Wednesday, October 14, 2009

Allergy


The body’s defence mechanism works over time to react against foreign particles which may pose danger to normal functioning of the human system. These foreign particles are known as Allergens.
People who are known to be allergic, respond to harmless allergens in an exaggerated manner thus resulting in irritations and discomfort to the body.There are several types of allergies like: Hay Fever, Asthma, Eczema, Food allergy, Contact Dermatitis (Skin Reactions), Conjunctivitis (Red eye), Sinusitis, Anaphylaxis (Life-Threatening Reaction).

Anything can act as an allergen if your system is sensitive to it, but the most common allergens are pollen, dust, dust mites, mold, mildew, cat and dog dander, foods (such as peanuts, milk and shellfish), drugs (such as penicillin and anesthetics) and certain chemicals.

Signs and symptoms
Allergy is a local or systemic inflammatory response to allergens. Local symptoms are:
  • Nose: swelling of the nasal mucosa (allergic rhinitis)
  • Eyes: redness and itching of the conjunctiva (allergic conjunctivitis)
  • Airways: Sneezing, bronchoconstriction, wheezing and dyspnea, sometimes outright attacks of asthma, in severe cases the airway constricts due to swelling known as anaphylaxis.
  • Ears: feeling of fullness, possibly pain, and impaired hearing due to the lack of eustachian tube drainage.
  • Skin: various rashes, such as eczema and hives (urticaria)
 Systemic allergic response is also called anaphylaxis; multiple systems can be affected including the digestive system, the respiratory system, and the circulatory system. Depending of the rate of severity, it can cause cutaneous reactions, bronchoconstriction, edema, hypotension, coma and even death. This type of reaction can be triggered suddenly or the onset can be delayed. The severity of this type of allergic response often requires injections of epinephrine. The nature of anaphylaxis is such that the reaction can seemingly be subsiding, but may recur throughout a prolonged period of time.

Etiology
The exact cause of the IgE malfunctions that result in allergic reactions are not always apparent, however, and several arguments from genetic-basis, environmental-basis and intermediate proponents exist with varying validity and acceptance.

Genetic basis
There is much evidence to support the genetic basis of allergy. Allergic parents are more likely to have allergic children, and their allergies are likely to be stronger than those from non-allergic parents. However some allergies are not consistent along genealogies with parents being allergic to peanuts, but having children allergic to ragweed, or siblings not sharing the same allergens. It seems that the likelihood of developing allergies is inherited (due to some irregularity in the way the immune system works) but the developing of an allergy to a specific allergen is not.
Ethnicity has also been shown to play a role in some allergies. Interestingly, in regard to asthma, it has been suggested that different genetic loci are responsible for asthma in people of Caucasian, Hispanic, Asian, and African origins. It has also been suggested that there are both general atopy genes and tissue-specific allergy genes that target the allergic response to specific mucosal tissues. Potential disease associated alleles include both coding region variation and SNPs. Caucasians display the greatest incidence of asthma.

Relationship with parasites
Some recent research has also begun to show that some kinds of common parasites, such as intestinal worms (e.g. hookworms), secrete immunosuppressant chemicals into the gut wall and hence the bloodstream which prevent the body from attacking the parasite. This gives rise to a new slant on the "hygiene hypothesis" — that co-evolution of man and parasites has in the past led to an immune system that only functions correctly in the presence of the parasites. Without them, the immune system becomes unbalanced and oversensitive. In particular, research suggests that allergies may coincide with the delayed establishment of infant gut flora. Gutworms and similar parasites are present in untreated drinking water in undeveloped countries, and in developed countries until the routine chlorination and purification of drinking water supplies. This also coincides with the time period in which a significant rise in allergies has been observed. So far, there is only sporadic evidence to support this hypothesis — one scientist who suffered from seasonal allergic rhinitis (hayfever) infected himself with gutworms and was immediately 'cured' of his allergy with no other ill effects. Full clinical trials have yet to be performed however. It may be that the term 'parasite' could turn out to be inappropriate, and in fact a hitherto unsuspected symbiosis is at work.

