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I.

Allergy
You live in a hostile environment, with enemies all around. These enemies are generally
microbes or germs (bacteria, viruses, fungi, and others). They are ever on the offensive,
awaiting an opportunity to invade your body- through your skin, your lungs or your intestinal
wall. Your major defense forces are organized under your immune system, an arrangement of
organs, glands, cells, and chemicals.
When enemy forces attempt to enter your body, skin cells block their pathway. Should
this first line of defense be breached, sentry cells in the tissues called T lymphocytes or T cells
sound an alarm. While killer cells (macrophages) are being mobilized, the T cells provide
detailed information regarding the enemy to B lymphocytes. The B lymphocytes prepare
chemicals specifically designed to inactivate or destroy the enemy forces. Its a very real form of
chemical warfare. Enemy forces exposed to these special chemicals are more easily destroyed
by the defense forces, the phagocytes or macrophages.
Another name for the enemy or invader is allergen, while the chemical weapon
designed to attack and destroy the allergen is called an antibody. For each allergen there is a
custom-made molecule or antibody that will only attack that specific allergen.
Besides microbes, you are constantly being exposed to countless chemicals in the air,
on the objects you touch, and in the food and water you eat and drink. Some people inherit an
immune system that fails to distinguish between these harmless substances and those that
are real enemies (see diagram below). The immune systems of these people are overly
sensitive to these substances and react to them as if they were enemies. If your body
overreacts to one or more otherwise harmless substances, you are said to have a
hypersensitivity or allergy. You are allergic to these substances.

Antigen
(A substance; usually a protein, pollen, milk, feathers, etc.)

Person A

Person B

Antibody formed

Antibody not formed

The immunity protects the person.

No immunity, with tissue damage.

An antigen in Person A stimulates the

The antigen in Person B fails to

body to form a protective antibody. It

provoke antibody formation. It is

is called an immunogen.
called an allergen.
Individuals differ in their ability to handle antigens. Person A is protected,
while Person B is not.

II. Kinds of allergens


Allergies can be caused by a wide variety of substances. Those listed in the categories
below are merely suggestive of the many allergens commonly known to cause problems.

Skin Allergens
Chemicals (mercury, wood alcohol, grease, solvents, detergents), plants (poison ivy,
poison oak, poison sumac), dyes (as in leather, shoe polish), furs, feathers, cosmetics,
fingernail polish, metals (nickel, jewelry), and insecticides.

Inhaled Allergens
Causing conjunctivitis, hay fever, and asthma. Pollens (Bermuda grass, ragweed,
flowers of trees), animal dandruff (cats, dogs), feathers, molds, dust, mites, tobacco
smoke; and perfumes.

Food Allergens
Present in wheat, corn, peas, beans, strawberries, nuts, sesame seed, milk, eggs, pork,
fish, shellfish, chocolate, and certain food dyes and vegetable gum thickeners.

Additives and preservatives


Additives and preservatives have been implicated as allergens. Among them are sodium
and potassium metabisulfite, used to preserve dried fruits, some canned items, and
fresh vegetables. BHA, BHT, and tartrazine (FD&C yellow dye no.5), and butylated
hydroxytoluene may also provoke allergic reactions.

Injected allergens

Insect bites, such as from bees, wasps, yellow jackets, hornets, and the bites of ants.
Injection of certain drugs, especially penicillin, and hormones, such as insulin, may
provoke a reaction.

Drug allergens
Antibiotics (penicillin, streptomycin), sulfa drugs, local anesthetics, hormones (as
insulin), and certain vitamins may cause allergic reactions. Morphine, codeine, and
aspirin may mimic allergic-type reactions but do not work through an allergic
mechanism.

Germ allergens
Bacteria, viruses, fungi, and certain parasites may at times provoke allergic reactions.

Physical allergens
Heat, cold, pressure, and light may provoke allergic like symptoms. Whether the
response is a true allergic reaction in all cases is not clear.

