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5StepstoCombatAsthmaandAllergies

©2010,Dr.AnjaliAroraarora_doc@hotmail.comISBN978-81-207-4920-7E-ISBN978-81-207-9042-1

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Contents1.Allergy:TypeandTreatment2.HistamineandHistamineReleasingFoods3.InsectAllergyandAnaphylaxis4.DrugAllergy:AnOverview5.Asthma:ItsManagementandTreatmentMythsandFactFile

Findoutthelevelofyourawarenessaboutallergyandasthma.1.Ifarashappearsanddisappearsoveraperiodoftimea.Itmaybechickenpoxb.Rashc.Itmaybepricklyheat

2.Youareallergictohairdyea.Thereisnoitchingafterapplicationb.Thereisitchingbehindearsandnapeofneckafter24hoursofapplicationc.Thereisitchingaftertwomonthsofapplication

3.Continuouscoughinginanasthmaticthroughoutthedayandnightcanleadtoa.Whoopingcoughb.Statusasthmaticusc.Allergy

4.Airpollutioncanbeduethepresenceofoneofthefollowinggasesa.Oxygenb.Nitrousoxidec.ManganeseoxideAnswertheabovequestionnaireandthemoreyouanswer(b),themoreknowledgeableyouareaboutthisproblem.

1Allergy:TypeandTreatment

Anythingwhichentersthebodyisforeigntoit.Thelistisendlessstartingfromyourfood,drinkstocosmeticsandevenmedication.Theimmunesystemdealswiththeseforeignsubstancescontinuously.Itisonlywhenan“allergic

substance” comes in contact with the body that it reacts to suppress or eliminate it. This allergicreactionmaybeintheformofmucoussecretion,itching,oreruption.Theforeignsubstancesactivatetheimmunesysteminordertofightandprotectthebody.Animmunesystemwhichisdeficientprovidesalowerdefensemechanismthanrequired.Onthe

otherhand,ahypersensitivereactionoccurswhenthebodyoverreactstocertainsubstances.Allergyisadisorderoftheimmunesystem.Itisalsocalledatopy.Allergicreactionscanoccurdue

tothepresenceofcertainsubstancesknownasallergens.Commonallergicreactionsincludeeczema,hives,hayfever,asthmaandfoodallergies.Reactionstothevenomofstinginginsectssuchaswaspsandbeesarealsoallergicinnature.All over theworldmild allergies like hay fever, conjunctivitis, itching and a running nose are

highly prevalent among human beings. Similarly, conditions such as asthma are common. In anasthmatic attack, the body reacts by releasing mucous. It also causes constriction which can bebetweenagentlewheezeandatightfeelingwhichcanmakebreathingverydifficult.Asthmacanoftenbe accompanied with other problems like eczema. In some people, severe allergies to dietaryallergens,environmentormedicationmayresultinlifethreateninganaphylacticreactions.

Antibodies,AntigensandImmunoglobinsAntibodiesarefoundinthebloodserumandareproducedagainstforeignbodies(virus,bacteria).

Antigenisasubstancethatcausestheproductionofantibodieswhichactagainsttheallergen.

Immunoglobinsisascientifictermforantibodies.

Immunoglobinsaredividedintofivegroups

IgEorImmunoglobulinEistheantibodyresponsibleforallergicreactions.Igisthefirsttoappearduringanimmuneresponsebutremainsforashortperiod.IgAisconcernedwithprotectioninthegutormucosalsurfaces.Itisonlypresentinasmallquantity.Itisalsoavailableinsweat,salivaandtears.IgGisthelargestamountofantibodyfoundinthebody.Itispresentinresponsetothepresenceofbacteriaorvirus.ItalsohelpsinblockingIgEfromtriggeringanallergicresponse.IgDrespondsagainstfoodantigens.

AllergicReactionType I – immediate or anaphylactic. This involves the presence of IgE immunoglobulin and thereleaseofpowerfulchemicalsfromthecellsofthebody.Itispresentindiseaseslikeasthmaandhayfever.

AllergiesWhichCommonlyOccurUrticariaItisalsoknownashivesornettlerash.Therashbecomesworseonscratching.Inurticariatherashcan appear anywhere on the body. The rash appears aswelts. Thewelts come in groups – big orsmall. The welts which spread over a large area of the body are referred to as “giant urticaria”.Angioedema is the twin condition of urticaria. It does not itch but has more complications anddisfiguring.Boththeseconditionsmayoccurinindividualswhoappeartohavenootherallergies.

Causesofurticaria:–

Certainfoodse.g.fish,shellfish,peanutsandeggsFoodadditiveslikeazodyes,benzoates(preservationusedinmanufactureoffoods).Salicylates:Aspirincanalsobeacauseofanallergicreactionresultinginurticaria.Theskinlesionscausedinurticariaareduetotheinflammatoryreactionintheskin.Theleakageofcapillariesinthedermis,alayeroftheskinresultsinoedema(swellingofthearea).

Commontypesofurticaria:–

AcuteUrticaria:–Normally comes up after a fewminutes of contact with the allergen. Food allergic reactions areusuallyacauseofthiscondition.

ChronicUrticaria:–Persistsfor6weeksormore.Itisduetothehiveswhicharealreadypresent.

PhysicalUrticaria:–Canoccurduetocold,asareactiontobodyheatordirectsunlight.

ExerciseUrticaria:–Strenuousexercise,particularlyjoggingcanresultinthistypeofurticaria.

ManagementofurticariaUrticaria is not an easy disease to manage. The primary part of the management involves theawarenessofone’strigger.Medicaltreatmentgivenisof:AntihistamineslikecetrizineorotherH1receptorantagonists.Stressmanagement(helpsrelievediscomfortanditchinessduringanattack).Drinking6-8glassesofwatereachdayhelpstokeeptheskinwellhydrated.

ContactDermatitis

ContactDermatitisisatermusedfordefiningaskinreaction.Thisreactionresultsfromexposureofthe skin to allergens (allergic contact dermatitis) or irritants (irritant contact dermatitis). It can beeither acute or chronic. Contact dermatitis is normally associated with irritants like toxins indetergentsorsurfactants.Theseirritantshavetheeffectofdirectlyaffectingthebarrierpropertiesoftheskinepidermis(upperlayerofskin).Thefatemulsiongetsremovedinflictingcellulardamageontheepithelium.Thisincreasesthetransepidermalwaterloss,damagingthehornylayerofcellsintheskin.Inturnwater-bindingmechanismsgetaffecteddamagingtheDNA(deoxyribonucleicacid)oftheskin.Theresultisthinningoftheskinlayer.

Contactdermatitiscanbecausedbycertainmetals Nickel isahighlyallergenicmetal.It isusedcommonlyinplatingandalloys.The“goldplated”nickel sleeper used in ear piercing can cause rash on the ear lobe.Clip-on earrings and cheaperonescanalsocauseanallergicreaction.Hairpins,spectacles,zips,rings,watchstraps,andbraceletscancausecontactdermatitis.Apersoncanalsobeallergictoarmsofmetalchairs,taps,scissorsandsurgicalinstruments. Artificial rubber isanothercommoncauseofcontactdermatitis.Sponges, shoesandglovescanproducesymptomswithcontact.

Bubblegumallergy(reactiononthelips)canbeduetothepresenceofartificialrubberinthegum.Hairdyescanalsobeasourceofallergy.Anindividualcanreacttoformalinoranyotherpreservativefoundinashampoo.

Nailvarnish,furniturelacquersanddyesareknowntocausecontactdermatitis.Certainplantscanalsocauseitchinganddermatitis.Avoidtheallergens.Forallergytopicalsteroidsshouldbeusedasadvisedbyyourdoctor.