Pathophysiology
The pathophysiology of allergic responses can be divided into two phases; firstly the acute response, which can then either subside or progress into a "late phase response" which can substantially prolong the symptoms of a response.

Acute response
Degranulation process in allergy.1 - antigen; 2 - IgE antibody; 3 - FcεRI receptor; 4 - preformed mediators (histamine, proteases, chemokines, heparine); 5 - granules; 6 - mast cell; 7 - newly formed mediators (prostaglandins, leukotrienes, thromboxanes, PAF)
A type I hypersensitivity reaction against an allergen via the normal humoral response against a foreign body results after plasma cells secrete IgE as opposed to other classes of immunoglobulins such as IgM (against novel antigens) or IgG (against immunized antigens). IgE binds to Fc epsilon R1 (high affinity) receptors on the surface of mast cells and basophils, both involved in the acute inflammatory response. The class switch in the plasma cell leading to IgE is tightly regulated by the immune system. CD45 plays a critical regulatory role in receptor signaling through its protein tyrosine phosphatase and Janus kinase (JAK) phosphatase activities. IL-4 is the primary interleukin which induces switch recombination. Class switch recombination to IgE can also be triggered by the TH2 cytokine IL-13. CD45 is able to function as JAK phosphatase in human B cells, and this activity is directly associated with negative regulation of the class switch recombination to IgE. IgE-bearing epidermal dendritic cells have also been found.
When IgE is first secreted it binds to the Fc receptors on a mast cell or basophil, and such an IgE-coated cell is said to be sensitized to the allergen in question. A later exposure by the same allergen causes reactivation of these IgE, which then signals for the degranulation of the sensitized mast cell or basophil. There is now strong evidence that mast cells and basophils require costimulatory signals for degranulation in vivo, derived from GPCRs such as chemokine receptors. These granules release histamine and other inflammatory chemical mediators (cytokines, interleukins, leukotrienes, and prostaglandins) into the surrounding tissue causing several systemic effects, such as vasodilation, mucous secretion, nerve stimulation and smooth muscle contraction. This results in the previously described symptoms of rhinorrhea, itchiness, dyspnea, and anaphylaxis. Depending on the individual, allergen, and mode of introduction, the symptoms can be system-wide (classical anaphylaxis), or localized to particular body systems (for example, asthma to the respiratory system; eczema to the dermis).

Late-phase response
After the chemical mediators of the acute response subside, late phase responses can often occur. This is due to the migration of other leukocytes such as neutrophils, lymphocytes, eosinophils and macrophages to the initial site. The reaction is usually seen 4-6 hours after the original reaction and can last from 1-2 days. Cytokines from mast cells may also play a role in the persistence of long-term effects. Late phase responses seen in asthma are slightly different from those seen in other allergic responses.

Diagnosis
Before a diagnosis of allergic disease can be confirmed, possible differential causation should be carefully considered and included or excluded. Vasomotor rhinitis is one of many maladies that can mimic many of the symptoms of allergic rhinitis, underscoring the need for professional differential diagnosis.
Once a diagnosis of asthma, rhinitis, anaphylaxis, or some other allergic disease has been made, there are several methods for finding out what the patient is allergic to.

