ALLERGY AND IMMUNOLOGY

Introduction by Dr. Shahid Abbas

Consultant Allergy and Immunology 

WHAT IS ALLERGY:

Allergy is genetically transmitted immune disease which progresses both in severity and in frequency with time. Allergy occurs when the immune system reacts to substances in air (Pollens, Dust, Molds) foods (meats, nuts, grains) and water which do not bother most people (not having genes of allergy)

WHAT ARE THE DIFFERENT TYPES OF ALLERGIES?

1. Apparent Allergy

This is where the cause is known and you can avoid it and be free from allergic symptoms.

2.   Hidden Allergy

Is the type of allergy that, even after years of suffering from allergy one cannot know the cause of allergy. We diagnose both apparent and hidden allergies.

ALLERGY ICEBERG

Allergy affects each organ of the body, but symptoms are like iceberg. A Person may be suffering from either Allergic Rhinitis (hay fever) or Asthma or Urticaria or IBS (one of these) which is tip of the iceberg, but he/she will also be suffering from less severe symptoms like headache, itching, rashes, feverish feelings, pain abdomen, depression, irritability, fatigue, tiredness, memory and concentration problems, pains and aches

WHAT ARE THE ORGANS AFFECTED IN ALLERGY?

HEAD: Headache, dizziness, decrease in memory and concentration, irritability, and aggressiveness may cause schizophrenia. Losing interest in daily activities.

NOSE: Itching nose, sneezing, watering nose, nasal blockage.

THROAT: Sore throat, pharyngitis, swelling of voice box causing immediate suffocation and even death due to allergic reaction or anaphylaxis, back dripping.

EARS: Impaired hearing, ringing in the ears.

LUNGS: Asthma

SKIN: Itching, hives, rashes and eczema.

URINARY TRACT: Frequent desire to pass urine

GASTROINTESTINAL TRACT: IBS, reflux, heartburn due to acidity in the stomach, pain in the stomach due to ulcer which worsens in the pollen season. Or other allergies. Food allergies can be the cause of hyperacidity, reflux, or even ulcer. People develop frequent loose stools, gas, distention, and pain in the abdomen during the pollen season or due to other allergies

BODY: Feverish feeling but doesn’t have a fever, pains, and aches in the body. Low energy level and patients feel drained off, fatigued, and tired.

Do you know Allergy is a genetically transmitted immune Disease affecting 50-60% population of the world?

If two parents have allergic genes, then 3 out of 4 children will develop allergic diseases at any time in life from infancy to old age. Allergy progresses both in severity and in frequency with time despite the medicines like antiallergics and steroids.

WHAT CAN BE TREATED?

Did you know it is a misconception that allergies cannot be treated? I believe in finding the cause of allergy and treating it. I strongly affirm the international consensus that allergy is a genetically transmitted immune disease and cannot be treated with symptomatic treatments and it has to be treated immunologically and with Immunotherapy (SLIT drops/tablets, SCIT, or allergy shots).

SYMPTOMATIC TREATMENT VS FINDING THE CAUSE OF DISEASE AND TREATING IT

Treatment of any disease is of two types, and one has to decide what suits him.

• • SYMPTOMATIC TREATMENT: –Either one can treat the symptoms of the disease such as headache, itching nose, sneezing, watering nose, blockage of nose, sinus pain, feverish feelings, brain fog, fatigue and tiredness, irritability, mood swings, sleep disorders. One can have all these symptoms due to dust allergy. So symptomatic treatment can be anti-allergic for sneezing, pseudoephedrine for blocked nose as decongestant, paracetamol or ibuprofen for headaches/pains aches, tranquilizers for sleeplessness, nasal sprays for watering and itching nose, eye drops for itching eyes and so on.
  • FINDING THE CAUSE OF ALLERGY AND TREATING IT: –If you find the cause of allergy and treat it immunologically (since it is immune disease.

• OUTCOME OF SYMPTOMATIC OR FINDING THE CAUSE OF ALLERGY AND TREATING IT IMMUNOLOGICALLY

If one treats the symptoms the disease progresses both in severity and in frequency with time since allergy is not like infection that one takes antibiotics, and he is ok. It is immune disease which becomes severer and severer with time in spite of treatments like antiallergics and steroids etc. 

RESULT OF SYMPTOMATIC TREATMENT IS: –

1. DISEASE BECOMES SEVERE AND MORE FREQUENT WITH TIME AND ONE BECOMES SICKER AND SICKER
2. Around 80% patients of nasal allergy develop allergic asthma.
3. IMMUNE SYSTEM IS AFFECTED AND ONE CAN EASILTY DEVELOP OTHER DISEAES LIKE FREQUENT INFECTIONS LATTER
4. ONE SPENDS HUGE MONEY FOR YEARS ON INHALERS, ANTIALLERGICS, STEROIDS with all the side effects.