Allergycanworseninanindividualdueto:-?InfectionWeatherconditionsEmotionaldisturbances

PhotoContactDermatitis(PCD)PCDisaneczematousconditionwhichistriggeredbyaninteractionbetweenalessharmfulsubstanceontheskinandultravioletlight(320-400nmUV).Itmanifestsitselfonlyinregionswherethesuffererhasbeenexposedtotheserays.Areasofskinwhichareleftuncoveredbyclothingdevelopthisformofcontactdermatitis.

SymptomsRedrashesBlistersItchy,burningskin

TreatmentImmediatelyafteranexposuretoaknownallergenorirritant,washtheaffectedareawithsoapandcoldwater.Thiswillhelpremoveorinactivatemostoftheoffendingsubstances.

Toavoidirritation,oralantihistaminescanbetaken.Applicationofcalaminelotionandcoolcolloidaloatmealbathsmayhelprelieveitching. Ifblisteringdevelops,coldmoistcompressesappliedfor30minutes three timesadaycanofferrelief.Avoidscratching,asthiscancausesecondaryinfections.Incaseofseverereaction,contactyourdoctor.

EczemaEczemaresultsintheinflammationoftheupperlayersoftheskin.Itisaformofdermatitis.Theterm“eczema” is broadly applied to a range of persistent skin conditions. These include dryness andrecurring skin rashes. The rashes are characterised by redness, skin oedema, itching, dryness andcracking.Crusting,flaking,blistering,oozing,orbleedingcanalsooccur.Areasoftemporaryskindiscolourationmaydevelop.Theseareoftenduetohealedlesions.

CommonTypesofEczema

AtopiceczemaItisaskinconditionwhichisofteninherited.Heretheeczematousreactionisduetofood(eggsormilk)orinhaledallergens(pollenordust).

XeroticeczemaIt isadryskinconditionthatbecomessoacutethatit turnsintoeczema.Itworsensindrywinter

weather.SeborrhoeicdermatitisDryorgreasyscalingof thescalpandeyebrowsresult in thiscondition.Innewborns itcausesathick,yellowcrustyscalprashcalledcradlecap.

IrritanteczemaItcanbecausedduetocontactwitheverydayirritants,e.g.washingpowderanddetergent.

DiagnosisDiagnosis of eczema is generally based on the appearance of an inflamed, and itchy skin in theeczemasensitiveareassuchasface,chestandotherskincreaseareas.Iftheeczemaflaresup,yourdoctorislikelytoascertainanumberofotherthingsbeforemakingadiagnosisAninsightintofamilyhistoryDietaryhabits

LifestylehabitsAllergictendenciesAnychemicalormaterialexposureathomeorworkplace

AnyprescribeddrugintakeInthediagnosisofeczema,thebloodmayshowaraisedIgEoraneosinophilia.ThebloodcanalsobesentforaspecifictestcalledRadioallergosorbentTest(RAST)oraPaperRadioimmunosorbentTest(PRIST).Highlevelsofantibodiesinthebloodsignifyanallergytothatsubstance.Anothertestforeczemaisskinpatchtesting.Thediagnosismayalsobemadeonthebasisofaskinbiopsy.

CareandTreatmentMildeczemainababyorindividualshouldnotbeoverlooked.Factorsafflictingtheskinconditionofanyindividualshouldbelookedfor.Someofthesefactorscanbe:–Diet–Foodsthatarecommonlyallergenic(fish,milk,eggs,prawns)canbedetectedwiththehelpofskintests.Arestricteddiet,avoidingtheallergenicfoodsoftenhelpstheskincondition.

Personal clothing – Wool, polyester fabrics can be skin irritants. Pure cotton is ideal for anallergicoreczematousindividual.

Furnishings–Heavyfurnishings,e.g.rugs,heavyfabricsinanallergicchild’sbedroomshouldbeavoided.The roomshouldbekept clean.Linenandcurtains shouldbewashed regularly.Pillows

filledwithdownorfeathersshouldnotbeused.Pets–Ifthepresenceofapetisexacerbatingallergy,partingwiththefamilypetmaybepainfulbutnecessary.

Scratching –Achildor individual affectedbyeczema should avoid scratching. In ababy,nailsshouldbekept short and filedgently.Medicatedbandages can be used for soothing the inflamedeczematousskin.Soap–Ifasoaphastobeusedbyapersonsufferingfromeczema,thenthefollowingshouldbekeptinmind:

a)Avoidharshdetergentsordryingsoapsb)Chooseasoapthathasanoilorfatbase.A‘superfatted’goatmilksoapisbestc)Useanunscentedsoapd)Patchtestyourchoiceofsoapbyusingitonlyonasmallareauntilyouaresureofitsresults.e)Useplainyoghurtinsteadofsoap.f)Neverrubyourskindryorelseyourskin’soil/moisturewillgetdepleted.Patdryinstead.

MoisturisingEczemacanbeexacerbatedbydrynessoftheskin.Moisturisingisoneoftheimportantself-caretreatmentsforsufferersofeczema.Anotheroptionistryingtobathewitha“colloidaloatmealbath”.Moisteningagentsor‘emollients’e.g.,medioil,bathoilsandaqueouscream,etc.canalsobeused.

ItchReliefAnti-itchdrugs,oftenwithantihistamine,mayhelpreducetheitch.

Corticosteroids – Dermatitis is often treated by doctors with a prescribed glucocorticoid (acorticosteroidsteroid)ointment,creamorlotion.Prolongeduseofthesecreamscancausetheskintothinandbecomefragile.

Immunosuppressants–aresometimesprescribedforeczema.

DietandNutritionAn individual suffering from eczema has to be particular in his eating and drinking habits. Foodallergymaytriggeratopicdermatitis.

AlternativeTherapiesNon-conventional medical approaches like traditional herbal medicines have been advocated andadministered for decades.Sulfur has beenused formanyyears as a treatment in the alleviationofeczema.Swimming in theocean is known to relieve symptoms and clear up the redpatchy scales.Oatmealisacommonkitchenremedytorelieveitching.Itcanbeappliedtopicallyasacreamorasacolloidinthebath.

InfantileEczemaItisoftenknownasatopicdermatitisoratopiceczema.Itisachronicrelapsingitchydiseaseoftheskin. Itchingmayoccur as a resultof continuous rubbingand scratchingof theaffectedarea.Thisleadstothickeninganddiscolorationoftheskin.The individualsufferingfrominfantileeczema isoftenseen tohavea familyhistoryofallergic

disease,e.g.asthma,eczemaorhayfever.

RemedyKeeptheskinmoistbyusingcreamoranyointmentapplication.Antihistaminecreamshelpreduceitching.

Inseverecasessteroidcreamscontainingantihistaminederivativesandcorticosteroidsareusefulapplicants.Avoidexcessivementalorphysicalstress.Ininfantsavoidhistaminereleasingfoodssuchas,bananas,strawberries.

Sufferersofeczemaaremorepronetoskininfections,e.g.bacterial,fungal,viral.Oralantibioticscanbeprescribedtotreatinfectedeczema.

Commonsiteswhereallergicreactionsoccur

EyeAllergiesAnallergicreactionintheeyesoccurswheneveranallergencomesintocontactwithyoureyes.Theallergen activates the mast cells to release histamine and other chemicals which cause the bloodvesselstoswell.Theeyesthenbecomeitchy,redandwatery.

Thecommonoutdoorairborneallergensaregrass,treeandweedpollens.Peoplesensitivetotheseallergenssufferfromseasonalallergicconjunctivitis.Theindoorallergensarenormallypethairordander,dustmitesandmoulds.