Emotional allergens
Strong emotions of any type, including anxiety, laughter, or depression, may, in some
people, provoke, such as hives and asthma, but this does not appear to be due to an
allergic mechanism.

III. The bodys response to allergens


Allergens can be inhaled, ingested, or enter through the skin. Common allergic
reactions, such as hay fever, certain types of asthma, and hives are linked to an antibody
produced by the body called immunoglobulin E (IgE). Each IgE antibody can be very specific,
reacting against certain pollens and other allergens. In other words, a person can be allergic to
one type of pollen, but not another. When a susceptible person is exposed to an allergen, the
body starts producing a large quantity of corresponding IgE antibodies. Subsequent exposure to
the same allergen may result in an allergic reaction. Symptoms of an allergic reaction will vary
depending on the type and amount of allergen encountered and the manner in which the body's
immune system reacts to that allergen.
Allergies can affect anyone, regardless of age, gender, race, or socioeconomic status.
Generally, allergies are more common in children. However, a first-time occurrence can happen
at any age, or recur after many years of remission. Allergies tend to run in families. Hormones,

stress, smoke, perfume, or environmental irritants may also play a role in the development or
severity of allergies.
In response to allergens, your immune system produces several types of antibodies. The
most common one causing allergic reaction is immunoglobulin E, or IgE. As mentioned above,
every allergen has its own specific IgE. When an antibody attacks an allergen, the allergic
response is caused by the release of a variety of chemicals, often called mediators. These
mediators are released from mast cells- tiny chemical factories that line the tissues of the nose,
nasal sinuses, lungs, skin, and intestinal tract. Thus, when an antibody attaches itself to an
allergen on the membrane of these mast cells, the mediators released include histamine,
serotonin, leukotrienes, prostaglandins, and various others that are known as chemotactic
factors.
The action of these mediators can be divided into three broad classes: (1) those that
allow fluid to leak through the small blood vessel and contract smooth or involuntary muscles.
(2) those that attract other inflammatory cells into the area of reaction that, in turn, may cause
allergic symptoms. (3) those that modulate the release of other mediators. The net effect of
these chemicals depends on the sensitivity of the tissue in which they collect.
Histamine is probably the best-studied chemical to date. Histamine contracts some
smooth muscles, but relaxes others. those of the bronchi and gut contract, while those of the
small blood vessels relax. Histamine stimulates many glands to secrete, such as the
hydrochloric acid secreting glands in the lining of the eyes, nose, throat, and bronchi. Histamine
allows fluid to seep out of the small blood vessels. This is the cause of runny eyes and eyes. It
also stimulates nerve endings, which causes itching and pain. A knowledge of the effects of
histamine and other mediators provides some understanding of an allergic reaction.
IV. Allergic Reactions
Allergic reactions differ, depending on the area of the body in which the allergen and
antibody have their disagreement. Following are some examples:

Skin allergens
Allergens affecting the skin cause itching, swelling, redness, and blistering.

Inhaled allergens

Allergens that are inhaled affect the respiratory tract, causing sneezing and runny nose.
In the lungs these allergens cause difficulty in breathing (asthma).

Food allergens
The allergens in food may cause local reactions, such as itching and swlling of the lips
and lining of the mouth, or, after being swallowed, they may cause nausea, cramps, and
diarrhea. A food allergen may also be absorbed into the bloodstream.

Blood allergens
Allergens that enter the bloodstream from food or from an injection (such as an insect
sting) may cause generalized hives and an itching, runny nose, or asthma. Some people
may experience swelling airways, and a drop in blood pressure. A severe response may
end in collapse, unconsciousness, and death. This type of reaction is termed as
anaphylactic shock.

V. Allergic Symptoms

Anaphylaxis
When a specific allergen enters the circulation, the reactions are widespread. Histamine
entering the circulation causes the small blood vessels to dilate and fluid and protein to
seep from the blood into tissues. In a severe case, circulation will collapse, causing
victim to die. However, chemicals or mediators other than histamine (which are less well
understood) are also probably involved in anaphylaxis, especially when the lungs are
affected. That cause the air passenger ways (bronchi) in the lungs to constrict, producing
asthma. A severe case of asthma will result in death from suffocation.