RESULT OF FINDING THE CAUSE OF ALLERGY AND TREATING IT: –

1. One gets better and better in few weeks, 
2. One does not develop complications like asthma
3. Immune System improves and one does not develop other diseases like frequent infections.
4. Does not develop side effects due to long-term use of medicines like anti allergics and steroids
5. Calculating the long-term medicine cost and cost of the treatment with treating the cause of allergy and treating it, immunotherapy is much cheaper. 

WHAT ALLERGIES DO WE TREAT?

• Environmental Allergy
• Food Allergy
• Drug Allergy
• Immunology
• Children Allergies
• Immuno-Nutrition
• Immuno-Boost
• IV Immuno-Hydration
• The conditions I treat go beyond the usual ones such as acne, asthma, and sinusitis. I also specialize in treating severe diseases having allergy/immunology pathological association in diseases such as autism, Crohn’s Disease, depression, and Tourette syndrome.

HOW DO WE TEST?

ALLERGY is not a disease which one can diagnose in 5 minutes.  One has to find the cause of the allergy through thorough testing and treat the cause. It takes on average 3 to 4 hours to find the cause of allergy.

After an initial consultation, I conduct extensive testing relating to our patient’s complaints.  The established treatment of allergy is immunotherapy which should be given for a minimum of 3 years. To find the cause we do the world’s latest Painless Allergy Tests with the special disposable sterilized device and do 8 tests at a time and these are painless. For foods we do skin prick tests and also confirmed with painless intradermal tests causing minimal pain. Since effective treatment will depend on the results of the allergy tests so we do comprehensive tests and it takes around 3-4 hours to complete the procedure. We do this with utmost safety and precaution.  Patients are never left alone and always have a nurse of the Dr with them to monitor them as well as having an anaphylaxis kit and anaphylaxis cart for management of emergency allergic reactions. 

WHAT ARE THE TREATMENTS TO REDUCE MY ALLERGIC SYMPTOMS?

There are two type of treatments available.  Once allergy tests are complete the results of these tests are tabulated and given to the patient. The patient is advised to get the immunotherapy from different vendors of their choice. They must send the prescription and the registered pharmacy or facility prepares it according to the formulation provided (as per the allergy tests). 

• These are called SLIT (Sublingual Immunotherapy) sprays or tablets or injectables. Most of the patients see a 70% – 80% improvement in their symptoms within a few months.
• Along with the immunotherapy, Rotatory Diversified Program is recommended based on food allergy tests
• Pharmacotherapy is also recommended if needed.

Most of our patients have remarkable improvement in 2-3 months.  If some patients are not improving, we do a free reassessment.  If a patient is not improving after 6 months even after reassessment then immunotherapy is discontinued, sadly 10% of patients are non responders.

MY DUTY OF CARE

All my patients are on my WhatsApp and they are advised to keep me updated with their progress and ask me any questions they have in mind to ensure high quality care.

IS THERE A CURE FOR ALLERGIES?

YES … After 30 years of experience in allergy and immunology seeing thousands of international patients suffering from different allergies and skin allergies, most of my patients have been cured with immunotherapy and they now lead an allergy-free life. I always say to my patients: With our novel allergy and immunology treatment you will not only feel better but you will look better too.

DO COSMETICS CAUSE ALLERGIC REACTIONS?

I always had concerns about allergic reactions to cosmetics and hair dyes. To help the patients and understand the mechanisms of cosmetic science, I completed a one-year Diploma in Cosmetic Science Formulations from Australia.  After realizing there are allergens in these products I developed novel cosmetic, dermatological products and anti-hair fall products that are hypoallergenic and have a strong scientific basis.  It is important to read the ingredients in all your cosmetics carefully to avoid suffering in the future.  As per the FDA allergens to avoid in cosmetics are grouped into 5 categories: natural rubber, fragrances, preservatives, dyes, and metals.

Coping with Allergy Symptoms During Pregnancy

Women need to be cautious about any medicine taken during pregnancy, and this applies to medicine to help with allergy symptoms. They should consult with their physician for specific instructions, advises Allergy and Asthma Network. A physician is likely to recommend ways to reduce symptoms without medication, such as allergy proofing the home, using saline nasal sprays and nasal strips. Generally, oral antihistamines may be taken after the first trimester. Second generation oral antihistamines, loratadine and cetirizine, are considered safe during pregnancy.(1)

Approximately one-third of pregnant women who have allergies report their allergy symptoms worsen during pregnancy, according to Allergy and Asthma Network. Another third reports their symptoms remain about the same, with the final third finding their symptoms actually improve during pregnancy.(1)

A pregnant woman who is undergoing allergenic immunotherapy (allergy shots) may continue treatment during pregnancy. Current doses are maintained during pregnancy, and not increased until after delivery, states the American Academy of Allergy, Asthma and Immunology. Immunotherapy is not initiated during pregnancy.(2)

For pregnant women with moderate to severe symptoms, a physician may recommend a corticosteroid spray (nonprescription) at the lowest effective dose.(3) On the other hand, decongestant nasal sprays are problematic, with some studies showing an increased risk of birth defects when they are used. “Pregnant women should avoid antihistamine nasal sprays, as there is not enough research to prove their safety,” states Allergy and Asthma Network.(1).