PrecautionstoAvoidEyeAllergiesStayindoorsasmuchaspossiblewhenpollencountsareattheirpeak,usuallyduringmidmorningandearlyevening.

Useairconditioninginyourcarandhome.Air-conditioningunitsshouldbekeptclean.WearglassesorsunglasseswhenoutdoorsAvoidrubbingyoureyesReducedustmiteexposureinyourhome.Keepthehumiditylowinyourhome(between30percentand50percent).Cleanfloorswithadampragormopratherthanbydrydustingorsweeping.

ReplacecarpetingwithhardwoodWashyourhandsimmediatelyafterpettinganyanimal.

Medication

Eyedropsthatcontainantihistaminesoftenhelptoreducetheitching,rednessandswelling.Iftheitchingandrednessdonotsubside,non-steroidalantibioticeyedropsareoftenprescribed.

ConjunctivitisAnexternallayeroflooselyboundskincoverseacheyelid.Theskinhereisthethinnestinthebody.Thedelicatemucousmembraneliningtheinsidesofbothupperandlowereyelidsextendsoverthefrontoftheeye.Inflammationoftheconjunctiva,isacommondisease.Itisapainfulinfectionoftheeyeswhichmakesthemredandmakestheeyelidsbecomeswollenandsticky.

AllergicConjunctivitisItisoftenduetocommonairborneallergenslikepollen,dustandmoulds.Itisalsopresentwithhayfever.

Symptoms•Itching•Reddening•Watering•SwellingEyelidsgetstucktogetheraftersleepingforafewhours.Athickmucousalongwithcrustdevelops

ontheeyelashes.

PrecautionsWearsunglassesDonotusethetowelorhandkerchiefofapersonwithconjunctivitis.EyedropsshouldbeusedasprescribedbytheOphthalmologist.

VernalConjunctivitisSwelling (inflammation) of the outer lining of the eyes due to an allergic reaction results in acondition called vernal conjunctivitis. Vernal conjunctivitis occurs in people with a strong familyhistoryofallergies.Itarisescommonlyduringthespringandsummerseason.

AllergiesRelatedtoContactLensApersoncanalsosufferfromallergiesasadirectresultofhisorherwearingcontactlenses.Pollen,dust, dander and fungus, can be the allergens. In some cases, itmay be necessary to stopwearingcontactlensesandusespectaclesinstead.

AllergyduetoHairDye(paraphenylenediamine)Paraphenylenediamine(PPD)isachemicalsubstancewhichisusedasapermanenthairdye.Itcanbefoundintextileorfurdyes,darkcolouredcosmeticsandtemporarytattoos.Photographicdeveloper,lithographyplates,photocopyingandprintinginks,blackrubber,oils,greasesandgasolinehavePPDinthem.Mildreactioncausedbytheuseofhairdye(Paraphenylenediamine)usuallyinvolvesdermatitisof

theuppereyelidsortherimsoftheears.Inmoreseverecases,theremaybemarkedreddeningandswellingofthefaceandscalp.

AllergicRhinitisAllergicrhinitisorhayfeverisacollectionofsymptoms.Itisanallergyinvolvingthenoseandeyes,causedbyairborneparticlesofdust.Whenthesesymptomsarecausedbypollen,theallergicrhinitisiscommonlyknownashayfever.

Medication

Short-acting antihistamines can relieve mild to moderate symptoms, but can cause drowsiness.Someofthesecanbeboughtoverthecounter.Apediatricianshouldbeconsultedbeforeusingthesemedicines in children.Medicines causingdrowsinessor affecting learning in children, shouldbeavoided.Longer-actingantihistaminesareavailablebyprescription.Azelastine(Astelin)isanew,nasalantihistaminethatisusedtotreatallergicrhinitis.Decongestantsarealsohelpfulinreducingsymptomssuchasnasalcongestion.Theyshouldnotbeusedforlongperiods.Antihistaminesareavailableforitchy,bloodshoteyesandnasalspraysfortreatinghayfever.

ComplicationsWithlongtermuseofmedicationthefollowingcomplicationscanoccur:–DrowsinessandothersideeffectsofantihistaminesSinusitisNasalpolyps

PerennialAllergicRhinitisAllyeararoundonemayseesomeindividualscomplainingofastuffynose.Itmaybeaccompaniedbysneezingandarunningnose.Childrenwiththesesymptomsoftendevelopahabitofwipingtheirnosewiththeirhand.Thisprobablygivesthemtemporaryrelieffromtheabovesymptoms.Inthechronicstageofthisdisease,thenasalmembraneappearsasswollenandmayhavemucous

orpuspresent.Nasalpolypscanalsodevelop,whichblockthenoseandmakeitdifficulttobreathe.

MedicationNasaldropscontainingephedrineandantihistamineprovidetemporaryrelief.

OthertreatmentCauterisationRemovalofpolypsthroughendoscopicsurgery

NasalPolypsNasal polyps are growths that result from inflamed mucous membranes in the sinuses and nasalpassages.Theycanoftenextendtotheopeningofthenostrils,downtothethroatareaandthesinuses.Thesegrowthscanblockthenasalpassages.

Diagnosis ofNasal Polyps ismade through nasal endoscopy (a small camera is placed into thenosetogetabetterlookatthenasalpassages).ACTscan(‘catscan’)ofthesinusesmayberequired.

TreatmentSurgeryofpolypsfollowedbymedicaltherapyisrecommendedCorticosteroids–TheuseofcorticosteroidshelptoshrinkthesizeofnasalpolypsAntileukotrieneMedicationNasalSalineIrrigation–Itishelpfulinpeoplewithnasalpolypsandchronicsinusinfections.AllergyShots–Theyareusedtopreventnasalpolypsfromgrowingbackaftersurgery.

2HistamineandHistamineReleasingFoods

Histamine is a natural substance produced by the body. It is released by the body during times ofstressandallergy.Histamineisalsopresentinvarioustypesoffood.Histamineisavasoactiveaminethat causes dilatation of the blood vessels. The release of histamine can be caused by almost anyallergen,e.g.pollen,dustmite,drugs (penicillin, sulfa, aspirin), stinging insectvenoms, and foods(egg,wheat,milk,fish,etc).

Therearemanyfoodscontaininghistamine.Certaintypesoffoodmakethebodyreleasehistamineon their ingestion leading to food intolerance. This is different from food allergy as the immunesystemisnotinvolvedinthisreaction.Foodscontainingthechemicaltyraminecantriggerheadaches.Large amounts of tyramine is found in alcoholic beverages, chocolate, fish, soy sauce, cheese,processedmeatandsauerkraut.Fermentedfoodscanalsocauseallergicsymptoms.Thesefoodsarerichinhistamine

SomeHistamineRichFoods

Alcoholicbeverages,especiallybeerandwine.Ciderandhome-maderootbeer.

AvocadosandanchoviesCheese,especiallyagedorfermented.Variouscheeselikeparmesanorbluecheese.Driedfruits,e.g.apricots,dates,prunes,figsandraisins(youmaybeabletoeatthesefruitswithoutareaction,ifthefruitisthoroughlywashed)Fish-Mackerel,Sardines,etcMushroomsProcessedmeats-sausages,etc

Milkproducts-Sourcream,yogurt,etcCoffee,cakesandotherfoodsVegetables-Spinach,tomatoes,eggplantVinegarorvinegar-containingfoods

HistamineReleasingFoodsCertainfoodsafterconsumptionreleasehistamineinthebody,e.g.AlcoholFruits-Bananas,pineapple,papayas,strawberriesFish

MilkEggsChocolateTomatoes

FoodAllergy

Afoodallergycanbedefinedasanadverseimmuneresponsetoafoodprotein.Themostcommonfoodallergensare:MilkPeanutSoyaEggSeafoodWheatShellfish

SpecificFoodAllergiesRiceallergy iscommon inEastAsia. InCentralEurope,celeryallergy ismorecommon. InJapanallergytobuckwheatflourusedforSobanoodlesiswellknown.