Skin testing
For assessing the presence of specific IgE antibodies, allergy skin testing, when possible, is the preferred method in comparison with various blood allergy tests because it is more sensitive and specific, simpler to use, and less expensive. Different blood allergy testing methods are currently available; the radioallergosorbent test (RAST) test method, which uses radioactive isotopes for testing, has largely been replaced by more modern methods.
The typical method of diagnosis and monitoring of Type I Hypersensitivity is skin testing, also known as "puncture testing" and "prick testing" due to the series of tiny puncture or pricks made into the patient's skin. Small amounts of suspected allergens and/or their extracts (pollen, grass, mite proteins, peanut extract, etc.) are introduced to sites on the skin marked with pen or dye (the ink/dye should be carefully selected, lest it cause an allergic response itself). A small plastic or metal device is used to puncture or prick the skin. Sometimes, the allergens are injected "intradermally" into the patient's skin, with a needle and syringe. Common areas for testing include the inside forearm and the back. If the patient is allergic to the substance, then a visible inflammatory reaction will usually occur within 30 minutes. This response will range from slight reddening of the skin to a full-blown hive (called "wheal and flare") in more sensitive patients.
The skin prick test is the preferred means of testing because of its simplicity, cost, and its accuracy relative to other available tests.
Interpretation of the results of the skin prick test is normally done by allergists on a scale of severity, with +/- meaning borderline reactivity, and 4+ being a large reaction. Increasingly, allergists are measuring and recording the diameter of the wheal and flare reaction.
Theoretical concerns include how to choose patients, interpret results, and maintain safety. If a serious life threatening anaphylactic reaction has brought a patient in for evaluation, some allergists will prefer an initial blood test prior to performing the skin prick test. Skin tests may not be an option if the patient has widespread skin disease or has not avoided antihistamines for several days. Additionally, some patients may believe they have determined their own allergic sensitivity from observation, but a skin test has been shown to be much better than patient observation to detect allergy.
Some people may display a small, delayed reaction that can occur up to 6 hours after application of the allergen and last up to 72 hours. It is often easily treated with anti-inflammatory creams. Interpretation by well-trained allergists is often guided by relevant literature which can offer calculation of 95% and 99% predicted probabilities using logistic regression revealed predictive decision points.
Another consideration with the application of previously un-encountered insect venom allergen is the theoretical possibility that this minute exposure can actually sensitize one to these allergen, causing the inception of a new sensitivity, but such a development is almost unheard of in clinical experience. For all these reasons skin testing should be offered by individuals with advanced training in the diagnosis and treatment of allergic disease.

Blood testing
This kind of testing is also known as a "total IgE level". This method measures the total amount of IgE contained within the patient's serum. This can be determined through the use of radiometric and colormetric immunoassays. The levels of IgE specific to certain allergens can be measured through use of various blood allergy test methods. The radioallergosorbent test (RAST) method uses radioactive isotopes for the measuring process. Other newer methods use colorimetric or fluorometric technology. Some "screening" test methods are intended to provide qualitative test results, giving a "yes" or "no" answer in patients with suspected allergic sensitization. One such method has a sensitivity of about 70.8% and a positive predictive value of 72.6% according to a large study.
A low total IgE level is not useful to rule out sensitization to common inhalant allergens. Statistical methods, such as ROC curves, predictive value calculations, and likelihood ratios have been used to examine the relationship of various testing methods to each other. These methods have shown that patients with a high total IgE have a high probability of allergic sensitization, but further investigation with specific allergy tests for a carefully chosen allergens is often warranted.

Signs of anaphylactic shock
When one goes into anaphylactic shock, the blood vessels dilate and begin to leak into the surrounding tissues, which may affect some organs. Below are signs and symptoms to look for.
· The skin is the first place to look. Hives, itching, swelling, redness and a stinging or burning sensation may appear. On the flip side, skin may also appear extremely pale.
· Because the blood vessels are leaking a person may feel lightheaded or faint. Some people will lose consciousness because of a rapid drop in blood pressure.
· Sometimes the throat, nose, and mouth become swollen and breathing passages become obstructed. The first signs of this are usually hoarseness or a lump in the throat. In some cases the swelling is so bad the air supply is cut off and the person experiences severe respiratory distress.
· Another respiratory problem could be the constricting of the airways, giving someone the chest  tightness, wheezing and shortness of breath commonly associated with asthma
             There have been enormous improvements in mainstream medical treatments developed by allergists. Recently, advances in anaphylaxis and hypersensitivity reactions to foods, drugs, and insects and in allergic skin disease include: the identification of food proteins to which IgE binding is associated with severe reactions, improvements in skin prick test predictions; evaluation of the atopy patch test; and advances in yellow jacket sting outcomes predictions and a rapidly disintegrating epinephrine tablet and development of low-allergen foods, and anti-IL-5 for eosinophilic diseases.
            Traditionally treatment and management of allergies revolved around simply avoiding the allergen in question or otherwise reducing exposure to said allegern. For instance, people with cat allergies were encouraged not to own cats and to avoid them as best as possible. While this had some effectiveness in reducing symptoms and avoiding life-threatening anaphylaxis for some, it was not always possible for those with pollen or similar air-borne allergies. For most allergies it is simply easier to reduce exposure rather than avoiding the allergens altogether. Strict avoidance still has a role in management though and is often used in managing food allergies
Causes of Sinus Allergies
 
