Living with Allergies

What are allergies?

An allergy, or ‘hypersensitivity’, occurs when there is an abnormally vigorous overreaction by the immune system in response to a usually harmless, foreign substance (like pollen or certain foods) that your body incorrectly identifies as a “threat”. The foreign substances that bring about allergic reactions are known as allergens.

Allergies are very common, and while they are just irritating to most people who suffer from them, they can also make you feel pretty miserable. Some people, however, may experience severe symptoms or anaphylaxis – an allergic reaction that is a life-threatening emergency.

Generally, allergies cannot be cured, but treatments can help relieve your symptoms.

What are the types of allergies and their symptoms?

Allergy symptoms, which can range from mild to severe, depend on the type of allergen and may affect different parts of your body, most commonly the upper airways, sinuses and nasal passages, skin and digestive system. The common types of allergy and their symptoms are listed below:

1. Hay fever, also known as allergic rhinitis, may cause you to experience the following:
   • Sneezing
   • A runny and stuffy (congested) nose
   • Itching, pain, redness or swelling in the mucous membranes of the nose, eyes or roof of the mouth
   • A scratchy or sore throat that can cause you to try and “clear your throat” by coughing
   • Watery, red or swollen eyes (allergic conjunctivitis)
   • Black colouration (dark circles) underneath the eyes (called allergy “shiners”)
   • A loss of smell or taste
   • Headache, especially around the sinuses, nose and eyes
   • Feeling tired or run down
2. Food allergies can cause:
   • Swelling, tingling or itching of the tongue, lips, throat, mouth or face
   • Hives (medically known as urticaria) that commonly manifest as a sudden outbreak of swollen, pale red bumps or plaques (wheals) on the skin
   • An itchy skin rash (eczema)
   • Vomiting, diarrhoea or stomach pain
   • In severe cases, sudden hypotension (a drop in blood pressure), difficulty breathing and wheezing
3. Allergic reactions to insect bites and stings may cause:
   • Swelling (medically known as oedema), redness and pain at the bite/sting site, and after time, a lump may form there
   • Itching or hives
   • In severe cases, difficulty breathing and wheezing
4. Drug allergies can cause:
   • Itchiness
   • Rash or hives
   • Swelling (commonly of the face)
   • Wheezing and breathing problems
5. Skin allergies, like contact dermatitis or atopic dermatitis (or eczema), can cause the following dermatological (skin) symptoms:
   • Itchiness
   • Rashes or blisters
   • Redness
   • Dryness, cracking, flaking or peeling
   • Swelling.

What causes allergies?

According to the Allergy Foundation of South Africa (AFSA), about one-third of South Africans will probably experience an allergic reaction at least once in their lives.

The following describes the allergic reaction in the body:

• When a specific allergen (such as pollen) that you are allergic to enters your body, it triggers your immune system to make allergy-causing antibodies called immunoglobulin E (IgE).
• The antibodies attach themselves to specialised cells called mast cells that respond by releasing the chemical histamine.
• The release of histamine causes inflammation (redness, swelling and itching).

Common allergens or “triggers” include:

• Airborne allergens: Commonly pollen, animal dander, dust mites and mould spores.
• Foods: Commonly including peanuts, tree nuts, gluten in wheat germ products (for example, in people with coeliac disease), soya, shellfish, eggs and milk.
• Pet allergies: These include allergies to the hair, skin cells, saliva or urine of pets (typically dogs and cats) and other animals.
• Insect stings and bites: These include stings from a bee, wasp or hornet and bites from mosquitoes, ticks or spiders (snake venoms or other “poisonous” animal bites or stings are also caused by an allergic reaction).
• Medications: Particularly penicillin and penicillin-based antibiotics, sulpha-containing antibiotics (sulphonamides), aspirin or non-steroidal anti-inflammatories.
• Metals: This is generally in the form of contact dermatitis in reaction to nickel found in jewellery.
• Environmental allergens: These can include cigarette smoke and pollution.
• Other: Latex as well as detergents and cosmetics can also cause skin allergies in some people, while resins from certain plants, like poison ivy, are also well-known skin allergens. Cockroaches can also cause asthma or allergic rhinitis.