References:

(1) Allergy and Asthma Network, Pregnancy and Allergies, https://allergyasthmanetwork.org/allergies/
(2) American Academy of Allergies, Asthma and Immunology, Asthma, Allergies and Pregnancy, https://www.aaaai.org/Tools-for-the-Public/
(3) Marnach, M. MD, Mayo Clinic, Is it Safe to Take Allergy Medications During Pregnancy, https://www.mayoclinic.org/healthy-lifestyle/

YOUR CHILD MAY BE ALLERGIC

An important message for Parents, teachers, and the general public is that Allergy affects the physical and mental development of children, consult the allergies before your child develops such problems.

EARLY SIGNS AND SYMPTOMS OF ALLERGY

Observe early signs of allergy in your child and prevent sever diseases like asthma and behavioral, physical and mental problems.  Look out for:

RED EARS: Children develop red ears after taking allergic food or being exposed to pollens, molds, or house dust mites.

RED CHEEKS 

EYE CIRCLES & EYE WRINKLES 

NOSE RUB: These children are continuously rubbing the nose and develop creases on the upper side of the nose called Shiners.

BED WETTING: Allergic children have bed wetting for several years even after nappy training and this may continue even after 15 yrs of age.

MEMORY AND CONCENTRATION: They are either very intelligent or slow in class. Intact in the early stage of the disease they are very intelligent and as the disease progresses, they become less and less interested in studies and in-class since allergy affects memory and concentration.

RESTLESSNESS AND HYPERACTIVE: Allergic children are typically restless and hyperactive. They cannot sit or stay still or quiet.

BEHAVIORAL PROBLEMS: Allergy can cause behavioral problems in children, present only when exposed to allergic foods or aeroallergens.

IRRITABLE AND AGREESIVE: Such children are crying without apparent reason, they become easily irritable, and will bite other children and even parents. 

In ADD (Attentive and Attention Deficit Disorder): Some children are slow, they become inattentive and look blank.

DEPRESSION

WHAT ARE THE COMMON ALLERGIC REACTIONS SEEN IN CHILDREN?

Children having allergies to foods, aeroallergens and chemicals can present symptoms such as:

1. Stuffiness or sniffling.
2. Clucking throat sounds or throat clearing.
3. Coughing or wheezing.
4. Itchy watery eyes.
5. Swollen eyelids.
6. Puffy bags below eyes.
7. Swollen cracked lips.
8. Itchy skin rashes, especially in the arm or leg creases.
9. Frequent hearing loss after frequent ear infections.
10. Sudden ear pain or ringing in the ears.
11. Recurrent headaches.
12. Recurrent leg aches or muscle aches. The child complains of pains in their limbs after playing.
13. They are not still and start moving their hands or their legs up and down or sideways rapidly.
14. Recurrent intestinal symptoms of nausea, bloating, pain, belching, halitosis, diarrhea, or constipation.
15. Unexplained facial pallor.
16. Extreme ticklishness.
17. Children’s allergies behavior.
18. Dark blue-black or red eye circles.

These children often act as if spaced out and if you try to snub him, he does not seem to acknowledge it or hear it. Some appear always sleepy, or tired whilst others are fidgety and cannot stand still.

They can’t concentrate on their books nor follow the advice or directions given to them. This type of in attentive behavior is seen after one eats artificially colored beverages or cereals, candies, popcorns, corn products, chocolates, peanut butter, tomato products like pizza, milk or dairy products, bakery products, which contain additives or preservatives, and apple, grape or orange juice. These foods can cause hyperactivity, depression, fatigue, headache, abdominal discomfort, asthma, or hay fever. Parents can feel depressed by their child’s behavior, and similarly in school teachers can be frustrated with the seemingly lack of commitment from their students.  This can all be broken down with proper allergy testing from the start of symptoms.