AllergyTesting Skinprick testing iseasy todoandresultsareavailable inminutes.Differentallergistsmayusedifferentdevicesforskinpricktesting.Abifurcatedneedlewhichlookslikeaforkwithtwoprongscanbeused.Someallergistsdoa‘multi-test’,whichmaylooklikeasmallboardwithseveralpinsstickingoutofit.Inthesetests,atinyamountofthesuspectedallergenisputontotheskinorintoatestingdevice,and thedevice isplacedon theskin toprickorbreak through the top layerof theskin.Asmallamountoftheallergenisplacedundertheskin.Ahivewillformatanyspotwheretheperson is allergic. This test generally yields a positive or negative result. It detects allergicantibodiesknownas IgEandone candiagnose if aperson is allergic to aparticularkindoffood.BloodtestsareotherusefuldiagnostictoolsforevaluatingIgE-mediatedfoodallergies.

AllergyandtheInfantToavoidallergyininfantsAtthebeginningofweaningyourbaby(4-6monthsold)frombreastmilk,naturalfoodsshouldbegivenastheyareeasilydigestible.Pureedvegetablesshouldbegoodforastart.

Thefollowingcanbegiventoaninfant(4-6monthsofage)

Vegetables(avoidtomatoes,potatoesandpeppers)Fruits(avoidcitrusfruits)Rice,millet,wheatPulsesandbeans

From9monthsofage,ababycanrelishMeat,fish,poultryOats,corn,barley,ryeTomatoesandpotatoes,canbeincludedYoghurtEggsSoya(Tofu,orsoyamilk)

From12monthsofage,thefollowingcanbeincludedinachild’sdietCitrusfruitsDairyproductsNutsandseeds(avoidpeanuts)Wheat

Someofthecommonallergiesthatoccurinchildhoodare:–

Milk – Cow’s milk is a foreign food protein. Its consumption can result in urticaria, eczema,diarrhoeaorchestdisease. Improvement in thechild’shealthaftereliminationofmilk in thedietwouldpointtomilkallergy.Substitutioncanbedonethroughsoyamilk.Egg–Eggwhitecontainsalbumin.Thisproteincanbeasourceofallergy. Wheat–Next tomilk, it isoneof themostcommonsourcesofallergy. It isoftendetectedonlywhenthebabyisgivencerealsforthefirsttime.Abdominalcolic,diarrhoeaorurticariacanbetheresultofwheatallergy.Fish–Seafoods,e.g.fish,prawnscanbeextremelyallergicagents.

3InsectAllergyandAnaphylaxis

ThewellknownstinginginsectsareMosquitoesHornetsWaspsandFireAntsBeesYellowjackets

InsectVenomAllergyInsectvenomallergyresultsinaharmfulreactiontoinsectstings.Thisoccursinpeoplewhohaveanabnormallyhighsensitivitytoinsectvenom.Thereactionisnotseenduringthefirstexposuretothevenom,butsensitisationoftenoccursafterthefirstorsubsequentexposures.Allergicreactionstothevenomofsomestinginginsects,suchashoneybee,yellowjacket,hornet,wasporfireantcanbelifethreatening.

Peoplewhoareseverelyallergictothevenomofstinginginsectsshouldundergodesensitisation.

DesensitisationSkintestingisperformedbyanallergyspecialisttodeterminethetypeofinsectthatisresponsibleforthevenomallergy.Thesearefollowedupwithmonthlyboostershotsandcontinuedfor3to5yearstoconsolidatethecure.The pain and swelling occurring after an insect bite is due to the venom injected. In some

individualsthevenomactsasanantigen.Anallergicreactiontoinsectslikemosquitoorsandflyisadelayedone.

RemedyTocheckitching,sometimes,atabletofantihistaminemayberequired.Forstingsfromwasps,bees,etc.disinfecttheaffectedarea.Keepthebittenareacleanandapplyice.Iftheswellingincreases,antihistaminesaswellassteroidsmayberequired.Ifthestingsitebecomesinfected,antibioticswouldberecommended.

Anallergicreactionduetoinsectstingvariesfromoneindividualtoanother.Theseriousreactioniscalledanaphylaxiswhichcanbe fatal.Anaphylaxis results indifficulty inbreathing, swallowing,hoarseness, swelling of the tongue, dizziness and fainting. These are signs of a severe allergicreaction.Thesetypesofreactionsusuallyoccurwithinminutesofthesting,buthavebeenknowntobedelayedupto24hours.Prompttreatmentisessentialandrememberthisisanemergency.Honeybee’sstingerscanbebarbedstingers.Oftenthestingisleftbehindintheperson’sskin.Ifthe

stingerisremovedbypinchingthestinger,morevenomisinjectedintotheskin.Itisbettertoremovethestingergentlybyusingafingernailorknifeedgeto‘flick’thestingeroutoftheskin.Ifthestingis on the limb, a tourniquet should be tied tightly above the sting area. This would prevent thespreadingofthevenomfromtheinsecttothewholebody.If the allergy is severe, your doctormay treat it with epinephrine (adrenaline), and prescribe a

medicationincludinganEpiPen.

InsectRemnants

Remnantsofinsectsespeciallyduringtherainyseasoncanbecomeacauseofallergy.Thousandsoftheseinsectsdieafterashortlifespanandcancausehypersensitivityinsomeindividuals.

Precaution Toprevent insectbitesandstings,avoidtheuseofflowerycolognesandsoapsor lotionswhichattractinsects.

Donotkeepopengarbageorfoodthatattractsstinginginsects.Wearlight,protectiveclothingwithlongsleeveswheneveryouareoutsideforlongerperiodsoftime.Makesureanyinsectnestsaroundyourhomeareremovedanddestroyed.

Anaphylaxis

It is a severe Type I Hypersensitivity allergic reaction which can be life threatening. The acutereaction can involve organs and their functions. The term “Anaphylaxis” comes from the Greekwordsana(against)andphylaxis(protection).Anaphylaxisoccurswhenanindividualisexposedtoatrigger substance, calledanallergen, towhichhehas alreadybecome sensitised.This reactioncanoccurinanimalsaswell.Anaphylacticreactioninvolvesthewholebodyafterskincontact,ingestionorinjectionofanallergen.Inrarecases,itmayariseafterinhalationofanallergen.

AnaphylacticshockIt occurswhen an allergic response triggers a quick release of large quantities of immunologicalmediatorsfromthemastcells.Thisleadstoasuddendropinbloodpressure.Oedemaofbronchialmucosa(resultinginbronchoconstrictionanddifficultyinbreathing)alsooccurs.Anaphylacticshockcanleadtodeathinamatterofminutesifleftuntreated.

Symptoms/Signs

PolyuriaRespiratorydistress(difficultyinbreathing,tightnessofchest,throattightness,wheezing)RapidorirregularheartbeatHypotension(lowbloodpressure)UnconsciousnessUrticaria(hives)Angioedema(swellingofthelips,face,neckandthroat)VomitingItchingDiarrhoeaAbdominalpain

Almostallanaphylacticreactionsoccurwithinhoursofconsumingoradministrationofadrug.Aseverereactioncanoccurwithinminutesorevensecondsoftakingadrug.