               There are several airborne substances that we inhale through our mouth and nose. Many of these irritate the sinuses and can lead to allergies. For example, Pollen, which is nothing but a small particle released by flowering plant, enters our body while breathing. The mucus that is present in sinuses ambushes that dirt as a defense mechanism to prevent it from entering our lungs.
               However, the mucus cannot cope with the relentless onslaught. Over time, these pollen allergens prevent the mucus from draining properly, which then accumulates and becomes the perfect breeding ground for viruses and bacteria. This leads to nasal blocks and infections.
             Over time, ragweed and pollen lead to allergies. Hay Fever, which is a serious problem, starts with ragweed and pollen allergy but is often ignored because the symptoms are very similar - itchy and flowing nose etc. If not cured on time, it can lead to major disorders.
Other allergens that can cause sinus inflammation are dirt, pollution, animal hair, food particles cloth fibers, mold, dead insects remains and wastes, and other remains.

When do the allergy symptoms occur?
 While everything in our environment can create allergic problems round the year, most sinus allergies occur mostly in spring, late summer and early fall seasons. During this time, the air is dry and moisture free and it's the right time for airborne particles like pollen and ragweed to flow in the air. Therefore, this time is very critical for diseases concerned with allergies. These allergies usually end by the starting of winter because of frost etc.

Symptoms of Allergies
 
Some of the symptoms of these allergies are very common but should not be ignored - a runny nose, excessive sneezing (it can be 8 to 10 times in a row), itching nose (feel like scratching), sore throat, bad breath, watery eyes, postnasal drips which can be very irritating, loss of taste and smell and excess coughing, specially in the night. Any one or more of these symptoms are enough to make a person weak and fatigued all the time.
Caution: If the behavioral changes, mind disturbances, headache, eyesight problems, or seizures are long lasting and are not cured, infection may spread and lead to other allergic problems.

Treating sinus allergies at the first appearance of symptoms... or even before
Usually symptoms of sinus allergies can be mitigated at the first instance through a completely natural irrigation process.
This process, called 'neti' (in yoga) or simply saline nasal irrigation is so effective, that thousands of people suffering for years -- have experienced miraculous relief.
Antihistaminics help to relieve the symptoms.
               Hay fever" is a misnomer. Hay is not a usual cause of this problem and it does not cause fever. Early descriptions of sneezing, nasal congestion, and eye irritation while harvesting field hay promoted this popular term. Many substances cause the allergic symptoms noted in hay fever and hay represents only a small percentage. "Allergic rhinitis" is the correct term used to describe this allergic reaction. Rhinitis means "irritation of the nose" and is a derivative of "Rhino," meaning nose. Allergic rhinitis which occurs during a specific season is called "seasonal allergic rhinitis". When it occurs throughout the year, it is called "perennial allergic rhinitis."
Symptoms of allergic rhinitis, or hay fever, frequently include nasal congestion, a clear runny nose, sneezing, nose and eye itching, and tearing eyes. Post nasal dripping of clear mucus frequently causes a cough. Loss of smell is common and loss of taste occurs occasionally. Nose bleeding may occur if the condition is severe. Observers of the person experiencing allergic rhinitis will commonly notice frequent rubbing of the nose using the index finger. This is the so called "allergic salute." Eye itching, redness, and tearing frequently accompany the nasal symptoms. The eye symptoms are referred to as "allergic conjunctivitis" (inflammation of the whites of the eyes). These allergic symptoms often interfere with one's quality of life and total health. Allergic rhinitis can lead to other diseases such as sinusitis and asthma. Many allergic people have difficulty with social and physical activities. For example, concentration is often difficult while experiencing allergic rhinitis.
Food allergy is caused by immunological reactions to foods, sometimes in individuals or families predisposed to allergies. A number of foods, especially shellfish, milk, eggs, peanuts, and fruit can cause allergic reactions (notably hives, asthma, abdominal symptoms, lightheadedness, and anaphylaxis) in adults or children. When a food allergy is suspected, a medical evaluation is the key to proper management. The differential diagnosis comprises other abnormal responses to food, that is, food intolerances, which actually are far more common than food allergy. Once the diagnosis of food allergy is made (primarily by the medical history) and the allergen is identified (usually by skin tests), the treatment basically is to avoid the offending food. People with food allergies should work with their physicians and become knowledgeable about allergies and how they are diagnosed and treated

