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Women Talk Health

Dr. Barbara Jost

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Allergy 101

What is allergy?

I like to think of allergy as a misdirected, hyperactive immune response to an otherwise innocuous substance. Why should a dust mite or a pollen grain or your pet's dander be a threat to your body? The allergic response to many of these substances can be exuberant and harmful. It is characterized by inflammation. This translates into swelling of the lining of the nose, sinuses, and bronchial tubes.

Why does it happen?

People are born with the tendency to develop allergic diseases, such as allergic rhinitis, asthma, and eczema. Repeated exposures to proteins in the environment sensitize the predisposed person. A prevailing theory is that improved hygiene over the last century and the industrialization of more regions of the world are responsible for the increased prevalence of allergic disease. This theory has been called "the hygiene hypothesis." Researchers have demonstrated an increased prevalence of allergic disease among children raised in urban areas as opposed to rural areas, in only children as opposed to children in a home with multiple siblings, in children cared for at home as opposed to children attending daycare, and among children in industrialized nations as opposed to developing nations. That is, if a child has to fend off numerous infectious insults, his or her immune system is less likely to develop allergy to otherwise non-threatening substances (e.g. mites, pollens, danders). The flip side is also true; exposure to fewer infectious agents increases the chances of allergic disease. So, the lesson is eat dirt!

What are examples of allergic diseases?

Allergic rhinitis (e.g. "hay fever") is manifest as nasal congestion, drippy nose, post-nasal drainage, sneezing, and itching of the eyes, ears, nose, and throat. This condition can be seasonal, like hay fever, or year-round like allergic rhinitis due to dust mites, molds, and animal dander.

Asthma is exhibited by wheezing, chest tightness, coughing, and a shortness of breath. The course of asthma is variable, and symptoms can be mild and intermittent to severe and persistent. Asthma can be fatal. More generally, though, asthma affects many aspects of daily life, such as sleep, ability to exercise, and school and work attendance.

Eczema is characterized by itchy, dry, red patches of skin. Babies with eczema usually have facial involvement (cheeks, chin). Toddlers often have involvement of the elbows and knees. The area behind the knees and the crook of the arm are more commonly affected in adults. Food allergy is very common in persons with eczema. An important complication of eczema is skin infection with bacteria like streptococcus ("strep") and staphylococcus ("staph") because eczema breaks down the natural protective barrier of the skin. Often eczema is the beginning of the "allergic march," the progression from eczema to allergic rhinitis and, ultimately, to asthma in susceptible individuals.

Immunology 101

We've seen what can happen when the immune system wages a hyperactive attack on otherwise harmless substances in the environment. When the immune system is under-active, recurrent infections ensue. Proper functioning of the immune system requires at least three components: an adequate number of immune cells (B-cells, T-cells), immune globulins specific for infectious agents, and a healthy body. Many problems with the immune system are present at birth, particularly when the issue is low numbers of immune cells. Immune disorders are more commonly acquired later in life. Individuals receiving chemotherapy or immune suppressants for rheumatic conditions or after organ transplant are immune-suppressed. Diabetics and patients with kidney disease, liver disease, or bone marrow diseases like leukemia, lymphoma, and myeloma also have low immunity.

Persons with recurrent sinus and bronchial or lung infections may have low total numbers of immune globulins or they may not be able to make specific immune globulins when challenged with infectious agents. Immune globulins can be given to patients by infusion every four to six weeks. Some patients can be managed more simply with continuous low doses of preventive antibiotics, particularly in the cough and cold season.

It is important to seek the help of an allergist/immunologist when sinus infections, ear infections, bronchitis, and pneumonias occur frequently. What's too frequent? More than four sinus or ear or bronchial infections per year is too many. Similarly, more than one pneumonia per decade is too much.

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