You may be more sensitive to certain allergies based on whether you have the following:

• Atopy if you are still a child: Atopy is a genetic predisposition to asthma or allergy, typically seen in children with a family history of these conditions. While you can develop allergies as an adult for the first time, it is far more likely to develop an allergy as a child.
  According to the AFSA, a child without a family history of allergies has about a 15 % risk of developing an allergic condition within the first few years of life. However, if one parent has an allergic condition, this risk increases to 40-50 %, and if both parents have allergies, up to 60-80 %. More than 40 % of allergy sufferers in South Africa are children
• Asthma or other allergic conditions: It is more likely that you are allergic to other allergens as well.
• Female sex: While as children, more boys develop allergies than girls, this reverses after puberty. This is because the female hormone oestrogen is known to exacerbate sensitivity to allergens, while the male hormone testosterone is probably protective.
• Overweight or obesity.

How can you avoid allergies?

Preventing an allergic reaction depends on the type of allergy you have. The following measures may help you to avoid allergies and manage your allergy symptoms:

• Avoid known triggers: The best way to prevent allergy symptoms is to avoid or eliminate the allergens that trigger them. This can include keeping a diary when trying to identify what causes or worsens your symptoms by tracking what you are exposed to (for example, what you ate) when symptoms occurred.
  Try to avoid or eliminate allergens from your life (for example, avoiding certain foods).
  It is also important to know when your exposure to certain allergens might be highest so that you can take actions to avoid them; for example, staying indoors or keeping windows closed during seasonal hay fever/pollen season.
  Additionally, avoid insect bites by covering your skin with clothes, wearing closed shoes outdoors and using insect repellent during summer.
  Always tell your doctor about any allergies you have before they prescribe you medication or before you have a medical procedure. Furthermore, you must always check the ingredients of over-the-counter medications, supplements or herbal remedies for any substances that can cause you to suffer an allergic reaction.
• Get your allergies diagnosed: You may not know what is causing your allergies. You can visit your doctor, who can help diagnose your allergy based on the symptoms you report experiencing and any physical signs you may have on examination.
  You may also be asked by your doctor to keep a diary to identify potential allergens, especially food allergies. Your doctor may also recommend a skin test or blood test to specifically determine what substances you are allergic to.
• Wear a medical alert bracelet: If you have a severe allergy that causes severe symptoms, or that may cause anaphylaxis, you can wear a medical alert bracelet or necklace to let others know in case you need help during an allergic reaction. Alternatively, you can carry a medical information card with you.
• Make your house allergy-free: This includes regularly cleaning your house of dust and mould and washing bedlinens or fabrics in warm water to avoid dust mites and other allergens. You can also install small particle or HEPA air filters to rid your living spaces of airborne allergens. Removing carpets or curtains and decluttering spaces may also reduce accumulated dust and make it easier for you to clean.
• Enjoy a healthy lifestyle: Avoid cigarette smoke and pollution, as these are known allergens. If you smoke, you can talk to your doctor about ways to quit.
  Also exercise regularly to help manage your weight, get enough sleep and find ways to relieve stress. High levels of stress has been proven to cause allergy flare-ups and may worsen allergy symptoms.
  Eating a healthy diet rich in fruit and vegetables, with high amounts of vitamins and minerals, is also important. Vitamin C is a natural antihistamine, while there is growing evidence that zinc and vitamin D play a protective role against developing atopic disease, with some studies indicating that supplementation in early childhood may prevent the development of certain allergies as children grow older.
  See Cooking from the Heart for healthy and delicious meal ideas.

What allergy medications are available?