AngioedemaAngioedemaofteninvolvesthedeepertissuesoftheskin.Apainfulandburningsensationoftheskinispresent.It is the rapid swelling (oedema) of the skin, mucosa and submucosal tissues which results in

enlargedlips,swolleneyesanddistortedface.Iftheconditionbecomessevere,acrisiscanoccur.Theswelling can also affect the respiratory passage. In cases where angioedema progresses rapidly,affectingtheglottis(openingupperendofthewindpipe)ithastobetreated–asamedicalemergency.Anepinephrineinjection(EpiPen)canbelifesavingifangioedemaisallergicinnature.

EpiPenTheEpiPenshouldbecarriedbyindividualswhodevelopasevereallergyandthosewhorunariskofananaphylacticshock.TheEpiPenisself-administeredandisfast-acting.

4DrugAllergy:AnOverview

Drugreactioncanrangefromamild localisedrashtoseriouseffectsonorgansandtheirsystems.Normallyitdoesnotoccurthefirsttimeyoutakeamedication.Areactionismuchmorelikelytooccurthenexttimeyoutakethatparticularmedication.Symptomsofdrugallergyareimportantastheyresultinalife-threateningsituation.

Somedrugswhichcancauseareactionare Painkillers(calledanalgesics)suchascodeine,morphine,non-steroidalanti-inflammatorydrugs(NSAIDs,suchasibuprofenorindomethacin),andaspirinAntibiotics(e.g.penicillin,sulfadrugsandtetracycline)Antiseizuremedicationssuchasphenytoin(Dilantin)orcarbamazepine(Tegretol)

DrugallergysymptomsSkinreactionsRashHivesPhotoallergy—Sensitivitytosunlightfollowingsunexposure,anitchyandscalyrashRed,raisedanditchypatchesontheskinthathaveashapelikebull’seyetargets.Themayoccurtogetherwithswellingofthefaceortongue:-

•Fever•Muscleandjointaches

•Lymphnodeswelling•Inflammationofthekidney

DrugAllergyTreatmentIncaseofamildallergicreaction,carecanbetakenathome.Forreducinglocalisedskinreactions,thefollowingcanbedone:Takeacoolshowerorapplyacoolcompress.Wearlightclothingthatdoesn’tirritateyourskin.Keepyouractivitylevellow.Torelievetheitching,applycalaminelotionandtakeanantihistaminetablet.

MedicalCareTrytostaycalm. If the individual displays any symptoms such as fever or vomiting ask him to stop taking therecommendedmedicationandcontactthedoctor. If the person has difficulty in breathing or his throat is swollen, he may be in the process ofsuffering fromananaphylactic reaction. Immediately takehim toahospital emergency.Don’t lethimdrive. Ifapersonisfeelinglight-headedorfaint,makehimliedownandraisehislegshigherthantheheadtohelpthebloodflowtothebrain. A cardiopulmonary resuscitation (CPR) should be administered to a person who becomesunconscious.

5Asthma,ItsManagementandTreatment

Asthma is an inflammatory condition of the bronchial airways. Inflammation causes the normalfunction of the airways to become over-reactive. This reaction results in production of increasedmucous,mucosalswellingandmusclecontraction.

Thereactivechangesleadtoairwayobstruction,chesttightness,coughingandwheezing.Inseverecasesitcancausesevereshortnessofbreathanddecreasedoxygenlevelsintheblood.However, children suffering from asthma, mostly have reversal of symptoms until some otherallergytriggersthenextepisode.Wheezing–Wheezingisahigh-pitchedsoundthatoccursfromforcedexhalationacrossnarrowed

obstructedairways.

CausesofAsthma Some individualshavean inheritedpredisposition todevelopasthmawhenexposed toallergenslikehomedust,pollens,moulds,fungi,etc.

Theseindividualsmaynotbeasthmaticduetoapreexistinglungdisease,e.g.chronicbronchitis.

Exercise induced asthma – It occurs in certain individuals after exercising. This occurs morecommonlywhenphysicalexerciseisperformedincoldregionsorincoldweather. Inflammation of the airways is a common cause in all asthmatic patients. This inflammation isproducedbyallergy,viral,respiratoryinfectionsandairborneirritants.Studiesindicatethatallergicreactionsproducebothimmediateandlatephase(delayed)reactions.It isseenthatapproximatelyhalf of the immediate allergic reactions due to inhaled allergens are followed by a late phasereaction.Thislatephasereactionoftenproducesseriousinjuryandinflammationtotheairway.Thisairwayinflammation leads to irritability or hyper responsiveness of the airways. In addition, prolongedinflammationoftheairwaycancausescarring. Asthma can startwith symptomsof a common cold and then lead to rapid breathingwith shortbreaths.

SymptomsofAsthma

CoughingWheezingorwhistlingsoundswhichareaudiblewhenanasthmaticpersonexhalesShortnessofbreathorrapidbreathingNightcoughiscommon,asasthmaisoftenworseatnight.Chesttightnesswithshortnessofbreathareothersymptomsofasthma. Chronic bronchitis can be present due to acute asthma.This often presents itselfwith excessiveproductionofmucous.

TeststoDiagnoseAsthmaAfter discussing your asthma symptoms and possible asthma triggers, your doctorwill conduct aphysicalexaminationonyou.Hewillsendsamplesofyourblood/urineforlaboratorytesting.

PulmonaryFunctionTestsNormalvaluesarebaseduponyourage,height,ethnicity,andsex.Normalresultsareexpressedasapercentage.A value is usually considered abnormal if it is less than 85%of your predicted value.Abnormalresultsusuallymeanthatyoumayhavesomechestorlungdisease.

SpirometryTest

Spirometryisthemostfrequentlyperformedtestofpulmonary(lung)function.TheSpirometerisadevicetomeasurehowmuchairanindividual’slungscanholdandhowwelltherespiratorysystemisabletomoveairinandoutofthelungs.Spirometryrecordstheentireforcedbreathingcapacity.Thepeakflowreadingrecordsthelargestbreathingflowthatcanbesustainedfor10milliseconds.Bothareoftenusedtodetectandmanageasthma.

ChestX-rayItwillhelpyourdoctormakethediagnosis.

BloodGasAnalysisItwillindicatethestatusofbloodgasexchangeinyourbody.Yourmedication(inhalers)oroxygentobegivenwillbeadvisedaccordingtotheresults.

AsthmaandDrugInteractionTheelderly,aremorepronetobruisingaftertakingcortisonemedication(oralorinhaled).Oralcortisonecansometimesraisebloodpressure.Patientstakingcortisone(likeprednisone)canexperiencemusclecramps.Thiscanberelievedwiththehelpoforangejuice,bananas,potassiumliquidorpills.

Asthmacangetaggravatedinindividualsusingbeta-blockingdrugsforhighbloodpressureandheartdisease.

TheElderlywithAllergiesorAsthma Any individual over 55 years of age should try the newer anti-histamines. With the earlierantihistaminestheelderlycanexperiencedrymouth,dizziness,prostateproblemsandsedation.CalciumandvitaminDshouldbetakenregularlytoavoidosteoporosis.Allseniorcitizenssufferingfromasthmashouldreceivetheirannualshotofpneumoniavaccine.

NocturnalAsthmaA peak flow expiratory flowmeter can be used to record the severity of night time asthma. If anindividual’speakflowreadingdropsinthemorning,thentheindividualisa“morningdipper”.Suchindividualsaremorepronetonocturnalasthma.

Nocturnal asthmatic attacks usually occur between midnight and early morning. Some of thereasonscitedforthisare:–Gastricreflux(foodoracidregurgitation)SleepingmodeAtnightthefallofcirculatorycortisoneandepinephrinehormonelevels,donotgiveprotectionagainstallergens.Exposuretodustmiteinthebedroom.Any individual getting upmore than two or three times a month due to nocturnal asthma shouldconsulthisdoctor.