Rhinitis (hay fever)


When the allergen-antibody reaction takes place in the nose, histamine causes the blood
vessels to dilate, which allows fluid to leave the blood. The glands in the lining of the
nose pour out their secretions, causing the nose to become runny and congested;
sneezing is common.

Hives
An allergic reaction in the skin causes the release of the histamine. The blood vessels
dilate, and fluid flows out the capillaries. The result is a red flare and local swelling with
itching, which is typically called hives.

Conjunctivitis

The allergic response seen in the eyes is due to a reaction similar to that which occurs in
the nose. Dilation of the blood vessels causes redness, and stimulation of the nerves
provokes itching. Fluid entering the tissues causes swelling, which stimulates the
lachrymal glands, causing tears flow.

Wheezing, coughing, and tightness in the chest


These symptoms are often produced when an allergen-antibody reaction takes place in
the bronchioles (small air passages). Many chemicals are released from mast cells that
line the tissue of the breathing passages. Other white blood cells are attracted to the
lung and also release chemicals. This results in a spasm of the muscles that surround
the breathing tubes (bronchioles). It also causes the secretion of very thick, tenacious
mucus into the opening of the bronchioles and swelling of the lining of these air
passageways. The combined effect is a narrowing of the breathing passageways with
symptoms of wheezing, coughing, and tightness of the chest.

VI. Diagnosing Allergies


Allergic reactions can be diagnosed by your doctor. If you experience symptoms of an
allergic reaction, your doctor will perform an exam and ask you about your health history. If your
allergic reactions are severe, your doctor may ask you to keep a journal that details your
symptoms and what substances appear to cause them. Your doctor may want to order tests to
determine what is causing your allergy. The most common types of allergy tests are:

skin tests

challenge (elimination-type) tests

blood tests

A skin test involves applying a small amount of a suspected allergen to the skin and
watching for a reaction. The substance may be taped to the skin (patch test), applied to a small
prick in the skin (prick test), or injected just under the skin (intradermal test). A skin test is most
valuable for diagnosing:

food allergy

mold, pollen, and animal dander allergy

penicillin allergy

venom allergy (such as mosquito bites or bee stings)

allergic contact dermatitis (a rash you get from touching a substance)

Challenge testing is useful in diagnosing food allergies. Testing for food allergies is
somewhat more difficult and is not as accurate as skin testing. It involves removing a food from
your diet for several weeks and watching for symptoms when you eat the food again. If the
symptoms decrease or disappear during the diet, then resume after the special diet is
terminated, the doctor will suspect a food allergy as the cause of the problem.
A blood test for an allergy checks your blood for antibodies against a possible allergen. An
antibody is a protein your body produces to fight harmful substances. Blood tests are used
when skin testing is not helpful or cannot be done.
VII. Allergic Disorders
The various allergic disorders are discussed under the systems of the body which they
occur. To avoid repetition and for convenience, the reference is given to where the common
disorder is described, together with its suggested treatment.

Atopic Disorder (Eczema)


Atopic dermatitis is an inherited disorder that, in most cases, affects the skin. It causes
itching, burning, and a red, blistering rash, possibly accompanied by hives, hay fever,
and asthma. It is likely to occur during three age periods: infancy, childhood, and
adulthood. It may appear for the first time during any one of these periods.

Allergic dermatitis (Contact dermatitis)


Allergic dermatitis occurs when a person touches something to which he has developed
sensitivity from a previous exposure. The two most common examples are poison ivy
and poison oak. Sensitivity may be acquired to a wide variety of substances.

Hay Fever (Allergic rhinitis)


Hay fever is an allergic response to substances carried in the air that are breathed into
the lungs. It is often associated with allergic conjunctivitis. The nose is congested and
runny, and there is a frequent sneezing.