There are several different types of medications available in different forms (tablets, liquids, nasal sprays, eyedrops and ointments or skin creams) to help relieve and manage allergy symptoms, including:

• Antihistamines: These are the most common medication for the relief of allergy symptoms. They work by blocking the chemical, histamine, that causes the symptoms of allergy.
  There are several different types of antihistamines available over-the-counter in different forms to ease the different types of allergy symptoms.
  Take these medications with precaution as they tend to cause drowsiness and may make you feel tired. As such, antihistamines may not be suitable for use if you are going to be driving or doing any activity that requires full alertness.
• Decongestants: These are usually available as nasal sprays that can relieve congestion (stuffiness) in the nose or sinuses.
• Corticosteroids: These medications help relieve symptoms by reducing inflammation. Steroids can be found in some nasal sprays and skin creams but are also available in tablet or inhaler form. Your doctor may need to prescribe you a steroidal medication that can help manage your symptoms.
  Long-term corticosteroid use can cause cataracts, osteoporosis, muscle weakness, thinning of the skin, stomach ulcers, increased blood sugar (glucose) levels, delayed growth in children and can also worsen high blood pressure. Talk to your doctor or healthcare provider if you are going to be using corticosteroids for a long period of time.
• Mast cell-stabilisers: These medications block mast cells from releasing histamine. Your doctor may prescribe these when you cannot use antihistamines or when antihistamines are not working effectively to relieve your symptoms. Mast cell stabilisers do not provide immediate relief of symptoms but require at least a few day’s use to be effective.
• Leukotriene inhibitors: These tablets block the other chemicals that help to cause allergy symptoms. Your doctor will have to prescribe these medications as they are sometimes known to cause, or aggravate, psychological conditions like anxiety and depression.

If you cannot use these medications or if they have not worked to relieve your allergy symptoms, your doctor may suggest allergen immunotherapy. The goal of immunotherapy is to try to train your body’s immune system not to react to specific allergens by the carefully timed and gradually increasing exposure to allergens, such as pollens, dust mites and mould. Immunotherapy is usually given as a series of injections at a healthcare facility or immunology clinic. Immunotherapy needs to be carefully monitored by a healthcare professional, as it can cause side-effects, such as swelling and pain at the site of injection, or even anaphylaxis.

Recently, cellulose powders as barrier protections, such as hydroxypropyl methylcellulose (HPMC), which literally ‘shields’ the nasal membrane from airborne allergens, or other similar products used as nasal sprays, have been found to provide some benefit in preventing or relieving hay fever symptoms. Some of these products may be available over-the-counter to purchase.

What are some of the potential complications of allergies?

Having an allergy increases your risk of certain other medical problems, including:

• Anaphylaxis
• Asthma: If you have an allergy, particularly hay fever, you are more likely to have asthma. Asthma attacks are also very often triggered by exposure to airborne and environmental allergens
• Upper respiratory tract, ear and lung infections: Your risk of getting rhinitis, sinusitis, otitis media and bronchitis is higher if you have hay fever or asthma.

What is anaphylaxis?

Anaphylaxis is an allergic reaction that is serious and life-threatening.

Anaphylaxis most commonly occurs because of reactions to food (for example, peanuts and shellfish), insect bites and stings, or certain medications.
Anaphylaxis requires immediate medical treatment, including a prompt injection of adrenalin.

Common symptoms of anaphylaxis include:

• Sudden hypotension (a drop in blood pressure)
• Breathing difficulties, including shortness of breath, feeling like your chest is tight and wheezing
• Skin rash
• Feeling weak/light-headed
• Tachycardia (a fast heartbeat) and/or a weak pulse
• Nausea and vomiting
• Loss of consciousness.

To treat anaphylaxis, an injection of adrenalin (also known as epinephrine) is given. People with severe allergies may need to carry a self-injecting needle and syringe device (known as an auto-injector) to use in cases of anaphylaxis. These self-administering injections are commonly known as “epi-pens”.

Even if your symptoms improve after self-administration of an adrenalin injection, you should still seek medical attention to make sure you are in no more danger and because you may require a second shot to stop symptoms from worsening again.
Additionally, if you have ever experienced any signs or symptoms of anaphylaxis in the past, make an appointment to see your doctor for proper management of your allergy.