As
a child I had battled allergies, specifically food allergies, that childhood
experience was itchy, painful and terrible. All through my childhood, I did not
understand the disease and failed to manage it properly. I grow up with a
belief it was my fault and deserved the discomfort. My ignorance, indignity and
shame had been a useful tool my parents utilized to keep me in check and controlled.
There is no permanent physical damage, but emotional and psychological scars, manifested
with self-esteem, confidence and autonomy issues. Learning from that mistake I would
like to share tidbits about allergy with initial focus on food allergy.
Allergy
Allergy
is the most common form of immunologic disease. It is defined as an altered
and/or exaggerated immune reaction to foreign substances or physical agents,
also known as antigen (allergen), causing tissue inflammation, that leads to
organ dysfunction. Colloquially, it implies
that an individual become over reactive to an antigen which would not normally
produce an adverse response.
Classification
Allergy
or allergic diseases can be classified according to (1) immune system
mechanism, (2) affected organs, and (3) the nature and source of allergen, example
route of exposure. The last
classification makes the diagnosis or identification and management of allergy
more convenient. The 4 routes of exposure are inhalants (pollens), injectants
(bee sting), contactants (nickel in jewelries), and ingestants (food and
medicine).
Food Allergy
The
rise in prevalence of allergic disease has continued in the industrialized
world for more than 5 decades. Allergic conditions are the most common health
issues that affect children. In addition, children have food allergies more
than adults.
Pathological Mechanism
Immune
system induced inflammation involves two major pathways, the reaction of the (1) antigen with T cells
and (2) with B cell products, which is
also known as antibodies. Of the five classes of antibodies, only three: IgG,
IgM and IgE, are known to be involved in hypersensitivity reactions. For most
food allergy involves IgE antibodies, as it occupies receptors sites of mast
cells, then within minutes after exposure to the allergen, vascular activity
and inflammatory mediators are activated causing vasodilation (skin rashes, ,
itchy nose and eyes, nausea, vomiting), visceral smooth muscle contraction
(cramp, bloating, diarrhea), and mucus secretary gland stimulation (sneezing
wheezing, coughing). Other mediators have late-phase inflammatory response that
appears several hours later.
Food
allergens cause two clinical sub-groups of IgE-mediated allergy: atopy and
anaphylaxis. Atopy denotes a group of disease, namely, allergic rhinitis,
allergic asthma, atopic dermatitis and allergic gastroenterophy. This happen in
certain persons with an inherited tendency to develop IgE antibodies to
multiple common environmental allergens. The reaction maybe localized to the
target organ, but more than one of diseases may occur simultaneously. While anaphylaxis,
a fatal condition that warrant medical emergency, is characterized by
hypotension or shock, bronchospasm, gastrointestinal and uterine muscle contraction, urticaria (hives) and
angioedema. The most common allergens that trigger this deadly disease are
drugs, insect venom and foods.
Diagnosis
Almost
all of the symptoms of allergy can occur in the absence of an immunological
mechanism. For example, Inhalation of dusts and fumes trigger an non-allergic
asthma attack. Therefore, a thorough history is essential, including the
symptoms and survey of possible allergens. Aside from physical examination
during a period of being expose to allergen, there are allergy tests that reveal
an immune response to a particular allergen. There is IgE antibody test, in
which IgE antibodies are detected by skin tests or in vitro methods. Another is
provocation tests, in which under a controlled conditions, a double-blind placebo-controlled
oral challenge is conducted, but this test is not recommended on patients with
history of anaphylaxis.
Management
Allergic
disease management requires both symptomatic therapy and allergen-specific
treatment. The three basic principles of allergic management are avoidance
therapy, drug therapy and immunotherapy. And when it comes to health issues always
seek professional help, see the proper health care specialist, for allergic
diseases please see an allergist or immunologist.
This
will be an introduction on future articles on allergy. Is there a health issue
you want to talk about? Please share your thoughts, feel free to post your inquiry,
violent reaction, suggestion, and/or correction, as it will help create better
content. And do not forget to follow this blog for more interesting information
and ideas. Thank you!
As
always please take care, keep it simple, be real and enjoy!
References
1. Centers
for Disease Control and Prevention (CDC). National Center for Health
Statistics. (n.d.) FastStats: Allergies
and Hay Fever. Retrieved from https://www.cdc.gov/nchs/fastats/allergies.htm
2. Guyton,
A.C. & Hall, J.E. (2006). Textbook of
Medical Physiology, 11th Edition. Philadelphia, Pennsylvania,
USA: Elsevier Saunders.
3. American
College of Allergy, Asthma, and Immunology. (n.d.). Allergy Facts. [Blog Post]. Retrieved from https://acaai.org/news/facts-statistics/allergies