AdolescenceandAsthmaAsthmainadolescencecanbeduetothefollowingreasons:SmokingFailuretotakeantiinflammatorymedicationasprescribedOveruseofinhalers

AsthmaticAttackDuringanasthmaticattack:-Thelungsfailtofunctioninthenormalfashion.Drycoughandwheezingmaybepresent.Theskinisclammy,andcanappearblue(duetolackofoxygen).Theaffectedindividualwantstositwithelbowontheknees(typicalposture).Asthmaticsprefersittingtolyingdown.Speechisoftendifficult.

AsthmainChildren

Inthewesternworldasthmaisthethirdleadingcauseofhospitalisationamongchildrenundertheageoffifteen.Itisthemostcommoncauseofschoolabsenteeismduetochronicdisease.Italsoaccounts

for one third of all pediatric emergency room visits. Hypersensitive airways result from stimuli,leadingtotriggering,narrowingorobstructionoftheairways.Severalsmallstudiesseemtosuggestthattonsillectomyandadenoidectomymaydecreaseseverityofasthmainpatientspostoperatively.

CausesofAsthmainChildren Exercise – Running can trigger an episode in over 80 per cent of children with asthma.Bronchodilatormedicationsusedbeforeexercisecanpreventmostoftheseepisodes.Infections–Respiratoryinfections,bronchitis,flu,frequentlytriggersevereepisodesofasthma.Chronicsinusitisinchildhoodduetobacteriacanbeaverystubbornchronictriggerforasthma.Allergy–Inmanychildrenoutdoorasthmaistriggeredbyallergies(pollen,mould).Theallergensinvolved indoor can be inhalants, such as, dust mites, feathers, moulds; or insects especiallycockroaches;orpetsor ingestedfoodssuchas,milk,soya,egg,etc.Allergymaybethecauseofunrecognisedorhiddenasthma.Drugslikeaspirincantriggerattacksofasthma.Irritants–Cigarettesmoke,airpollution,strongodours,aerosolspraysandpaintfumesaresomeof the substanceswhich irritate the tissues of the lungs and upper airways. Passive smoking canharmchildren.Irritantsmustberecognisedandavoided. Weather – Breathing cold air can act as a trigger and precipitate asthma in children. Outdoorinhalantallergens(e.g.pollensandmoulds)aredependentupontheweather.Duringspring,moreallergensare scattered in theair,whileaheavy rainfallmakes theair cleanof theseallergens.Alight rain helps wash out pollen but on the other hand may actually increase the mouldconcentration.

Chemicals –Anumber of chemicals can produce occupational asthma.These can be isocynateswhichareusedformakingplasticfoam,syntheticinks,paints,adhesives,enzymesusedforbaking,hardeningagentsusedforsurfacecoatings,etc.Pets–ThetypeIallergicreactioncanbeproducedbycats.Thisisduetotheirhair(tinyparticlesofskinthatareinhaled).ASkintestcanhelpdetectanyallergytothepetanimal.

Emotions

DietandtheAsthmaticChildAsthmaticchildrendonotputonweighteasily.Theasthmaticchildrequiresmorecalories/kgbodyweight, in comparisonwith the healthy one. This is due to a highermetabolic rate present in theasthmaticchild.Besidesgrowthandactivitythischildneedsmorecaloriesduetoafastbreathingrate.Alongwith a diet ofminerals, vitamins, etc. the carbohydrate andprotein intake in such a child

shouldbeincreased.Theamountoffoodingestedthroughouttheday,i.e.breakfasttodinnershouldbebalanced.Toavoidanocturnalasthmaticattack,dinnershouldbekeptlight.

AsthmaandDietFoodsthatcantriggerasthmaticattackscanbe:

Foodscontainingadditives,e.g.benzoates,sulphites,etc.whichareusedincider,wineandbeer.Foodscontainingyeastormould,suchasbreadandbluecheese.

FoodsordrinkscontainingcolouringsE102,E104andE110essence.Cow’smilk,cereals(wheat),egg,fish,soya,andnuts(especiallypeanuts).Alwaysread the labelsonfoodpackages toknowthekindof ingredientspresent.Thiswillhelp inavoidinganyfoodstuffwhichmaytriggerasthma.

Somefoodshelpinthinningthemucousandopeningthemupforbetterbreathing.Theseincludespicy, pungent foods like chili, hot mustard, garlic and onions. Certain foods help controlinflammationof the airways because of their antiinflammatory components.These includeonions,foodsrichinVitaminCandfattyfishoil(whichhasbeenproventobeanti-inflammatoryandhighinomega3fattyacids).

HealthyFoodsforAsthmaticsAntioxidantsincludeVitaminAfromfoodssuchasliver;betacarotenefrombrightly-colouredfruitsandvegetableslikeapricots,carrots,redoryellowpeppers,darkgreenleafyvegetablessuchasspinach;VitaminCfromcitrusfruits;andVitaminEfromoliveoilhelpstrengthenthelungsbymoppingupfreeradicals.

FoodsrichinVitaminBaregreenleafyvegetablesandpulses.Somegoodsourcesofmagnesiumaresunflowerseedsanddriedfigs.

DidyouknowthatLindaGamlin(TheAllergicBible)describeshowpeopleallergictofoodcanbekilledbyakiss.Shewrites of a young man with fish allergy who required emergency care after being kissed by hisgirlfriendwhohadjusteatenmackerel.

Monosodiumglutamateandasthma

Individualssufferingfrommonosodiumglutamate(MSG)sensitivityexperiencefacialflushingandageneralised tingling sensation after eating MSG. Chinese food normally contains this salt so theconditionisdescribedas“TheChineseRestaurantSyndrome”.

AsthmaInducedbyAlcoholIt has been seen that half of the asthmatics in Japan wheeze after consuming alcohol. StudiesconductedinJapanhaveshownthattheJapanesepeoplehaveageneticallydeterminedenzymedefect.Thisdefectprevents thebreakdownofacetaldehyde,aby-productofalcohol.Acetaldehyde inhighlevels, trigger the release of histamine from the mast cells. This leads to bronchospasms andwheezing.

CockroachAllergy

Cockroachallergycametoberecognisedinthe1960s.Cockroachallergenispresentinsaliva,skinshedding, faeces and dead bodies of the insects. Cockroach sensitive people are seen to have aseasonalpattern,withtheallergypeakinginthesummermonths.Itwasobservedthatchildrenlivingincockroachinfesteddwellingsweremorepronetoasthmaduringthosemonths.

StatusAsthmaticusWhen a severe asthma attack does not respond to the intake of bronchodilators and becomesassociatedwithsymptomsofpotentialrespiratoryfailureitisknownasstatusasthmaticus.Itisalife-threateningconditionandrequiresimmediatemedicalattention.

Thesymptomsmayinclude:–PersistentshortnessofbreathInabilitytospeak.

Statusasthmaticusoftenoccurswithfewwarningsigns. Itoftenoccursquicklyandcanprogressrapidly to asphyxiation. Patients with status asthmaticus often have poor control of allergens orasthmatriggersinthehomeand/orattheworkplace.Thesepeoplemayalsohaveinfrequentuseofapeak flow monitor and inhaled corticosteroids. People who have status asthmaticus may have ahistoryoffrequentbadhealth,whichresultsinpoortreatmentofasthma.Statusasthmaticusmaynotrespondquicklytoroutinetreatmentwithasthmainhalers.Continuoususeofanasthmanebulizerandinjectedmedication such as epinephrine and prednisone are often necessary for asthma. To avoidhospitalisationwithasevereasthmaattack,it is imperativetobeginimmediatetreatmentat thefirstsignofsymptoms.