Asthma (Bronchial Asthma)


Doubtless half or more of the episodes of asthma are due to an allergic response. The
smaller air passageways are narrowed by contraction of the bronchial muscles, swelling
of the lining membrane, and an outpouring of mucus that narrows the bronchial tubes.
Breathing becomes extremely difficult.

Drug Allergy
An allergic reaction may occur in sensitive individuals after taking of certain drugs. Many
drugs can cause a reaction, although there are a few in which an adverse response is
more frequently seen. A rash is the usual manifestation. Fever and symptoms of shock
may occur in more extreme cases. Treatment will depend on the severity of the reaction.
The drug must, of course, be promptly discontinued. If you know that you are sensitive to
a particular drug, report this to your physician.

Serum Sickness
Serum sickness may result from the injection of animal serum into a human (horse,
bovine, rabbit), or from the use of a number of drugs (penicillin, streptomycin,
sulfonamides). The adverse reaction may come on immediately, or it may be delayed for
two to three weeks. It generally starts with hives, accompanied by fever, nausea, pain in
the abdomen, swelling of the lymph nodes, and joint pains. Emergency treatment
requires the use of epinephrine. See your physician immediately or go to an emergency
room.

Anaphylactic shock
In some persons an allergic reaction to an insect sting or to a drug such as penicillin is
so sudden and so intense that it is called anaphylactic shock. The symptoms include
skin rash (hives), swelling of the lining og the air passages, difficult breathing, a drop in
blood pressure, collapse, unconsciousness, and if not treated immediately, possible
death.

VIII. Preventing the allergic reaction


Since an allergy is an inherited sensitivity to one or more allergens, or an inherited
capability of developing such sensitivity, there is no real cure. However, there are five ways to
prevent or modify the allergic response.

Avoid the allergens


This is not always possible, but once an allergic person has learned what allergens
trigger his attacks of allergy, avoiding the allergens makes common sense. Stay indoors
at certain times of the year when plants are blooming and producing pollens to which
you are sensitive. If the pollens are confined to a certain locality, then stay away from
that area. If animal dander is the problem, avoid contact with animals to which you are

sensitive. You may use a mask when house cleaning to protect yourself against dust
allergy. Some people find that air conditioning units with good filters bring relief.
However, if molds get into the filter, they may cause trouble.

Use antihistamines
As discussed above under Allergic reactions, when the allergen to which you are
sensitive causes the release of histamine an antihistamine may relieve the attack.
Histamine attaches itself to specific receptors (or sites), which then brings about the
allergic response- the allergic symptom. Antihistamines are molecules that attach
themselves to the same receptors that histamine attaches to, but they do not bring about
the allergic response. Flooding the bloodstream with antihistamine molecules prevents
most of the histamine molecules from attaching to their receptors. Thus the allergic
reaction is averted.
Unfortunately, many antihistamines cause drowsiness, making it unwise to drive
automobile or work around machinery when taking this type of medication. Certain
relatively new antihistamines that do not cause sedation are, for most people, a good
alternative to conventional antihistamines. Your physician can advise you which
antihistamine would be best for you.

Topical sprays and inhalers


These are available by prescription only for allergic rhinitis and asthma, and should be
used under the direct supervision of a physician. They prevent allergic reactions from
developing. These agents, which include corticosteroids, cromolyn sodium, are not to be
confused with over-the-counter decongestants.

Desensitization
This procedure requires a series of injections, in gradually increasing doses, of the
allergen to which you are sensitive. This allow s your body to build up neutralizing
antibodies which may help to prevent the allergen producing the allergic response. It will
also make available less of the IgE antibodies that provoke the allergic response. While
desensitization will not cure your hypersensitivity, it will allow you to be free of your
allergy for reasonable lengths of time. large numbers of desensitizing allergens are
available. If your are troubled with allergies, you should seek the advice of a physician
who specializes in handling these disorders.

Hormone therapy
Oral and injectable corticosteroids are available for serious allergic reactions. That
cannot be controlled by the use of antihistamines, topical sprays, or inhalers. They
should be used under the direct supervision of a physician.

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