The Bland and the Bizarre World of Allergy

The Bland

What is all the fuss about allergy? Snotty noses and itchy rashes certainly don’t seem as important as other healthcare conditions. Firstly, allergic disorders are common. Asthma remains the commonest chronic health condition in childhood. And allergic disorders like eczema and food allergy seem to be on the increase across the globe. This means that there are many, many people affected by these disorders. There is a great need to provide evidence-based allergy care and to advocate for those living with these common conditions.

The second truth; that any allergy sufferer will confirm, is that allergic disorders have a significant and often daily impact on quality of life. Nobody likes a runny nose or breaking out in hives. Certain allergic disorders are potentially life-threatening, and studies have shown that caregivers of children with food allergies experience similar levels of psychosocial stress to caregivers of type 1 diabetics.

Allergic disorders are chronic health conditions that are characterized by episodic flares. They are largely incurable but controllable with adherence to an effective day-to-day treatment plan. This treatment plan may be time consuming and strict compliance with correct technique of using one’s medications is vital to treatment success. This all may sound tedious, but the outcome of excellent control is almost always achievable. The journey to improved quality of life, is the heart of allergy care. And there’s nothing boring about better health.

The Bizarre

We are all quite familiar with your garden-varietal allergies, but allergic disorders can be strange too. Take cold-induced urticaria (hives). This is a condition when a rapid drop in body temperature causes hives and body swelling. If severe; extreme cold exposure, such as swimming in cold water on a hot summer’s day may cause anaphylaxis. Cold-induced anaphylaxis belongs to the group of chronic inducible urticarias along with pressure urticaria, solar urticaria and a few others. This is not allergy to cold (or pressure or sunlight) but rather the exposure causes allergy cells in the skin to release chemical messages that cause hives, itching and swelling.

Did you know that exercise can cause anaphylaxis in certain people? Whilst that may sound like the ideal excuse not to go to the gym, this is a severely limiting and possibly even fatal condition. Symptoms of anaphylaxis may develop at any stage of exercise and sometimes occur closely after physical exertion has been completed. In certain individuals, anaphylaxis occurs with exercise only if a specific food is eaten prior to physical activity, this is known as food-dependent exercise induced anaphylaxis. The most common trigger food is wheat; but many other foods have been implicated including grains, legumes, shellfish and nuts.

Food sensitization and allergy affects 5-10% of young children across the world with a peak prevalence at one year of age. A study done in Cape Town found that 2.5% of urban children have a confirmed food allergy. Common food allergens include eggs, milk, nuts, fish and shellfish. But increasingly more unusual foods have been recognized to cause allergic reactions such as fenugreek seeds which can be used in spice blends, coriander, meat and fruits like mango, pineapple and fig. Unusual food allergies may be seen when foods that are not regularly consumed by a population are introduced. Such as allergy to edible insects or crocodile meat! In both these circumstances the allergic reactions could be attributed to a cross-reaction with an existing allergy to another food protein, shrimps in the former and chicken in the latter.

Allergic to money? Nickel used in coins may cause an allergic contact dermatitis when the coins are handled. This produces an itchy, red, scaly rash of the hands. Nickel can be found in jewelry, buckles and metal buttons and may cause a rash at the site of contact with the skin in those who are allergic.

Idiopathic environmental intolerance (IEI), previously called multiple chemical sensitivity syndrome, is a condition characterized by a variety of symptoms triggered by exposure to low levels of various odorants, electro-magnet fields or certain buildings. Symptoms are varied and may include multiple organ systems. Prominent symptoms are difficulty breathing, nasal congestion, rapid heart rate, anxiety, muscle ache, rash, nausea and difficulty concentrating that develop on exposure to non-toxic levels of the trigger. Individuals with IEI often conclude their symptoms are as a result of an allergy but research has not been able to show a scientifically sound mechanism to explain the condition. Having said that, the symptoms of IEI are as real as the ache in your stomach before delivering an important presentation. One study demonstrated that individuals with IEI identified at least 79 triggers of symptoms and many sufferers of IEI make drastic changes to their lifestyle and environment to avoid their triggers.

The world of allergy is a varied, evolving group of disorders in which much research and information sharing is required. The landscape of treatment is constantly shifting, with new treatment modalities becoming available all the time. Many people across the globe are impacted by allergy to a greater or lesser degree and ensuring they are well cared for should not be neglected.