MedicalCareOxygenistheprimarytherapeuticmodality.Oxygenmustbeprovidedtoanypatientwhopresentswithstatusasthmaticus.Oxygenisprovidedthroughnasalcannulaorfacemasks.

Medication – The appropriate use and dosage of the prescribed medication, should be inaccordancewithyourdoctor ’sprescription.Themorecautiousyouareaboutyourasthmatriggers,

thelessasthmasymptomswillinterferewithyouractivities.

ManagementandTreatmentofAsthmaAsthmacanbecontrolledwithpropermanagement.Tryandmakeyourenvironmentconduciveforyourhealth.Keepyourhouseclean.Whilecleaning,wearamask.Washthebedding(sheets,pillowcases,mattress,etc)weeklyinhotwaterandsundry.

Replacebeddingmadeofdown,kapokorfoamrubberwithsyntheticorcottonmaterialTryandkeepthehumidityinthehouselow. Monitor lung function.Asthmatics canuseapeak flowmeter.Lung functiondecreases2-3daysbeforesymptomsofanasthmaattack.If themeter indicates thepeakflowisdownby20percentfromyourusualbesteffort,beforewarnedofanasthmaattack. Control asthmatic symptoms by avoiding the triggers and start using your requiredmedication.Immunotherapy(allergyshots)areoftengiven.Theprocessinvolves‘desensitizing’thepatient.Thetreatmentbeginswithinjectionsofasolutionofallergen.Accordingtoschedule,thestrengthoftheallergensolutionisgraduallyincreased.

TheScheduleforHyposensitisationPre-seasonalInjections are started about 3 weeks prior to the onset of season in which the patient developsasthmaticsymptoms.Injectionsareadministeredaccordingtoaschedule.

Co-seasonalThis schedule is administered to those individuals who present themselves with symptoms justpriortothepollenseason.

SeasonalHere thescheduleofhyposensitisation isadministeredevenafter theaggravatingseason isover.Theinjectionsaregiventheyearround.

ElderlyPeopleandAsthmaIf an older patient has lostweight, itmust be supplementedwith a diet to regainweight.A certainamountofproteinasinsoya,milk,cheese,pulsesisamust.Chickensoupishealthy.Supplementationthrougheggandfishcanhelp.Ifmasticationisaproblem(duetoteethproblem),thenfoodshouldbepureed.Carbohydratesupplementationthroughoats,porridge,semolinaisalsohelpful.

PrecautionforAsthmaticsTheyshouldnotOvereat

SmokeDrinkHavefried,fattyorspicyfoods

ExposethemselvestothecoldShakehandswithanyonewithaviralinfection

TheyShouldBeregularwiththeirfoodhabitsKeepthedinnerlightTryandkeepagapoftwohoursbetweeneatingandsleepingtimeKeeptheroomwell-ventilatedGettheirannualantifluvaccineshot

NewerDrugsforAsthmaManynewdrugsareinthepipelineforasthma.Themostpromisingcouldbetheinhaledcortisonedrugciclesonide(Aventis).Itshouldbeadministeredtothepatientonceadayininactiveform.Itgetsactivatedinthelungs.

HiddenAsthmaUntil rapid breathing, coughingbecomesobvious, the conditionofmany individuals/childrenwithasthma goes undetected. Unfortunately hidden asthma produces few recognizable symptoms.Pulmonaryfunctiontestingusuallyrevealsthesecasesofairwayobstruction.

MedicationforAsthmaticPatientsLong-term control medication is administered daily to maintain continuous control of persistingasthma.Thismedicationhelpstocontrolairwayinflammation.Thequick-reliefmedicationistakentoachievepromptreversalofanacuteasthma‘attack’.Asthma control is mainly done through antiinflammatories and bronchodilators.

Antiinflammatories help to reduce the number of inflammatory cells in the airways.This preventsbloodvesselsfromleakingfluidintotheairwaytissue.Reductionininflammationreducesthespasmoftheairwaymuscle.Antiin-flammatoriesalsohelplessentheriskofacuteasthmaattacks.

Anti-inflammatoryAgents

AntihistaminesAllergic cough in children can be helped by giving a combination of antihistamines withbronchodilators.Thismedicationisnoteffectiveinadults.

SodiumcromoglycateItisderivedfromtheleavesofaplant.Itsactionisunique.Whenit isinhaledasapowder,ithelpscoattherespiratorymucousmembrane.Whenanallergicindividualinhalesanallergenlikepollenordust, normally these allergens settle on the cells to which are attached the antibodies. Sodiumcromoglycatehelpsprevent the releaseofhistamineandotherchemicals from themastcells (as itmakesthecellwallstrongandstable).Ashistamineandotherchemicalsarenotreleasedonexposuretotheallergy,thepatientsuffersnosymptoms.

Thespinhaleristhespecialinhalerusedfortheinhalationofsodiumcromoglycate.Theeffectofasingleinhalationhelpsagainstallergensforfourtosixhours.Repeatedinhalation3-4times/daycanhelpavoidanasthmaticattack.

LifeSavingApparatusAsthmainhalers

Anasthmainhalerisahandhelddevicethatdeliversasthmamedicationstraightintotheairways.Theinhaledmedicationgoesdirectlyintothelungs.Thishelpsrelieveasthmasymptomsfasterandwithfewersideeffects.Today,anumberofinhalersareavailabletohelprelieveorcontrolsymptomsofasthma.

MetereddoseinhalerThisinhalerconsistsofachemicalpropellantwhichforcesameasureddoseofmedicationoutoftheinhaler.Theapparatusconsistsofapressurisedcanistercontainingmedication,amouthpieceandameteredvalvethatdispensesthecorrectdoseofpresetmedication.Themedicationisreleasedeitherbysqueezingthecanisterorbyinhaling.Somemetereddoseinhalershavecountersforyoutodetectthe number of doses remaining. The chemical propellant in metered dose inhalers are usually ofchlorofluorocarbon(CFC)orofhydrofluoroalkane(HFA).

DrypowderinhalerInthisinhalerthemedicationisreleasedbybreathinginmorequickly,ascomparedtothemetereddoseinhaler.The choice of the right kind of inhaler depends on several factors like your hand-breath

coordination,yourdexterity,whetheryoucan takeadeep, fastbreath,andwhat typeofmedicationyouneed.

DeliveryofMedicationInhalersareusedtodeliveravarietyofasthmamedicationswhichassistwithlong-termcontrolandprovidequickreliefofsymptoms.Inhaledasthmamedicationsinclude:–

Short-actingbronchodilatorsThesemedicationprovideimmediaterelief,e.g.albuterol.

Long-actingbronchodilatorsThesemedicationrelieveasthmasymptomsforlongerperiodsoftime.

CromolynornedocromilThesemedicationareusedforlong-termpreventionofinflammation.

CorticosteroidsTheyareusedtopreventlong-termasthmaattacks.

Corticosteroidandlong-actingbronchodilatorThismedicationcombinesacorticosteroidandalongactingbronchodilator.Eachinhalermaycomewithaslightlydifferentinstruction.Itisimportantforyoutouseyourinhalercorrectlysothatthemedicationreachesyourlungs.Ask

yourdoctor,nurseorpharmacistforademonstration.

ApparatusUsefulatHomeAirPurifiersAirfiltersareusuallyclassifiedaccordingtotheirabilityofremovingparticlesofdifferentsizes.HEPAaretheHighEfficiencyParticulateAirfilterswhichremoveparticlesassmallas3microns.Theyareexpensivebutnearly99%efficient.

