcel of hay fever or rhinitis (see above).

Symptoms include:

  • Redness
  • Itching
  • Pouring tears
  • Swelling of the lids
  • Sometimes a ‘stringy’ discharge

Obviously, if you get an eye allergy you need in future to avoid whatever caused it. In the actual attack, anti-allergy drops (including mild steroids) will help calm everything down quickly.

Some long-term protection can be achieved by using drops such as cromoglycate or nedocromil.

Well, that’s it! There’s more anti-allergy advice in the first part of our Question and Answer section, which follows below.

Q I am a widow, and I have just started a very happy romance with a new man. Only trouble is, I am wondering if I could be ALLERGIC to him?

You see, every time we make love, I get a violent stinging sensation, which lasts for hours. I also get rather red and itchy. This has not happened with previous lovers.

A Yes, it has recently become apparent that a woman can indeed be allergic to the sex fluid of a particular man. Unfortunately, there is no effective medication for this, but the problem can be beaten by simply using condoms.

If these don’t put everything right, check with your doctor – to make sure it really IS an allergy.

Q My little grandson gets wheezing attacks every time he comes to stay with us – but nowhere else. Could this be connected with my darling pet Corgi?

A Unfortunately, yes. But the only way to establish the fact would be for your grandson to have skin tests for dog allergy.

Q Ever since I started using this expensive brand of conditioner, I had irritation and little bumps on my scalp. Is this an allergy?

A Possibly. But the only sane thing to do is to change your conditioner.

Q Under the fastener of my new bra, I have developed a nasty itchy red patch. Would that be due to an allergic reaction, doctor?

A No, this is a contact dermatitis, caused by a reaction to nickel – or some other ‘ingredient’ of the fastener. Vast numbers of women carry the same red patch on their backs.

© Dr D Delvin / Retirement Matters Ltd  2007