Eczema is a general term for many types of skin inflammation, also known as dermatitis. The most common form of eczema is atopic dermatitis (some people use these two terms interchangeably). However, there are many different forms of eczema.
Eczema can affect people of any age, although the condition is most common in infants. Eczema will permanently resolve by age three in about half of affected infants. In others, the condition tends to recur throughout life. People with eczema often have a family history of the condition or a family history of other allergic conditions, such as asthma or hay fever.

What are the causes of eczema?
Doctors do not know the exact cause of eczema, but an abnormal function of the immune system is believed to be a factor. Some forms of eczema can be triggered by substances that come in contact with the skin, such as soaps, cosmetics, clothing, detergents, jewelry, or sweat. Environmental allergens (substances that cause allergic reactions) may also cause outbreaks of eczema. Changes in the weather, or even psychological stress for some people lead to outbreaks of eczema.

What are the symptoms of eczema?
Eczema most commonly causes dry, reddened skin that itches or burns, although the appearance of eczema varies from person to person and varies according to the specific type of eczema. Intense itching is generally the first symptom in most persons with eczema. Sometimes, eczema may lead to blisters and oozing lesions, but eczema can also result in dry and scaly skin. Repeated scratching may lead to thickened, crusty skin.
While any region of the body may be affected by eczema, in children and adults, eczema typically occurs on the face, neck, and the insides of the elbows, knees, and ankles. In infants, eczema typically occurs on the forehead, cheeks, forearms, legs, scalp, and neck.

The goals for the treatment of eczema are to prevent itching, inflammation, and worsening of the condition. Treatment of eczema may involve both lifestyle changes and the use of medications. Treatment is always based upon an individual's age, overall health status, and the type and severity of the condition.
Keeping the skin well hydrated through the application of creams (with a low water and high oil content) as well as avoiding overbathing is an important step in treatment. Lifestyle modifications to avoid triggers for the condition are also recommended.
Corticosteroid creams are sometimes prescribed to decrease the inflammatory reaction in the skin. These may be mild-, medium-, or high-potency corticosteroid creams, depending upon the severity of the symptoms. If itching is severe, oral antihistamines may be prescribed. To control itching, the sedative type antihistamine drugs (e.g. diphenhydramine, hydroxyzine, and cyproheptadine) appear to be most effective.
In some cases, a short course of oral corticosteroids (such as prednisone) is prescribed to control an acute outbreak of eczema, although their long-term use is discouraged in the treatment of this non life-threatening condition because of unpleasant and potentially harmful side effects. The oral immunosuppressant drug cyclosporine has also been used to treat some cases of eczema. Ultraviolet light therapy (phototherapy) is another treatment option for some people with eczema.


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