DehumidfiersAdehumidifier removeswater vapour/moisture from the surrounding air.This helps reduce thegrowthofdustmitesandmoulds.

AirConditionersTheyindirectlyhelplowerdustmitesandmouldastheyactasadehumidifier.Airconditioninginthebedroomhelps the sleeping asthmatic to avoid earlymorning release of pollen by trees andplants.The important factor is the regularcleaningofair-conditioners toavoiddust,mouldandpollenbuildup.

NebulizerAnebulizerisadevicewhichadministersmedicationintheformofaliquidmisttotheairwaysofthepatient.Itiscommonlyusedintreatingcysticfibrosis,asthma,andotherrespiratorydiseases.Nebulizerusageisusuallyadvisedforseriouscasesofrespiratorydisease.Anebulizerisdesignedforthosewhocan’tuseaninhaler;suchas,infants,youngchildrenandthosewhoareseriouslyill.

TheCurrentSituationAsthma remains themost commonchronicdiseaseof any sort in childhoodand themost frequentchronicrespiratorydisorderatanyage.

AsthmaPredictiveIndexinChildrenTheasthmapredictive index (API)hasgivenguidelines for thediagnosis and treatmentof asthma.Thisdetermineswhichsmallchildrenarelikelytohaveasthmainlateryears.Highriskchildrenwhohavehadfourormorewheezingepisodesinthepastyearthatlastedmorethanoneday,andaffectedsleep,aremuchmorelikelytohavepersistentorlifelongasthma.Thefollowingcriteriahelpsinthepredictiveindex.

InvolvementofOneMajorCriteriaofthefollowing:–ParentwithasthmaPhysiciandiagnosisofatopicdermatitis(oftencalledeczema)Evidenceofsensitisationtoallergensintheair(i.e.,positiveskintestsorbloodteststoallergense.g.trees,grass,moulds,ordustmites)

InvolvementofTwoMinorCriteriaofthefollowing:–Evidenceoffoodallergies>4percentbloodeosinophilia(i.e.increasednumbersofwhitebloodcells)Wheezingapartfromcolds

RescueInhalersMetereddoseinhalers(MDI)likeAlbuterolareundergoingachangeinfeatures.

ThenewHFAinhalershavethefollowingfeatures:–AdifferentpropellantbuttheAlbuterolmedicineisthesameandthereisnochangeinthekindofmedication.HFAinhalersmighttastedifferentinyourmouthThe“puff”yougetfromyourHydrofluoroalkane(HFA)inhalermightnotseemasstrongbuttheamountofmedicineinthepuffisthesame,sotakeonlythenumberof“puffs”recommended(HFAinhalerswillprobablycostmorethantheChloroflurocarbon(CFC)inhaler).Askyourdoctororpharmacisttoexplainhowtouseyournewinhaler.Insteadofwaiting till youget ill, the rescue inhaler (also calledAlbuterol or quick-relief inhaler)should be used at the first sign of asthma symptoms.Thewarning signsmay start 24 to 48 hoursbeforeanasthmaattackbegins,andshouldbetreatedasearlyasthmasymptoms.

Totreatasthmaquickly,notethesignsinvolvingthebeginningofanattack:–Acoughthatdoesn’tgoaway,especiallyatnightSorethroatorthroatclearingRunnyorstuffynoseDarkcirclesundereyesIncreasedtirednessandmoodchangeWakingupatnight

Eczemaflare-upIfanyofthewarningsignsarepresentconsultyourdoctor.

ManagingYourMedicationTheDo’sandDon’tsIfyouaretakingmanydifferenttypesofmedicinesDokeeparecordofallyourprescriptionsandover-the-countermedicines. Do read and save written information that comes with your prescriptions or over-the-countermedicines.Docheckthelabelonyourmedicinebeforetakingit.Dotakeyourmedicineexactlyasdirected.Usingmedicinesimproperlycanmakeyourconditionworseinsteadofbetter.Dochecktheexpirydateonyourprescription.Docallyourdoctororchemistrightawayifyouhaveanyproblemaftertakingyourmedication.Donotstoptakingaprescribedmedicinejustbecauseyoursymptomsgoaway.DonottakemedicinesprescribedforsomeoneelseDonotgiveyourprescriptiontoanyoneelse.Donotusealcoholwhiletakingamedicine.Donothesitatetocontactyourdoctor,chemistorpharmacistifyouhaveanyquestions–eventuallyit’saboutyourhealth!

MythsandFactFile

MythAnindividualallergictoaparticularallergene.g.pollen,cannotbeallergictoanyotherallergens.

FactIndividualsallergictoanallergen,canbeallergictopollen,moulds,dustaswell.Whilebeingtreatedforaparticularallergen, the individualshouldbehyposensitisedagainstalloffendingallergens,aswell.

MythMedicationforasthmaisunsafeduetosteroidusage

FactSteroidsusedintreatmentofasthmaaremainlyinhalers.Medicallyitisshownthatsteroidsareoftenessentialtoreduceandcontroltheasthmaticattack.

MythEveryonehasthesamekindandintensityofasthma.

FactTypeandintensityofasthmavariesfrompersontoperson.Thereisnocommonkindofasthmalikeacommoncoldorsneezing.

MythAllergiesarenobigdeal.

FactManyof us suffer from somekindof allergy.Statistics from theUnitedStates quotes that 20%ofpeoplehavehayfever,whichcosts$3billionperyearandlosttimefromworkandschool.

MythIamtoooldtohaveallergies.

FactYoucandevelopanallergyatanystageoflife.Hayfever,drugandfoodallergiescanoccurbothinchildrenandadults.

MythIcangrowoutofanallergy.

FactMaybeyes,maybeno.Foodallergiescanoftensubsidewithtime,butallergiesduetomedicationandhayfevernormallydonotsubside.

MythThere’snotmuchIcandoaboutallergies.

FactSeeyourdoctorandgetontoindividualisedallergyprogramme,itoftenhelps!

MythSportsareastrictno-nowithasthma.

FactThisisagainanothermyththataccompaniesasthma.Thereisnoneedtokeepyourchildawayfromsportsifyourchildisasthmatic.Manyathletesandswimmershavebeenasthmatics.Whatisimportantistounderstandtheprecipitationofanasthmaticattackandhowtoavoidandcontrolit.

MythMylungscangrowtoughandimmunetoasthmaattacks.

FactIfyougowithoutmedicine,youwillonlysuffer.Asthmaoccursduetoachronicinflammationofthelungs.Nottakinganymedicinewillworsenthecondition,andthatcanbefatal.Itisnotafactthataperson’slungsbecometoughduetoavoidanceofmedicines.

MythCardiacasthmaisthesameasthebronchialasthma.

FactCardiacasthmaisprecipitatedduetofailureoftheleftventricleoftheheart.Thebreathlessnesshereisprimarilyduetoheartdisease.

MythAsthmaticchildrencangetcurediftonsilsareremoved.

Fact

Enlargedtonsilsbeingremovedisstillacontroversialsubject.Theremovaloftonsilsmayeliminateaprecipitatingfactorwhichleadstoasthma.Thisontheotherhand,doesnotalleviatetheallergyinachild.Itisthebasiccauseofasthmawhichshouldbedealtwith.

MythFoodallergyisinthemind.Ifonewants,onemayeatanddrinkanything.

FactAllergytocertainfoods,insomeindividualsisscientificallyproven.Foodslikemushrooms,fishandother sea foods can sometimes produce a severe reaction, which may sometimes lead tohospitalisationoftheaffectedindividual.