Aging and Allergies

Diagnosis and management of allergic rhinitis (hay fever) can be challenging in older patients, who may have other chronic health issues, such as asthma, high blood pressure, or heart disease, according to the American College of Allergy, Asthma and Immunology.(1) And considering the fastest growing segment of the population is people ages 65 and over, the challenges are here to stay.(2)

People suffering from hay fever show symptoms after breathing in an allergy-causing substance, such as tree, grass or weed pollens, or dust. Symptoms include:

• Stuffy nose due to blockage or congestion, runny nose, or postnasal drainage

• Itching, usually in the nose, mouth, eyes, or throat
• Red and watery eyes
• Puffy, swollen eyelids
• Sneezing
• Cough(3)

Older people with hay fever often turn to over-the-counter medicines to control symptoms. First-generation antihistamines can be effective at addressing symptoms but may have serious side effects. Generally, second and third-generation antihistamines are considered safer for older patients.(4)

Practical lifestyle changes can help, too. The Mayo Clinic offers these tips for reducing allergy triggers:

• Stay indoors on dry, windy days. The best time to go outside is after a good rain, which helps clear pollen from the air.
• Delegate lawn mowing, weed pulling and other gardening chores that stir up allergens.
• Remove clothes you’ve worn outside and shower to rinse pollen from your skin and hair.
• Don’t hang laundry outside — pollen can stick to sheets and towels.
• Wear a pollen mask if you do outside chores.(5)

A study published in the Annals of Allergy, Asthma, and Immunology examined the effectiveness of subcutaneous immunotherapy (allergy shots) for hay fever sufferers between the ages of 65 and 75. Half of the subjects received allergy shots for three years, and half received placebo. In patients receiving shots, symptoms were reduced by 55 percent and the amount of medication taken to reduce symptoms decreased by 64 percent. The study concluded that subcutaneous immunotherapy is safe in the elderly and results in an immune response comparable to what is found in younger patients.

References:

 (1) American College of Allergy, Asthma and Immunology, https://www.newswise.com/

 (2) Cardona, V. MD, Guilarte, M. MD, et. al., Clinical and Translational Allergy, Allergic Diseases in the Elderly, https://www.ncbi.nlm.nih.gov/

(3) American College of Allergy, Asthma, and Immunology, Allergic Rhinitis, https://acaai.org/allergies/

(4) American College of Allergy, Asthma, and Immunology, Medications and Older Adults, https://www.aaaai.org/

(5) Mayo Clinic, Seasonal Allergies: Nip Them in the Bud, https://www.mayoclinic.org/

Advice from Dr. Shahid Abbas Consultant Allergy & Immunology on Dust Mites

Mattresses, bedding, upholstered furniture, carpets – they all contain dust, and thus make ideal homes for dust mites, tiny insect-like pests that feed on flakes of skin shed by people and pets. Dust mites are common triggers for allergies and asthma.(1) Even a very clean home has dust mites, but there are techniques to reduce their numbers, and thus cut down on symptoms.(2)

A person’s allergic reaction to dust mites can include congestion, itchy eyes, and wheezing, is caused by inhaling dust mite droppings.(1) Dust mites can also trigger an asthma attack in people who have asthma and also have the dust mite allergy.(3)

Allergenic immunotherapy is an option for people with dust mite allergy. Traditionally, this meant subcutaneous immunotherapy (SCIT or “allergy shots”). In 2017, the FDA approved an allergen extract to be administered under the tongue (sublingual immunotherapy or SLIT) to treat dust mite allergy.(4)

While it’s impossible to remove all dust mites from a home, there are several strategies to reduce the number of dust mites. The following tips are offered by the National Institute of Environmental Health Services:

• Use a dehumidifier or air conditioner to maintain humidity levels at, or below, 50 percent.
• Encase your mattress and pillows in dust-proof or allergen impermeable covers.
• Wash all bedding and blankets once a week in hot water, 130 to 140 degrees Fahrenheit, to kill dust mites. Non-washable bedding can be frozen overnight.
• Replace wool or feathered bedding products with synthetic materials, and traditional stuffed animals with washable ones.
  In bedrooms, replace wall-to-wall carpeting with bare floors, and remove fabric curtains and upholstered furniture, whenever possible.
• Use a damp mop or rag to remove dust. Never use a dry cloth, as it stirs up allergens.
• Use a double-layered microfilter bag or a HEPA filter in your vacuum cleaner.
• Wear a mask while vacuuming, and stay out of the vacuumed area for 20 minutes after vacuuming, to allow dust and allergens to settle.

References:

 (1) Allergy and Asthma Network, Ask the Allergist, Dust Mite Immunotherapy Options, https://allergyasthmanetwork.org/

(2) Miller, K., Health, How to Get Rid of Dust Mites, According to Allergists, https://www.health.com/condition/allergy/

(3) Centers for Disease Control, Common Asthma Triggers, https://www.cdc.gov/asthma/triggers.html

(4) Food and Drug Administration, FDA Approves Odactra for House Dust Mite Allergies,  https://www.fda.gov/news-events/

(5) National Institute of Environmental Health Services, Dust Mites and Cockroaches, https://www.niehs.nih.gov/health/topics/agents/